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Clinical Accuracy of 3D-Planned Maxillary Positioning Using CAD/CAM-Generated Splints in Combination With Temporary
S Pietzka1,2, F Mascha1,2, K Winter3
1Department of Oral and Maxillofacial Surgery, University Hospital Ulm, Ulm, Germany.
Craniomaxillofacial Trauma & Reconstruction
|January 18, 2021
Summary
This study shows that computer-aided design/computer-aided manufacturing (CAD/CAM) splints with temporary mandibular fixation accurately position the maxilla in bimaxillary orthognathic surgery. The method proved predictable across all three planes of positioning.
Area of Science:
- Oral and Maxillofacial Surgery
- Orthodontics
- Biomedical Engineering
Background:
- Accurate maxillary positioning is crucial in bimaxillary orthognathic surgery.
- Traditional methods face challenges in vertical plane accuracy due to the mobile mandibular reference.
- Computer-assisted design (CAD)/computer-assisted manufacturing (CAM) splints offer potential for improved precision.
Purpose of the Study:
- To evaluate the accuracy of 3D-planned maxillary positioning using CAD/CAM splints and temporary mandibular fixation.
- To specifically assess precision in the vertical plane compared to axial and sagittal planes.
- To determine the overall predictability of this technique in bimaxillary orthognathic surgery.
Main Methods:
- Retrospective analysis of 35 consecutive patients undergoing bimaxillary orthognathic surgery.
- Utilized 3D planning, CAD/CAM splints, and temporary mandibular fixation.
- Calculated deviations of 5 maxillary occlusal landmarks by fusing pre- and post-operative CT scans.
Main Results:
- Overall median deviation for maxillary positioning was 0.99 mm.
- Accuracy in left-right (axial) plane: 0.96 mm.
- Accuracy in anterior-posterior (sagittal) plane: 0.94 mm.
- Accuracy in upward-downward (vertical) plane: 1.06 mm.
Conclusions:
- CAD/CAM splints combined with temporary mandibular fixation demonstrate high predictability for maxillary positioning.
- The technique is accurate across all three spatial axes (sagittal, axial, vertical).
- This approach enhances the reliability of transferring 3D surgical plans to the operative site.
