Maxilla-first patient-specific osteosynthesis vs mandible-first bimaxillary orthognathic surgery using splints: a randomized controlled trial

Patient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly advanced orthognathic surgery, enhancing surgical accuracy. This study compares the outcomes of the mandible-first approach using an intermediate splint and...

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Vydáno v:	International journal of oral and maxillofacial surgery Ročník 54; číslo 8; s. 720 - 726
Hlavní autoři:	van der Wel, H., Schepers, R.H., Baan, F., Spijkervet, F.K.L., Jansma, J., Kraeima, J.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	Denmark Elsevier Inc 01.08.2025
Témata:	Adolescent Adult Bone Plates Computer-aided design Cone-Beam Computed Tomography Female Humans Imaging, Three-Dimensional Male Mandible - surgery Maxilla - surgery Oral and Maxillofacial Surgery Orthognathic surgery Orthognathic Surgical Procedures - instrumentation Orthognathic Surgical Procedures - methods Patient-specific computational modelling Splints Surgery, Computer-Assisted - methods Three-dimensional imaging Treatment Outcome Orthognathic surgery Bone plates Computer-aided design Patient-specific computational modelling Three-dimensional imaging
ISSN:	0901-5027, 1399-0020, 1399-0020
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Abstract	Patient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly advanced orthognathic surgery, enhancing surgical accuracy. This study compares the outcomes of the mandible-first approach using an intermediate splint and manually bent osteosynthesis plates with the maxilla-first approach utilizing patient-specific osteosynthesis fixation in bimaxillary orthognathic surgery. This multi-centre randomized controlled trial included 88 patients, with 77 completing the study. Patients were randomly assigned to either the ‘mandible-first’ group (mandible-first with an intermediate splint) or the ‘maxilla-first with PSO’ group (maxilla-first with patient-specific osteosynthesis). Postoperative evaluation using cone beam computed tomography images showed significantly lower deviations from the preoperative plan in the maxilla-first with PSO group compared to the mandible-first group, for anteroposterior (median 1.0 mm vs 1.8 mm, P = 0.008) and left/right translations (median 0.4 mm vs 0.8 mm, P = 0.003), and yaw rotation (median 0.5° vs 1.0°, P = 0.013). Regarding clinical accuracy (categorized as optimal, good, or suboptimal), 59.5% of the patients in the maxilla-first with PSO group had an optimal or good result compared to 17.5% in the mandible-first group. The study findings suggest the maxilla-first PSO approach offers enhanced accuracy, supporting its adoption in orthognathic surgery for better surgical outcomes.
AbstractList	Patient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly advanced orthognathic surgery, enhancing surgical accuracy. This study compares the outcomes of the mandible-first approach using an intermediate splint and manually bent osteosynthesis plates with the maxilla-first approach utilizing patient-specific osteosynthesis fixation in bimaxillary orthognathic surgery. This multi-centre randomized controlled trial included 88 patients, with 77 completing the study. Patients were randomly assigned to either the ‘mandible-first’ group (mandible-first with an intermediate splint) or the ‘maxilla-first with PSO’ group (maxilla-first with patient-specific osteosynthesis). Postoperative evaluation using cone beam computed tomography images showed significantly lower deviations from the preoperative plan in the maxilla-first with PSO group compared to the mandible-first group, for anteroposterior (median 1.0 mm vs 1.8 mm, P = 0.008) and left/right translations (median 0.4 mm vs 0.8 mm, P = 0.003), and yaw rotation (median 0.5° vs 1.0°, P = 0.013). Regarding clinical accuracy (categorized as optimal, good, or suboptimal), 59.5% of the patients in the maxilla-first with PSO group had an optimal or good result compared to 17.5% in the mandible-first group. The study findings suggest the maxilla-first PSO approach offers enhanced accuracy, supporting its adoption in orthognathic surgery for better surgical outcomes. Patient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly advanced orthognathic surgery, enhancing surgical accuracy. This study compares the outcomes of the mandible-first approach using an intermediate splint and manually bent osteosynthesis plates with the maxilla-first approach utilizing patient-specific osteosynthesis fixation in bimaxillary orthognathic surgery. This multi-centre randomized controlled trial included 88 patients, with 77 completing the study. Patients were randomly assigned to either the 'mandible-first' group (mandible-first with an intermediate splint) or the 'maxilla-first with PSO' group (maxilla-first with patient-specific osteosynthesis). Postoperative evaluation using cone beam computed tomography images showed significantly lower deviations from the preoperative plan in the maxilla-first with PSO group compared to the mandible-first group, for anteroposterior (median 1.0 mm vs 1.8 mm, P = 0.008) and left/right translations (median 0.4 mm vs 0.8 mm, P = 0.003), and