Refining Post-orthognathic Surgery Facial Contour with Computer-Aided Designed/Manufactured (CAD/CAM) Alloplastic Implants
Imran Ratanshi, MD MSc FRCSC, Jeffrey H. Lee, MD, Michael J. Yaremchuk, MD FACS.
Harvard University, Boston, MA, USA.
BACKGROUND: Le fort I maxillary osteotomies and sagittal split mandibular osteotomies are performed to correct significant dentofacial deformities. The multidimensional skeletal movements, particularly those of large magnitude, while optimizing occlusion, may result in contour irregularities and facial imbalances. These include upper midface deficiency after Lefort I advancement as well as ramus asymmetry and border irregularities after sagittal and horizontal mandibular osteotomies. In circumstances where facial soft tissues cannot camouflage these unique deficits, prefabricated “off-the-shelf” implants have offered a simple strategy to improve facial contour. Recently, computer assisted design/manufacture (CADCAM) strategies based on computerized tomography (CT) scan data has enabled fabrication of custom implants that bring added refinement to facial contour after orthognathic surgery.
METHODS: Three dimensional images were reconstructed from CT scans in patients unhappy with their appearances after Le Fort I advancement and/or bilateral sagittal split osteotomies (BSSO). The data from these scans were used in CAD/CAM planning to design alloplastic implants for surgical correction of contour irregularities and imbalances. These implants were surgically placed through intraoral and submental incisions and fixed using titanium screws. This presentation will highlight senior author's experience (MJY) use of customized implant augmentation in patients who have undergone previous orthognathic procedures. Representative cases reported will describe indications and planning concepts to optimize aesthetic outcomes.
RESULTS: A total of 21 patients underwent CAD/CAM implant placement. One patient required removal of implants secondary to infection. All other patients were satisfied with their result.
CONCLUSIONS: Orthognathic surgery, while improving dental function, can result in unique deficits resulting in facial aesthetic disharmony. Customized, patient-specific implants offer a precise method for improving contour irregularities and improve facial harmony.
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