Accuracy of Three-Dimensional Upper Airway Prediction in Orthognathic Cases Using Dolphin Three-Dimensional Software
Tarek Elshebiny, BDS, MSD1, Rany Bous, BDS, MSD1, Thimanthi Withana, BS2, Manish Valiathan, DDS, MSD1.
1Case Western Reserve University, Cleveland, OH, USA, 2Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA.
Background: Orthodontists and surgeons have been looking for more accurate methods to predict surgical outcomes in patients with skeletal discrepancies. The impact on the airway is an important consideration for patients with sleep disordered breathing, or those who may be at a high risk. Thus, predicting post-surgical changes to the airway volume may be important for patients undergoing orthognathic surgery. Methods: The sample consisted of 20 subjects from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, BSSO, with or without genioplasty. All subjects had to have preoperative (T0) and at least 6 months postoperative (T1) CBCTs that were imported to Dolphin three-dimensional (3D) software. 3D voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. Virtual orthognathic surgery was performed at T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A predicted 3D soft tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The upper airway was segmented and exported as STL surface files in both T1 and Tp. The measurements of the 3D volume of the airway were calculated and compared among T1 and Tp by using surface superimposition technique, on Mesh Mixer software. Means and standard deviations of upper airway volume were compared and correlated using Paired t-test and correlated using Pearson correlation. Intra-rater reliability analysis was done using Intraclass correlation. Results: Intraclass correlation showed an excellent intra-rater reliability (ICC = 0.994, p<0.001). No statistically significant differences were found between the upper airway volume of T1 and Tp (p=0.07). Pearson correlation showed a strong significant correlation between Tp and T1 (r=0.897, p<.001). Conclusion: Dolphin 3D is reliable and delivers accurate airway prediction which is an important step in 3D virtual planning.
| Tp (meaną SD) | T1 (meanąSD) | paired t-test (p-value) | Pearson correlation | |
| 14684ą7545 | 16220ą7789 | p=0.07 | r= .0897 p<0.001 | |
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