正顎手術模擬技術

24 J. Taiwan Assoc. Orthod. 2012, Vol. 24. No. 2

Research Report

Planning the Surgery-firSt aPProach in Surgical-orthodontic treatment with a comPuter aided Surgical Simulation (caSS) Planning Protocol

Sam Sheng-Pin Hsu1,2,3

, Dhruv Singhal3,4

, James J. Xia5, Jaime Gateno

5

Cheng-Hui Lin3,4

, Chiung-Shing Huang1,2,3

, Lun-Jou Lo2,3,4

, Ellen Wen-Ching Ko2,3,4

,Yu-Ray Chen2,3,4

Department of Craniofacial Orthodontics, Chang Gung Memorial Hospital, Taipei, Taiwan1

Graduate Institute of Dental and Craniofacial Science, Chang Gung University2

Craniofacial Research Center, Department of Medical Research, Chang Gung Memorial Hospital at Linkou3

Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan4

Department of Oral and Maxillofacial Surgery, the Methodist Hospital, Houston, TX5

The surgery-first approach in surgical orthodontic treatment is re-emerging as the preferred technique when

compared to the traditional orthodontic first-approach. Despite its growing popularity, no planning protocol that

offers comprehensive and accurate predictions has been described for the surgery-first approach. In this article,

the authors utilize computer aided surgical simulation (CASS) to provide two planning methods for the surgery-

first approach. The benefits of using CASS for planning include enhanced 3-dimensional visualization of treatment

progression, the ability for surgeons and orthodontists to discuss and visualize in detail any potential treatment

algorithm, and providing a more precise prediction for the surgeon, orthodontist, and patient in surgery first cases.

(J. Taiwan Assoc. Orthod. 24(2): 24-37, 2012)

Key words: Surgery-first, Computer-aided surgical simulation, Orthognathic surgery, Surgical orthodontic treatment

Received: July 3, 2012 Revised: July 13, 2012 Accepted: July 18, 2012Reprints and correspondence to: Dr. Cheng-Hui Lin, Department of Plastic Surgery, Chang Gung Memorial Hospital 6F, No.199, Tung-Hwa North Rd., Taipei, Taiwan Tel: 02-27135211 ext. 3533 E-mail: [email protected]

INTRODUCTION

In recent years, there has been a growing interest

in the surgery-first approach for surgical orthodontic

treatment1-14

though Bell15

had first suggested this

approach in 1973. Epker16

elucidates many of the

advantages offered by the surgery-first approach in

surgical orthodontic treatment which include early

improvement of facial form and function, relatively rapid

orthodontic tooth movement, and improved stability.

25J. Taiwan Assoc. Orthod. 2012, Vol. 24. No. 2

Moreover, overall improved patient compliance was noted

which was attributed to the early improvement of facial

form and function. Lee et al.17

also supported the surgery-

first approach and emphasized the benefits of post-

surgical orthodontics which include the ability to achieve

biological decompensation, correct surgical inaccuracy

and relapse, and overcome unpredictable soft tissue

changes following surgical movement.

Conventional paper and model surgery remains the

most widespread and standard method by which surgical

planning is achieved.1-6,8,9,11,13

Detailed approaches to plan

these cases have also been described using cephalometric

and occlusogram predictions.5,8

However, the limitation

of these conventional techniques results from using

2-dimensional tools to attempt accurate prediction of

3-dimensional surgical and orthodontic movements.

Moreover, conventional planning techniques do not

provide a final 3-dimensional visual treatment objective to

Fig 1. A female case with obstructive sleep apnea (OSA)A) Pre-surgical profile photo reveals her retrusive mandible.B) Pre-surgical CBCT image indicates narrowing or her airway.C) Post-surgical profile photo demonstrates that her mandible has been advanced.D) Post-surgical CBCT image with an enlarged airway.

A B

C D

further guide surgical and orthodontic precision.

