EVIDENCE FOR UTILIZING THREE-DIMENSIONAL TECHNOLOGY IN ORTHOGNATHIC SURGERY AND SLEEP APNEA CARE

摘要

Routine orthognathic surgery for correction of severe malocclusion is relatively recent with the development of predictable intra-oral surgical procedures occurring in the late 1950s. Imaging techniques at the time were limited to two dimensions; sagittal and vertical. Early surgical treatment planning and prediction required several manual (i.e., by hand) cumbersome, time-intensive steps fraught with multiple opportunities for error. In the 1980s, personal computers became available and the first attempts at computerized treatment planning began. Planning remained in two dimensions, but now enabled digital measurements of plane film radiographs. As technology advanced, further direct computer-based video capture was included to enable the team to overlay a single lateral photograph onto the lateral cephalometric radiograph; however, the third dimension remained elusive. As technology continued to evolve and computing power increased, new imaging modalities became available including digital photography, medical computed tomography and more recently, cone-beam computed tomography (CBCT) and laser model scanning. When these seemingly disparate records are merged, the surgical orthodontic team now can visualize all three planes of space simultaneously to finally plan patient care in all three dimensions. With the increased treatment planning capabilities, questions remain whether the new tools are better, worse or only equally effective in obtaining predictable and safe surgical outcomes. A critical review of the best available evidence behind the classic two- and new three-dimensional (2D and 3D) orthognathic surgery treatment planning approaches will be contrasted to provide an update on the current status of combined surgical orthodontic treatment planning.