A method to improve positioning of denture teeth on denture bases for CAD-CAM complete dentures: A dental technique.

In the digital workflow of complete denture fabrication, one solution for producing computer-aided design and computer-aided manufacturing dentures has been to mill the denture teeth and base separately and then bond them together. The correct bonding of the denture teeth and base is important to reproduce the designed occlusion in the definitive prosthesis. A novel technique is described to assist in the accurate positioning of denture teeth on the denture base by constructing auxiliary positioning slots on the denture base and auxiliary positioning posts on the denture teeth. The technique can assist in accurately assembling CAD-CAM milled complete dentures and may shorten chairside time by reducing clinical occlusal adjustment.

Three-Dimensionally-Printed Polyether-Ether-Ketone Implant with a Cross-Linked Structure and Acid-Etched Microporous Surface Promotes Integration with Soft Tissue.

Polyether-ether-ketone (peek) is one of the most common materials used for load-bearing orthopedic devices owing to its radiolucency and favorable mechanical properties. However, current smooth-surfaced peek implants can lead to fibrous capsule formation. To overcome this issue, here, peek specimens with well-defined internal cross-linked structures (macropore diameters of 1.0-2.0 mm) were fabricated using a three-dimensional (3D) printer, and an acid-etched microporous surface was achieved using injection-molding technology. The cell adhesion properties of smooth and microporous peek specimens was compared in vitro through a scanning electron microscope (SEM), and the soft tissue responses to the both microporous and cross-linked structure of different groups were determined in vivo using a New Zealand white rabbit model, and examined through histologic staining and separating test. The results showed that the acid-etched microporous surface promoted human skin fibroblasts (HSF) adherence, while internal cross-linked structure improved the ability of the peek specimen to form a mechanical combination with soft tissue, especially with the 1.5 mm porous specimen. The peek specimens with both the internal cross-linked structure and external acid-etched microporous surface could effectively promote the close integration of soft tissue and prevent formation of fibrous capsules, demonstrating the potential for clinical application in surgical repair.

Advanced biomaterials and their potential applications in the treatment of periodontal disease.

Periodontal disease is considered as a widespread infectious disease and the most common cause of tooth loss in adults. Attempts for developing periodontal disease treatment strategies, including drug delivery and regeneration approaches, provide a useful experimental model for the evaluation of future periodontal therapies. Recently, emerging advanced biomaterials including hydrogels, films, micro/nanofibers and particles, hold great potential to be utilized as cell/drug carriers for local drug delivery and biomimetic scaffolds for future regeneration therapies. In this review, first, we describe the pathogenesis of periodontal disease, including plaque formation, immune response and inflammatory reactions caused by bacteria. Second, periodontal therapy and an overview of current biomaterials in periodontal regenerative medicine have been discussed. Third, the roles of state-of-the-art biomaterials, including hydrogels, films, micro/nanofibers and micro/nanoparticles, developed for periodontal disease treatment and periodontal tissue regeneration, and their fabrication methods, have been presented. Finally, biological properties, including biocompatibility, biodegradability and immunogenicity of the biomaterials, together with their current applications strategies are given. Conclusive remarks and future perspectives for such advanced biomaterials are discussed.

Finite Element Study of PEEK Materials Applied in Post-Retained Restorations.

BACKGROUND: This study aimed to investigate the biomechanical behaviors of polyether ether ketone (PEEK) and traditional materials (titanium and fiber) when used to restore tooth defects in the form of prefabricated post or customized post via computational modelling. METHODS: First, the prototype of natural tooth, and the prototypes of prefabricated post and customized post were established, respectively, whilst the residual root was restored with dentin ferrule using reverse engineering methods. Then, the stress and strain of CFR-PEEK (PEEK reinforced by 30% carbon fiber) and pure PEEK (PEEK without any reprocessing) post were compared with those made in traditional materials using the three-dimensional finite element method. RESULTS: From the stress point of view, compared with metal and fiber posts, CFR-PEEK and pure PEEK prefabricated post both demonstrated reduced post-core interface stress, post stress, post-root cement stress and root cement stress; moreover, CFR-PEEK and pure PEEK customized post demonstrated reduced post stress, post-root cement stress and root cement stress, while the strain of CFR-PEEK post was the closest to that of dentin. CONCLUSIONS: Compared with the traditional posts, both the CFR-PEEK and pure PEEK posts could reduce the risk of debonding and vertical root fracture, whether they were used as prefabricated posts or customized posts, but the biomechanical behavior of carbon fiber-reinforced CFR-PEEK restorations was the closest to dentin, no matter if they were used as prefabricated post or customized post. Therefore, the CFR-PEEK post could be more suitable to restore massive tooth defects. Pure PEEK needs filler reinforcement to be used for post-retained restoration.

