Virtually-Planned Orthognathic Surgery Achieves an Accurate Condylar Position.

PURPOSE: Accuracy in orthognathic surgery with virtual planning has been reported, but detailed analysis of accuracy according to anatomic location, including the mandibular condyle, is insufficient. The purpose of this study was to compare the virtual plan and surgical outcomes and analyze the degree and distribution of errors according to each anatomic location. PATIENTS AND METHODS: This retrospective cohort study evaluated skeletal class III patients, treated with bimaxillary surgery. The primary predictor was anatomic locations that consisted of right and left condyles, maxilla, and the distal segment of the mandible. Other variables were age and gender. The primary outcome was surgical accuracy, defined as mean 3-dimensional distance error, mean absolute error, and mean error along the horizontal, vertical, and anteroposterior axes between the virtual plan and surgical outcomes. Landmarks were compared using a computational method based on affine transformation with a 1-time landmark setting. The mean errors were visualized with multidimensional scattergrams. Bivariate and regression statistics were computed. RESULTS: This study included 52 patients, 26 men and 26 women, with a mean age of 21 years and 3 months. The mean 3D distance errors for condylar landmarks, maxillary landmarks, and landmarks on the distal segment of the mandible were 1.03, 1.25, and 2.24 mm, respectively. Condylar landmarks, maxillary landmarks, and the landmarks on the distal segment of the mandible were positioned at 0.49 mm inferior, 0.28 mm anterior, and 1.25 mm inferior, respectively. The landmark errors for the distal segment of the mandible exhibited a wider distribution than those for condylar and maxillary landmarks. CONCLUSIONS: Agreement between the planned and actual outcome aided by virtual surgical planning was highest for the condyles, followed by the maxilla, and the distal segment of the mandible. It is important to consider the tendency for surgical errors in each anatomic location during operations.

Postoperative Three-Dimensional Evaluation of Mandibular Contouring Surgery Using Computer-Assisted Simulation Planning and a Three-Dimensional-Printed Surgical Guide.

Mandibular contouring surgery was performed using computer-assisted simulation planning (CASP) and 3-dimensional printed surgical guide. The outcome of the surgery was evaluated by overlapping preoperative image. The patient underwent mandibular contouring surgery according to CASP for his residual facial asymmetry of the mandibular angle and mental area. The overall facial aesthetic of the patient was improved. In the overlapping image, the left mandibular border area was slightly overcorrected. However, the other portion was operated as planned. The overcorrection was due to the improper adaptation of the surgical guide adjacent to the mental foramen. In conclusion, usage of CASP and a surgical guide could reduce operation time and increase the accuracy of the operation. However, the design of the stent should be improved around the mental foramen to avoid nerve damage and improper adaptation.

Hydroxyapatite and silk combination-coated dental implants result in superior bone formation in the peri-implant area compared with hydroxyapatite and collagen combination-coated implants.

PURPOSE: The objective of this study was to compare bone formation after installation of uncoated (UC), hydroxyapatite-coated (HA), collagen plus HA-coated (CH), and silk plus HA-coated (SH) implants. MATERIALS AND METHODS: Implants in the UC group had acid-etched surfaces. Surface coating was applied using the aerosol deposition method. Cellular responses on the coated surfaces were examined with scanning electron microscopy. Cellular responses to the surfaces were studied with the corresponding coated discs and MG63 cells. Subsequently, 3-(4, 5-dimethylthiazole-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and alkaline phosphatase (ALP) assays were performed. Peri-implant bone formation was evaluated with the rabbit tibia model. Twenty-four implants from each group were installed. The animals were sacrificed 6 weeks after implant installation. Peri-implant bone formation and implant-to-bone contact were measured in histologic sections. Significance of differences across groups was evaluated using analysis of variance. RESULTS: Scanning electron microscopic images showed that the CH and SH groups exhibited cells that appeared more spread out than those in the other groups. The SH group exhibited the highest value in the MTT assay. The CH group exhibited the highest level of ALP activity. Comparisons of these modifications with the acid-etched surfaces showed that the CH and SH groups displayed significantly greater peri-implant bone formation (P < .001). CONCLUSION: The SH group displayed significantly greater new bone formation and bone-to-implant contact than did the other groups.