Computer aided surgical simulation (CASS) utilizing

3-dimensional images obtained from multi-slice computer

tomography (MSCT)/cone beam computer tomography

(CBCT) has been successfully performed previously

to plan craniofacial surgery.18-29

By substituting the

dentition in MSCT/CBCT images with images acquired

from surface laser scanning of dental models, we can

virtually construct a composite skull model that can be

used for accurate diagnosis, planning, and simulation

not only of the facial skeleton but orthodontics30

as well.

Alfaro et al.11

initially described the utility of CASS for

planning the surgery-first approach in surgical orthodontic

treatment. However, this description did not detail the

planning procedure. In this article, the authors introduce

two detailed approaches to plan surgery-first cases in

surgical orthodontic treatment.

Planning the Surgery-first Approach in Surgical-Orthodontic Treatment with a Computer Aided Surgical Simulation (CASS) Planning Protocol


the virtual plan with surface laser scanning (Figure 5A,

5B). Using the virtual casts as a reference, the lower

dentition, along with the distal segment, is brought into

the post-surgical occlusion. The relationship between

the maxillary dentition, mandibular dentition, Le Fort I

and distal segments (i.e. maxilla-mandibular complex,

MMC) are then appropriately positioned. (Figure 5C,

5D).

4. Simulate orthognathic skeletal movement24

(Figure 6):

The MMC is now moved to achieve skeletal symmetry

and all the cephalometric values are normalized.

Utilizing a technique previously described by Gateno

and Xia24

, we create a triangle to represent the maxilla.

The triangle is bounded by the mid-point of the central

incisors and the mesial-buccal cusp tips of the bilateral

1st molars. The triangle, along with the MMC, is then

rotated to achieve a zero degree roll (i.e. correction of

any maxillary occlusal cant) and a zero degree yaw. The

triangle is translated along the x-axis to coincide the

maxillary midline and midsagittal plane. Finally, we

adjust the pitch (i.e. the maxillary occlusal plane angle),

anteroposterior, and vertical position of the triangle,

along with the MMC, to fit the 2D-cephalometric

norms. After finishing the aforementioned procedures,

we complete the surgical simulation by obtaining the

symmetry and averageness of the composite skull.

In the present case, the mandibular advancement

was achieved by advancement and counterclockwise

rotation of the MMC (Figure 6C).

5. Simulate post-surgical orthodontics with 3-dimensional

tooth movement (Figure 7): Move every tooth

virtually to achieve the final occlusion in which all

the cephalometric values are within normal range30,31

(Figure 7B). Compare the final and original position

of the teeth and allow the orthodontists to evaluate if

the planned tooth movement is achievable according to

their treatment philosophy and ability (Figure 7C, 7D).

If so, the plan works and can be carried out accordingly.

Method B (Figure 8)

Hsu SP, Singhal D, Xia JJ, Gateno J, Lin CH, Huang CS, Lo LJ, Ko WC, Chen YR

METHODS

Below, we will use one case example of a female

patient with obstructive sleep apnea to highlight two

different planning procedures for the surgery-first

approach in surgical orthodontic treatment (Figure 1A,

1B). The major treatment goal is to open her airway by

advancing her mandible by a minimum of 10 mm.

Method A (Figure 2)

1. Construct a composite skull model in neutral head

posture (NHP) (Figure 3): As has been previously is to

collect preoperative records, including by Gateno and

Xia24

, the first step direct anthropometric measurements,

clinical photographs, stone dental models, a patient-

specific bite jig, a NHP recording, and a CT scan. The

bite jig is connected to a facebow with fiducial markers.

The patient then undergoes a CBCT scan with the bite

jig in place. Simultaneously, the dental models are laser

scanned (3D Scan Company, Atlanta, GA) with the bite

jig in place. Fiducial markers, present in both images,

can then be used for precise registration to construct a

composite skull model. The composite model consists

of a skull model derived from the CBCT and dentition

from the dental model image (Figure 3C). The bite jig,

attached to a gyroscope, (i.e. digital orientation sensor;

3DM, MicroStrain Inc, Williston, VA) allows for the

patient's NHP to be recorded. Inputting the orientation

setting to the computer-aided design (CAD) gyroscope,

the virtual head (i.e. virtual head) can be aligned to the

patient's actual NHP 23.