Chitosan/Hyaluronic Acid/MicroRNA-21 Nanoparticle-Coated Smooth Titanium Surfaces Promote the Functionality of Human Gingival Fibroblasts.

Purpose: Forming a compact biological seal between the gingiva and the implant interface around the percutaneous parts of an implant is one of the key issues in preventing peri-implantitis. Methods: In this study, since microRNA-21 (miR-21) has been approved to promote fibroblast proliferation and collagen formation in skin fibrosis, we prepared miR-21-loaded chitosan (CS)/tripolyphosphate (TPP)/hyaluronic acid (HA) nanoparticles (CTH NPs) and cross-linked them to smooth Ti surfaces with 0.2% gel solution for reverse transfection, after which isolated human gingival fibroblasts were cultured on the miR-21-functionalized Ti substrates. Results: An optimal CS:TPP:HA ratio (1:0.15:0.1) and N/P ratio (20:1) were chosen to produce appropriate nanoparticles. Finally, the CTH/miR-21 nanoparticle-coated smooth Ti surfaces demonstrated increased fibroblast adhesion, proliferation and expression of extracellular matrix-related genes along with similar cytotoxicity and cell spreading on the miR-21-functionalized Ti surface and the unmodified smooth Ti surface. Conclusion: The chitosan-based nanoparticles might be an efficient nonviral miRNA vector to form a stable biological seal in percutaneous areas of Ti for clinical use.

Reconstruction of mandibular defects using a custom-made titanium tray in combination with autologous cancellous bone.

PURPOSE: To esthetically and functionally restore a 40-mm canine mandibular discontinuity defect using a custom-made titanium bone-grafting tray packed with autologous iliac bone. MATERIALS AND METHODS: Individualized titanium bone-grafting trays were made using a reverse engineering, computer-aided design, and rapid prototyping technique. A 40-mm discontinuity defect in the right mandibular body was created in 10 hybrid dogs. The defect was restored immediately using the tray that was densely packed with autologous cancellous iliac particles and covered with trimmed iliac chips. Sequential radionuclide bone imaging was performed postoperatively at 2, 4, 8, 12, and 24 weeks. The ratio of activity between the grafted mandible and the contralateral native mandible on each transaxial slice was calculated. The mean activity ratio was analyzed at each time point to evaluate the bone metabolism and reconstitution of the grafts. The subjects were sacrificed at 4, 12, and 24 weeks after grafting. The specimens were evaluated by postmortem gross dissection, biomechanical testing, 3-dimensional microcomputed tomographic scanning, and histologic examination. RESULTS: All the subjects tolerated the grafting operation well. Over an observation period of 24 weeks, tray extrusion occurred in 3 of the 10 subjects. Bony continuities were reconstructed in 9 of the 10 subjects. Radionuclide bone imaging revealed that the tracer uptake increased in the grafted mandible, and the radionuclide ratio between the graft and the native mandible decreased with time. Gross evaluation, microcomputed tomographic examination, biomechanical testing, and histologic examination demonstrated corticalization of the grafts. CONCLUSIONS: The use of a customized technique using reverse engineering, computer-aided design, and rapid prototyping tray containing autologous cancellous bone is a potentially powerful grafting technique for the reconstruction of mandibular discontinuity defects.

Modified animal model and computer-assisted approach for dentoalveolar distraction osteogenesis to reconstruct unilateral maxillectomy defect.

