The creation of a novel full-coverage orthognathic surgical splint utilizing 3D printing & virtual surgical planning

2015-04-03Background: Orthognathic surgery is difficult to plan and execute for both the orthodontist and oral surgeon. Though recent strides in technology and diagnostic tools have been made, connecting these tools has not been accomplished in an efficient manner. The advent of virtual surgical planning has brought a new level of detail to surgery, but the execution is still difficult when applied in a clinical setting. By combining 3D printing and virtual surgical planning, a better resultant surgical result may be achieved. ❧ Purpose: In this project, the purpose was to combine existing methods of surgical planning to create a novel full-coverage surgical splint that allowed for better communication between the orthodontist and oral surgeon and to enable a better patient outcome from an increased accuracy of surgical splint and decreased patient finishing times using clear aligner therapy. ❧ Methods: Immediately prior to surgical workup, braces or clear aligner therapy attachments are removed if present so that all surfaces are smooth. The novel full-coverage splint is designed and manufactured using intraoral scanning of the pre-surgical dentition and CAD/CAM creation on a 3D printer. Orthognathic surgery is completed using the full-coverage splint(s) and Maxillomandibular fixation is applied by means of skeletal anchor screws placed at the start of surgery. Post-surgery protocol is completed using clear aligner therapy and the initial clear aligner tray is delivered 2-3 weeks post surgery. ❧ Discussion: The current golden standard for orthognathic surgical planning is still utilizing a plaster model for model surgery and then hand fabricating an acrylic splint. Only the most forward thinking surgeons are utilizing the cutting edge technology of virtual surgical planning and taking CBCT scans of their stone models to have an orthognathic surgical splint wafer printed. There exist inherent flaws with both the golden standard and cutting edge methods of splint fabrication. The advantages of using a full-coverage 3D printed splint are: 1) Increased accuracy of post-surgical occlusion. 2) Increase in patient comfort and acceptance of treatment. 3) Accelerated speed in post surgical orthodontic finishing. ❧ Conclusion: By creating a more accurate and full-coverage splint, the following was achieved: 1) Operating room time is decreased. 2) Patient outcomes, including fewer complications and faster rehabilitation, have been improved. 3) Increased surgical precision. 4) Increased communication between the doctor and patient, including better surgical predictions. 5) Better communication between the surgeon and referring orthodontist. 6) Highly predictable surgical results