Application of the DDS PRO software for planning of bilateral sagittal split osteotomy of the mandible: clinical case description

Abstract

Aim. Traditionally, one of the most important and precise parts of orthognatic interventions will always be planning. After this stage, the surgeon knows exactly which bones and in what way must be rebuilt to get the best result. Earlier, the conducting of a "virtual operation" was not possible. Everything has changed with the advent of the 3D scanners and printers and related software. Accordingly, the task of the study was to confirm the effectiveness of the application of virtual planning in general, and on the example of the application of specific software, in particular, 3D printing technologies in the execution of bilateral sagittal split osteotomy of the mandible, and to introduce this complex into routine surgical practice. Material and Methods. For the virtual planning of the surgical intervention, we selected the software complex DDS PRO of the manufacturer Natrodent (Lodz, Poland). A clinical example of the first application in the clinic of the department of the university and the department of the hospital of software for virtual simulation of orthognatic operations was the case of patient P. with progeny and open bite - a class III skeletal defect with a significant cosmetic and functional defect (indistinct language and difficulty in eating). As a method of surgical treatment, a bilateral sagittal split osteotomy of the mandible was selected. Results and Discussion. Before the start of treatment, the patient underwent a detailed examination of the maxillofacial area by the surgical team in conjunction with the orthodontist, and underwent orthodontic preparation. Immediately before the operation, gypsum models were made and scanned in 3D scanners. These files, as well as pre-operative spiral computed tomography, were uploaded to the DDS PRO software. The simulation of surgical intervention with bilateral sagittal split osteotomy of the mandible on the previously obtained combined 3D model was performed. A virtual 3D operating template was created and printed. Subsequently, an operation was performed. After osteotomy of the mandible, the dental arches of both jaws were reduced to the position of the expected occlusion by using a template and were fixed together with the IMF screws with wires. Fixation of the fragments was performed following the well-known method of M. Champy et al. (1975). The treatment period passed without complications. On the 10th day, the patient was discharged from the department for post-hospital observation. The resulting occlusion and changes in the shape of the face fully met his psychological and cosmetic expectations. Conclusions. The use of computer 3D visualizations provides real help to the surgeon in planning future interventions, and evaluating their likely effects and outcomes. The result of this activity is the creation of a surgical template, which is the quintessence of all diagnostic and preparatory activities that precede the surgery. Of course, 3D planning cannot replace a patient's clinical examination, but it has all the prerequisites to supplement it. DDS PRO software is easy to learn and work with. It has a convenient, informative user interface. The manufacturer of the software has the ability to provide technical support to the user. All of the foregoing suggests that the DDS PRO software can be implemented in the routine process of preparing and planning patients with jaw and (or) bite deformations before conducting orthognatic interventions.

Keywords

• virtual planning, mandible, orthognatic surgery, osteotomy