2. Separation of teeth into single units with associated

dental roots that are ready for orthodontic assessment

and simulation30

(Figure 4): Utilizing Simplant OMS

software, we perform a segmentation for all the dental

roots (Figure 4B). The 3D rendition of the teeth is then

cut into single crowns connected to their corresponding

roots. In this format, the dentition is ready for

simulating virtual tooth movement (Figure 4C).

3. Set up a "treatable" post-surgical occlusion (Figure 5):

Determine a treatable post-surgical occlusion with the

stone dental casts and transfer that arrangement into


Fig 2. Protocol of Method AA) Construct a composite skull model.B) Isolate each tooth with its respective dental root.C) Set up a treatable post-surgical occlusion in CASS

virtual planning.D) Simulate skeletal movement.E) Simulate post-surgical orthodontics.

Fig 3. Construct a composite skull model by using a CASS planning protocol.A) separate CBCT image and dental model image.B) Register the accurate dental model image onto the CBCT

image.C) Replace the dental parts of the CBCT image with the

dental model image.

A

B

C

D

E

A

B

C



Fig 4. Isolate each tooth crown and root.A) The original composite skull model.B) Construct each dental root out of the CBCT image.C) Cut the dentition into single tooth segments and connect

each crown to the respective corresponding root.

Fig 5. Set up a treatable post-surgical occlusion in CASS virtual planningA) Original occlusion.B) Treatable post-surgical occlusion set up by orthodontists.C) Register the treatable post-surgical occlusion onto the

CBCT image with a surface-best-fit over maxillary dentition.

D) Register the lower dentition along with distal mandibular segment to the treatable post-surgical occlusion with a surface-best-fit over the lower dentition.

A

B

C

A

B

C

D



Fig 6. Simulate skeletal movement in orthognathic surgeryA) Original position with treatable post-surgical occlusion.B) Counterclockwise rotation of the maxilla-mandibular complex.C) Comparison of pre- and post-surgical position.

Fig 7. Simulate post-surgical orthodonticsA) Post-surgical skeletal position with post-surgical treatable occlusion.B) Post-surgical skeletal position with final occlusion.C) A comparison of Maxillary dentition between the post-surgical treatable occlusion (light blue) and final occlusion (white).D) A comparison of Mandibular dentition between the post-surgical treatable occlusion (light blue) and final occlusion (white).

A

B

C

A

B

C

D



1. Construct a composite skull model in NHP24: As aforementioned and demonstrated in Figure 3.

2. Separation of teeth into single units with associated dental roots that are ready for orthodontic assessment and simulation

30: As aforementioned and demon-

strated in Figure 4. 3. Simulate pre-surgical orthodontics

30, 31 (Figure 9, 10):

Utilizing Simplant OMS software, the tooth movement is simulated according to the orthodontist's ability and treatment philosophy regarding pre-surgical orthodontics. In the present case, the pre-surgical orthodontics is limited to leveling and alignment in relation to her alveolar base. For the maxillary dentition, we limit proclination of her maxillary incisors by arch expansion and optional stripping of the anterior teeth because the upper incisor angle, with reference to SN, is at the upper limit of normal (Figure 9). For the mandibular dentition, the curve of Spee is leveled with proclination of the anterior teeth (Figure 10).

4. Simulate the skeletal movements of orthognathic surgery

24 (Figure 11): Set up the post-surgical

occlusion as would be done with conventional techniques (i.e. with both jaws having finished pre-surgical orthodontics and having established a post-surgical occlusion, Figure 11A, 11B). The relationship between the maxillary dentition, mandibular dentition, Le Fort I and distal segments (i.e. maxilla-mandibular complex, MMC) are then appropriately positioned and the MMC is manipulated to achieve skeletal symmetry and normalize cephalometric values (Figure 11C, 11D).

