A Novel Orthognathic Surgery With a Half-Millimeter Accuracy for the Maxillary Positioning Using Prebent Plates and Computer-Aided Design and Manufacturing Osteotomy Guide.

This retrospective study aimed to assess the accuracy of prebent plates and computer-aided design and manufacturing osteotomy guide for orthognathic surgery. The prebent plates correspondent to the planning model were scanned with a 3-dimensional printed model for guide design and used for fixation. Forty-two patients who underwent bimaxillary orthognathic surgery using computer-aided design and manufacturing intermediate splint with the guide (guided group: 20 patients) or with conventional fixation under straight locking miniplates (SLMs) technique (SLM group: 20 patients) were analyzed. A deviation of the maxilla between the planned and postoperative positions was evaluated using computed tomography, which was taken 2 weeks before and 4 days after the surgery. The surgery time and the infraorbital nerve paranesthesia were also evaluated. The mean deviations in the mediolateral ( x ), anteroposterior ( y ), and vertical directions ( z ) were 0.25, 0.50, and 0.37 mm, respectively, in the guided group, while that in the SLM group were 0.57, 0.52, and 0.82 mm, respectively. There were significant differences in x and z coordinates ( P <0.001). No significant difference in the surgery duration and paranesthesia was seen, suggesting the present method offers a half-millimeter accuracy for the maxillary repositioning without increasing the risk of extending surgery duration and nerve complication.

Accuracy and influencing factors of maxillary and mandibular repositioning using pre-bent locking plates: a prospective study.

In-house repositioning methods based on three-dimensional (3D)-printing technology and the use of pre-bent plates has been gaining popularity in orthognathic surgery. However, there remains room for further improvement in methods and investigations on clinical factors that affect accuracy. This single-centre, prospective study included 34 patients and aimed to evaluate the accuracy and factors influencing maxillary and mandibular repositioning using pre-bent locking plates. The plates were manually pre-bent on the 3D-printed models of the planned position, and their hole positions were scanned and reproduced intraoperatively with osteotomy guides. The accuracy of repositioning and plate-hole positioning was calculated in three axes with the set landmarks. The following clinical factors that affect repositioning accuracy were also verified: deviation of the plate-hole positioning, amount of planned movement, and amount of simulated bony interference. The median deviations of the repositioning and hole positioning between the preoperative plan and postoperative results were 0.26 mm and 0.23 mm, respectively, in the maxilla, and 0.69 mm and 0.36 mm, respectively, in the mandible, suggesting that the method was highly accurate, and the repositioning concept based on the plate hole and form matching was more effective in the maxilla. Results of the correlation test suggest that large amounts of bony interference and plate-hole positioning errors in the up/down direction could reduce mandibular repositioning accuracy.

Mandibular autorotation revisited: A retrospective study of accuracy and stability of maxillary impaction in retrognathic patients with condylar osteoarthritis.

The aim of this retrospective study was to evaluate the accuracy of maxillary positioning with mandibular autorotation using the straight locking miniplate (SLM) technique and computer-aided design/computer-aided manufacturing (CAD/CAM) wafers on postoperative stability in patients with skeletal class II malocclusion and condylar osteoarthritis. Cephalometric analysis of the maxillary position and MA center (ARC) before (T0), 3 days (T1), 3 months (T2), and 1 year (T3) after surgery was performed. Analysis of 21 patients revealed a mean movement of -2.0 ± 2.2 mm (x-axis) and 5.4 ± 2.4 mm (y-axis) at U1 and of -1.5 ± 2.4 mm (x-axis) and 4.9 ± 1.6 mm (y-axis) at U7. The SNA, SNB, ANB, and SN-MP angles and ramus inclination at T0 were significantly different from those at T1, T2, and T3. The distance from the ARC to the Co of T2 and T3 was significantly smaller than that of T1 on the x-axis, indicating that the ARC converged horizontally to Co. There was no significant difference in the amount of rotation at any time point. Accurate maxillary positioning with mandibular autorotation using SLM and CAD/CAM wafers may correct the unstable rotation axis of the mandible and prevent early postoperative relapse.