PURPOSE: The purpose of this report is to show the establishment of an animal model with a unilateral maxilla defect, application of virtual reality and rapid prototyping in the surgical planning for dentoalveolar distraction osteogenesis (DO). MATERIALS AND METHODS: Two adult dogs were used to develop an animal model with a unilateral maxillary defect. The 3-dimensional model of the canine craniofacial skeleton was reconstructed with computed tomography data using the software Mimics, version 12.0 (Materialise Group, Leuven, Belgium). A virtual individual distractor was designed and transferred onto the model with the defect, and the osteotomies and distraction processes were simulated. A precise casting technique and numeric control technology were applied to produce the titanium distraction device, which was installed on the physical model with the defect, which was generated using Selective Laser Sintering technology, and the in vitro simulation of osteotomies and DO was done. RESULTS: The 2 dogs survived the operation and were lively. The osteotomies and distraction process were simulated successfully whether on the virtual or the physical model. The bone transport could be distracted to the desired position both in the virtual environment and on the physical model. CONCLUSIONS: The novel method to develop an animal model with a unilateral maxillary defect was feasible, and the animal model was suitable to develop the reconstruction method for unilateral maxillary defect cases with dentoalveolar DO. Computer-assisted surgical planning and simulation improved the reliability of the maxillofacial surgery, especially for the complex cases. The novel idea to reconstruct the unilateral maxillary defect with dentoalveolar DO was proved through the model experiment.

Injectable cartilaginous template transformed BMSCs into vascularized bone.

Regeneration of alveolar bone for dental implant remains a major issue, partifcularly for patients suffering from severe bone adsorption and irregular socket trauma. Recapitulating embryological development is becoming an attractive approach for engineer organ or three-dimensional tissues from stem cells. In this study, we aimed to develop an injectable "cartilaginous" graft with adequate mechanical resistance and ideal bone remodelling potential. The cartilaginous graft was composed of a particulate decellularised cartilage matrix (PDCM), chondrogenically primed bone mesenchymal stem cell (BMSC) bricks (CB), and enriched platelet-rich plasma (P) gel. In immunodeficient mice, we found that angiogenesis occurred quickly inside PDCM-CB-P constructs after implantation, thereby improving tissue survival and bone formation. In rabbit tibia bone defects around implants, we confirmed that CBs not only transformed into bone tissue rapidly, but also significantly promoted bone remodelling and replacement of PDCM, thus realising osseointegration of dental implants within 3 months. In conclusion, CBs exhibited the potential for endochondral ossification in vivo, and application of a cartilaginous template composed of PDCM, CB, and P provided a minimally-invasive, "free material residual" approach to regenerate alveolar bone tissues in vivo. This method could have applications in peri-implant bone regeneration.

Platelet-rich plasma gel composited with nondegradable porous polyurethane scaffolds as a potential auricular cartilage alternative.

Total auricular reconstruction is still a challenge, and autologous cartilage transplant is the main therapy so far. Tissue engineering provides a promising method for auricular cartilage reconstruction. However, although degradable framework demonstrated excellent initial cosmetic details, it is difficult to maintain the auricular contour over time and the metabolites tended to be harmful to human body. In this study, biocompatible and safe nondegradable elastic polyurethane was used to make porous scaffold in specific details by rapid prototyping technology. Platelet-rich plasma contains fibrin and abundant autologous growth factors, which was used as cell carriers for in vitro expanded cells. When crosslinking polyurethane framework, platelet-rich plasma and cells together, we successfully made polyurethane/platelet-rich plasma/cell composites, and implanted them into dorsal subcutaneous space of nude mice. The results showed that this method resulted in more even cell distribution and higher cell density, promoted chondrocyte proliferation, induced higher level expressions of aggrecan and type II collagen gene, increased content of newly developed glycosaminoglycans, and produced high-quality cartilaginous tissue. This kind of cartilage tissue engineering approach may be a potential promising alternative for external ear reconstruction.

In vitro studies on human periodontal ligament stem cell sheets enhanced by enamel matrix derivative.

Numerous preclinical and clinical studies have focused on the periodontal regenerative functions of enamel matrix derivative (EMD), a heat-treated preparation derived from enamel matrix proteins (EMPs) of developing porcine teeth. In this study, periodontal ligament (PDL) stem cells (PDLSCs) were isolated, and the effects of EMD on the extracorporeal induction process and the characteristics of PDLSC sheets were investigated for their potential as a more effective stem-cell therapy. EMD-enhanced cell sheets could be induced by complete medium supplemented with 50 µg/mL vitamin C and 100 µg/mL EMD. The EMD-enhanced cell sheets appeared thicker and more compact than the normal PDLSC sheets, demonstrated more layers of cells (3-7 layers), secreted richer extracellular matrix (ECM), showed varying degrees of increases in mRNA expression of periodontal tissue-specific genes (COL I, POSTN), calcification-related genes (RUNX2, OPN, OCN) and a cementum tissue-specific gene (CAP), and possessed a better mineralization ability in terms of osteogenic differentiation in vitro. These EMD-enhanced cell sheets may represent a potential option for stem-cell therapy for PDL regeneration.