yaw rotation (median 0.5° vs 1.0°, P = 0.013). Regarding clinical accuracy (categorized as optimal, good, or suboptimal), 59.5% of the patients in the maxilla-first with PSO group had an optimal or good result compared to 17.5% in the mandible-first group. The study findings suggest the maxilla-first PSO approach offers enhanced accuracy, supporting its adoption in orthognathic surgery for better surgical outcomes.Patient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly advanced orthognathic surgery, enhancing surgical accuracy. This study compares the outcomes of the mandible-first approach using an intermediate splint and manually bent osteosynthesis plates with the maxilla-first approach utilizing patient-specific osteosynthesis fixation in bimaxillary orthognathic surgery. This multi-centre randomized controlled trial included 88 patients, with 77 completing the study. Patients were randomly assigned to either the 'mandible-first' group (mandible-first with an intermediate splint) or the 'maxilla-first with PSO' group (maxilla-first with patient-specific osteosynthesis). Postoperative evaluation using cone beam computed tomography images showed significantly lower deviations from the preoperative plan in the maxilla-first with PSO group compared to the mandible-first group, for anteroposterior (median 1.0 mm vs 1.8 mm, P = 0.008) and left/right translations (median 0.4 mm vs 0.8 mm, P = 0.003), and yaw rotation (median 0.5° vs 1.0°, P = 0.013). Regarding clinical accuracy (categorized as optimal, good, or suboptimal), 59.5% of the patients in the maxilla-first with PSO group had an optimal or good result compared to 17.5% in the mandible-first group. The study findings suggest the maxilla-first PSO approach offers enhanced accuracy, supporting its adoption in orthognathic surgery for better surgical outcomes. AbstractPatient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly advanced orthognathic surgery, enhancing surgical accuracy. This study compares the outcomes of the mandible-first approach using an intermediate splint and manually bent osteosynthesis plates with the maxilla-first approach utilizing patient-specific osteosynthesis fixation in bimaxillary orthognathic surgery. This multi-centre randomized controlled trial included 88 patients, with 77 completing the study. Patients were randomly assigned to either the ‘mandible-first’ group (mandible-first with an intermediate splint) or the ‘maxilla-first with PSO’ group (maxilla-first with patient-specific osteosynthesis). Postoperative evaluation using cone beam computed tomography images showed significantly lower deviations from the preoperative plan in the maxilla-first with PSO group compared to the mandible-first group, for anteroposterior (median 1.0 mm vs 1.8 mm, P = 0.008) and left/right translations (median 0.4 mm vs 0.8 mm, P = 0.003), and yaw rotation (median 0.5° vs 1.0°, P = 0.013). Regarding clinical accuracy (categorized as optimal, good, or suboptimal), 59.5% of the patients in the maxilla-first with PSO group had an optimal or good result compared to 17.5% in the mandible-first group. The study findings suggest the maxilla-first PSO approach offers enhanced accuracy, supporting its adoption in orthognathic surgery for better surgical outcomes.
Author	Kraeima, J. Schepers, R.H. Baan, F. Jansma, J. van der Wel, H. Spijkervet, F.K.L.
Author_xml	– sequence: 1 givenname: H. surname: van der Wel fullname: van der Wel, H. email: h.van.der.wel@umcg.nl organization: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands – sequence: 2 givenname: R.H. surname: Schepers fullname: Schepers, R.H. organization: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands – sequence: 3 givenname: F. orcidid: 0000-0002-3626-656X surname: Baan fullname: Baan, F. organization: Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands – sequence: 4 givenname: F.K.L. surname: Spijkervet fullname: Spijkervet, F.K.L. organization: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands – sequence: 5 givenname: J. orcidid: 0000-0003-2536-4786 surname: Jansma fullname: Jansma, J. organization: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands – sequence: 6 givenname: J. surname: Kraeima fullname: Kraeima, J. organization: Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Snippet	Patient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly advanced... AbstractPatient-specific osteosynthesis plates and three-dimensional virtual surgical planning with patient-specific surgical guides have significantly...
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SubjectTerms	Adolescent Adult Bone Plates Computer-aided design Cone-Beam Computed Tomography Female Humans Imaging, Three-Dimensional Male Mandible - surgery Maxilla - surgery Oral and Maxillofacial Surgery Orthognathic surgery Orthognathic Surgical Procedures - instrumentation Orthognathic Surgical Procedures - methods Patient-specific computational modelling Splints Surgery, Computer-Assisted - methods Three-dimensional imaging Treatment Outcome
Title	Maxilla-first patient-specific osteosynthesis vs mandible-first bimaxillary orthognathic surgery using splints: a randomized controlled trial
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