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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Vydané v:International journal of oral and maxillofacial surgery Ročník 54; číslo 8; s. 720 - 726
Hlavní autori: van der Wel, H., Schepers, R.H., Baan, F., Spijkervet, F.K.L., Jansma, J., Kraeima, J.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Denmark Elsevier Inc 01.08.2025
Predmet:
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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Shrnutí: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.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0901-5027
1399-0020
1399-0020
DOI:10.1016/j.ijom.2025.01.016