5. Finally, the teeth are "reversed" to recreate the original dentition in the "post-surgical" skull model, allowing acquisition of the anticipated post-surgical occlusion (Figure 12). Afterwards, the entire mandible (i.e. the distal segment and bilateral proximal segments) is rotated clockwise or counterclockwise to avoid collision or open contact, respectively. The orthodontist then evaluates whether or not the post-surgical occlusion is treatable. If so, the plan works and can be performed accordingly.

Fig 8. Protocol of Method BA) Construct a composite skull modelB) Isolate each tooth crown with its respective dental root.C) Simulate pre-surgical orthodonticsD) Simulate skeletal movementsE) Return the dentition to its original state to establish the

post-surgical occlusion

A

B

C

D

E



Fig 9. Simulate pre-surgical orthodontics with the maxillary dentitionA) Maxillary dentition before pre-surgical orthodonticsB) Maxillary dentition after pre-surgical orthodonticsC) A comparison of the maxillary dentition before pre-

surgical orthodontics (light blue) and after pre-surgical orthodontics (white)

Fig 10. Simulate pre-surgical orthodontics with the mandibular dentitionA) Mandibular dentition before pre-surgical orthodonticsB) Mandibular dentition after pre-surgical orthodonticsC) A comparison of the mandibular dentition comparison

between before pre-surgical orthodontics (light blue) and after pre-surgical orthodontics (white)

Fig 11. Simulate orthognathic surgery with dentition after pre-surgical orthodonticsA) Original skeletal position with pre-surgical orthodontics simulatedB) Achieve a post-surgical stable occlusion by moving the distal segmentC) Prior to counterclockwise rotation of the MMCD) After counterclockwise rotation of the MMC

A

B

C

A

B

C

A

B

C

D



RESULTS

Figure 1 reveals the pre-operative and post-operative

profile photos and CBCT images of our model patients.

The images demonstrate that the patient's mandible has

been advanced thereby enlarging the airway after the

orthognathic surgery. The orthodontic treatment will

follow to address the post-surgical treatable malocclusion.

DISCUSSION

The surgery-first approach in surgical orthodontic

Fig 13.The CASS planning protocol provides superior control on the rotation of the proximal segments.A) The premature contact between the distal segment and

left proximal segment causing a kick-out effect of the left proximal segment after positioning of the maxillary and mandibular segments. If the segments were forced together during fixation the left proximal segment may rotate thus causing, post-surgical TMJ symptoms/signs and un-predictable relapse.

B) Eliminate the kick-out effect by rotating the MMC along the axial axis.

Fig 12.Return the "original" dentitions and evaluate the stability and ability to treat the post-surgical occlusionA) Occlusion after pre-surgical orthodontics and simulated

skeletal movementB) Replace double jaw dentitions with original arrangement,

thereby producing a post-surgical occlusionC) A comparison between the post-surgical occlusion (light

blue) and final occlusion (white)

treatment has been gaining popularity for years given a

multitude of advantages as compared to the conventional

orthodontic-first approach. An increasing number of

centers now utilize this treatment approach for patients

who present with a malocclusion and coincident

craniofacial deformity. However, for surgical planning,

the conventional 2-dimension planning using paper and

model surgery remains the most prevalent technique

described in the literature. This is the first article to detail

the procedures of planning the surgery-first approach in

surgical orthodontic treatment with 3-dimensional images

and CASS.

