Digitale Fortschritte in der kombiniert kieferorthopädisch-kieferchirurgischen Therapie erwachsener Patienten

Zusammenfassung

Im Zuge der Digitalisierung hat sich auch die Fallplanung im Rahmen kieferorthopädisch-kieferchirurgischer Therapien verändert. Dabei wird die klassische Modelloperation auf Basis von 2-dimensionalen Röntgenbildern und einartikulierten Gipsmodellen zunehmend durch eine digitale Planung mittels digitaler Volumentomografie, Stereofotogrammetrie und 3-dimensionalen Druckverfahren ersetzt. Als Vorteile werden eine Reduktion von Laborschritten, die damit einhergehende Zeitersparnis und Eliminierung potenzieller Fehlerquellen sowie die verbesserte Visualisierung präoperativer Asymmetrien und des postoperativen Ergebnisses beschrieben. Der Artikel stellt die digitalen Fortschritte und einen möglichen Workflow für die klinische Praxis exemplarisch dar.

Abstract

Digitization has also led to major changes in treatment planning in the context of combined orthodontic-surgical therapies. The conventional model surgery based on 2-dimensional X-rays and plaster casts in the articulator is increasingly being replaced by virtual planning procedures including cone-beam CTs, stereophotogrammetry and 3-dimensional printing. Advantages like the reduction in laboratory steps, the associated time savings and elimination of potential sources of error as well as the improved visualization of preoperative asymmetries and the postoperative result are discussed. This article provides an overview of the virtual opportunities and presents a workflow, which is easy to implement in the clinical routine.

Schlüsselwörter

orthognathe Chirurgie - Erwachsenenkieferorthopädie - Dysgnathietherapie - Umstellungsosteotomie - 3-dimensionale Planung

Key words

orthognathic surgery - adult orthodontics - treatment of malocclusion - bilateral sagittal split osteotomy - 3-dimensional planning

Publication History

Article published online:
07 July 2021

• Literatur

• 1 Christensen L, Luther F. Adults seeking orthodontic treatment: expectations, periodontal and TMD issues. Br Dent J 2015; 218: 111-117
• 2 Proffit WR, Ackermann JL. A systematic approach to orthodontic diagnosis and treatment planning. Current orthodontic concepts and techniques. C. V. Mosby and Co, Saint Louis. 1985
• 3 Modig M, Andersson L, Wårdh I. Patients’ perception of improvement after orthognathic surgery: pilot study. Br J Oral Maxillofac Surg 2006; 44: 24-27
• 4 Kiyak AH, Zeitler DL. Self-assessment of profile and body image among orthognathic surgery patients before and two years after surgery. J Oral Maxillofac Surg 1988; 46: 365-371
• 5 Quast A, Santander P, Witt D. et al. Traditional face-bow transfer versus three-dimensional virtual reconstruction in orthognathic surgery. Int J Oral Maxillofac Surg 2019; 48: 347-354
• 6 Quast A, Santander P, Trautmann J. et al. A new approach in three dimensions to define pre- and intraoperative condyle-fossa relationships in orthognathic surgery – is there an effect of general anaesthesia on condylar position?. Int J Oral Maxillofac Surg 2020;
• 7 Marchetti C, Bianchi A, Muyldermans L. et al. Validation of new soft tissue software in orthognathic surgery planning. Int J Oral Maxillofac Surg 40: 26-32
• 8 Quast A, Santander P, Leding J. et al. Orthodontic incisor decompensation in orthognathic therapy-success and efficiency in three dimensions. Clin Oral Investig 2020;
• 9 Schwestka-Polly R. Fortschritte in der gelenkbezüglichen kieferorthopädisch-kieferchirurgischen Therapie. Inform Orthodont Kieferorthop 2004; 36: 205-218
• 10 Luhr H-G. The Significance of Condylar Position Using Rigid Fixation in Orthognathic Surgery. Clinics in Plastic Surgery 1989; 16: 147-156
• 11 DGFDT Terminologie. https://www.dgfdt.de/terminologie-nomenklatur Accessed 26 Feb 2021
• 12 Al-Moraissi EA, Wolford LM. Is Counterclockwise Rotation of the Maxillomandibular Complex Stable Compared With Clockwise Rotation in the Correction of Dentofacial Deformities? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg 2016; 74: 2066.e1-2066.e12
• 13 Swennen G. 3D Virtual Treatment Planning of Orthognathic Surgery. Springer Berlin Heidelberg, Berlin, Heidelberg 2017
• 14 Proffit WR, Fields HW, Sarver DM. et al. Contemporary orthodontics. 5 ed. Elsevier/Mosby; St; Louis, Mo: 2013
• 15 Verna C. Regional acceleratory phenomenon. Tooth Movement. 18. 28-35 Karger Publishers; 2016