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Use of Three-Dimensional Medical Modeling Methods for Precise Planning of Orthognathic Surgery

Mavili, Mehmet Emin MD*; Canter, Halil Ibrahim MD*; Saglam-Aydinatay, Banu DDS, PhD; Kamaci, Soner DDS; Kocadereli, Ilken DDS, PhD

Journal of Craniofacial Surgery: July 2007 - Volume 18 - Issue 4 - p 740-747
doi: 10.1097/scs.0b013e318069014f
Original Articles

Stereolithographic (medical rapid prototyping) biomodeling allows three-dimensional computed tomography to be used to generate solid plastic replicas of anatomic structures. Reports in the literature suggest that such biomodels may have a use in maxillofacial surgery, craniofacial surgery, orthopedics, neurosurgery, otology, vascular, and nasal research. A prospective trial to assess the usefulness of biomodeling in orthognathic surgery has been performed. In 12 patients with mandibular prognathism and/or maxillary retrusion, in addition to routine preoperative cephalometric analysis, preoperative high-resolution (cutting slice thickness of 1 mm) three-dimensional computed tomography scan of the patients was obtained. Raw data obtained from computed tomography scanning was processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Belgium). Fabrication of three-dimensional medical models was obtained through a process called powder depositional modeling by use of a Spectrum Z 510 3D Color Printer (Z Corporation, Burlington, MA). Alveolar arches of the maxilla and mandibula of the models were replaced with orthodontic dental cast models. Temporomandibular joints of the models were fixed with Kirschner wire. Maxillary and mandibular bony segments were mobilized according to preoperative orthodontic planning done by analysis of cephalometric plain radiographs. The relation between proximal and distal mandibular segments after bilateral sagittal split osteotomies were evaluated on models preoperatively. The same surgeon had a role in both model cutting preoperatively and as an instructor preoperatively. The same bony relation was observed both in preoperative modelsand in the perioperative surgical field in all patients. Condylar malpositioning was not observed in any of the patients. Studying preoperative planned movements of osteotomized bone segments and observing relations of osteotomized segments of mandibula and maxilla in orthognathic surgery increased the intraoperative accuracy. Limitations of this technology were manufacturing time and cost.

From the *Department of Plastic and Reconstructive Surgery, Faculty of Medicine, and the †Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Ankara, Turkey.

Address correspondence and reprint requests to Dr. Mehmet Emin Mavili, Department of Plastic and Reconstructive Surgery, Faculty of Medicine, Hacettepe University Sihhiye Ankara 06100, Turkey; E-mail: emavili@hacettepe.edu.tr

© 2007 Mutaz B. Habal, MD