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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.
Objective:
This study aimed to evaluate the transfer accuracy of virtually planned maxillary repositioning within a Surgery First protocol using 3D-printed guides and patient-specific implants. In addition, the feasibility of a fully digital interdisciplinary workflow was analyzed.
Material & Methods:
The patients in this study were treated with a completely virtually planned interdisciplinary treatment pathway according to the Surgery First concept using a 3D-printed maxillary guide and patient-specific implants as well as a 3D-printed final occlusion-splint. The osteosynthesis in the mandible was performed conventionally using miniplates. The postoperative cone beam computed tomography (CBCT) was overlaid with the planning data set and the transfer precision was analyzed with defined bony landmarks in the upper jaw using Onyx Ceph software (Image Instruments).
Results:
63 patients were included in the analysis. The gender distribution was almost 2:1. Included were 41 female and 22 male patients. Mean age was 37.9 ± 10.1 years, and 12 patients presented with OSAS. Postoperative complications were rare and managed conservatively. The transfer accuracy of maxillary positioning was within ±1-2 mm at all landmarks, with only occasional minimal exceedance of the 3-mm threshold, indicating high clinical accuracy. Regional differences were observed, with slightly larger deviations at L4 and L5 and smaller deviations at L9-L11 (global p < 0.01); however, these did not compromise overall clinical precision.
Conclusion:
Virtual surgical planning combined with patient-specific cutting guides and customized osteosynthesis plates enables clinically accurate maxillary positioning in Surgery First patients, with transfer deviations predominantly within the accepted 1-2 mm threshold. The fully digital interdisciplinary workflow allows predictable intraoperative transfer despite the absence of a presurgical occlusal reference and can be safely applied across different indications for bimaxillary surgery.