New bone formation between bare titanium surface and hydroxyapatite coating by the aerosol deposition technique in the nasal mucosal penetration model.

OBJECTIVE: The aim of this study was to compare new bone formation with titanium (Ti) surface and hydroxyapatite (HA)-coated titanium surface in mucosal perforation model. MATERIALS AND METHODS: HA coating to the Ti disc and implant were done by aerosol deposition technique. Alkaline phosphatase assay and cell migration assay were done in Ti and HA surface disc with MG63 cells. For the in vivo test, 5 New Zealand white rabbits were used. Two penetration defects were prepared in the nasal bone. Subsequently, 2 types of implants were installed into the defect (diameter: 3.0 mm, length: 6.0 mm). Approximately 5.0 mm of the fixture's surface penetrated into the nasal cavity. In the experimental group, HA-coated implants were used. The same design of implants without coating was used in the control group. The animals were sacrificed 8 weeks postoperatively. Subsequently, a histomorphometric analysis was done. RESULTS: Alkaline phosphatase activity was significantly higher in HA-coated surface than in titanium surface (P < 0.05). In addition, more cells were migrated into the HA-coated surface when compared to Ti surface. In the animal experiments, mean new bone formation was 30.68 ± 14.16% in the experimental group and 6.92 ± 5.12% in the control group (P = 0.001). Mean bone-to-implant contact was 31.71 ± 8.41% in the experimental group and 7.98 ± 5.58% in the control group (P < 0.001). Mean height of the bone regeneration was 3.70 ± 0.76 mm in the experimental group and 1.04 ± 0.67 mm in the control group. The difference between the 2 groups was statistically significant (P < 0.001). CONCLUSIONS: HA-coated implants exhibited more bone regeneration in the mucosal penetration model than the uncoated implants.

Redefining precision and efficiency in orthognathic surgery through virtual surgical planning and 3D printing: a narrative review.

Orthognathic surgery, essential for addressing jaw and facial skeletal irregularities, has historically relied on traditional surgical planning (TSP) involving a series of time-consuming steps including two-dimensional radiographs. The advent of virtual surgical planning (VSP) and 3D printing technologies has revolutionized this field, bringing unprecedented precision and customization to surgical processes. VSP facilitates 3D visualization of the surgical site, allowing for real-time adjustments and improving preoperative stress for patients by reducing planning time. 3D printing dovetails with VSP, offering the creation of anatomical models and surgical guides, enhancing the predictability of surgical outcomes despite higher initial setup and material costs. The integration of VSP and 3D printing promises innovative and effective solutions in orthognathic surgery, surpassing the limitations of traditional methods. Patient-reported outcomes show a positive post-surgery impact on the quality of life, underlining the significant role of these technologies in enhancing self-esteem and reducing anxiety. Economic analyses depict a promising long-term fiscal advantage with these modern technologies, notwithstanding the higher initial costs. The review emphasizes the need for large-scale randomized controlled trials to address existing research gaps and calls for a deeper exploration into the long-term impacts and ethical considerations of these technologies. In conclusion, while standing on the cusp of a technological renaissance in orthognathic surgery, it is incumbent upon the medical fraternity to foster a collaborative approach, balancing innovation with scrutiny to enhance patient care. The narrative review encourages the leveraging of VSP and 3D printing technologies for more efficient and patient-centric orthognathic surgery, urging the community to navigate uncharted territories in pursuit of precision and efficiency in the surgical landscape.

Aerosol deposition of hydroxyapatite and 4-hexylresorcinol coatings on titanium alloys for dental implants.

