mock surgery,softwares & advances orthognathic
TRANSCRIPT
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MOCK SURGERY
SOFTWARES & RECENT ADVANCES
IN ORTHOGNATHIC SURGERY
Dr ARJUN SHENOY
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INDEX
MOCK SURGERY
SOFTWARES IN ORTHOGNATHIC SURGERY
RECENT ADVANCES
CONCLUSION
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MOCK SURGERY
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Model Surgery
Analytic model surgery allow transfer of prescribed 3-D
movement directly to pt.
Allow surgeon to conform surgical movement by using
maxillary and mandibular cast
Provide quantitative data that are useful at the time of surgery
.
The geometrically precise information is then applied to patient by using specific measurement, reference point, splints
to reposition maxillofacial skeleton.
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Model Surgery
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Model Surgery - Double Jaw Surgery
Impressions
Face-bow record
Wax bite to record Pre surgical occlusion
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Casts mounted on semi-adjustable
articulator
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Mounting of maxillary cast with spacer
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Blue plaster used for initial mounting
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Jig positioned in articulator
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Maxillary cast stabilized with putty
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Initial mounting plaster removed
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Maxillary impaction
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Measurement of amount of impaction
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Simulation of mandibular autorotation
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Intermediate splint
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Mandible advanced to desired position
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Final splint fabricated
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Final Splint
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If the jig is not available, markings can be
made on the cast
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Common Problems at this Stage
1. Interferences from the second molar teeth: arise from
the absence of bands on lower second molars or from
the presence of bands on the upper second molars
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2. Incompatible canine widths: rarely a problem in Class II patients; Class III patients cannot simulate the postsurgical position
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SOFTWARES IN ORTHOGNATHIC
SURGERY
NEMOCEPH
DOLPHIN SOFTWARE
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NEMOCEPH
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NEMOCEPH
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INTEGRATE
•BITE REGISTRATION
DATA ASSORTMENT
•LASER SCANS OF DENTAL CAST
•CT SCAN
FINAL PRODUCT
•3D DENTAL + SKELETAL RECONSTRUCTION
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VIRTUAL MERGING OF DETAILS
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VIRTUAL PLANNING
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VIRTUAL MOCK SURGERY
Online web meeting
(with assistance of software engineeers to
manipulate the scan in 3D with proprietary software)
TREATMENT PLAN-
Clinical findings
Dental cast assesment
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SKELETAL REPOSITIONING
Mandibular autorotation
Saggital split osteotomies
Inverted osteotomies
Subapical osteotomies
Genioplasty
Repositioning of maxilla
(single or multiple segments)
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Model surgery with a passive robot arm for
orthognathic surgery planning
greater 3-dimensional spatial accuracy-reliability-
precision.
Tamer Theodossy BDS, MSc, MFDSRCS(Eng) *and Mohammad Anwar Bamber PhD†
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OPS
ORTHOGNATHIC POSITIONING SYSTEM:
INTRAOPERATIVE SYSTEM TO TRANSFER VIRTUAL SURGICAL
PLAN TO OPERATING FIELD DURING ORTHOGNATHIC SURGERY
Journal of Oral-MaxilloFac Surg 2013;71: 911-920
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TECHNIQUE
IDENTIFICATION OF STABLE BONY LANDMARKS
Bilaterally
Landmarks placed on stable bone
Will not be repositioned during surgery
Bone thickness surveyed in CT data
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USE OF LANDMARKS
Serve as reference points that will be used to transfer the
osteomized segment(s) to its final postoperative position
P.S- All reference points should be positioned so as to not
interfere with the fixation process
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LANDMARK LOCATION
MAXILLA-
Above the osteotomy line
Above stable thick bone
MANDIBLE
Lateral and anterior surface of ramus
(percutaneous approach)
Medial aspect of coronoid ridges
IN GENIOPLASTY
Lateral to midline below the osteotomy
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DIGITAL FABRICATION OF OCCLUSAL SPLINT
AND OPS
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OCCLUSAL SPLINT
Splint ,the drilling and positioning guides are manufactured
by stereolithography and autoclaved for sterilization.
Designed with occlusal relationship in final position
Lateral attachment sites on right and left sides of the splint
Attachment for maxillary drlling guides
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MAXILLARY DRILLING GUIDES
Bone borne footplates are designed with
anatomically contoured struts
Splint footplates attach precisely to lateral
attachment on occlusal splints (attach and
detach independently)
The bone borne footplates have two large
diameter openings
Designed to fit the metal drill guide(does not
rotate)
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MAXILLARY POSITIONING GUIDES
Designed with maxilla in simulated final position
A bone borne positioning plate with small diameter that fit
over the previously determined reference landmark is
designed
Attached to occlusal splint and also secured to stable
maxillary bone using screws
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Temporarily secures the Le-Fort 1 segment in its final
position before rigid skeletal fixation
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DURING SURGERY
Occlusal splint is permenantly secured to
maxillary dentition in Le-Fort 1 cases
Temporarily secured to dentition in case of
multiple segment osteotomies, double jaw cases
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Maxilla exposed
Drilling guide attached
Two reference landmarks
drilled
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IN MANDIBLE
Drilling and positioning of proximal segment is
done with similar concept
Assists in maintaining the proximal segment in AP
plane and condyle position during fixation
Prevents lateral torquing of condyles
Precise repositioning of large advancements
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STEREOLITHOGRAPHY
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Stereolithography skulls
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3D PRINTER
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3D PHOTOGRAPHY
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CONCLUSION
In order for patients to receive state-of-art care when
correcting their deformities, the orthognathic team must be able to
Correctly diagnose existing deformities.
Establish an appropriate treatment plan.
Execute the recommended treatment.
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Dentofacial deformities – epker vol 1
Orthognathic surgery – Fonseca vol2
Text book of maxillofacial surgery- Peter ward booth –vol 2
Cephalometrics for orthognathic surgery – j. oral surgery
vol 36 apr 1978
Science Direct
Essential of orthognathic surgery – Reyenke
REFERENCES
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