A three dimensional analysis of soft tissue and bone changes following orthognathic surgery

Introduction: This report investigates the ability of surgeons to achieve predicted surgical movements in five different groups of patients, and analyses both the predictions and the changes in two dimensions using scale space analyses (Campos 1991). The report then progresses to the three dimensional analysis of the bone, the soft tissues and the ratio of soft tissue to bone following surgery, using a colour coded techniques (Fright and Linney, 1991) to illustrate the changes. The average soft tissue scans from each group of patients were averaged and compared to a control group at the preoperative, three months and 1 year postoperative stages (Fright, 1991) Data Acquisition: Bone measurements were recorded from lateral skull radiographs preoperatively and 48 hrs postoperatively, and CT scans preoperatively and 1 year postoperatively. Soft tissue measurements from an optical scanner, preoperatively, three months and 1 year postoperatively. Patients 1) Control group: 30 females and 30 males 2) Skeletal class 2 patients: 15 Females and 2 Males 3) Skeletal class 3 patients: 9 Females and 7 Males 4) Cleft Palate Patients a) Unilateral cleft lip and palate: I 6 Females: 2 left and 4 right sided clefts 7 Males: 3 left and 4 right sided clefts b) Bilateral cleft lip and palate: 5 Males and 1 Female c) Clefts of the Hard and Soft palate: 5 Females. Results: Prediction: There was a surprisingly poor match between the predicted and achieved movements in both the horizontal and vertical direction in all patient groups. The scale space analysis provided an efficient method of illustrating profile changes. Soft tissue movements There were definite patterns of change and relapse in the patient groups. The relapse being most marked in the cleft palate patients. Bone movements and soft tissue to bone ratios Definite patterns of movement for the maxilla and the mandible became apparent for both the bone and soft tissue to bone ratio of movement in each group. For maxillary impactions in the skeletal 2 group there was a 1:1 ratio of movement of the soft tissue to bone in the midline increasing to 1.25:1 in the canine region and 1.5:1 in the paranasal region. Conclusions: There is a need to develop a technique to aid the the surgeons in carrying out planned surgical movements. The colour coded method was shown to be a simple, efficient and easily understandable way of analysing surgical change. Diagnosis of surgical requirements was aided by the ability to objectively compare the individual to a control group. The prediction of surgical change should be greatly aided by adapting the current database to include the distinct patterns of movement in the bone and ratio of movements of the soft tissues to the bone

A pilot study for the digital replacement of a distorted dentition acquired by Cone Beam Computed Tomography (CBCT)

Abstract Introduction: Cone beam CT (CBCT) is becoming a routine imaging modality designed for the maxillofacial region. Imaging patients with intra-oral metallic objects cause streak artefacts. Artefacts impair any virtual model by obliterating the teeth. This is a major obstacle for occlusal registration and the fabrication of orthognathic wafers to guide the surgical correction of dentofacial deformities. Aims and Objectives: To develop a method of replacing the inaccurate CBCT images of the dentition with an accurate representation and test the feasibility of the technique in the clinical environment. Materials and Method: Impressions of the teeth are acquired and acrylic baseplates constructed on dental casts incorporating radiopaque registration markers. The appliances are fitted and a preoperative CBCT is performed. Impressions are taken of the dentition with the devices in situ and subsequent dental models produced. The models are scanned to produce a virtual model. Both images of the patient and the model are imported into a virtual reality software program and aligned on the virtual markers. This allows the alignment of the dentition without relying on the teeth for superimposition. The occlusal surfaces of the dentition can be replaced with the occlusal image of the model. Results: The absolute mean distance of the mesh between the markers in the skulls was in the region of 0.09mm ± 0.03mm; the replacement dentition had an absolute mean distance of about 0.24mm ± 0.09mm. In patients the absolute mean distance between markers increased to 0.14mm ± 0.03mm. It was not possible to establish the discrepancies in the patient’s dentition, since the original image of the dentition is inherently inaccurate. Conclusion: It is possible to replace the CBCT virtual dentition of cadaveric skulls with an accurate representation to create a composite skull. The feasibility study was successful in the clinical arena. This could be a significant advancement in the accuracy of surgical prediction planning, with the ultimate goal of fabrication of a physical orthognathic wafer using reverse engineering

3D soft-tissue, 2D hard-tissue and psychosocial chantes following orthognathic surgery

A 3D imaging system (C3D®), based on the principles of stereophotogrammetry, has been developed for use in the assessment of facial changes following orthognathic surgery. Patients’ perception of their facial appearance before and after orthognathic surgery has been evaluated using standardised questionnaires, but few studies have tried to link this perception with the underlying two-dimensional cephalometric data. Comparisons between patients’ subjective opinions and 3D objective assessment of facial morphology have not been performed. Aims: (1) To test the reliability of the 3D imaging system; (2) to determine the effect of orthognathic surgery on the 3D soft-tissue morphology; (3) to assess skeletal changes following orthognathic surgery; (4) to evaluate soft-tissue to hard-tissue displacement ratios; (5) to ascertain the impact of orthognathic surgery on patients’ perception of their facial appearance and their psychosocial characteristics, (6) to explore the dentofacial deformity, sex and age on the psychosocial characteristics; (7) to evaluate the extent of compatibility between the cephalometric and the three-dimensional measurements and (8) to determine if the magnitude of facial soft-tissue changes affects the perception of facial changes at six months following surgery. Results and Conclusions: C3D imaging system was proved to be accurate with high reproducibility. The reproducibility of landmark identification on 3D models was high for 24 out of the 34 anthropometric landmarks (SD£0.5 mm). One volumetric algorithm in the Facial Analysis Tool had an acceptable accuracy for the assessment of volumetric changes following orthognathic surgery (mean error=0.314 cm3). The error of cephalometric method was low and the simulation of mandibular closure proved to be reproducible. 2D soft-tissue measurements were compatible with 3D measurements in terms of distances, but angular measurements showed significant differences (p<0.05)