Comput. Aided Surg. - RapidSplint: virtual splint generation for orthognathic surgery - results of a pilot series.


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CKGROUND: Within the domain of craniomaxillofacial surgery, orthognathic surgery is a special field dedicated to the correction of dentofacial anomalies resulting from skeletal malocclusion. Generally, in such cases, an interdisciplinary orthodontic and surgical treatment approach is required. After initial orthodontic alignment of the dental arches, skeletal discrepancies of the jaws can be corrected by distinct surgical strategies and procedures in order to achieve correct occlusal relations, as well as facial balance and harmony within individualized treatment concepts. To transfer the preoperative surgical planning and reposition the mobilized dental arches with optimal occlusal relations, surgical splints are typically used. For this purpose, different strategies have been described which use one or more splints. Traditionally, these splints are manufactured by a dental technician based on patient-specific dental casts; however, computer-assisted technologies have gained increasing importance with respect to preoperative planning and its subsequent surgical transfer.METHODS: In a pilot study of 10 patients undergoing orthognathic corrections by a one-splint strategy, two final occlusal splints were produced for each patient and compared with respect to their clinical usability. One splint was manufactured in the traditional way by a dental technician according to the preoperative surgical planning. After performing a CBCT scan of the patient's dental casts, a second splint was designed virtually by an engineer and surgeon working together, according to the desired final occlusion. For this purpose, RapidSplint, a custom-made software platform, was used. After post-processing and conversion of the datasets into .stl files, the splints were fabricated by the PolyJet procedure using photo polymerization. During surgery, both splints were inserted after mobilization of the dental arches then compared with respect to their clinical usability according to the occlusal fitting.RESULTS: Using the workflow described above, virtual splints could be designed and manufactured for all patients in this pilot study. Eight of 10 virtual splints could be used clinically to achieve and maintain final occlusion after orthognathic surgery. In two cases virtual splints were not usable due to insufficient occlusal fitting, and even two of the traditional splints were not clinically usable. In five patients where both types of splints were available, their occlusal fitting was assessed as being equivalent, and in one case the virtual splint showed even better occlusal fitting than the traditional splint. In one case where no traditional splint was available, the virtual splint proved to be helpful in achieving the final occlusion.CONCLUSIONS: In this pilot study it was demonstrated that clinically usable splints for orthognathic surgery can be produced by computer-assisted technology. Virtual splint design was realized by RapidSplint?, an in-house software platform which might contribute in future to shorten preoperative workflows for the production of orthognathic surgical splints.

Resumo Limpo

ckground within domain craniomaxillofaci surgeri orthognath surgeri special field dedic correct dentofaci anomali result skelet malocclus general case interdisciplinari orthodont surgic treatment approach requir initi orthodont align dental arch skelet discrep jaw can correct distinct surgic strategi procedur order achiev correct occlus relat well facial balanc harmoni within individu treatment concept transfer preoper surgic plan reposit mobil dental arch optim occlus relat surgic splint typic use purpos differ strategi describ use one splint tradit splint manufactur dental technician base patientspecif dental cast howev computerassist technolog gain increas import respect preoper plan subsequ surgic transfermethod pilot studi patient undergo orthognath correct onesplint strategi two final occlus splint produc patient compar respect clinic usabl one splint manufactur tradit way dental technician accord preoper surgic plan perform cbct scan patient dental cast second splint design virtual engin surgeon work togeth accord desir final occlus purpos rapidsplint custommad softwar platform use postprocess convers dataset stl file splint fabric polyjet procedur use photo polymer surgeri splint insert mobil dental arch compar respect clinic usabl accord occlus fittingresult use workflow describ virtual splint design manufactur patient pilot studi eight virtual splint use clinic achiev maintain final occlus orthognath surgeri two case virtual splint usabl due insuffici occlus fit even two tradit splint clinic usabl five patient type splint avail occlus fit assess equival one case virtual splint show even better occlus fit tradit splint one case tradit splint avail virtual splint prove help achiev final occlusionconclus pilot studi demonstr clinic usabl splint orthognath surgeri can produc computerassist technolog virtual splint design realiz rapidsplint inhous softwar platform might contribut futur shorten preoper workflow product orthognath surgic splint

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