The use of platelet-rich fibrin combined with periodontal ligament and jaw bone mesenchymal stem cell sheets for periodontal tissue engineering.

Periodontal regeneration involves the restoration of at least three unique tissues: cementum, periodontal ligament tissue (PDL) and alveolar bone tissue. Here, we first isolated human PDL stem cells (PDLSCs) and jaw bone mesenchymal stem cells (JBMSCs). These cells were then induced to form cell sheets using an ascorbic acid-rich approach, and the cell sheet properties, including morphology, thickness and gene expression profile, were compared. Platelet-rich fibrin (PRF) derived from human venous blood was then fabricated into bioabsorbable fibrin scaffolds containing various growth factors. Finally, the in vivo potential of a cell-material construct based on PDLSC sheets, PRF scaffolds and JBMSC sheets to form periodontal tissue was assessed in a nude mouse model. In this model, PDLSC sheet/PRF/JBMSC sheet composites were placed in a simulated periodontal space comprising human treated dentin matrix (TDM) and hydroxyapatite (HA)/tricalcium phosphate (TCP) frameworks. Eight weeks after implantation, the PDLSC sheets tended to develop into PDL-like tissues, while the JBMSC sheets tended to produce predominantly bone-like tissues. In addition, the PDLSC sheet/PRF/JBMSC sheet composites generated periodontal tissue-like structures containing PDL- and bone-like tissues. Further improvements in this cell transplantation design may have the potential to provide an effective approach for future periodontal tissue regeneration.

Microarc-oxidized titanium surfaces functionalized with microRNA-21-loaded chitosan/hyaluronic acid nanoparticles promote the osteogenic differentiation of human bone marrow mesenchymal stem cells.

Dental implants have been widely used for the replacement of missing teeth in the clinic, but further improvements are needed to meet the clinical demands for faster and tighter osseointegration. In this study, we fabricated safe and biocompatible chitosan (CS)/hyaluronic acid (HA) nanoparticles to deliver microRNA-21 (miR-21) and thereby accelerate osteogenesis in human bone marrow mesenchymal stem cells (hBMMSCs). The CS/HA/miR-21 nanoparticles were cross-linked with 0.2% gel solution onto microarc oxidation (MAO)-treated titanium (Ti) surfaces to fabricate the miR-21-functionalized MAO Ti surface, resulting in the development of a novel coating for reverse transfection. To characterize the CS/HA/miR-21 nanoparticles, their particle size, zeta potential, surface morphology, and gel retardation ability were sequentially investigated. Their biological effects, such as cell viability, cytotoxicity, and expression of osteogenic genes by hBMMSCs on the miR-21-functionalized MAO Ti surfaces, were evaluated. Finally, we explored appropriate CS/HA/miR-21 nanoparticles with a CS/HA ratio of 4:1 and N/P ratio 20:1 for transfection, which presented good spherical morphology, an average diameter of 160.4±10.75 nm, and a positive zeta potential. The miR-21-functionalized MAO Ti surfaces demonstrated cell viability, cytotoxicity, and cell spreading comparable to those exhibited by naked MAO Ti surfaces and led to significantly higher expression of osteogenic genes. This novel miR-21-functionalized Ti implant may be used in the clinic to allow more effective and robust osseointegration.

MAPs/bFGF-PLGA microsphere composite-coated titanium surfaces promote increased adhesion and proliferation of fibroblasts.

Infection and epithelial downgrowth are two major problems with maxillofacial transcutaneous implants, and both are mainly due to lack of stable closure of soft tissues at transcutaneous sites. Fibroblasts have been shown to play a key role in the formation of biological seals. In this work, titanium (Ti) model surfaces were coated with mussel adhesive proteins (MAPs) utilizing its unique adhesion ability on diverse inorganic and organic surfaces in wet environments. Prepared basic fibroblast growth factor (bFGF)-poly(lactic-co-glycolic acid) (PLGA) microspheres can be easily synthesized and combined onto MAPs-coated Ti surfaces, due to the negative surface charges of microspheres in aqueous solution, which is in contrast to the positive charges of MAPs. Titanium model surfaces were divided into three groups. Group A: MAPs/bFGF-PLGA microspheres composite-coated Ti surfaces. Group B: MAPs-coated Ti surfaces. Group C: uncoated Ti surfaces. The effects of coated Ti surfaces on adhesion of fibroblasts, cytoskeletal organization, proliferation, and extracellular matrix (ECM)-related gene expressions were examined. The results revealed increased adhesion (P < 0.05), enhanced actin cytoskeletal organization, and up-regulated ECM-related gene expressions in groups A and B compared with group C. Increased proliferation of fibroblasts during five days of incubation was observed in group A compared with groups B and C (P < 0.05). Collectively, the results from this in vitro study demonstrated that MAPs/bFGF-PLGA microspheres composite-coated Ti surfaces had the ability to increase fibroblast functionality. In addition, MAPs/bFGF-PLGA microsphere composite-coated Ti surfaces should be studied further as a method of promoting formation of stable biological seals around transcutaneous sites.

