14h50 Real-Time 3D Intraoperative Accuracy Verification in Orthognathic Surgery Using Intraoperative CBCT: Validation of IPS CaseDesigner and Comparison with Brainlab Elements - A Feasibility Study
Authors: Xander Jackers1, G. De Fazio Renato1,5, A. Diez-Fraile1,2, J. Abeloos1, T. De Backer1,4, J. De Ceulaer1,4, C. De Clercq1, F. De Ketelaere3, M. Desmedt1,4, P. Lamoral1,3, K. Nagy1, N. Neyt1,4, K. Supply3, B. Veys1,3, C. Spaas1,4, G. Swennen1
1 Division of Maxillo-Facial Surgery, Department of Surgery, AZ Sint-Jan Brugge, Ruddershove 10, 8000 Bruges, Belgium
2 Clinical Research Scientist, Division of Maxillo-Facial Surgery, Department of Surgery, AZ Sint Jan Brugge, Ruddershove 10, 8000 Bruges, Belgium
3 Division of Maxillo-Facial Surgery, Department of Surgery, AZ Sint-Lucas, Sint-Lucaslaan 29, 8310 Bruges, Belgium
4 Division of Maxillo-Facial Surgery, Department of Surgery, AZ ZENO, Kalvekeetdijk 260, 8300 Knokke, Belgium
5 Division of Maxillo-Facial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
Keywords: orthognathic, 3D Intra-operative imaging & accuracy, 3D superimposition software, 3D virtual planning.
Objectives: 3D virtual planning has revolutionized orthognathic surgery by enabling more precise diagnoses and predictive treatment planning, ultimately aiming for optimal function and aesthetics. However, the intraoperative (IO) transfer of 3D virtual plans remains prone to errors. Enhancing preoperative data acquisition, adopting standardized and clinically focused 3D virtual planning protocols, and refining surgical techniques can potentially improve the accuracy of planned movements. Despite these advances, current methods for verifying treatment outcome during surgery are limited, relying primarily on conventional clinical assessment which may be subject to bias. Recent technological advances, such as IO CBCT imaging and automated virtual superimposition software tools (e.g., IPS Casedesigner, Brainlab), now enable real- time, high-quality, and more objective evaluations.
Materials and Methods: this study has been designed to qualitatively and quantitatively evaluate and validate the module of the IPS CaseDesigner software (KLS Martin). Thirty-six patient cases, all operated by the same surgeon (GS), were each analyzed twice by two independent observers (GLDF, XJ). The accuracy of three translational and three rotational movements was calculated. We also assessed inter- and intra- observer variability, as well as differences in clinical interpretation and duration of real-time IO evaluations. Finally, an illustrative comparison was made to the superimposition tool of the Brainlab Elements software.
Results: the results of this study demonstrated good inter- and intra-observer accuracy for the “Compare Models” tool in IPS Casedesigner. A comparison with Brainlab Elements software revealed nuanced differences in functionality and performance.
Conclusion: while 3D virtual planning of orthognathic surgery has become the standard of care, 3D evaluation of treatment outcomes remains less commonly implemented. However, several new software tools are now available for real-time IO or immediate postoperative outcome evaluation. Integrating these tools into daily clinical practice can advance evidence-based medicine and improve quality control.
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