3D driven protocol for surgery first orthognathic approach.pptx

Surgery First Options

1. 3D driven protocol for surgery first orthognathic approach using Virtual Surgical Planning Seminar-Surgery First Dec 2022 YASIR ISRAR

2. Surgery First Orthognathic For this approach to be successful Essential to visualize the ‘transitional occlusion’ A transitional occlusion is the setup that visualizes the corrections enabled after simulation of surgical movements Where minor problems can be later corrected by Orthodontics

3. Transitional occlusion cannot be visualized with 2d records and traditional model surgeries Discrepancies in pitch, roll and yaw cannot be determined, especially in the midline area These limitations are overcome by introduction of 3d visualization and planning in the field of orthognathic surgeries

4. Step up from conventional approach Enhanced diagnosis using AI Treatment planning on 3d models Precision fabrication of surgical splints Superimposition tools color coded with distance mapping to to predict outcomes

5. Machine learning and AI Machine learning is the process by which a computer algorithm adapts to learn more from continued data input This enables them to take and advise predictive approaches based on past data, streamlining the judgement process Can predict Peri-operative blood loss Surgical planning Segmentation of structures Differential diagnosis

6. Designing Virtual Surgical Planning A pre-requisite of such a process Hard tissue scans like CBCT Soft tissue scan (facial scan) Intra-oral scan Surface rendering of the cranial structure is performed after software automatically detects structures based on voxel data

7. For CBCT Mandible should be in CR Patients head in Natural Head Position Registration bite-forks should not disturb soft tissues Chin rest or headbands should not stretch the soft tissues

8. 3D generated AUM comprising of CBCT superimposed with scanned models and 3D facial scan. Errors avoided with this method Cephalometric mistracing Errors during facebow transfer Incorrect mounting Irregular cutting

9. Regardless of technology used A surgical treatment objective Discussed between the orthodontist and maxillofacial surgeon is imperative 6 degrees of freedom in movement of maxilla Transverse, Sagittal and Vertical Pitch, Roll, and Yaw

10. After the maxilla has been repositioned using these 6 parameters Mandible is set according to the maxilla Optimal transitional occlusion 2 posterior contacts each side 1 Anterior contact point If this cannot be achieved, reassessment of both jaws is needed

11. Airway analysis to calculate the volume

12. Wafer-less surgery Vertical movements cannot be predicted by surgical splints To overcome guess work Software developments allow us to Plan surgical movements virtually Surgical movement guides generated Surgical plates generated using AI and open source softwares Printed using Titanium 3d printing

13. Skeletal Class II with hyperdivergent facial pattern with a menton deviation of 10.6mm was observed. A mandible yaw of 7.5 degrees was seen.

14. Initial and after CASS. Canting correction of the maxilla, yaw correction of the mandible, and advanced genioplasty was planned.

15. Settling of occlusion using clear aligner therapy

16. Conclusions Virtual Surgical Planning in conventional or surgery First Accurate Faster Decreased guess work by surgeon Less post-operative trauma Major Con Costs of software subscription and 3d printing

17. THANK YOU