Computational fluid dynamic analysis of the nasal respiratory function before and after postero-superior repositioning of the maxilla.

Morphological changes in the upper airway and the resulting alteration in the nasal respiratory function after jawbone repositioning during orthognathic surgery have garnered attention recently. In particular, nasopharyngeal stenosis, because of the complex influence of both jaws, the effects of which have not yet been clarified owing to postero-superior repositioning of the maxilla, may significantly impact sleep and respiratory function, necessitating further functional evaluation. This study aimed to perform a functional evaluation of the effects of surgery involving maxillary repositioning, which may result in a larger airway resistance if the stenosis worsens the respiratory function, using CFD for treatment planning. A model was developed from CT images obtained preoperatively (PRE) and postoperatively (POST) in females (n = 3) who underwent maxillary postero-superior repositioning using Mimics and ICEM CFD. Simultaneously, a model of stenosis (STENOSIS) was developed by adjusting the severity of stenosis around the PNS to simulate greater repositioning than that in the POST. Inhalation at rest and atmospheric pressure were simulated in each model using Fluent, whereas pressure drop (ΔP) was evaluated using CFD Post. In this study, ΔP was proportional to airway resistance because the flow rate was constant. Therefore, the magnitude of ΔP was evaluated as the level of airway resistance. The ΔP in the airway was lower in the POST compared to the PRE, indicating that the analysis of the effects of repositioning on nasal ventilation showed that current surgery is appropriate with respect to functionality, as it does not compromise respiratory function. The rate of change in the cross-sectional area of the mass extending pharynx (α) was calculated as the ratio of each neighboring section. The closer the α-value is to 1, the smaller the ΔP, so ideally the airway should be constant. This study identified airway shapes that are favorable from the perspective of fluid dynamics.

Effectiveness of subspinal Le Fort I osteotomy in preventing postoperative nasal deformation.

PURPOSE: This study sought to determine the effectiveness of subspinal Le Fort I osteotomy (SLFIO) in preventing nasal deformation, by analyzing changes in the nasal profile on three-dimensional computed tomography (3D-CT) images. PATIENTS AND METHODS: The participants were 39 Japanese patients with mandibular prognathism (6 men and 33 women) who underwent bilateral sagittal split ramus osteotomy and Le Fort I osteotomy with maxillary advancement: SLFIO was performed in 20 patients and conventional Le Fort I osteotomy (CLFIO) in 19 patients. All patients underwent modified alar base cinch suture, V-Y closure, and reduction of the piriform aperture. CT data acquired before and 1 year after the surgery were evaluated three-dimensionally with software to determine changes in the nasal profile. RESULTS: Changes in alar width, alar base width, nasal length, and nasofrontal angle were significantly smaller following SLFIO than following CLFIO, although there were no significant differences in nasal projection, nasal tip angle, or nasolabial angle between two procedures. CONCLUSION: SLFIO for anterior repositioning of the maxilla can prevent undesirable transverse soft tissue changes of the nose.

Three-dimensional quantification of magnetic resonance imaging artifacts associated with shape factors.

Differences in the volumes of artifacts caused by variously shaped titanium objects on magnetic resonance imaging (MRI) were evaluated. Spherical-, square cubic-, and regular tetrahedron-shaped isotropic, and elongated spherical-, elongated cubic-, and elongated tetrahedron-shaped anisotropic objects, with identical volumes, were prepared. Samples were placed on a nickel-doped agarose gel phantom and covered with nickel-nitrate hexahydrate solution. Three-Tesla MR images were obtained using turbo spin echo and gradient echo sequences. Areas with ±30% of the signal intensity of the standard background value were considered artifacts. Sample volumes were deducted from these volumes to calculate the total artifact volumes. Isotropic samples had similar artifact volumes. For anisotropic samples, the artifact volume increased in proportion with the normalized projection area. MRI artifact size can be reduced by high anisotropic designs, and by positioning the long axis of the metal device as parallel as possible to the magnetic field axis.

