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The Accuracy of Computer-Aided Design and Manufacturing in Orthognathic Surgery
Mark Fisher, M.D.1, Michael Sosin, M.D.2, Katie Weimer, MS3, Eduardo D. Rodriguez, MD, DDS4.
1North Shore-LIJ Health System, New Hyde Park, NY, USA, 2R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA, 3Medical Modeling, Golden, CO, USA, 4New York University Langone Medical Center, New York, NY, USA.

PURPOSE: To evaluate the accuracy of computer-aided design and manufacturing (CAD/CAM) in orthognathic surgery.
METHODS: Seventeen patients who underwent orthognathic surgery by a single surgeon using CAD/CAM digital planning were evaluated. In order to assess the accuracy of surgical results, post-operative CT scans were compared to the pre-operative digital surgical plans using superimposed overlay imaging technology (Medical Modeling; Golden, Colorado) (Figure 1). SNA, SNB, occlusal plane, tooth position, pitch, roll, and yaw of the maxilla were compared. Statistical analysis of cephalometric data was completed using unpaired t tests of continuous variables.
RESULTS: Mean deviation for SNA, SNB, and occlusal plane was 2.03 degrees (1.73, 1.68, 2.69, respectively). Mean deviation of tooth position was 3.07mm, and mean menton deviation was 4.37mm. The range of deviation varied from 0.00 to 10.70mm. (Table 1) Subgroup analysis of multi-piece Le Fort I osteotomy vs. single-piece Le Fort I osteotomy, and inclusion vs. exclusion of BSSO/genioplasty did not impact postoperative accuracy.
CONCLUSION: Computer-aided surgical plans can achieve a high degree of accuracy when implemented in orthognathic surgery. Variability among patients may be a result of minor intraoperative adjustments made due to the limitations of CAD/CAM in the context of soft tissue and ongoing skeletal growth.

Table 1.
SNA (deg)SNB (deg)Occlusal Plan (deg)Tooth Position (mm)Menton (mm)Pitch (deg)Roll (deg)Cant (deg)Yaw (deg)
All1.731.682.693.074.373.431.601.371.52
Range0.12 - 5.050.00 - 4.310.96 - 8.010.69 - 4.990.50 - 10.700.51 - 9.550.05 - 3.380.05 - 2.910.24 - 3.87
Le Fort I3.651.833.762.22-4.681.971.570.78
Le Fort I & BSSO1.421.933.752.984.553.311.771.512.67
Le Fort I & BSSO & Genioplasty1.371.552.344.016.123.472.091.761.44
Single-piece LeFort I +/- BSSO/Genio1.80-3.112.88-3.701.991.661.56
Multi-piece LeFort I +/- BSSO/Genio1.58-1.773.80-2.930.890.841.43


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