Utilization of a 3D printed dental splint for registration during electromagnetically navigated mandibular surgery
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ORIGINAL ARTICLE
Utilization of a 3D printed dental splint for registration during electromagnetically navigated mandibular surgery S. G. Brouwer de Koning1 · J. J. M. Riksen2 · T. P. ter Braak2 · M. J. A. van Alphen1 · F. van der Heijden2 · W. H. Schreuder1 · L. H. E. Karssemakers1 · M. B. Karakullukcu1 · R. L. P. van Veen1 Received: 25 May 2020 / Accepted: 24 September 2020 © CARS 2020
Abstract Purpose A dental splint was developed for non-invasive rigid point-based registration in electromagnetically (EM) navigated mandibular surgery. Navigational accuracies of the dental splint were compared with the common approach, that is, using screws as landmarks. Methods A dental splint that includes reference registration notches was 3D printed. Different sets of three points were used for rigid point-based registration on a mandibular phantom: notches on the dental splint only, screws on the mandible, contralateral screws (the side of the mandible where the sensor is not fixated) and a combination of screws on the mandible and notches on the dental splint. The accuracy of each registration method was calculated using 45 notches at one side of the mandible and expressed as the target registration error (TRE). Results Average TREs of 0.83 mm (range 0.7–1.39 mm), 1.28 mm (1.03–1.7 mm), 2.62 mm (1.91–4.0 mm), and 1.34 mm (1.30–1.39 mm) were found, respectively, for point-based registration based on the splint only, screws on the mandible, screws on the contralateral side only, and screws combined with the splint. Conclusion For dentate patients, rigid point-based registration performs best utilizing a dental splint with notches. The dental splint is easy to implement in the surgical, and navigational, workflow, and the notches can be pinpointed and designated on the CT scan with high accuracy. For edentate patients, screws can be used for rigid point-based registration. However, a new design of the screws is recommended to improve the accuracy of designation on the CT scan. Keywords Mandibular surgery · Electromagnetic surgical navigation · Rigid point-based registration · Dental splint · Target registration error
Introduction Computer-aided-design/computer-aided-manufacturing (CAD/CAM) techniques are routinely used in mandibular surgery. To prepare for surgery, the surgeon uses a 3D rendered model of the mandible, that is, constructed from a preoperative computed tomography (CT) scan. The exact positions of the osteotomies are planned virtually, in order to achieve adequate tumor margins and to ensure
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R. L. P. van Veen [email protected]
1
Verwelius 3D Lab, Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
2
Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
an accurate fit of the bone segments that will be used for reconstruction after resection. To translate the positions of the osteotomies to the clinical situation in the operating room, patient-specific cutting guides and bone segment fixation plate
