Orthognathic Positioning System: Intraoperative System to Transfer Virtual Surgical Plan to Operating Field During Orthognathic Surgery

• Published in: Journal of oral and maxillofacial surgery Vol. 71; no. 5; pp. 911 - 920
• Main Authors: Polley, John W., MD, Figueroa, Alvaro A., DDS, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2013
• Subjects: Adolescent; Anatomic Landmarks - anatomy & histology; Centric Relation; Computer-Aided Design; Dental Models; Dental Occlusion, Centric; Dentistry; Equipment Design; Facial Asymmetry - surgery; Female; Fiducial Markers; Humans; Image Processing, Computer-Assisted - methods; Imaging, Three-Dimensional - methods; Jaw Relation Record - instrumentation; Mandible - abnormalities; Mandible - surgery; Maxilla - surgery; Occlusal Splints; Orthognathic Surgical Procedures - instrumentation; Orthognathic Surgical Procedures - methods; Osteotomy, Le Fort - instrumentation; Osteotomy, Le Fort - methods; Osteotomy, Sagittal Split Ramus - instrumentation; Osteotomy, Sagittal Split Ramus - methods; Patient Care Planning; Photography, Dental; Prognathism - surgery; Surgery; Surgery, Computer-Assisted - instrumentation; Surgery, Computer-Assisted - methods; Tomography, Spiral Computed; User-Computer Interface
• ISSN: 0278-2391; 1531-5053
• DOI: 10.1016/j.joms.2012.11.004

Purpose To introduce the concept and use of an occlusal-based "orthognathic positioning system" (OPS) to be used during orthognathic surgery. Materials and Methods The OPS consists of intraoperative occlusal-based devices that transfer virtual surgical planning to the operating field for repositioning of the osteotomized dentoskeletal segments. The system uses detachable guides connected to an occlusal splint. An initial drilling guide is used to establish stable references or landmarks. These are drilled on the bone that will not be repositioned adjacent to the osteotomy line. After mobilization of the skeletal segment, a final positioning guide, referenced to the drilled landmarks, is used to transfer the skeletal segment according to the virtual surgical planning. The OPS is digitally designed using 3-dimensional computer-aided design/computer-aided manufacturing technology and manufactured with stereolithographic techniques. Conclusions Virtual surgical planning has improved the preoperative assessment and, in conjunction with the OPS, the execution of orthognathic surgery. The OPS has the possibility to eliminate the inaccuracies commonly associated with traditional orthognathic surgery planning and to simplify the execution by eliminating surgical steps such as intraoperative measuring, determining the condylar position, the use of bulky intermediate splints, and the use of intermaxillary wire fixation. The OPS attempts precise translation of the virtual plan to the operating field, bridging the gap between virtual and actual surgery.