A

B

C

A

B



Our described Method A is a modification of the

planning protocol used at the Craniofacial Center in

Chang Gung Memorial Hospital for many years. The

original planning protocol was based on setting up an

orthodontically treatable and stable occlusion with a

minimum of 3 contact points between maxillary and

mandibular dental casts. Paper and model surgery were

then utilized to plan the skeletal movements and transfer

the surgical plan to the operating room with appropriate

splints4,7,10,12

.While this protocol has been executed for

years with excellent results, a limitation that has always

existed is the potential for minor occlusal interferences

when establishing the post-surgical occlusion in cases

without pre-surgical orthodontics. In these cases, model

surgery could not depict the effects on the final surgical

results with regard to skeletal symmetry and profile

manifestation. By contrast, CASS allows for depiction of

the surrounding anatomic structures24

thereby providing

more information on the final position of the craniofacial

skeleton and is therefore superior when planning surgery-

first approach cases in surgical orthodontic treatment

(Figure 6 and 11). In addition, with accurate anatomic

depictions, the rotational movement of the proximal

segments (especially along the axial axis) is better-

controlled thereby preventing post-surgical stresses on the

temporomandibular joint (Figure 13).

Method B, on the other hand, provides a more

straightforward approach for individuals more comfortable

with the conventional orthodontic-first treatment. By

simulating pre-surgical orthodontic tooth movements

and establishing a post-surgical occlusion, the sequence

of events exactly mirrors those of the conventional

orthodontic-first approach. After the "conventional

procedures", the final surgical plan and respective surgical

splints are determined by simply superimposing the

original dentitions.

However, method B does have its own limitations.

The procedure could produce an unstable occlusion

because there could potentially be less than 3 points in

contact between maxillary and mandibular dentitions. In

addition, the procedure does not adequately address cases

that present with a difficult or even untreatable occlusion

such as with a complete buccal crossbite of the posterior

teeth or extreme midline discrepancies. In cases of an

unstable occlusion, a modified surgical splint can serve as

a bite plate/bite stabilizer for 3 months after surgery5, 8

On

the other hand, modifying the occlusion to a more stable

and treatable condition could solve both aforementioned

problems. The authors would recommend combining

both method A and method B for clinicians who are not

familiar with planning the surgery-first approach. Method

B allows the clinician to establish a temporary post-

surgical occlusion using familiar conventional techniques.

Method A is then utilized to check the post-surgical

skeletal position.

Another issue in planning the surgery-first approach

with a CASS planning protocol is determining how to

simulate orthodontic tooth movement? Many guidelines

regarding orthodontic movement have been previously

published31

. In the present case, the focus is to avoid

exaggerated proclination of the upper incisors after

surgical counterclockwise rotation of the MMC as the

patient's initial upper incisor angle was already at the upper

limit. Extraction therapy could be a solution to achieve

normal incisor inclination in this case. Instead, we adopted

arch expansion to relieve mild crowding of the patient's

upper dentition (i.e. rotation of the upper right lateral

incisor) in order to prevent proclination of her maxillary

incisors in non-extraction orthodontics. This approach led

us to investigate the extent to which we can perform arch

expansion. The question was answered with generated 3D

images of orthodontic tooth movement simulation. In the

images, we were able to observe the relationship between

the dental roots and the surrounding alveolar bone (12A).

After simulated arch expansion, dental roots angled

outside the alveolar bone indicate a tooth movement

beyond the biological limit. The CASS planning protocol

is an excellent tool to facilitate and predict reasonable andan excellent tool to facilitate and predict reasonable and

practical orthodontic treatment plans.

When applying the CASS planning protocol, the

skeletal movements can be transferred with the surgical

splint that is output with the rapid-prototyping technique.



Many methods exist to transfer the orthodontic tooth

movements to patients. One method is using Invisalign to

cover the accuracy and esthetics in suitable cases32-34

. In

addition, we can utilize 3D simulation for indirect bonding

procedures on either the buccal or lingual sides30

. In this

ways, we can accurately transfer the virtual orthodontic

tooth movement to the patient for pre-surgical and post-

surgical orthodontics.

