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Real-Time Dynamic Navigation System for the Precise Quad-Zygomatic Implant Placement in a Patient with a Severely Atrophic Maxilla
Published on: October 18, 2021
Accuracy of maxillary positioning using patient-specific implants in a surgery-first approach
Shady Abu-Sirhan1, Simon Bigus1, Nils Lucca Kern1
1Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Oral and Maxillofacial Surgery, Augustenburger Platz 1, Berlin, 13353, Germany.
Summary
Virtual surgical planning with 3D guides accurately positions the maxilla in Surgery First orthognathic surgery. This digital workflow ensures predictable results for bimaxillary procedures.
Area of Science:
- Oral and Maxillofacial Surgery
- Digital Dentistry
- Orthognathic Surgery
Background:
- The Surgery First approach prioritizes surgical intervention before orthodontic alignment.
- Accurate intraoperative transfer of virtual surgical plans is crucial for successful outcomes.
- A fully digital workflow, including 3D-printed guides and patient-specific implants, offers potential for enhanced precision.
Purpose of the Study:
- To evaluate the transfer accuracy of virtually planned maxillary repositioning in a Surgery First protocol.
- To assess the feasibility of a fully digital interdisciplinary workflow for bimaxillary surgery.
Main Methods:
- A prospective study involving 63 patients undergoing Surgery First orthognathic surgery.
- Utilized virtual surgical planning, 3D-printed maxillary guides, and patient-specific implants.
- Postoperative cone beam computed tomography (CBCT) was used to analyze transfer precision against planning data.
Main Results:
- Maxillary positioning accuracy was predominantly within ±1-2 mm, with high clinical precision.
- Slight regional deviations were observed but did not compromise overall accuracy.
- Postoperative complications were infrequent and managed conservatively.
Conclusions:
- Virtual surgical planning and patient-specific guides achieve clinically accurate maxillary positioning in Surgery First cases.
- The fully digital workflow enables predictable intraoperative transfer without a presurgical occlusal reference.
- This digital approach is safe and effective for various bimaxillary surgery indications.
