Accuracy of custom temporomandibular joint replacement surgery using a virtual surgical planning protocol
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ORIGINAL ARTICLE
Accuracy of custom temporomandibular joint replacement surgery using a virtual surgical planning protocol Mustafa Mian 1,2 & David Ackland 3 & Sarah Fink 4 & Nathan Wang 4 & George Dimitroulis 4,5 Received: 15 September 2020 / Accepted: 17 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Accurate placement of TMJ implant components may be facilitated by virtual surgical planning (VSP) technologies. The aim of this study was to assess the accuracy of a typical VSP protocol and describe the pattern of surgical error associated with total alloplastic TMJ replacement. Methods A retrospective analysis was undertaken on 40 adult patients who were implanted with a fully customised, 3D printed TMJ prosthesis due to end-stage TMJ disease. Planned TMJ implant position based on preoperative CBCT images was compared with final position on postoperative OPGs using a previously validated linear rescaling method. Translational discrepancy was described in the anterior-posterior direction and superior-inferior direction. Rotational discrepancy was described as anterior or posterior. Results Lin’s concordance between preoperative and postoperative position was 0.97, with no significant differences (p > 0.05). The Bland-Altman analysis showed a 95% limit of agreement between planned and final position of − 5.9 to 5.4 mm. Overall, final implant position was more anterior (0.4 mm), superior (0.4 mm) and posteriorly rotated (2.4°) compared with planned position. Conclusion The use of VSP in TMJ replacement surgery results in accurate implant placement with good agreement between planned and final implant position. Discrepancies in planned and final implant position tended to result in the mandibular component of the implant being translated anterior superiorly and rotated posteriorly, with potential implications for the biomechanical performance of the implant and overall device longevity. These results should be used to assist TMJ surgeons pre- and intraoperatively to facilitating accurate implant positioning and optimal surgical rehabilitation. Keywords Virtual surgical planning . TMJ replacement . 3D printing . OPG . CBCT
Introduction
* Mustafa Mian [email protected] 1
Oral and Maxillofacial Surgery Unit, Royal Dental Hospital of Melbourne, Carlton, Victoria, Australia
2
Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
3
Department of Biomedical Engineering, University of Melbourne, Parkville, Victoria, Australia
4
OMX Solutions, Melbourne, Victoria, Australia
5
Department of Surgery, St Vincent’s Hospital, Fitzroy, Victoria, Australia
Temporomandibular dysfunction refers to a wide spectrum of disease, from mild discomfort to debilitating pain and limited jaw opening. In end-stage temporomandibular dysfunction, where few or no joint structures are salvageable, total alloplastic TMJ replacement is an established treatment [1]. The major objectives of TMJ replacement are to restore mandibular form and function, reduce
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