Avaliação da acurácia do planejamento virtual tridimensional e de diferentes programas dedicados à cirurgia ortognática
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Data
2022-12-13
Autores
Gorla, Luis Fernando de Oliveira
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
O objetivo desta pesquisa foi avaliar a acurácia do planejamento cirúrgico virtual tridimensional e a acurácia dos programas IPS Case Designer 2.2.5.2 (KLS Martin, Tuttlingen, Alemanha), NemoFAB 22.0.1 (Nemotec, Madri, Espanha) e Dolphin Imaging 3D 11.95 (Dolphin Imaging & Management Solutions, Chatsworth, CA, USA) no planejamento de tecidos duros e moles.de pacientes portadores de deformidades dento-esquelética-faciais. Para tanto, foram selecionados 23 pacientes submetidos a cirurgia ortognática, que realizaram tomografias pré-operatória, pós-operatória imediata e pós-operatória tardia. Os resultados obtidos na cirurgia foram mensurados e comparados com o planejado, para avaliar a acurácia posicional e rotacional da técnica de planejamento virtual 3D. Após, para assegurar a acurácia dos programas, novos planejamentos foram realizados tendo as posições pós-operatórias como referência, e os resultados mensurados foram comparados com os resultados obtidos. As discrepâncias entre o tecido mole planejado nos três programas e o tecido mole obtido no pós-operatório tardio também foram mensuradas por meio do cálculo do valor eficaz (RMS) e da porcentagem de pontos com distâncias inferiores a 2 mm entre as malhas 3D. Quanto à técnica, o planejamento virtual tridimensional mostrou-se acurado para transferência das posições e orientações, exceto para a posição sagital da maxila, com mediana de -1,57 mm (IC95m -2,80 – -0,81 mm), da mandíbula, com mediana de -1,83 mm (IC95m -2,76 – -0,62 mm), e do mento, com mediana de -3,36 mm (IC95m-5,52 – -1,13 mm) e para a posição vertical do mento, com mediana 0,72 mm (IC95m -0,37 – 2,96 mm), que superam os limites clínicos aceitáveis (<2 mm para as diferenças posicionais e <4 ° para as rotacionais). Quanto à acurácia dos programas, não houve diferença estatística entre as mensurações nestes e as mensurações reais, validando suas ferramentas de movimentação. Quanto a acurácia da previsão dos tecidos moles, a face foi separada em sub-regiões e os programas mostraram resultados dentro dos limites clínicos aceitáveis na previsão da área paranasal e nariz, mas não foram suficientemente precisos para simular lábio superior, lábio inferior e mento. Ao comparar os programas quanto à capacidade de previsão do tecido mole, não houve diferença estatística entre os programas em nenhum dos parâmetros avaliados nas diferentes sub-regiões. Podemos concluir que a técnica e os programas estudados podem ser utilizados com sucesso no tratamento de pacientes que serão submetidos à cirurgia ortognática, desde que especial atenção seja dada ao reposicionamento sagital do complexo maxilo-mandibular e que cuidados na transferência da posição do mento sejam tomados, como o uso de guias cirúrgicos específicos. Concluímos também que, frente a ausência de acurácia na previsão dos tecidos moles do terço inferior, é importante informar o paciente sobre as limitações da simulação.
