Assessment of mandibular advancement surgery with 3D CBCT models superimposition

Alexandre Trindade Simões da MOTTA, Felipe de Assis Ribeiro CARVALHO, Lúcia Helena Soares CEVIDANES, Marco Antonio de Oliveira ALMEIDA

Objectives: To assess surgery and short-term post-surgery changes in the position of the condyles, rami and chin after mandibular advancement. Methods: Pre-surgery (T1), 1 week post-surgery (T2), and 6 week post-surgery (T3) CBCT scans were acquired for 20 retrognathic patients with short or normal face height. 3D-models were built and superimposed through a fully automated voxel-wise method using the cranial base of the pre-surgery scan as reference. Anatomic regions of interest were selected and analyzed separately. Within-subject surface distances between T1-T2, T2-T3, and T1-T3 were computed. Color-coded maps and semi-transparent display of overlaid structures allowed the evaluation of displacement directions. Results: After an anteroinferior chin displacement with surgery in all the cases (>4mm in 87.5%), 25% of the patients showed some kind of posterior movement (< 3mm), and 69% showed an anterosuperior movement after splint removal. Comparing T1-T3, an anteroinferior (87.5% of the cases) or only inferior (12.5%) displacement was observed (>4mm in 80%). Considering all directions of displacement, the surface distance differences for the condyles and rami were small: 77.5% of the condyles moved <2mm with surgery (T1-T2), and 90% moved <2mm in the short-term (T2-T3) and in the total evaluation (T1-T3), while the rami showed a <3mm change with surgery in 72.5% of the cases, and a <2mm change in 87.5% (T2-T3) and in 82% (T1-T3). Conclusion: Expected displacements with surgery were observed and post-surgery changes suggested a short-term adaptive response toward recovery of condyle and ramus displacements. The changes on the chin following splint removal suggested an acceptable adaptation, but with considerable individual variability.

Keywords: Cone-beam computed tomography. Tridimensional image. Computer-assisted surgery. Computer simulation. Orthodontics. Oral surgery.

Friday, December 27, 2024 14:23