Effects of irradiation on osteoblast-like cells on different titanium surfaces in vitro.

The aim of this study was to investigate the effects of irradiation on adhesion ability, proliferation, and differentiation of MC3T3-E1 cells on microarc oxidation (MAO) titanium surfaces and polished titanium (PT) surfaces. MC3T3-E1 cells were exposed to a single dose at 2, 4, 6, 8, or 10 Gy using a (60) Co source, with tissue culture polystyrene plates chosen as controls. On all surfaces, irradiation resulted in a dose-dependent decrease in cellular proliferation. At 4 Gy dose, the cell proliferation of cells decreased by 17.8% on MAO and 18.6% on PT surfaces, respectively, compared with nonirradiated controls. Cells exposed to 8 Gy dose showed significant inhibition in collagen secretion and osteogenesis-related genes expression (OSX, COL-Iα1, and OCN). In contrast, irradiation increased cell adhesion to three surfaces dose dependently. It was also demonstrated that cells on MAO surface showed higher adhesion and collagen secretion than on PT surface at different radiation doses. This study revealed the effects of irradiation on osteoblasts in vitro on two titanium surfaces. MAO surface could be used in dental implants in irradiated bone due to enhanced adhesion ability and collagen secretion in osteoblasts.

Prototyped flexible grafting tray for reconstruction of mandibular defects.

In our previous studies, prototyped individual bone-grafting trays have been used to restore discontinuous mandibular defects. However, the attempts have shown that the trays have shielded the graft from stress, which caused considerable resorption of bone. To eliminate the shielding, we designed a flexible tray. Finite element analysis was used to compare the distribution of strain on the bone grafts that were placed in flexible and conventional trays. The analogue computation suggested that most of the strain on the graft in the flexible tray resulted in a beneficial mechanical environment, while in the conventional tray more than half of graft was in the lowest class of strain (disuse - <50 µstrains). Animal experiments were conducted on hybrid dogs, and the prototype flexible tray was used to carry particles of autologous cancellous iliac bone to reconstruct a 40 mm defect in the mandibular body. Sequential radionuclide bone imaging was used to monitor the bone metabolism. Animals were killed at 4, 12 and 24 weeks, and specimens processed for quantitative histological examination. The data from the flexible trays were compared with those from the conventional trays, as in our previous study. The results showed that bone metabolism was more active in the flexible tray than in the conventional tray during the early stages. There was increased bony adaptation in the flexible tray. These results indicate that the flexible tray can efficiently eliminate the shielding from stress, and allow more occlusive force to be conducted on to the bone graft, which results in better remodelling of the graft.

Alveolar crest regeneration using curvilinear dentoalveolar distraction osteogenesis: a preliminary study.

OBJECTIVE: The objective of this study was to reconstruct alveolar crest at home position using distraction osteogenesis (DO) with a personalized curvilinear distractor designed through computer-aided technology. STUDY DESIGN: Five adult dogs were recruited and the maxillary alveolar bone from the first incisor to the first premolar was excised. The dentoalveolar segment adjacent to the defect was osteotomized as a bone transport disk. After 8 weeks of consolidation, the dogs were humanely killed, and the regenerated bone was analyzed. RESULTS: The DO was successful in the experimental group. The radiographs and histology both verified new bone bridging distraction gap. However, the newly formed bone was located more internally and was not in original position. CONCLUSIONS: The proposed method to reconstruct alveolar crest at home position is improper. The key point was how to maintain the distraction space and hold it at the home position. The barrier membrane technique may be used together with DO to resolve the problem.

[Effect of pigments concentration on physical and mechanical properties of MDX-4-4210 silicone elastomer].

