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Intraoral Scanning and Setting Up the Digital Final Occlusion in Three-Dimensional Planning of Orthognathic Surgery

Its Comparison with the Dental Model Approach

Ho, Cheng-Ting, M.D.; Lin, Hsiu-Hsia, Ph.D.; Lo, Lun-Jou, M.D.

Plastic and Reconstructive Surgery: May 2019 - Volume 143 - Issue 5 - p 1027e–1036e
doi: 10.1097/PRS.0000000000005556
Pediatric/Craniofacial: Original Articles
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Background: Three-dimensional surgical planning for orthognathic surgery is becoming prevalent, with improving outcomes. However, conventional dental casts are still used for evaluations, digital image conversion, surgical planning, and occlusal splint production. This study used intraoral scanning for the three-dimensional planning of the final digital occlusion and compared this method with the conventional dental cast approach.

Methods: Thirty consecutive patients who underwent two-jaw orthognathic surgery to treat mandibular prognathism and asymmetry were included. Dental casts (control group) and intraoral scans (study group) were collected simultaneously for designing the final dental occlusion. A step-by-step setup of the final digital occlusion was established for the study group. To validate results, the intraoral scanning–based virtual occlusion was superimposed over the dental model–based final digital occlusion for comparison. Intraobserver and interobserver variability were assessed for setting up the final digital occlusion. The fitness of splints fabricated using the conventional and virtual occlusion methods were compared.

Results: The steps for setting up the final digital occlusion were applicable in all cases. The average root-mean-square difference of final occlusion images between the two groups was 0.45 mm, indicating a comparable occlusal relationship. The intraobserver reproducibility and interobserver reliability for setting up the virtual occlusion were satisfactory. Moreover, no significant difference existed in the splint fitness test between the groups.

Conclusions: The proposed intraoral scan and setup process of the final digital occlusion was reliable and accurate. Thus, the method can replace the dental model approach for the three-dimensional planning of orthognathic surgery.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Taoyuan, Taiwan

From the Division of Orthodontics, Department of Dentistry, the Craniofacial Research Center, and the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital.

Received for publication March 1, 2018; accepted August 31, 2018.

Disclosure:None of the authors have any sources of financial or other support or any financial or professional relationships that might pose a competing interest.

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Hsiu-Hsia Lin, Ph.D., Craniofacial Research Center, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kwei Shan, Taoyuan, Taiwan 333, sharley@cgmh.org.tw, Instagram: @phd9417 Lun-Jou Lo, M.D., Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, 5 Fu-Shin Street, Kwei Shan, Taoyuan, Taiwan 333, lunjoulo@cgmh.org.tw, Facebook: Lun-Jou Lo, Instagram: @lunjoulo

©2019American Society of Plastic Surgeons