Clinicians should be aware of the disadvantages and

limitations with regards to the surgery-first approach in

surgical orthodontic treatment. First, patients with severe

mal-alignment and exaggerated curves of Spee could

present a contraindication to this approach because of

unavoidable occlusal interferences in setting the post-

operative occlusion that may result in skeletal deviation

during surgery. Second, because occlusion cannot be

used as a guide to determine the skeletal position, the

surgical design could be quite different from that obtained

using traditional techniques. Nagasaka5 and Sugawara

8

recommend using Wits appraisal and Craniofacial

Drawing Standards (CDS) analysis to establish individual

treatment goals. Third, immediate post-surgical occlusion

could be unstable in the surgery-first approach because

of no pre-surgical orthodontics. In such cases, wearing

an occlusal splint while eating to stabilize the mandible5,

8 or considering an orthodontic-first approach should be

entertained. Finally, any orthodontists undertaking this

approach should be trained to handle an un-expected

malocclusion immediately after surgery. Along these

lines, the ability to utilize temporary anchorage devices

(TADs) is highly recommended and encouraged. In our

protocol, unlike that of Nagasaka5 and Sugawara

8, we do

not routinely utilize the TADs for the surgery-first approach.

However, with the help of TADs, the orthodontist can have

even greater more control on a dental midline deviation or

to help solve a post-surgical anterior open bite35

.

CONCLUSIONS

The surgery-first approach in surgical orthodontic

treatment has been proven to have comparable results to

the conventional orthodontic-first approach. CASS has

recently gained much popularity because of its ability

to clearly depict the anatomic structures when planning

orthognathic surgery. In this article, the authors combine

CASS and the surgery-first approach to demonstrate two

useful and practical methods for planning these cases.

ACKNOWLEDGEMENT

This work was supported by Research grants

CMRP381603.

REFERENCES

1. Hsieh HY, Hsu SSP, Huang CS, Liou EJW, Ko EWC,

Liao YF, Lin CCH, Chen YR. Correction of facial

asymmetry with surgery-first orthognathic approach-

case report. J Taiwan Assoc Orthod 2009;21(4):30-39.

2. Hsieh HY, Liou EJW, Hsu SSP, Huang CS, Lin CCH.

Facial asymmetry corrected with surgical orthodontic

treatment-case report. J Taiwan Assoc Orthod 2009;

21(3):28-36.

3. Hsu SSP, Huang CS, Liou EJW, Ko EWC, Liao YF,

Hsieh HY, Lin CCH, Chen YR. Correction of skeletal

class iii with surgery-first orthognathic approach-case

report. J Taiwan Assoc Orthod 2009;21(3):37-47.

4. Hsu SSP, Huang CS, Liou EJW, Ko EWC, Lin CCH,

Chen YR. Correction of mandibular prognathism

with double-jaw surgery and clockwise rotation of the

occlusal plane-case report. J Taiwan Assoc Orthod

2009;21(1):54-63.

5. Nagasaka H, Sugawara J, Kawamura H, Nanda R.

"Surgery first" skeletal Class III correction using

the Skeletal Anchorage System. J Clin Orthod

2009;43:97-105.

6. Yu CC, Chen PH, Liou EJW, Huang CS, Chen YR.

A Surgery-first approach in surgical-orthodontic

treatment of mandibular prognathism-a case report.

Chang Gung Med J 2009;33:699-705.

7. Liao YF, Chiu YT, Huang CS, Ko EWC, Chen



YR. Presurgical orthodontics versus no presurgical

orthodontics: treatment outcome of surgical-

orthodontic correction for skeletal Class III open bite.

Plast Reconstr Surg 2010;126:2074-2083.

8. Sugawara J, Aymach Z, Nagasaka DH, Kawamura H,

Nanda R. "Surgery first" orthognathics to correct a

skeletal Class II malocclusion with an impinging bite.

J Clin Orthod 2010;44:429-438.

