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Navigating Complexities in Surgical Orthodontic Cases Jerry English & Kurt Kasper. AAO June 2021. Episode 119

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Farooq Ahmed

Navigating Complexities in Surgical Orthodontic Cases Jerry English & Kurt Kasper

 

Computer Aided Surgical Simulation CASS

·      Planning : visualisation, surgical simulation, plan

·      Execution – occlusal splint, templates, drilling guide

·      Outcome assessment

 

Create 3D model of head and neck in NHP, accuracy in soft tissues, skeletal structures and dentition

 

Execution in 3D planning

·      Orthodontic

o   Occlusal adjustments prior to surgery

·      Surgical

o   Collisions in maxilla / mandible: for example Le Fort 1

 

Digital workflow in surgical planning

·      Image acquisition: e.g. CBCT

·      Digital manipulation: surgical simulation

·      3D printing: Visualisation

 

Use of 3D printing in orthognathic treatment Jacobs 2017, Lin 2017

 

1.     Contour model – 3D model print of bony structure to allow plate contour

2.     Surgical guide for osteotomy

3.     Splint – occlusal splint

4.     Implants

 

3D printing

·      Layer by layer process

·      Dimensional deviation less than 0.01mm  Favero 2017

·      Accuracy of models (0.25mm discrepancy) only DLP within threshold Akyalcin 2021

o   Clinical relevance of discrepancy requires clinical decision making

·      Print height, greater print height = less dimensional deviation (100microns Vs 25 microns, 0.080mm Vs 0.065mm) Favero 2017

o   Smaller layer heights = smoother does not translate to accuracy

o   May not be clinical significant

·      Printer orientation

o   Flat Vs Perpendicular =

§  Perpendicular = efficiency in number of models within printer,

§  Perpendicular = greater layers required

·      Greater dimensional deviation with perpendicular 0.17mm Vs 0.1mm flat

·      Orientation and layer height effect each other

 

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