In-house CAD/CAM fabricated repositioning guide in maxillary repositioning after Le Fort I osteotomy

Area of Science:

• Oral and Maxillofacial Surgery
• Biomedical Engineering
• Dental Technology

Background:

• Orthognathic surgery requires precise repositioning of the maxilla.
• Current methods for transferring virtual surgical plans to the operating room include CAD/CAM splints and customized guides.
• Assessing the accuracy of these transfer methods is crucial for surgical success.

Purpose of the Study:

• To compare the accuracy of a customized maxillary repositioning guide versus a CAD/CAM-fabricated intermediate splint for orthognathic surgery.
• To evaluate the discrepancy between virtual surgical simulations and actual surgical outcomes for both methods.

Main Methods:

• Virtual surgical simulations were used to collect patient data.
• Postoperative cone-beam computed tomography (CBCT) was superimposed with preoperative simulation data.
• Linear and angular differences were evaluated at three maxillary dentition landmarks to quantify accuracy.

Main Results:

• The customized guide group had significantly fewer instances of >2 mm positional errors (1 coordinate) compared to the CAD/CAM splint group (9 coordinates).
• No significant difference was found in overall 3D error distance between the groups.
• The customized guide group demonstrated a narrower interquartile range in most measurements, indicating more consistent accuracy.

Conclusions:

• Customized maxillary repositioning guides are more advantageous than CAD/CAM splints for achieving accuracy within a 2 mm discrepancy range in orthognathic surgery.
• This improved accuracy can lead to more predictable surgical results.
• The findings support the use of customized guides for enhanced precision in complex maxillofacial procedures.