9. Villegas C, Uribe F, Sugawara J, Nanda R. Expedited

correction of significant dentofacial asymmetry

using a "surgery first" approach. J Clin Orthod

2010;44:97-103.

10. Wang YC, Ko EWC, Huang CS, Chen YR, Takano-

Yamamoto T. Comparison of transverse dimensional

changes in surgical skeletal Class III patients with and

without presurgical orthodontics. J Oral Maxillofac

Surg 2010;68:1807-1812.

11. Hernández-Alfaro F, Guijarro-Martínez R, Molina-

Coral A, Badía-Escriche C. "Surgery first" in

bimaxillary orthognathic surgery. J Oral Maxillofac

Surg 2011;69:e201-207.

12. Ko EWC, Hsu SSP, Hsieh HY, Wang YC, Huang CS,

Chen YR. Comparison of progressive cephalometric

changes and postsurgical stability of skeletal Class III

correction with and without presurgical orthodontic

treatment. J Oral Maxillofac Surg 2011;69:1469-1477.

13. Liou EJW, Chen PH, Wang YC, Yu CC, Huang CS,

Chen YR. Surgery-first accelerated orthognathic

surgery: orthodontic guidelines and setup for model

surgery. J Oral Maxillofac Surg 2011;69:771-780.

14. Liou EJW, Chen PH, Wang YC, Yu CC, Huang CS,

Chen YR. Surgery-first accelerated orthognathic

surgery: postoperative rapid orthodontic tooth

movement. J Oral Maxillofac Surg 2011;69:781-785.

15. Bell WH, Creekmore TD. Surgical-orthodontic

correction of mandibular prognathism. Am J Orthod

1973;63:256-270.

16. Epker BN, Fish L. Surgical-orthodontic correction of

open-bite deformity. Am J Orthod 1977;71:278-299.

17. Lee RT. The benefits of post-surgical orthodontic

treatment. Br J Orthod 1994;21:265-274.

18. Gateno J, Teichgraeber JF, Xia J. Method and

apparatus for fabricating orthognathic surgical splints.

US Patent 6,671,539, 2003.

19. Gateno J, Teichgraeber JF, Xia JJ. Three-dimensional

surgical planning for maxillary and midface distraction

osteogenesis. J Craniofac Surg 2003;14:833-839.

20. Gateno J, Xia J, Teichgraeber JF, Rosen A. A

new technique for the creation of a computerized

composite skull model. J Oral Maxillofac Surg

2003;61:222-227.

21. Gateno J , Xia J , Teichgraeber JF, Rosen A,

Hultgren B, Vadnais T. The precision of computer-

generated surgical splints. J Oral Maxillofac Surg

2003;61:814-817.

22. Gateno J, Xia JJ, Teichgraeber JF, et al. Clinical

feasibility of computer-aided surgical simulation

(CASS) in the treatment of complex cranio-

maxillofacial deformities. J Oral Maxillofac Surg

2007;65:728-734.

23. Xia JJ, Gateno J, Teichgraeber JF. Three-dimensional

computer-aided surgical simulation for maxillofacial

surgery. Atlas Oral Maxillofac Surg Clin North Am

2005;13:25-39.

24. Xia JJ, Gateno J, Teichgraeber JF. New clinical

protocol to evaluate craniomaxillofacial deformity

and plan surgical correction. J Oral Maxillofac Surg

2009;67:2093-2106.

25. Xia JJ, Gateno J, Teichgraeber JF. A new paradigm for

complex midface reconstruction: a reversed approach.

J Oral Maxillofac Surg 2009;67:693-703.

26. Xia JJ, Gateno J, Teichgraeber JF, et al. Accuracy

of the computer-aided surgical simulation (CASS)

system in the treatment of patients with complex

craniomaxillofacial deformity: A pilot study. J Oral

Maxillofac Surg 2007;65:248-254.

27. Xia JJ, McGrory JK, Gateno J, et al. A new method to

orient 3-dimensional computed tomography models to

the natural head position: a clinical feasibility study. J

Oral Maxillofac Surg 2011;69:584-591.

