Research progress of digital occlusion setup in orthognathic surgery_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Lei ,  NIU Feng

The 1st Department of Craniomaxillofacial Plastic Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100144, P. R. China;

Corresponding author：

NIU Feng, Email: niufeng@psh.pumc.edu.cn

Keywords：

Dental occlusion; computer simulation; orthognathic surgery; three-dimensional imaging; dental model

DOI：

10.7507/1002-1892.202210086

Video：

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Objective To review the research progress of digital occlusion setup in orthognathic surgery. Methods The literature related to digital occlusion setup in orthognathic surgery in recent years was consulted, and the imaging basis, methods, clinical applications as well as existing problems were reviewed. Results Digital occlusion setup in orthognathic surgery includes manual, semi-automatics, and fully automatic methods. The manual method mainly relies on visual cues for operation, which is difficult to ensure the best occlusion set up, though relatively flexible. The semi-automatic method utilizes the computer software for partial occlusion set up and adjustment, but the occlusion result is still largely depended by manual operation. The fully automatic method completely depends on the operation of computer software, and targeted algorithms for different occlusion reconstruction situations are needed. Conclusion The preliminary research results have confirmed the accuracy and reliability of digital occlusion setup in orthognathic surgery, but there are still some limitations. Further research is needed in terms of postoperative outcomes, doctor and patient acceptance, planning time and cost-effectiveness.

Citation： LI Lei, NIU Feng. Research progress of digital occlusion setup in orthognathic surgery. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(2): 247-251. doi: 10.7507/1002-1892.202210086 Copy

