Orthognathic surgery refers to jaw surgery, and is a common treatment for people who have misaligned jaws. It was first used in the early 1900s, but has advanced with modern technology and tools, including 3D printing and digital surgical planning that have enhanced the patient experience and provided more efficiency to this surgery. The growing demand for orthognathic surgery is fueled by the increase of cosmetic procedures and new advancements in technology. In 2015, it was estimated that approximately 9.1 million orthognathic surgeries were performed worldwide.
Traditionally, generic surgical plates and screws are used during orthognathic jaw surgeries, those plates are bent to fit patient bone and using an occlusal splint based on 3D planning of orthognathic surgery. This Blog post brings to you an orthognathic surgery guide with Everything You Need To know about the advancements.
Digital surgical planning - Planning the desired outcome of the surgery.
Using high resolution, low dose CT data and intraoral scans is it possible to view and 3D reconstruct major anatomical structures within the facial bones to digitally plan the Orthodontic & Orthognathic assessment. With recent developments in oral imaging, more orthognathic surgeries are being planned using three-dimensional computer-aided design and manufacturing 3D CAD software. Digital planning is increasingly used in orthognathic surgery since it offers a number of advantages over conventional techniques. The global orthodontics market favored by the rising usage of the application of 3D printing and CAD/CAM systems, faster treatment dissemination by increasing in-house workflow, and a well-defined reward-based ledger for orthodontists and patients.
The ability to design precisely where the cuts are made controls some of the potential complications that have been present and well documented in jaw surgery procedures, namely the permanent numb tongue/lower lip and damage to roots of teeth. A well planned surgery should eliminate these complications.
3D printing - Building complex geometries
One of the difficulties however is reproducing the digitally planned movements in accurately executed surgery. A number of techniques have previously been proposed like: occlusal splints to help positioning osteotomized bone segments and positioning guides.
3D printed splints for orthognathic surgery and 3D printed custom cutting guides are placed on the facial bones and teeth to guide where the surgical bone cuts are made, and where the screws will be placed. They are designed so when the bone is cut, or the screws are placed, that the major anatomical structures such as the teeth roots and inferior dental nerve are avoided. The method enables accurate placement of the maxilla, independent of the condyle or mandible.
Patient Specific osteosynthesis miniplates — removing the reliance on intermaxillary occlusal splints
Custom surgical plates are plates that are made to fit the patient when the jaw bones have been moved into the position that has been preplanned. This means the results achieved post surgery are predictable and determined prior to your surgical procedure
Recently, Patient Specific osteosynthesis miniplates have been increasingly adopted for orthognathic surgery, as per recent evidence in Literature of gaining better accuracy for digital planning transfer to the patient to remove the reliance on classic intermaxillary occlusal splints. Moreover, they are designed to have more surface area in direct contact with the facial bones which increases the strength of the custom plates when compared to traditional jaw surgery plates.
But how do we get the facial bones in the correct position so the plates can be screwed in place?
To do so, custom-made guides are designed. They match perfectly with the custom-machined Miniplates for the fixation.
When using custom-plates, the planning of the orthognathic jaw surgery procedure is just as important as the procedure itself. The planning determines the final placement of the surgical plates, and therefore the positioning of the facial bones during the procedure.
Why do the advancements are working to make Orthognathic Surgery so efficient?
The position of the plates is determined by their desired outcome.
The shape and extent changes depending on what the patient needs, which means it can be tailored to very specific needs.
Custom surgical plates are stronger than traditional jaw surgery plates. They are manufactured to have maximum contact with the facial bones.
When designing the plates, the thickness of the bone is assessed to ensure there is adequate depth for the screws, this decreases the chance of the plate ”popping” out of place if a screw doesn’t have enough bone to secure the plate adequately.
A plate may have a screw hole adjusted or the shape modified to ensure all screws have adequate bone to engage them.
Once the surgical bone cuts and screw holes have been made using custom guides The jaw bones are positioned into the predetermined position and the custom plates are screwed in place. The position of the facial bones will mirror the final position of the facial bones in the plan.
The advancements in orthognathic surgery are incredible. You can now plan your surgical procedure digitally, use 3D printing for custom-made guides and miniplates to fix the jaw bone, or even have a virtual consultation with an expert before you undergo any treatment. Contact us today if you’d like help planning your first digital case using our cutting edge technology!