3D Virtual Treatment Planning of Orthognathic Surgery: A Step-by-Step Approach for Orthodontists and Surgeons

580 Pages·2017·74.76 MB·English

by  Gwen Swennen (eds.)

Gwen R.J. Swennen
Editor
3D Virtual Treatment
Planning of
Orthognathic Surgery
A Step-by-Step Approach for
Orthodontists and Surgeons
123
3D Virtual Treatment Planning of Orthognathic Surgery
Gwen R.J. Swennen
Editor
3D Virtual
Treatment Planning
of Orthognathic
Surgery
A Step-by-Step Approach for Orthodontists
and Surgeons
With Contributions by Martin Gaboury
Editor
Gwen R .J. Swennen
Division of Maxillofacial Surgery and Facial Plastic Surgery
Department of Surgery , General Hospital St-Jan Bruges-Ostend , Belgium
Bruges Cleft and Craniofacial Centre , Bruges , Belgium
Private Practice in Facial Cosmetic Surgery , Clinic Tilleghem , Bruges , Belgium
Associate Professor, Department of Oral and Maxillofacial Surgery
Hannover Medical School , Hannover , Germany
Affi liate Professor, Department of Oral and Maxillofacial Surgery
U niversity of Catalunya, B arcelona, S pain
ISBN 978-3-662-47388-7 ISBN 978-3-662-47389-4 (eBook)
DOI 10.1007/978-3-662-47389-4
Library of Congress Control Number: 2016957321
© Springer-Verlag Berlin Heidelberg 2017
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First of all, I want to dedicate this book to my lovely wife Valérie and my sons Joaquin
and Cédrique.
I also want to dedicate this colour atlas and manual to my former chairman,
colleague and above all personal good friend, Professor Calix De Clercq.
Gwen R. J. Swennen
Foreword I
I n the fi rst half of the previous century, long-term stability aft er orthognathic
radiographic cephalometry moved the surgery. Th e correction of cranio-facial
focus of orthodontists from malocclusions malformations and a symmetries by sur-
towards underlying skeletal disharmonies. gical repositioning of both jaws, and
Linear and angular measurements were not complex rotations in 3 planes, can now
only used to study the dento-alveolar virtually be simulated with high accuracy.
s tructures in relation to the jaws but also Intermediate wafers made by CAD/CAM
the jaws in relation to the rest of the cranio- or 3D printing are the link between the
facial complex. Data collected from longi- virtual simulation and the surgeon in the
tudinal growth studies were used to better operating room.
understand complex facial changes and
establish reference values for “ normality”. Gwen Swennen has written a masterpiece
For many decades, these cephalometric helping us to better explore all new
values and proportions were the bases for a p otentials of 3D imaging for the planning
better diagnosis of cranio-facial malforma- of orthognathic surgery. With splendid
tions, the planning of orthognathic surgery illustrations and step-by-step procedures,
and the long-term evaluation of treatment this is the perfect guide for all clinicians,
outcome. However, cephalometric analyses young and old, to improve their skills in
are limited to 2 dimensions. extracting and implementing all these data
for further improvement of the quality of
With the introduction of the cone- beam patient care. Th is atlas and manual is the
CT, reduction of the costs for the hard- result of many years of enthusiastic
ware and reduction of the radiation dose, research by the author. His input for the
3D imaging became available for a grow- development of adapted soft ware makes
ing group of clinicians and a standard this technology available to all of us. We
tool for diagnosis and treatment planning are grateful to the author willing to share
in several disciplines. Colour maps gener- his expertise with us.
ated aft er registration of 2 consecutive
CBCTs on stable structures in the ante- Professor Hugo De Clerck, DDS, PhD
rior cranial base give us new tools to Orthodontic Private Practice,
assess in  detail hard and soft tissue Brussels, Belgium
changes over time. Th is is a revolution for Adjunct Professor, Department of
future research to study growth modifi ca- Orthodontics,
tions induced by dento-facial orthopae- Chapel Hill NC, USA
dic appliances, treatment outcome and August 2016
vii
Foreword II
Foreword II
I fi rst met Gwen Swennen in May 2009, at same change. My personal shift to 3D vir-
the Spanish Association of Oral and Max- tual planning happened, and today, aft er 3
illofacial Surgery meeting in Bilbao. At years of its routine clinical application, I
that moment, I was still conventionally have become absolutely convinced.
planning my surgeries with good results
and was deeply convinced that computers Anyway, aft er this personal digression, let
would just unnecessarily complicate my us focus on Gwen Swennen’s book. It was
routine work, besides being eventually in Melbourne, last October, during the
time consuming. It was in that precise ICOMS 2015 congress that I assisted to the
occasion that I had the opportunity to fi rst presentation of his “integrated” work.
attend Gwen’s lecture on 3D virtual plan- Once more, Gwen surprised me with the
ning which was utterly enlightening. Th e lucidity and clarity with which he system-
speaker’s clear and rigorous demonstra- atized his pioneering work.
tion of the concept’s sequence, the high
quality of the images proposed, and the First, it is an atlas, a manual notwith-
compelling logic of the processes forced standing its impressive dimension. Th e
me to a critical revision of my own every- author’s experience is so deep that the
day activities. Th at young and clever sur- manuscript focuses on all aspects of 3D
geon had literally enchanted me, thanks to virtual planning of orthognathic surgery.
his technical knowledge and his passionate Th e division in thematic chapters is prone
application of 3D virtual planning of to a rapid consultation on specifi c topics.
orthognathic surgery. All subjects are exemplifi ed with illustra-
