Wafer as an adjunct to plating patient-specific implants for the multi-segment maxilla: a useful tool

Area of Science:

• Oral and Maxillofacial Surgery
• Biomedical Engineering
• Surgical Planning

Background:

• Virtual surgical planning for orthognathic surgery commonly uses patient-specific implants (PSI) without occlusal wafers.
• Waferless planning presents challenges in controlling accuracy for multi-segment maxillary osteotomies, particularly with expansion and rotational movements.
• Intraoperative manipulation of multiple small bone segments into PSI is technically demanding, risking positional inaccuracies and bony interferences.

Purpose of the Study:

• To propose and describe a maxillary tooth-supported surgical guide to improve accuracy in multi-segment maxillary orthognathic surgery.
• To overcome intraoperative difficulties associated with handling multiple maxillary segments during PSI fixation.
• To enhance positional precision of individual bone segments and visualize bony interferences before PSI plating.

Main Methods:

• Development and description of a maxillary tooth-supported surgical guide, functioning as a wafer and customized arch bar.
• Integration of the surgical guide before the placement of patient-specific implants (PSI).
• Utilizing the guide to manage multiple maxillary segments as a single unit, ensuring correct occlusion and identifying potential bony interferences.

Main Results:

• The tooth-borne surgical guide facilitates precise positioning of individual maxillary bone segments.
• It simplifies the intraoperative manipulation of multiple segments, allowing them to function cohesively.
• The guide aids in visualizing and managing bony interferences prior to PSI fixation, enhancing surgical accuracy.

Conclusions:

• A tooth-borne surgical guide is a cost-effective adjunct to virtual planning with PSI for multi-segment maxillary orthognathic surgery.
• This approach enhances accuracy by improving control over individual segment movements and occlusion.
• Further research is needed to validate the accuracy and benefits of wafers and PSI in complex multi-segment orthognathic procedures.