PURPOSE: Aerosol deposition is a newly developed technique, and it can deliver the drug from a hydroxyapatite (HA)-coated surface. 4-Hexylresorcinol (4-HR) is a well-known antiseptic. The influence of the 4-HR component of HA coatings on titanium surfaces was studied in vitro and in vivo. MATERIALS AND METHODS: X-ray diffraction and Fourier transform infrared techniques were used for the evaluation of the coating. The cellular response of the coating was evaluated by scanning electron microscopic study, MTT assay, alkaline phosphatase assay, and osteocalcin assay. In addition, the dental implant was coated with HA or HA + 4-HR. The implant was installed into the tibia of a rabbit after contamination by Aggregatibacter actinomycetemcomitans. The torque test and histologic analysis were then performed at 8 weeks after the operation. RESULTS: By use of an aerosol deposition technique, the combination of HA and 4-HR was successfully coated onto a titanium surface, which was confirmed by x-ray diffraction and Fourier transform infrared techniques. MG63 cells attached more rapidly to the HA + 4-HR coating than to the HA-only coating. The HA + 4-HR coating had significantly increased osteocalcin expression and alkaline phosphatase activity compared with the HA-only coating (P < .05). The dental implant coated with HA + 4-HR had a significantly higher removal torque value than that coated with HA alone at 8 weeks after surgery (P < .05). On histologic analysis, both the bone formation value and the bone-to-implant contact value were significantly higher in the HA + 4-HR group than in the HA-only group at 8 weeks after surgery (P < .05). CONCLUSIONS: Collectively, the HA + 4-HR-coated dental implant had clear advantages over the HA-coated dental implant. Therefore HA + 4-HR coatings can be considered for patients who need immediate implant installation after tooth extraction or who have poor-quality bone.

Effects of installation depth on survival of an hydroxyapatite-coated Bicon implant for single-tooth restoration.

PURPOSE: The present retrospective study evaluated various implant surface factors associated with Bicon implant survival for single-tooth restoration in the healthy individual. PATIENTS AND METHODS: A retrospective cohort study design was used. A total of 613 Bicon (Bicon System, Boston, MA) implants (272 patients) were included. Because the use of hydroxyapatite (HA) coating has been controversial, the surface type was chosen according to the patient's preference. A total of 308 HA-coated implants and 305 titanium plasma-sprayed (TPS) implants were used. The macroanatomy of both implant types was identical. Patients who had systemic disease, poor quality bone, or removable prosthetics were excluded from the present study. A chart review was conducted to record age, gender, implant diameter, implant length, installation depth, installation location, and the use of bone grafting. Implant failure was recorded, and the data were analyzed using the chi(2) test and logistic regression analysis. RESULTS: The installation depth was an important prognostic factor in the HA-coated implants. The failure rate for the HA-coated implants installed at margin level and 2 mm below level was 10.29% and 3.01%, respectively (chi(2) = 6.035, P = .014). The implant length was an important prognostic factor for the TPS-treated implants. The failure rate recorded for the TPS-treated implants installed with a length of less than 10 mm and 10 mm or longer was 15.46% and 2.40%, respectively (chi(2) = 18.414, P < .001). CONCLUSION: Many factors can influence the failure rate of TPS and HA-coated Bicon implants. Among these, installation depth played an especially significant role in the success of HA-coated Bicon implants in the present study.

A novel method for the management of proximal segment using computer assisted simulation surgery: correct condyle head positioning and better proximal segment placement.

Computer Assisted Simulation Surgery (CASS) is a reliable method that permits oral and maxillofacial surgeons to visualize the position of the maxilla and the mandible as observed in the patient. The purpose of this report was to introduce a newly developed strategy for proximal segment management according to Balanced Orthognathic Surgery (BOS) protocol which is a type of CASS, and to establish the clinical feasibility of the BOS protocol in the treatment of complex maxillo-facial deformities. The BOS protocol consists of the following 4 phases: 1) Planning and simulation phase, 2) Modeling phase, 3) Surgical phase, and 4) Evaluation phase. The surgical interventions in 80 consecutive patients were planned and executed by the BOS protocol. The BOS protocol ensures accuracy during surgery, thereby facilitating the completion of procedures without any complications. The BOS protocol may be a complete solution that enables an orthognatic surgeon to perform accurate surgery based on a surgical plan, making real outcomes as close to pre-planned outcomes as possible.

Restoration of a peri-implant defect by platelet-rich fibrin.