Magnetic susceptibility, artifact volume in MRI, and tensile properties of swaged Zr-Ag composites for biomedical applications.

Zr-Ag composites were fabricated to decrease the magnetic susceptibility by compensating for the magnetic susceptibility of their components. The Zr-Ag composites with a different Zr-Ag ratio were swaged, and their magnetic susceptibility, artifact volume, and mechanical properties were evaluated by magnetic balance, three-dimensional (3-D) artifact rendering, and a tensile test, respectively. These properties were correlated with the volume fraction of Ag using the linear rule of mixture. We successfully obtained the swaged Zr-Ag composites up to the reduction ratio of 96% for Zr-4, 16, 36, 64Ag and 86% for Zr-81Ag. However, the volume fraction of Ag after swaging tended to be lower than that before swaging, especially for Ag-rich Zr-Ag composites. The magnetic susceptibility of the composites linearly decreased with the increasing volume fraction of Ag. No artifact could be estimated with the Ag volume fraction in the range from 93.7% to 95.4% in three conditions. Young's modulus, ultimate tensile strength (UTS), and 0.2% yield strength of Zr-Ag composites showed slightly lower values compared to the estimated values using a linear rule of mixture. The decrease in magnetic susceptibility of Zr and Ag by alloying or combining would contribute to the decrease of the Ag fraction, leading to the improvement of mechanical properties.

Infiltration of trace metal ions in the oral mucosa of a rat analyzed using SRXRF, XAFS, and ICP-MS.

Although the accumulation and distribution of metals from metallic orthodontic appliances in the oral mucosa have been studied extensively, they remain unclear because their concentration is quite low. In this study, metal specimens (Ni, Ni-Ti, and Co-Cr) were sutured in the unilateral oral mucosa of rats, and the distribution of the eluted elements in the mucosal tissue was estimated using inductively coupled plasma mass spectrometry (ICP-MS) and synchrotron radiation X-ray fluorescence analysis (SR-XRF). While the infiltrations of Ni, Co, and Cr into the oral mucosal connective tissue were observed with SR-XRF, significant increases were only found in Ni from the pure Ni group and Cr from the Co-Cr group. Furthermore, Ni and Co were estimated as hydrated ions while Cr was estimated in oxide form through X-ray absorption fine structure (XAFS) analysis.

Three-dimensional quantification of susceptibility artifacts from various metals in magnetic resonance images.

Susceptibility artifacts generated in magnetic resonance (MR) images were quantitatively evaluated for various metals using a three-dimensional (3-D) artifact rendering to demonstrate the correlation between magnetic susceptibility and artifact volume. Ten metals (stainless steel, Co-Cr alloy, Nb, Ti, Zr, Mo, Al, Sn, Cu and Ag) were prepared, and their magnetic susceptibilities measured using a magnetic balance. Each metal was embedded in a Ni-doped agarose gel phantom and the MR images of the metal-containing phantoms were taken using 1.5 and 3.0 T MR scanners under both fast spin echo and gradient echo conditions. 3-D renderings of the artifacts were constructed from the images and the artifact volumes were calculated for each metal. The artifact volumes of metals decreased with decreasing magnetic susceptibility, with the exception of Ag. Although Sn possesses the lowest absolute magnetic susceptibility (1.8×10(-6)), the artifact volume from Cu (-7.8×10(-6)) was smaller than that of Sn. This is because the magnetic susceptibility of Cu was close to that of the agarose gel phantom (-7.3×10(-6)). Since the difference in magnetic susceptibility between the agarose and Sn is close to that between the agarose and Ag (-17.5×10(-6)), their artifact volumes were almost the same, although they formed artifacts that were reversed in all three dimensions.