FACEGIDE: Enhancing Accuracy and Predictability in Bimaxillary Protrusion Surgery - A Case Study

By Dr. Jong-Chul Park, Oral and Maxillofacial Surgeon

This case study examines how FACEGIDE, a 3D digital virtual surgery program, enhances the planning process for Anterior Segmental Osteotomy (ASO) surgery in patients with bimaxillary protrusion (protrusion of both upper and lower jaws), contrasting it with conventional methods.

1.  Conventional Bimaxillary Protrusion Surgery Planning:

• Bimaxillary protrusion surgery involves extracting four premolars (two upper, two lower) and retracting the anterior jaw segment to correct the protrusion.

  

  악안면성형외과학 교과서 발췌

• Conventionally, dental models are used to predict post-operative occlusion and anticipate facial changes. This is known as the Surgical Treatment Objective (STO).

  

  STO - Surgical Treatment Objective

• However, relying solely on dental occlusion for planning fails to accurately predict skeletal changes, particularly the movement of the A-point (the most anterior point on the maxillary bone). This can lead to discrepancies between the planned STO facial profile and the actual surgical outcome.

2. FACEGIDE-Driven ASO Surgery Planning for Bimaxillary Protrusion:

FACEGIDE utilizes 3D digital technology to simulate the entire surgical process, facilitating more precise surgical planning. This translates to several key advantages:

• Accurate Skeletal Movement Prediction: FACEGIDE predicts both dental occlusion and skeletal movement, accurately visualizing changes in the A-point and B-point (the most anterior point on the mandibular bone).

  • Let's examine how the initial planned occlusion affects skeletal movement. As shown, after skeletal movement based on the initial occlusion, a vertical line from the A-point nearly aligns with the B-point.

    

    돌출입수술시 수술교합에 의한 상하악위치관계변화

  • Checking the ANB angle in this scenario reveals a negative value, indicating a retruded maxilla relative to the mandible.

    

    돌출입수술시 수술교합에 의한 상하악위치관계변화

  • To address this, the occlusion is adjusted within the program to advance the A-point and retract the B-point. This adjustment results in a positive ANB angle of 0.8.

    

    돌출입수술시 수술교합에 의한 상하악위치관계변화

  • This highlights how FACEGIDE prevents unintended maxillary retrusion, which could occur with conventional planning and wafer fabrication.

  
  

• Optimized Surgical Planning:  Simulations allow for precise control over the A-point, ANB angle, and other parameters, enabling surgeons to develop an optimal surgical plan. To minimize lower teeth visibility, the mandibular anterior segment is further moved posteroinferiorly. This demonstrates the capability to achieve refined control with FACEGIDE.

  

  FACEGIDE 돌출입 ASO 수술

• Enhanced Surgical Accuracy: FACEGIDE provides surgical guides that ensure the planned outcome is accurately replicated during the actual surgery.

3. Surgical Outcomes:

Anterior Segmental Osteotomy (ASO) surgery

ASO surgery using FACEGIDE achieves more personalized results. By incorporating additional movements of lower anterior segment, surgeons can improve lower lip aesthetics. 3D soft tissue and skeletal images provide a clear visualization of pre- and post-operative changes.

Anterior Segmental Osteotomy (ASO) surgery

Anterior Segmental Osteotomy (ASO) surgery

4. Conclusion:

FACEGIDE significantly enhances the accuracy and predictability of ASO surgery planning for bimaxillary protrusion. By providing surgeons with powerful 3D visualization and simulation tools, FACEGIDE contributes to improved patient satisfaction and superior surgical outcomes.

FACEGIDE