Three-Dimensional Planning in Maxillofacial Fracture Surgery: Computer-Aided Design/Computer-Aided Manufacture Surgical Splints by Integrating Cone Beam Computerized Tomography Images Into Multislice Computerized Tomography Images

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Abstract

This study aimed to evaluate an innovative workflow for maxillofacial fracture surgery planning and surgical splint designing. The maxillofacial multislice computerized tomography (MSCT) data and dental cone beam computerized tomography (CBCT) data both were obtained from 40 normal adults and 58 adults who suffered fractures. The each part of the CBCT dentition image was registered into MSCT image by the use of the iterative closest point algorithm. Volume evaluation of the virtual splints that were designed by the registered MSCT images and MSCT images of the same object was performed. Eighteen patients (group 1) were operated without any splint. Twenty-one (group 2) and 19 patients (group 3) used the splints designed according to the MSCT images and registered MSCT images, respectively. The authors’ results showed that the mean errors between the 2 models ranged from 0.53 to 0.92 mm and the RMS errors ranged from 0.38 to 0.69 mm in fracture patients. The mean errors between the 2 models ranged from 0.47 to 0.85 mm and the RMS errors ranged from 0.33 to 0.71 mm in normal adults. 72.22% patients in group 1 recovered occlusion. 85.71% patients in group 2, and 94.73% patients in group 3 reconstructed occlusion. There was a statistically significant difference between the MSCT images based splints’ volume and the registered MSCT splints’ volume in patients (P <0.05). The MSCT images based splints’ volume was statistically significantly distinct from the registered MSCT splints’ volume in normal adults (P <0.05). There was a statistically significant difference between the MSCT images based splints’ volume and the registered MSCT splints’ volume in patients and normal adults (P <0.05). The occlusion recovery rate of group 3 was better than that of group 1 and group 2. The way of integrating CBCT images into MSCT images for splints designing was feasible. The volume of the splints designed by MSCT images tended to be smaller than the splints designed by the integrated MSCT images. The patients operated with splints tended to regain occlusion. The patients who were operated with the splints which were designed according to registered MSCT images tended to get occlusal recovered.

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