28. Xia JJ, Phillips CV, Gateno J, et al. Cost-effectiveness

analysis for computer-aided surgical simulation



in complex cranio-maxillofacial surgery. J Oral

Maxillofac Surg 2006;64:1780-1784.

29. Xia JJ, Shevchenko L, Gateno J, et al. Outcome study

of computer-aided surgical simulation in the treatment

of patients with craniomaxillofacial deformities. J

Oral Maxillofac Surg 2011;69:2014-2024.

30. Guo H, Zhou J, Bai Y, Li S. A three-dimensional

setup model with dental roots. J Clinl Orthod

2011;45:209-216.

31. Kuroda T, Motohashi N, Mutsushi Muramoto M.

Method of and apparatus for making a dental set-up

model. US Patent 5,605,459, 1997.

32. Djeu G, Shelton C, Maganzini A. Outcome assessment

of Invisalign and traditional orthodontic treatment

compared with the American Board of Orthodontics

objective grading system. Am J Orthod Dentofacial

Orthop 2005;128:292-298.

33. Kravitz ND, Kusnoto B, BeGole E, Obrez A, Agran B.

How well does Invisalign work? A prospective clinical

study evaluating the efficacy of tooth movement

with Invisalign. Am J Orthod Dentofacial Orthop

2009;135:27-35.

34. Krieger E, Seiferth J, Saric I, Jung BA, Wehrbein H.

Accuracy of invisalign® treatments in the anterior

tooth region. J Orofac Orthop 2011;72:141-149.

35. Sam Sheng-Pin Hsu, Yu-Fang Liao, Hsin-Yi Hsieh,

Grace Ya-Ying Teng, Yi-Ting Chiang, Shih-Han Chen:

Correction of Unexpected Post-surgical Anterior

Open Bite with Miniscrew Orthodontics. Journal of

the Taiwan Association of Orthodontists. Vol. 21(2):

51-63, 2009



以3D影像電腦輔助正顎手術矯正模擬技術來計劃手術優先之正顎手術矯正治療

許勝評1,2,3．Dhruv Singhal

3,4．James J. Xia

5．Jaime Gateno

5

林政輝3,4．黃炯興

1,2,3．羅綸州

2,3,4．柯雯青

2,3,4．陳昱瑞

2,3,4

台北長庚紀念醫院顱顏齒顎矯正科1

長庚大學顱顏口腔醫學研究所2

林口長庚紀念醫院顱顏研究中心3

台北長庚紀念醫院整形外科4

Department of Oral and Maxillofacial Surgery, the Methodist Hospital, Houston, TX

5

手術優先之正顎手術矯正治療由於其臨床上的諸多好處，國際上越來越多知名的醫學中心開始將

其應用於臨床的治療上，然而目前所發表的文獻當中並沒有清楚地提出一套理想的步驟與方法來制訂

全方位的、包括矯正以及手術的治療計劃。本文提出兩套以3D影像電腦手術模擬的技術來訂定手術優

先之手術矯正治療計劃的步驟與方法，藉由電腦立體影像所呈現精確地、可看見的模擬過程與治療目

標，提供一個矯正醫師與手術醫師之間最理想的溝通平台，讓即使是這方面經驗不多的臨床醫師也可

以容易的入門來訂定手術優先之手術矯正治療計劃。 (J. Taiwan Assoc. Orthod. 24(2): 24-37, 2012)

關鍵詞：手術優先、3D影像電腦手術模擬、正顎手術、手術矯正

收文日期：101年7月3日修改日期：101年7月13日接受日期：101年7月18日聯絡及抽印本索取地址：台北長庚紀念醫院整形外科台北市松山區敦化北路199號6F 林政輝F 林政輝林政輝張電話：02-27135211 電子信箱：[email protected]

正顎手術模擬技術

Documents

Transcript of 正顎手術模擬技術