1.	Naran S, Steinbacher DM, Taylor JA. Current concepts in orthognathic surgery. Plast Reconstr Surg, 2018, 141(6): 925e-936e.
2.	Klein KP, Kaban LB, Masoud MI. Orthognathic surgery and orthodontics: Inadequate planning leading to complications or unfavorable results. Oral Maxillofac Surg Clin North Am, 2020, 32(1): 71-82.
3.	Ter Horst R, van Weert H, Loonen T, et al. Three-dimensional virtual planning in mandibular advancement surgery: Soft tissue prediction based on deep learning. J Craniomaxillofac Surg, 2021, 49(9): 775-782.
4.	McAllister P, Watson M, Burke E. A cost-effective, in-house, positioning and cutting guide system for orthognathic surgery. J Maxillofac Oral Surg, 2018, 17(1): 112-114.
5.	Lo LJ, Niu LS, Liao CH, et al. A novel CAD/CAM composite occlusal splint for intraoperative verification in single-splint two-jaw orthognathic surgery. Biomed J, 2021, 44(3): 353-362.
6.	Ho CT, Denadai R, Lai HC, et al. Computer-aided planning in orthognathic surgery: A comparative study with the establishment of burstone analysis-derived 3D norms. J Clin Med, 2019, 8(12): 2106. doi: 10.3390/jcm8122106.
7.	Goulart ME, Biegelmeyer TC, Moreira-Souza L, et al. What is the accuracy of the surgical guide in the planning of orthognathic surgeries? A systematic review. Med Oral Patol Oral Cir Bucal, 2022, 27(2): e125-e134.
8.	Ho CT, Lin HH, Lo LJ. Intraoral scanning and setting up the digital final occlusion in three-dimensional planning of orthognathic surgery: Its comparison with the dental model approach. Plast Reconstr Surg, 2019, 143(5): 1027e-1036e.
9.	Liu XJ, Li QQ, Zhang Z, et al. Virtual occlusal definition for orthognathic surgery. Int J Oral Maxillofac Surg, 2016, 45(3): 406-411.
10.	Beek DM, Baan F, Liebregts J, et al. Surgical accuracy in 3D planned bimaxillary osteotomies: intraoral scans and plaster casts as digital dentition models. Int J Oral Maxillofac Surg, 2022, 51(7): 922-928.
11.	Badiali G, Costabile E, Lovero E, et al. Virtual orthodontic surgical planning to improve the accuracy of the surgery-first approach: A prospective evaluation. J Oral Maxillofac Surg, 2019, 77(10): 2104-2115.
12.	Glisic O, Hoejbjerre L, Sonnesen L. A comparison of patient experience, chair-side time, accuracy of dental arch measurements and costs of acquisition of dental models. Angle Orthod, 2019, 89(6): 868-875.
13.	Hou X, Xu X, Zhao M, et al. An overview of three-dimensional imaging devices in dentistry. J Esthet Restor Dent, 2022, 34(8): 1179-1196.
14.	Ajmera DH, Hsung RT, Singh P, et al. Three-dimensional assessment of facial asymmetry in Class Ⅲ subjects. Part 1:a retrospective study evaluating postsurgical outcomes. Clin Oral Investig, 2022, 26(7): 4947-4966.
15.	Ye J, Wang S, Wang Z, et al. Comparison of the dimensional and morphological accuracy of three-dimensional digital dental casts digitized using different methods. Odontology, 2022. doi: 10.1007/s10266-022-00736-2.
16.	Rangel FA, Maal TJJ, de Koning MJJ, et al. Integration of digital dental casts in cone beam computed tomography scans-a clinical validation study. Clin Oral Investig, 2018, 22(3): 1215-1222.
17.	Baan F, Bruggink R, Nijsink J, et al. Fusion of intra-oral scans in cone-beam computed tomography scans. Clin Oral Investig, 2021, 25(1): 77-85.
