Three-dimensional planning accuracy and follow-up of Le Fort I osteotomy in cleft lip/palate patients.

Dental rehabilitation is a major challenge for patients with severe jaw atrophy since the latter hinders the use of conventional dental implants. Virtual planning and CAD/CAM technologies have contributed to developing customized subperiosteal implants (IPS Implants® Pre-prosthetic, KLS Martin), which can be a safe and predictable treatment alternative in these cases. We present maxillary dental rehabilitation using custom subperiosteal implants in a 29-year-old patient with bilateral complete cleft lip and palate along with severe hard and soft tissue atrophy in the premaxilla following primary surgery. Customized subperiosteal implants are an alternative treatment option in cases where conventional dental implants are not possible or where bone augmentation procedures have failed or are not feasible. We therefore propose the use of these implants in patients with cleft lip and palate with complex bone defects. 

Prosthetic restoration with virtual planned subperiosteal implant in adult patient with cleft lip and palate with severe sequelae.

Virtual surgical planning (VSP) and computer-aided design/computer-aided manufacturing have become essential tools for planning orthognathic surgery. Despite widespread use, empirical gaps still exist in the literature regarding the logistics of the orthognathic planning session itself. More precisely, there is a need to explicate the VSP workflow on which specific parameters are needed for a translation into 3D software. Although each surgeon has his/her theoretical framework, none have been elucidated to properly communicate the necessary pieces of information needed to plan the correction of a variety of dentofacial deformities. The authors provide an outline for conducting a successful VSP planning session for orthognathic surgery.

Maximizing the Virtual Surgical Planning Session for Orthognathic Surgery.

Abstract Objectives To assess the surgical accuracy of 3D virtually planned orthognathic surgery among patients with and without cleft. Materials and methods This retrospective cohort study included cleft and non-cleft patients with class III malocclusion who underwent bimaxillary surgery. CBCT scans were acquired before and immediately after surgery. 3D virtual surgical planning (VSP) was performed using CBCT and digitalized dentition data. All orthognathic surgeries were performed by the same surgeons using interocclusal splints. The primary outcome variable was surgical accuracy, defined as the difference between the planned and surgically achieved maxillary movements, quantified in six degrees of freedom. Analysis of covariance was used to test for intergroup differences in surgical accuracy after correcting for differences in the magnitude of planned surgical maxillary movements. Results Twenty-eight cleft and 33 non-cleft patients were enrolled, with mean ages of 18.5 and 25.4 years, respectively ( P =0.01). No significant gender difference was present between the groups ( P =0.10). After adjustment for small differences in surgical movements, no significant differences in surgical accuracy were observed between cleft and non-cleft patients. Conclusion The present study demonstrates that high surgical accuracy in maxillary movements can be achieved in both cleft and non-cleft patients using VSP and interocclusal splints. Clinical relevance Orthognathic cases with cleft can be performed with 3D VSP to obtain a satisfactory surgical accuracy. 

Is there a difference in surgical accuracy following bimaxillary surgery between cleft and non-cleft patients?

Cleft and Craniofacial Surgery.

Maxillary hypoplasia is a common developmental deformity affecting patients with cleft lip and palate. Various surgical techniques including conventional orthognathic surgery, total maxillary distraction osteogenesis, and anterior maxillary segmental distraction have been applied to address the deformity. With the evolution of 3D computed tomography imaging, the visualization of skeletal complexities in different perspectives is greatly enhanced and comprehensive surgical planning is achieved. Intraoperative efficiency is also improved with the fabrication of 3D-printed templates. The study aims to present different surgical techniques with virtual surgical planning (VSP) and 3D-printed surgical templates and the solution of representative cases. From January 2014 to January 2019, VSP was transferred to actual surgery or distraction precisely in 80 adult patients with cleft-related maxillary hypoplasia. The accuracy was analyzed and the relapse was also estimated and observed in 18 patients after 1-year follow-up. Based on our experience, VSP provides a more reliable and effective option to conventional model surgery. It facilitates the preoperative planning and accurately transfers the virtual plan to correct the cleft-related maxillary hypoplasia.

Virtual Surgical Planning Assisted Management for Cleft-Related Maxillary Hypoplasia.

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Virtual Surgical Planning Assisted Management for Cleft-Related Maxillary Hypoplasia.