PURPOSE: To determine the optimum pigments concentration on the physical and mechanical properties. METHODS: In this study, control samples were prepared from MDX-4-4210 silicone base and tested along with the pigmented samples for comparison in accordance with the national standards. The pigments concentration to base elastomer was set at 0.1, 0.15, 0.2, 0.25, 0.3wt%,respectively; while other conditions were kept same, then the major physical properties of the elastomer were studied with a tensile tester. The data was processed with SPSS10.0 software package. RESULTS: When comparing the pigmented samples with the control, the tensile strength, the ultimate elongation, the tear resistance and the Shore A hardness of the MDX-4-4210 silicone elastomer was affected by the addition of the pigments. A decrease was found,while, the incorporation of pigments had no effect on the permanent deformation rate of the resulting elastomer by the addition of the pigments. CONCLUSIONS: The results obtained from physical and mechanical testing of pigmented silicone samples suggest that incorporation of 0.2wt% by weight of pigments can alter the initial physical and mechanical behavior of the base elastomer. Supported by National Natural Science Foundation of China (30630066).

New osteotomy for transport of a disc of alveolar bone to close an oronasal fistula during distraction osteogenesis for reconstruction of a maxillary defect: in vitro assessment.

We describe a new osteotomy for transport of a disc of alveolar bone, which can simultaneously close an oronasal fistula with two layers of mucoperiosteum during distraction osteogenesis for reconstruction of a maxillary defect.

Virtual transplantation in designing a facial prosthesis for extensive maxillofacial defects that cross the facial midline using computer-assisted technology.

PURPOSE: The aim of this article was to demonstrate a novel approach to designing facial prostheses using the transplantation concept and computer-assisted technology for extensive, large, maxillofacial defects that cross the facial midline. MATERIALS AND METHODS: The three-dimensional (3D) facial surface images of a patient and his relative were reconstructed using data obtained through optical scanning. Based on these images, the corresponding portion of the relative's face was transplanted to the patient's where the defect was located, which could not be rehabilitated using mirror projection, to design the virtual facial prosthesis without the eye. A 3D model of an artificial eye that mimicked the patient's remaining one was developed, transplanted, and fit onto the virtual prosthesis. A personalized retention structure for the artificial eye was designed on the virtual facial prosthesis. The wax prosthesis was manufactured through rapid prototyping, and the definitive silicone prosthesis was completed. RESULTS: The size, shape, and cosmetic appearance of the prosthesis were satisfactory and matched the defect area well. The patient's facial appearance was recovered perfectly with the prosthesis, as determined through clinical evaluation. CONCLUSION: The optical 3D imaging and computer-aided design/computer-assisted manufacturing system used in this study can design and fabricate facial prostheses more precisely than conventional manual sculpturing techniques. The discomfort generally associated with such conventional methods was decreased greatly. The virtual transplantation used to design the facial prosthesis for the maxillofacial defect, which crossed the facial midline, and the development of the retention structure for the eye were both feasible.

CAD/CAM surface templates as an alternative to the intermediate wafer in orthognathic surgery.

OBJECTIVE: A new simple technique using a pair of surface templates fabricated by CAD/CAM technique as an alternative to the use of intermediate surgical wafer is presented. STUDY DESIGN: A patient with transverse maxillary cant and maxillary midline deviation was scanned using computed tomography (CT) to create a 3D model of the maxillofacial bone. Eight virtual cylindrical markers were placed on the selected locations of maxilla. Subsequently, the locations of these cylinders were expressed as drill holes in the preosteotomy templates. The maxillary segment was separated and repositioned in the computer according to preoperative plans. Postosteotomy surface templates were then designed and resin templates were fabricated by a rapid prototyping machine. After investing and casting, metal templates were fabricated. At the beginning of operation, surgical fixation holes on the maxilla were drilled with the preosteotomy templates. Once maxillary osteotomy and segmentation were finished, screws were placed through the holes in the postosteotomy templates into the predrilled holes on the bone correspondingly, and maxillary segments were fixed with the titanium plates. RESULTS: After the postosteotomy templates were positioned and fixed, the maxillary segment was placed to the desired position. Maxillary transverse cant and midline deviation were corrected as the preoperative plan and simulation. CONCLUSION: The use of the surface templates before and after osteotomy as an alternative to intermediate wafer in orthognathic surgery can minimize labor and errors contained in the traditional way, reducing preoperative work as well as a reduction in operation time.