18.	Zou B, Kim JH, Kim SH, et al. Accuracy of a surface-based fusion method when integrating digital models and the cone beam computed tomography scans with metal artifacts. Sci Rep, 2022, 12(1): 8034. doi: 10.1038/s41598-022-11677-9.
19.	Liao YF, Atipatyakul P, Chen YH, et al. Skeletal stability after bimaxillary surgery with surgery-first approach for class Ⅲ asymmetry is not related to virtual surgical occlusal contact. Clin Oral Investig, 2022, 26(7): 4935-4945.
20.	Elnagar MH, Aronovich S, Kusnoto B. Digital workflow for combined orthodontics and orthognathic surgery. Oral Maxillofac Surg Clin North Am, 2020, 32(1): 1-14.
21.	De Luca Canto G, Pachêco-Pereira C, Lagravere MO, et al. Intra-arch dimensional measurement validity of laser-scanned digital dental models compared with the original plaster models: a systematic review. Orthod Craniofac Res, 2015, 18(2): 65-76.
22.	Emir F, Ayyıldız S. Evaluation of the trueness and precision of eight extraoral laboratory scanners with a complete-arch model: a three-dimensional analysis. J Prosthodont Res, 2019, 63(4): 434-439.
23.	Apostolakis D, Michelinakis G, Kourakis G, et al. Accuracy of triangular meshes of stone models created from DICOM cone beam CT data. Int J Implant Dent, 2019, 5(1): 20. doi: 10.1186/s40729-019-0171-9.
24.	Pagano S, Moretti M, Marsili R, et al. Evaluation of the accuracy of four digital methods by linear and volumetric analysis of dental impressions. Materials (Basel), 2019, 12(12): 1958. doi: 10.3390/ma12121958.
25.	Becker K, Schmücker U, Schwarz F, et al. Accuracy and eligibility of CBCT to digitize dental plaster casts. Clin Oral Investig, 2018, 22(4): 1817-1823.
26.	Suese K. Progress in digital dentistry: The practical use of intraoral scanners. Dent Mater J, 2020, 39(1): 52-56.
27.	Sfondrini MF, Gandini P, Malfatto M, et al. Computerized casts for orthodontic purpose using powder-free intraoral scanners: accuracy, execution time, and patient feedback. Biomed Res Int, 2018, 2018: 4103232. doi: 10.1155/2018/4103232.
28.	Rotar RN, Faur AB, Pop D, et al. Scanning distance influence on the intraoral scanning accuracy-an in vitro study. Materials (Basel), 2022, 15(9): 3061. doi: 10.3390/ma15093061.
29.	Wesemann C, Kienbaum H, Thun M, et al. Does ambient light affect the accuracy and scanning time of intraoral scans? J Prosthet Dent, 2021, 125(6): 924-931.
30.	Amornvit P, Rokaya D, Sanohkan S. Comparison of accuracy of current ten intraoral scanners. Biomed Res Int, 2021, 2021: 2673040.
31.	Kong L, Li Y, Liu Z. Digital versus conventional full-arch impressions in linear and 3D accuracy: a systematic review and meta-analysis of in vivo studies. Clin Oral Investig, 2022, 26(9): 5625-5642.
32.	Kim YK, Kim SH, Choi TH, et al. Accuracy of intraoral scan images in full arch with orthodontic brackets: a retrospective in vivo study. Clin Oral Investig, 2021, 25(8): 4861-4869.
33.	Lee JH, Yun JH, Han JS, et al. Repeatability of intraoral scanners for complete arch scan of partially edentulous dentitions: An in vitro study. J Clin Med, 2019, 8(8): 1187. doi: 10.3390/jcm8081187.