OBJECTIVE: The objective of this study was to evaluate the application of platelet-rich fibrin (PRF) into a peri-implant defect in vivo. STUDY DESIGN: Eight New Zealand white rabbits were used for this study. Two peri-implants with defects sized 3.0 × 5.0 mm (width × length) were prepared after drilling to host the dental implant in the tibia. Subsequently, the 2 dental implants were installed (diameter, 3.0 mm and length, 8.0 mm). In the experimental group, PRF was applied into the bony defect. In the control group, the peri-implant defect was left unfilled. The animals were humanely killed 8 weeks after implantation and histomorphometric analysis was done. RESULTS: In the histomorphometric analysis, mean new bone formation was 29.30% ± 7.50% in the experimental group and 11.06% ± 8.94% in the control group (P = .020). Mean bone-to-implant contact was 39.43% ± 7.39% in the experimental group and 17.11% ± 8.12% in the control group (P = .006). CONCLUSIONS: In the animal model, peri-implant defect sized 3.0 × 5.0 mm (width × length) was successfully repaired by the application of PRF alone.

Modified veneer bone graft with the concomitant installation of a dental implant: technical note.

BACKGROUND: Alveolar bone is usually resorbed after the loss of a tooth. As the buccal bony plate of the alveolar bone is thin compared to the palatal or the lingual bony plate, the bone resorption rate is higher on the buccal side. If a patient is partially edentulous, vertical bone resorption is restricted by the adjacent teeth. In such a case, the residual alveolar ridge becomes thin and narrow. As a result, a veneer graft is required. CASE REPORT: Two patients received a total of two implants with a modified technique. The modified technique is described in which the implant hole is made in both the mandibular ramus and the recipient site. Autogenous bone was taken from the mandibular ramus as a partial-thickness graft. The grafted bone was adapted to an installed dental implant and used as a veneer graft. There were no cases that showed the fixture exposure during the follow-up periods. Numbness was not reported after the operation in any of the cases. Additionally, osseointegration failures did not occur during the follow-up periods. CONCLUSION: Our technique has been shown high success rates and is reproducible for a veneer bone graft with concomitant implant installation.

Accelerated healing with the use of a silk fibroin membrane for the guided bone regeneration technique.

OBJECTIVE: The purpose of this study was to evaluate the bone regeneration ability of silk fibroin (SF) membrane. STUDY DESIGN: Fourier-transform infrared (FT-IR) and solubility test against distilled water were performed with 3 different types of SF membrane (SM1, SM2, and SM3). Subsequently, microscopic computerized tomography (µ-CT) and histomorphometric analyses were performed in rabbit calvarial defect model after SF membrane application at 4 and 8 weeks after surgery. RESULTS: FT-IR showed that the conformation of the SF membrane was a random coil structure and that SM1 was the least soluble. When SM1 was used in the animal model, the groups with SM1 had significantly higher new bone formation than the uncovered control in both the µ-CT and the histomorphometric analyses (P < .05). CONCLUSIONS: The SF membrane had more new bone formation compared with the uncovered control.

Inhibition of bone healing by pamidronate in calvarial bony defects.

OBJECTIVE: Pamidronate has been studied as a therapeutic drug for various osteopenic diseases. However, avascular osteonecrosis in the jawbone has been recently reported in patients receiving pamidronate. The objective of this study was to examine the effect of pamidronate on bone regeneration in a controlled animal model. MATERIALS AND METHODS: To determine the effect of parmidronate on bone healing in a local bony defect area, a rabbit calvarial bony defect model was used and poly L-lactide-co-glycolide (PLGA) used as a drug carrier material. Four defect groups were made in each rabbit calvaria and the defects were treated as follows: untreated bony defect (group 1), PLGA only (group 2), 2 mg of pamidronate with PLGA (group 3), and 3 mg of pamidronate with PLGA (group 4). Bone healing was evaluated by radiography and histology at 1, 2, 4, 6, and 8 weeks after surgery. RESULTS: In radiographic analysis, radiopacity was lower in pamidronate groups than non-operated rabbit calvarial bone at all observation points (P < .05). In histological analysis, the initial bone formation at 1 week was not different among groups, but it was much lower in the pamidronate groups than in the control or PLGA group after 2 weeks. Newly formed bone at 1 week underwent avascular necrosis after 2 weeks in both pamidronate groups. Avascular necrosis was not observed until 8 weeks in both topically applied pamidronate groups. CONCLUSION: Collectively, pamidronate inhibits bone healing in rabbit calvarial bony defect and it may explain the avascular necrosis of the jaws in patients receiving pamidronate.