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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (5): 954-958. doi: 10.19723/j.issn.1671-167X.2019.05.027

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Application of computer-aided virtual mandibular position in the simultaneous treatment of children with temporomandibular joint ankylosis and jaw deformity

Shuo CHEN,Yang HE,Jin-gang AN,Yi ZHANG()   

  1. Department of Oral and Maxillofacial Surgery,Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2017-10-10 Online:2019-10-18 Published:2019-10-23
  • Contact: Yi ZHANG E-mail:zhangyi2000@263.net
  • Supported by:
    Supported by the Program for New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-17B07)

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Abstract:

Objective: To evaluate the feasibility of computer-aided design virtual mandibular position in the simultaneous treatment of children with temporomandibular joint ankylosis (TMJA) and jaw deformity. Methods: The children with unilateral TMJA were surgically treated from January 2016 to June 2017 in the Department of Oral and Maxillofacial Surgery. The image data of jaw and dentition were imported into the computer software to simulate the surgical procedure. An osteotomy of the affected side was performed to remove ankylosed bone mass. Then the mandible was rotated around the unaffected condyle to eliminate the chin deviation by the virtual plan. An open bite was thus created on the affected side to provide space for vertical midfacial growth. In the virtual mandibular position, the affected ramus was reconstructed with costochondral grafting. Finally, digital occlusal splint was designed and pre-fabricated by 3D printing. During surgery, temporomandibular joint ankylosis was released and mandibular position was guided in place by the digital occlusal splint. In the new mandibular position, costochondral grafting was completed. After the surgery, the occlusal splint was wired to the mandibular dentition and would be gradually adjusted by grinding off the maxillary side to promote downward growth of the maxilla until the open bite was eliminated. The ramus height and chin deviation were measured before and one week after the surgery to validate the method. Comparisons of the measurements were made by means of a repeated-measures analysis of variance (ANOVA) (P=0.05). Pair-wise multiple comparisons were conducted using the Bonferroni correction (P=0.05). Results: Five patients were included in this study. Under the guidance of the digital occlusal splint, the mandible could reach the preoperative designed position smoothly in all the cases. The chin deviations were (0.58±0.20) mm in the virtual plan before surgery, and (0.70±0.27) mm after surgery, which were not significant statistically (P>0.05). The ramus heights on the affected side were (48.19±3.20) mm in the virtual plan before surgery, and (48.17±3.62) mm after surgery, which were not significant statistically (P>0.05). Conclusion: It is feasible and reliable in the simultaneous treatment of TMJA with jaw deformity under the guidance of virtual mandibular position.

Key words: Virtual mandibular position, Temporomandibular joints, Ankylosis, Jaw abnormalities, Computer-aided design

CLC Number: 

  • R782.6

Figure 1

Image fusion between CT of jaws and CBCT of teeth A,CT image of jaws; B, CBCT image of teeth; C, fusion between CT of jaws and CBCT of teeth. CBCT, cone beam computed tomography."

Figure 2

Determine the location of the osteotomy line, and complete osteotomy with computer-assisted design A, design the location of the osteotomy line in computer; B, complete osteotomy in computer."

Figure 3

Make a virtual plan of mandibular position A,mandibular position before rotation; B, mandibluar position after rotation."

Figure 4

Design and fabricate the digital occlusal splint A, design occlusal splint in computer; B, fabricate the occlusal splint by rapid prototyping manufacturing."

Figure 5

Simulate the costochondral graft in computer A, frontal view after costochondral graft; B, profile view after costochondral graft."

Figure 6

Complete the surgery with the guidance of occlusal splint A, expose the temporomandibular joint ankylosed bone mass; B, remove the bone mass; C, determine the mandibular position with the guidance of occlusal splint; D, complete the costochondral graft."

Table 1

Ramus height and chin deviation before surgery, during virtual plan, and after surgery"

Variable Pre-operation/mm Virtual plan/mm Post-operation/mm P
Ramus height of non-operation side 48.86±2.64a 48.92±2.78a 48.93±2.85a >0.05
Ramus height of operation side 39.87±4.27a 48.19±3.20b 48.17±3.62b <0.05
Chin deviation 6.79±2.32a 0.58±0.20b 0.70±0.27b <0.05

Figure 7

Left temporomandibular joint ankylosis of a 7-year-old male patient A, pre-operative frontal view: chin deviation was obvious; B, post-operative frontal view: chin deviation was corrected."

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