tions and easily understandable to a gen-
We became good friends and, since then, eral public. Diagnosis, transition from
we have been taking advantage of con- clinical practice to digital representation,
gresses and meetings around the world to orthodontical and surgical planning, and
meet, to reinforce our mutual consider- risk evaluation are clearly analyzed.
ation and respect, while sharing profes- Moreover, tricks but also potential pit-
sional and private experiences with a touch falls, risks, mistakes, and their prevention
of irony and j oie de vivre . All occasions are included in the treatise. Finally, a
were perfect to spend some spare time great variety of cases are shown as exam-
with Gwen and Valérie, his precious wife, ples in Chap. 6 .
in Bruges or in Knokke.
In short, all clinical relevant topics are
It was in 2011 that, aft er passionately critically analyzed by the author, who has
devouring all Gwen Swennen’s articles and been rationally applying his knowledge to
publications, I fi nally decided to convert to his everyday clinical routine practice,
3D virtual planning. I attended one of his going from fi rst intuitions to actual sim-
courses in Bruges which defi nitely con- plifi cation and moreover evaluation of
vinced me, and from that moment I dived potential future applications. Prof. Gwen
into 3D virtual planning. I was helped by Swennen with his well-known and recog-
two valid surgeons and friends in this quest: nized generosity is off ering the reader his
Prof. Dr. Federico Hernandez Alfaro and, fatigue, his knowledge, and his vast clini-
above all, Dr. Simonas Gribauskas. More- cal experience toward this subject. I am
over, I witnessed Dr. Bill Arnett, to whom I defi nitely suggesting his book to anyone
have tremendous respect, also making the who approaches 3D virtual planning in
v iii Foreword II
orthognathic surgery, ensuring that he from practical information to improve
will fi nd in this work a theological their own clinical practice in maxillofacial
“summa” on the subject. deformity surgery.
Moreover, even those surgeons who still Professor Mirco Raff aini, MD
rely on conventional planning technique Maxillofacial Surgery, University of
are advised to read Gwen Swennen’s book Florence, Florence, Italy
since they may fi nd in these pages, that Founder and Director, Face Surgery
sort of fl ash of inspiration which leads to Center, Parma, Italy
a  substantial change, besides benefi ting August 2016
ix
Pref ace
… Existing paradigms are held by a in the daily clinical routine. Th is book is
scientifi c community. They explain based on my personal experience having
observations, are the basis for being involved in more than 2700 clinical
communication and guide future cases on virtual planning since almost 20
research … years. Moreover, I was fortunate to be
… Observations that don’t fi t the c ontinuously triggered over all these years
paradigm are ignored, or are explained by my colleagues, residents, fellows, sur-
in ways that fi t the paradigm … geons and orthodontists all over the world
… A crisis occurs when the existing during scientifi c meetings, courses and
paradigms no longer explains the workshops.
observations and new theories arise.
Th e concept towards “step-by-step” indi-
A revolution occurs and new
vidualised and integrated 3D virtual
paradigms are accepted …
treatment planning of orthognathic sur-
… Once a paradigm shift has occurred,
gery outlined in this book aims to make
a veritable explosion of new ideas
once again the bridge between conven-
and information leads to rapid
tional and 3D virtual treatment plan-
advances in the fi eld …
ning:
Thomas S. Kuhn:
1. (3D-VPS ) “3D Cephalometry of
The Structure of Scientifi c Revolutions. 1
the Patient’s Hard Tissues and Teeth
The University of Chicago Press. 1996
(Sect. 2 .2.2 ) ” can be compared to
conventional cephalometric tracing.
When I refl ect on this new project, I realise 2. (3D-VPS ) “3D Cephalometry of the
2
that I was already playing with the idea Patient’s Soft Tissues (Sect. 2 .2.3 ) “can be
and preliminary outline of this book in my compared with direct or indirect anthro-
mind since 2009. Th is would defi nitely pometric assessment of the patient.
have been too early, and the book would 3. (3D-VPS ) “3D Virtual Osteotomies
3
most probably have been outdated already. (Sect. 3 .2 ) ” can be compared to some
Th e idea of our “Colour Atlas and Manual extent with conventional
on Th ree-Dimensional Cephalometry “orthognathic model surgery”.
(2005)” was an attempt to bridge conven- 4. (3D-VPS ) “3D Virtual Occlusal
4
tional cephalometry with the 3D virtual Defi nition (Sect. 3.3 ) ” can be
approach and 3D cephalometry. It is amaz- compared with conventional occlusal
ing that aft er more than 10 years the concept defi nition on plaster dental models.
of this latter atlas is currently more than 5. (3D-VPS ) “10 Step-by-Step Individu-
5
actual for both orthodontists and surgeons. alised 3D Virtual Treatment Planning
(Sect. 3 .5 ) ” fi nally attempts to provide
With this new book, I hope to off er a com- the clinician a manner to integrate 3D
prehensive, systematic, standardised and virtual planning in daily clinical rou-
above all individualised approach towards tine based on the concepts of conven-
3D virtual planning of orthognathic surgery tional treatment planning.
x Preface
Th e underlying philosophy of this colour Orthognathic and Orthofacial Surgery” to
atlas and manual is not to dogmatise but to further improve patient care.
push forward “the paradigm shift ” that
truly occurred in treatment planning of Professor Gwen R. J. Swennen , MD, DMD,
orthognathic surgery and especially stim- PhD, MSc, FEBOMFS
ulate further development and innovation Bruges, Belgium
in “3D Virtual Treatment Planning of August 2016