34.	Zarauz C, Sailer I, Pitta J, et al. Influence of age and scanning system on the learning curve of experienced and novel intraoral scanner operators: A multi-centric clinical trial. J Dent, 2021, 115: 103860. doi: 10.1016/j.jdent.2021.103860.
35.	Róth I, Czigola A, Joós-Kovács GL, et al. Learning curve of digital intraoral scanning-an in vivo study. BMC Oral Health, 2020, 20(1): 287. doi: 10.1186/s12903-020-01278-1.
36.	Liao YF, Lo SH. Surgical occlusion setup in correction of skeletal class Ⅲ deformity using surgery-first approach: Guidelines, characteristics and accuracy. Sci Rep, 2018, 8(1): 11673. doi: 10.1038/s41598-018-30124-2.
37.	Seo HJ, Denadai R, Pai BC, et al. Digital occlusion setup is quantitatively comparable with the conventional dental model approach: Characteristics and guidelines for orthognathic surgery in patients with unilateral cleft lip and palate. Ann Plast Surg, 2020, 85(2): 171-179.
38.	Frick CJ, Deng HH, English JD, et al. Clinical feasibility evaluation of digital dental articulation for three-piece maxillary orthognathic surgery: a proof-of-concept study. Int J Oral Maxillofac Surg, 2022, 51(8): 1043-1049.
39.	Ji H, Du W, Xu C, et al. Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry. Int J Oral Maxillofac Surg, 2019, 48(8): 1043-1050.
40.	Wu W, Chen H, Cen Y, et al. Haptic simulation framework for determining virtual dental occlusion. Int J Comput Assist Radiol Surg, 2017, 12(4): 595-606.
41.	Pongrácz F, Bárdosi Z. Dentition planning with image-based occlusion analysis. International Journal of Computer Assisted Radiology and Surgery, 2006, 1(3): 149-156.
42.	Nadjmi N, Mollemans W, Daelemans A, et al. Virtual occlusion in planning orthognathic surgical procedures. Int J Oral Maxillofac Surg, 2010, 39(5): 457-462.
43.	Awad D, Häfner A, Reinert S, et al. Plaster casts vs. intraoral scans:Do different methods of determining the final occlusion affect the simulated outcome in orthognathic surgery? J Pers Med, 2022, 12(8): 1288. doi: 10.3390/jpm12081288.
44.	Baan F, Van Meggelen EM, Verhulst AC, et al. Virtual occlusion in orthognathic surgery. Int J Oral Maxillofac Surg, 2021, 50(9): 1219-1225.
45.	Chang YB, Xia JJ, Gateno J, et al. An automatic and robust algorithm of reestablishment of digital dental occlusion. IEEE Trans Med Imaging, 2010, 29(9): 1652-1663.
46.	Deng H, Yuan P, Wong S, et al. An automatic approach to establish clinically desired final dental occlusion for one-piece maxillary orthognathic surgery. Int J Oral Maxillofac Surg, 2020, 15(11): 1763-1773.
47.	Wong S, Deng H, Gateno J, et al. Clinical evaluation of digital dental articulation for one-piece maxillary surgery. J Oral Maxillofac Surge, 2020, 78(5): 799-805.
48.	Zhang J, Xia JJ, Li J, et al. Reconstruction-based digital dental occlusion of the partially edentulous dentition. IEEE J Biomed Health Inform, 2017, 21(1): 201-210.
49.	Chang YB, Xia JJ, Gateno J, et al. In vitro evaluation of new approach to digital dental model articulation. J Oral Maxillofac Surg, 2012, 70(4): 952-962.
50.	Khosravi-Kamrani P, Qiao X, Zanardi G, et al. A machine learning approach to determine the prognosis of patients with Class Ⅲ malocclusion. Am J Orthod Dentofacial Orthop, 2022, 161(1): e1-e11.

