Using Virtual Surgical Planning and Three-Dimensional Printing Surgical Wafers Applied in Comprehensive Orthognathic Surgery-A Case Report

數位虛擬手術與三維列印手術導板臨床應用於綜合性正顎手術－病例報告

陳奎元(Kuei-Yuan Chen) ； 黃鴻麒(Hung-Chi Huang) ； 曾非凡(Fei-Fan Tseng) ； 賴義明(Yi-Ming Lai) ； 吳契璁(Chi-Tsung Wu) ； 陳元武(Yuan-Wu Chen)

《臺灣口腔顎面外科學會雜誌》 32卷1期 (2021/03) Pp. 30-44

摘要

Comprehensive orthognathic surgery (OGS) is designed to correct malocclusion, facial asymmetry, and deformity. Digital dentistry has become the mainstream technology for virtual surgical planning (VSP). Virtual surgical planning can apply three-dimensional (3D) imaging and software to present preoperative problems , predict postoperative outcomes, and fabricate surgical guides for orthognathic surgery in the same system. This is a case of a 21-year-old man who was diagnosed with skeletal Class III malocclusion caused by maxillary retrognathism, mandibular prognathism, and facial asymmetry. Conventional surgical planning methods, including clinical examinations, panoramic and cephalometric radiographic analysis, paper surgery, conventional model surgery (CMS), and handcrafted occlusal wafers, were performed. Virtual surgical planning methods, including computer tomographic (CT) imaging, intraoral dental scanning, Dolphin software simulation, and 3D printing technology, were then executed to overcome former limitations and obtain an optimal outcome. During the operation, we performed Le Fort I osteotomy, bilateral intraoral vertical ramus osteotomy, genioplasty, and intermaxillary fixation (IMF) without any complications, and postoperative follow-up demonstrated a satisfactory outcome. In this case, we acquired that VSP methods included several advantages, such as saving the cost of the dental models, combination of 2D imaging with 3D structure, surgical outcome simulation, and accurate surgical stent fabrication. Therefore, application of digital dentistry is the leading trend in virtual orthognathic surgical planning.

關鍵字

Comprehensive orthognathic surgery ； Virtual surgical planning (VSP) ； Digital dentistry application ； Conventional model surgery (CMS)

並列摘要

正顎手術被廣泛使用於咬合異常、顏面不對稱和生長畸形的患者身上。運用數位牙科技術來進行虛擬化手術模擬設計已成為主流。於正顎手術規劃中，虛擬化手術設計能融合3D影像技術和手術設計軟體，在同一系統中輔助醫師進行正確的術前診斷、數位化手術模擬、預測術後結果，並完成手術導引板之製作。本病例為21歲男性，診斷出上下顎發育異常且顏面不對稱所導致的骨性第三類異常咬合。其中我們同時運用傳統和數位化之術前模擬計畫來進行手術模擬與比較。以傳統方式執行臨床評估、環口和倒顱放射線影像分析，並使用紙本模擬手術和牙科模型模擬手術來執行手術設計；數位化模擬方式則運用3D電腦斷層影像、牙弓與齒列之口內掃描立體檔、Dolphin手術軟體模擬和3D列印技術來製作手術導引板。手術以勒福氏第一型上顎截骨術、雙側口內下顎枝垂直截骨術、頦成型術和上下顎間鋼絲固定術等術式執行，手術順利且術後追蹤良好無併發症。執行數位模擬計畫的過程中，我們發現許多優點：（1）能節省齒列模型的製作、（2）能結合咬合、牙弓、臉型和2D平面影像至整體性3D立體結構、（3）手術模擬過程中能同時預測結果，和（4）製作更精準且強度更佳的手術導引板。因此，運用數位牙科相關技術來進行正顎手術之模擬設計已成為未來之趨勢。

並列關鍵字

綜合性正顎手術 ； 虛擬化手術模擬設計 ； 數位牙科運用 ； 傳統模型模擬手術