Guided surgical digital planning for suture cortical perforation: Cortex Guide


Introduction: In MARPE (miniscrew-assisted rapid palatal expander) therapy, even using virtual surgery (MARPE Guide), some cases are borderline. Patients with increased interdigitation of the midpalatal suture, bone and soft tissue volume variation, presence of a palatine torus, present a strong resistance during the maxillary expansion process. For these cases, it is necessary to weaken the midpalatal and transpalatal sutures, locate their position, identify their shape and direction. Objective: To give precision to this process, the virtually guided drilling was created; thus this paper proposes the presentation of the technique of high precision guided cortical perforations, called Cortex Guide. Methods: The maturation analysis of the median palatal and zygomaticomaxillary sutures is performed using the DICOM file of the cone beam computed tomography (CBCT). Then the transpalatal suture is analyzed for its location, direction and shape. Each perforation is thoroughly analyzed in the three-dimensional simulation and verified on each CBCT slice. The virtual drill is positioned in such a way that it reaches the bicorticality and maintain a uniform distance, if possible, between each perforation, which varies on average from 2 to 3 mm. The cortical perforation guide (Cortex Guide) will reproduce in the mouth the digital perforation of each point created, with angulation and insertion limit. After the 3D design, an STL file is created and printed, for perfect reproduction of the cortical perforations in the mouth. Conclusion: By using the guided cortical perforation technique, the patient’s anatomy is safely and accurately respected, as well as variations in tissue thickness, asymmetries in the palate and other anatomical variations.

Keywords: Orthodontics. Osteotomy. Palatal expan- sion technique. Cone-beam computed tomography.

How to cite: André CB. Guided surgical digital planning for suture cortical perforation: Cortex Guide. Clin Orthod. 2022 Apr-May;21(2):74-85.

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