1. Naran S, Steinbacher DM, Taylor JA. Current concepts in orthognathic surgery. Plast Reconstr Surg, 2018, 141(6): 925e-936e.
2. Klein KP, Kaban LB, Masoud MI. Orthognathic surgery and orthodontics: Inadequate planning leading to complications or unfavorable results. Oral Maxillofac Surg Clin North Am, 2020, 32(1): 71-82.
3. Ter Horst R, van Weert H, Loonen T, et al. Three-dimensional virtual planning in mandibular advancement surgery: Soft tissue prediction based on deep learning. J Craniomaxillofac Surg, 2021, 49(9): 775-782.
4. McAllister P, Watson M, Burke E. A cost-effective, in-house, positioning and cutting guide system for orthognathic surgery. J Maxillofac Oral Surg, 2018, 17(1): 112-114.
5. Lo LJ, Niu LS, Liao CH, et al. A novel CAD/CAM composite occlusal splint for intraoperative verification in single-splint two-jaw orthognathic surgery. Biomed J, 2021, 44(3): 353-362.
6. Ho CT, Denadai R, Lai HC, et al. Computer-aided planning in orthognathic surgery: A comparative study with the establishment of burstone analysis-derived 3D norms. J Clin Med, 2019, 8(12): 2106. doi: 10.3390/jcm8122106.
7. Goulart ME, Biegelmeyer TC, Moreira-Souza L, et al. What is the accuracy of the surgical guide in the planning of orthognathic surgeries? A systematic review. Med Oral Patol Oral Cir Bucal, 2022, 27(2): e125-e134.
8. Ho CT, Lin HH, Lo LJ. Intraoral scanning and setting up the digital final occlusion in three-dimensional planning of orthognathic surgery: Its comparison with the dental model approach. Plast Reconstr Surg, 2019, 143(5): 1027e-1036e.
9. Liu XJ, Li QQ, Zhang Z, et al. Virtual occlusal definition for orthognathic surgery. Int J Oral Maxillofac Surg, 2016, 45(3): 406-411.
10. Beek DM, Baan F, Liebregts J, et al. Surgical accuracy in 3D planned bimaxillary osteotomies: intraoral scans and plaster casts as digital dentition models. Int J Oral Maxillofac Surg, 2022, 51(7): 922-928.
11. Badiali G, Costabile E, Lovero E, et al. Virtual orthodontic surgical planning to improve the accuracy of the surgery-first approach: A prospective evaluation. J Oral Maxillofac Surg, 2019, 77(10): 2104-2115.
12. Glisic O, Hoejbjerre L, Sonnesen L. A comparison of patient experience, chair-side time, accuracy of dental arch measurements and costs of acquisition of dental models. Angle Orthod, 2019, 89(6): 868-875.
13. Hou X, Xu X, Zhao M, et al. An overview of three-dimensional imaging devices in dentistry. J Esthet Restor Dent, 2022, 34(8): 1179-1196.
14. Ajmera DH, Hsung RT, Singh P, et al. Three-dimensional assessment of facial asymmetry in Class Ⅲ subjects. Part 1:a retrospective study evaluating postsurgical outcomes. Clin Oral Investig, 2022, 26(7): 4947-4966.
15. Ye J, Wang S, Wang Z, et al. Comparison of the dimensional and morphological accuracy of three-dimensional digital dental casts digitized using different methods. Odontology, 2022. doi: 10.1007/s10266-022-00736-2.
16. Rangel FA, Maal TJJ, de Koning MJJ, et al. Integration of digital dental casts in cone beam computed tomography scans-a clinical validation study. Clin Oral Investig, 2018, 22(3): 1215-1222.
17. Baan F, Bruggink R, Nijsink J, et al. Fusion of intra-oral scans in cone-beam computed tomography scans. Clin Oral Investig, 2021, 25(1): 77-85.
18. Zou B, Kim JH, Kim SH, et al. Accuracy of a surface-based fusion method when integrating digital models and the cone beam computed tomography scans with metal artifacts. Sci Rep, 2022, 12(1): 8034. doi: 10.1038/s41598-022-11677-9.
19. Liao YF, Atipatyakul P, Chen YH, et al. Skeletal stability after bimaxillary surgery with surgery-first approach for class Ⅲ asymmetry is not related to virtual surgical occlusal contact. Clin Oral Investig, 2022, 26(7): 4935-4945.
20. Elnagar MH, Aronovich S, Kusnoto B. Digital workflow for combined orthodontics and orthognathic surgery. Oral Maxillofac Surg Clin North Am, 2020, 32(1): 1-14.
21. De Luca Canto G, Pachêco-Pereira C, Lagravere MO, et al. Intra-arch dimensional measurement validity of laser-scanned digital dental models compared with the original plaster models: a systematic review. Orthod Craniofac Res, 2015, 18(2): 65-76.
22. Emir F, Ayyıldız S. Evaluation of the trueness and precision of eight extraoral laboratory scanners with a complete-arch model: a three-dimensional analysis. J Prosthodont Res, 2019, 63(4): 434-439.
23. Apostolakis D, Michelinakis G, Kourakis G, et al. Accuracy of triangular meshes of stone models created from DICOM cone beam CT data. Int J Implant Dent, 2019, 5(1): 20. doi: 10.1186/s40729-019-0171-9.
24. Pagano S, Moretti M, Marsili R, et al. Evaluation of the accuracy of four digital methods by linear and volumetric analysis of dental impressions. Materials (Basel), 2019, 12(12): 1958. doi: 10.3390/ma12121958.
25. Becker K, Schmücker U, Schwarz F, et al. Accuracy and eligibility of CBCT to digitize dental plaster casts. Clin Oral Investig, 2018, 22(4): 1817-1823.
