Lessons Learned In 15 Years Of Digital Orthognathic Surgery: Benefits, Failures And When It Is Pointless
Pravin K. Patel, MD.
University of Illinois, Chicago, IL, USA.
Purpose: We present long-term experience with orthognathic surgery in 450 cases using digital technology: computer aided surgical planning (CASP) to 3D fixation. We answer the following questions in comparison to conventional approach: does CASP reduce surgical planning-operative time, is CASP more accurate and when does the benefits of CASP outweigh the expense. Methods: We reviewed consecutive series of 448 OGS (268Developmental, 148Cleft, 43HFM and 32Monobloc/LeFort III cases). We assessed long-term skeletal stability with established methodology, occlusal outcome using PAR/ABO index, planning-operative efficiency and complications. We compared expense data between CASP and conventional approaches. Results: Maximal displacement at 1 year at the osteotomy level, in comparison to the VSP prediction, was less than 1.56mm, compared to 2.78 mm in control group. The occlusal PAR Index varied from 6.8 to 14 in both groups and not statistically different. The LeFort I operative time was reduced from 128 to 72 minutes. However, BSSO procedure increased by 23 minutes when printed titanium plates were used. Further details to be presented.Conclusion: 1. We found significant reduction in the operative time, less displacement at the osteotomy level, and improved skeletal stability in comparison to the conventional fixation system. 2. There is no difference in the occlusal outcome with the exception of the segmental cases. 3. There is a benefit in correcting skeletal asymmetry (developmental, hemifacial microsomia, cleft), LeFort III and monobloc advancement procedures. 4. In single jaw cases the benefit of CASP is surgeon dependent. 5. In select cases the benefits of CASP outweighs its expense.
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