Background: The objective of this research is to assess the accuracy of three-dimensional virtual surgical planning and the accuracy of three software applications, namely IPS Case Designer 2.2.5.2 (KLS Martin, Tuttlingen, Germany), NemoFAB 22.0.1 (Nemotec, Madrid, Spain) and Dolphin Imaging 3D 11.95. (Dolphin Imaging & Management Solutions, Chatsworth, CA, USA), in hard and soft tissue planning in patients with dento-skeletal deformities. In order to achieve this purpose, 23 patients with dento-skeletal-facial deformities undergoing orthognathic surgery were selected, who underwent preoperative, immediate postoperative and late postoperative CT scans. The results obtained in the surgery were measured and compared with the planning to evaluate the positional and rotational accuracy of the three-dimensional virtual planning technique. Afterwards, to ensure the accuracy of the applications, new planning was carried out with the postoperative positions as a reference, and the measured results were compared with the actual results. Discrepancies between the soft tissue planned in the three applications and the soft tissue obtained in the late postoperative period were also measured by calculating the root mean square value and the percentage of three-dimensional points with distances of less than 2 mm. With respect to the technique, the 3D virtual planning proved to be accurate for transferring positions and orientations, except for the sagittal position of the maxilla, with a median of -1.57 mm (CI95m -2.80 – -0.81 mm), of the mandible, with a median of -1.83 mm (CI95m -2.76 – -0.62 mm), and of the chin, with a median of -3.36 mm (CI95m -5.52 – -1.130 mm) and for the vertical position of the chin, with a median of 0.72 mm (CI95m -0.37 – 2.96 mm), which exceed the acceptable clinical limits (<2 mm for positional differences and <4° for rotational differences). In relation to the accuracy of the applications, there was no statistical difference between their measurements and actual measurements. About the accuracy of soft tissue prediction, the face was separated into subregions and the applications showed results within acceptable clinical limits in the prediction of the paranasal area and nose, although they were not accurate enough to simulate upper lips, lower lips and chin. When comparing them, there was no statistical difference between the applications in any of the parameters evaluated in the different sub-regions. It has been concluded that the technique and applications studied can be successfully used in the treatment of patients who need to undergo orthognathic surgery, provided that special attention is paid to the sagittal repositioning of the maxillomandibular complex and that caution is taken in transferring the position of the chin, namely the use of specific surgical guides. It has also been concluded that the applications provide a limited prediction of the soft tissues of the lower third, and it is important to inform patients about the limitations of the simulation.
Background: The objective of this research is to assess the accuracy of three-dimensional virtual surgical planning and the accuracy of three software applications, namely IPS Case Designer 2.2.5.2 (KLS Martin, Tuttlingen, Germany), NemoFAB 22.0.1 (Nemotec, Madrid, Spain) and Dolphin Imaging 3D 11.95. (Dolphin Imaging & Management Solutions, Chatsworth, CA, USA), in hard and soft tissue planning in patients with dento-skeletal deformities. In order to achieve this purpose, 23 patients with dento-skeletal-facial deformities undergoing orthognathic surgery were selected, who underwent preoperative, immediate postoperative and late postoperative CT scans. The results obtained in the surgery were measured and compared with the planning to evaluate the positional and rotational accuracy of the three-dimensional virtual planning technique. Afterwards, to ensure the accuracy of the applications, new planning was carried out with the postoperative positions as a reference, and the measured results were compared with the actual results. Discrepancies between the soft tissue planned in the three applications and the soft tissue obtained in the late postoperative period were also measured by calculating the root mean square value and the percentage of three-dimensional points with distances of less than 2 mm. With respect to the technique, the 3D virtual planning proved to be accurate for transferring positions and orientations, except for the sagittal position of the maxilla, with a median of -1.57 mm (CI95m -2.80 – -0.81 mm), of the mandible, with a median of -1.83 mm (CI95m -2.76 – -0.62 mm), and of the chin, with a median of -3.36 mm (CI95m -5.52 – -1.130 mm) and for the vertical position of the chin, with a median of 0.72 mm (CI95m -0.37 – 2.96 mm), which exceed the acceptable clinical limits (<2 mm for positional differences and <4° for rotational differences). In relation to the accuracy of the applications, there was no statistical difference between their measurements and actual measurements. About the accuracy of soft tissue prediction, the face was separated into subregions and the applications showed results within acceptable clinical limits in the prediction of the paranasal area and nose, although they were not accurate enough to simulate upper lips, lower lips and chin. When comparing them, there was no statistical difference between the applications in any of the parameters evaluated in the different sub-regions. It has been concluded that the technique and applications studied can be successfully used in the treatment of patients who need to undergo orthognathic surgery, provided that special attention is paid to the sagittal repositioning of the maxillomandibular complex and that caution is taken in transferring the position of the chin, namely the use of specific surgical guides. It has also been concluded that the applications provide a limited prediction of the soft tissues of the lower third, and it is important to inform patients about the limitations of the simulation.
Descrição
Palavras-chave
Cirurgia ortognática, Procedimentos cirúrgicos ortognáticos, Tomografia computadorizada por Raios X, Orthognathic surgery, Orthognathic surgical procedures, Tomography, XRay computed