26. Suese K. Progress in digital dentistry: The practical use of intraoral scanners. Dent Mater J, 2020, 39(1): 52-56.
27. Sfondrini MF, Gandini P, Malfatto M, et al. Computerized casts for orthodontic purpose using powder-free intraoral scanners: accuracy, execution time, and patient feedback. Biomed Res Int, 2018, 2018: 4103232. doi: 10.1155/2018/4103232.
28. Rotar RN, Faur AB, Pop D, et al. Scanning distance influence on the intraoral scanning accuracy-an in vitro study. Materials (Basel), 2022, 15(9): 3061. doi: 10.3390/ma15093061.
29. Wesemann C, Kienbaum H, Thun M, et al. Does ambient light affect the accuracy and scanning time of intraoral scans? J Prosthet Dent, 2021, 125(6): 924-931.
30. Amornvit P, Rokaya D, Sanohkan S. Comparison of accuracy of current ten intraoral scanners. Biomed Res Int, 2021, 2021: 2673040.
31. Kong L, Li Y, Liu Z. Digital versus conventional full-arch impressions in linear and 3D accuracy: a systematic review and meta-analysis of in vivo studies. Clin Oral Investig, 2022, 26(9): 5625-5642.
32. Kim YK, Kim SH, Choi TH, et al. Accuracy of intraoral scan images in full arch with orthodontic brackets: a retrospective in vivo study. Clin Oral Investig, 2021, 25(8): 4861-4869.
33. Lee JH, Yun JH, Han JS, et al. Repeatability of intraoral scanners for complete arch scan of partially edentulous dentitions: An in vitro study. J Clin Med, 2019, 8(8): 1187. doi: 10.3390/jcm8081187.
34. Zarauz C, Sailer I, Pitta J, et al. Influence of age and scanning system on the learning curve of experienced and novel intraoral scanner operators: A multi-centric clinical trial. J Dent, 2021, 115: 103860. doi: 10.1016/j.jdent.2021.103860.
35. Róth I, Czigola A, Joós-Kovács GL, et al. Learning curve of digital intraoral scanning-an in vivo study. BMC Oral Health, 2020, 20(1): 287. doi: 10.1186/s12903-020-01278-1.
36. Liao YF, Lo SH. Surgical occlusion setup in correction of skeletal class Ⅲ deformity using surgery-first approach: Guidelines, characteristics and accuracy. Sci Rep, 2018, 8(1): 11673. doi: 10.1038/s41598-018-30124-2.
37. Seo HJ, Denadai R, Pai BC, et al. Digital occlusion setup is quantitatively comparable with the conventional dental model approach: Characteristics and guidelines for orthognathic surgery in patients with unilateral cleft lip and palate. Ann Plast Surg, 2020, 85(2): 171-179.
38. Frick CJ, Deng HH, English JD, et al. Clinical feasibility evaluation of digital dental articulation for three-piece maxillary orthognathic surgery: a proof-of-concept study. Int J Oral Maxillofac Surg, 2022, 51(8): 1043-1049.
39. Ji H, Du W, Xu C, et al. Computer-assisted osteotomy guides and pre-bent titanium plates improve the planning for correction of facial asymmetry. Int J Oral Maxillofac Surg, 2019, 48(8): 1043-1050.
40. Wu W, Chen H, Cen Y, et al. Haptic simulation framework for determining virtual dental occlusion. Int J Comput Assist Radiol Surg, 2017, 12(4): 595-606.
41. Pongrácz F, Bárdosi Z. Dentition planning with image-based occlusion analysis. International Journal of Computer Assisted Radiology and Surgery, 2006, 1(3): 149-156.
42. Nadjmi N, Mollemans W, Daelemans A, et al. Virtual occlusion in planning orthognathic surgical procedures. Int J Oral Maxillofac Surg, 2010, 39(5): 457-462.
43. Awad D, Häfner A, Reinert S, et al. Plaster casts vs. intraoral scans:Do different methods of determining the final occlusion affect the simulated outcome in orthognathic surgery? J Pers Med, 2022, 12(8): 1288. doi: 10.3390/jpm12081288.
44. Baan F, Van Meggelen EM, Verhulst AC, et al. Virtual occlusion in orthognathic surgery. Int J Oral Maxillofac Surg, 2021, 50(9): 1219-1225.
45. Chang YB, Xia JJ, Gateno J, et al. An automatic and robust algorithm of reestablishment of digital dental occlusion. IEEE Trans Med Imaging, 2010, 29(9): 1652-1663.
46. Deng H, Yuan P, Wong S, et al. An automatic approach to establish clinically desired final dental occlusion for one-piece maxillary orthognathic surgery. Int J Oral Maxillofac Surg, 2020, 15(11): 1763-1773.
47. Wong S, Deng H, Gateno J, et al. Clinical evaluation of digital dental articulation for one-piece maxillary surgery. J Oral Maxillofac Surge, 2020, 78(5): 799-805.
48. Zhang J, Xia JJ, Li J, et al. Reconstruction-based digital dental occlusion of the partially edentulous dentition. IEEE J Biomed Health Inform, 2017, 21(1): 201-210.
49. Chang YB, Xia JJ, Gateno J, et al. In vitro evaluation of new approach to digital dental model articulation. J Oral Maxillofac Surg, 2012, 70(4): 952-962.
50. Khosravi-Kamrani P, Qiao X, Zanardi G, et al. A machine learning approach to determine the prognosis of patients with Class Ⅲ malocclusion. Am J Orthod Dentofacial Orthop, 2022, 161(1): e1-e11.

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