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Dental Tribune Middle East & African Edition

Dental Tribune Middle East & Africa Edition | March-April 2015 25referral clinic Dr. B. Philippe Dr Roze & Associates Dental Clinic - Maxillofacial Surgeon info@dradubai.com Contact Information Let’s share what we know For more information call 04 388 1313 or visit www.drrozedentalclinic.com Coming up soon: Orthodontic Seminars – by Dr Fabien Depardieu Restorative/Orthodontic interface: Working together to get the best results for our patients Orthodontics in 2015: What’s new Facial Aesthetics Orthognathic surgery Oral surgery seminars – by Dr David Roze Immediate implant into a fresh socket Oral surgery in the dental clinic: Review and results Implant crown restoration At Dr. Roze & Associates, we’re early adopters. When it comes to the latest technologies, techniques and processes, we never stop learning. Since we’re a referral clinic, many rely on us for oral surgery and orthodontic treatments. But what’s knowledge unless it’s shared? We’d like to invite you to attend our unique seminars, so we can help you bring even more value to your practice. Take part in one of our upcoming seminars. Fig 1: Lefort I and Genioplasty gut- ting guides Fig 2: Lefort I and Genioplasty custom made miniplates. Conflict of Interest: No Innovations in Maxillofacial Surgery: Guided Maxillofacial Surgery By Dr. B. Philippe (MD) Maxillofacial Surgeon T he precise realisation of osteotomies and exact positioning of skeletal parts released by osteotomy ma- neuvers can be concerns for maxillofacial surgeons. Guided maxillofacial surgery repre- sents one of the latest innova- tions in maxillofacial surgery and consists of simulating a computer osteotomy to ensure accurate three-dimensional positioning of intraoperative bone cutting and precise drill guides created through the use of miniplates that have been manufactured before surgery with commercially pure porous titanium (CPPTi) under direct metal laser sintering (DSLM). The size and shape of these pre- fabricated miniplates will match exactly to the anatomy of the skeletal parts released by osteot- omy maneuvers and the spaces created by the respective move- ment of skeletal fragments. The surgeon can dispose good model miniplates immediately. The joining of these miniplates also eliminates any intraopera- tive bending that can occur in minplates and promote precise positioning of the skeletal parts. After creating the computer simulation of the planned oste- otomy by the surgeon, the DI- COM data of the simulation is sent to the biomedical engineer who then draws the prototype of the ostetomy guide based on the recommendations of the surgeon. The stability of the os- teotomy guide on the maxilla is determined by its close contact with the underlying skeleton and this can be augmented by the placement of mini-screws. The design of the osteotomy guide must ascertain the precise execution of the Lefort I oste- otomy. Once the design of the osteotomy guide is validated by the surgeon, it is produced using sterilisable polyamide by stereo- lithography. (Fig.1) The design of the custom-made titanium miniplate system com- pleted by the biomedical engi- neer takes into consideration multiple factors, in particular, the size and form of the system. The miniplate system must lie on the maxilla in a completely passive fashion, without trans- mitting any tension or trauma to the underling skeleton. These custom-made miniplates are created as a single unity, initially joined together to allow for their use as a positioning guide. The use of this guide permits maxi- mal congruent contact between the bony segments and the mini- plates themselves and thus ena- bles the precise positioning of the skeletal segments freed by the osteotomy. The miniplates are joined together either in 4 by 4 configuration (Lefort 1 oste- otomy) or in 2 by 2 configuration (sagittal splitt, genioplasty). The positioning and depth of the mi- niscrews for osteosynthesis are also simulated. (Fig. 2) This new system of custom- made titanium miniplates (ei- ther 4x4 or the 2x2) functions intrinsically as a positioning guide and allows for precise po- sitioning and rapid fixation of the maxillary or mandibulary segments. This new miniplate system also has several other advantages: - It serves as an ideal drill guide as it takes into account the spe- cific anatomy of the patient. During virtual surgery planning, the length of the screws and their best position of placement can be ascertained in function to the thickness and density of the underlying bone. - It decreases the length of time needed for the surgical proce- dure. - It decreases any associated trauma to the underlying skel- etal structure as it is made in accordance to the individual anatomy of the patient and the desired skeletal displacement of the bony segments. - It makes the operation much easier for the surgeon and de- creases the time spent in the op- erating room. Guided maxillofacial surgery is mainly discussed in orthognath- ic surgery and implant surgery (Lefort 1 indicated for maxillary acquired atrophy) but other ap- plications can also benefit from guided surgery: - In patients who have unilat- eral deformities, the final result of the facial bone reduction and fixation can be based on the contralateral normal skeleton. In this situation, the miniplate system can be designed based upon a contralateral face by symmetrising digitally from the midline. - All cranio-maxillofacial oste- otomies or maxillofacial recon- structions may benefit from this new type of custom-fit miniplate osteosynthesis. References 1)B.Philippe. Oral-Maxillofacial Surgery Software. Chapter 11 In The art of computer-guided im- plantology. Edited by A. Rosen- feld, P. B Tardieu Quintessence International Chicago 2009 2) B. Philippe. Custom-made prefabricated titanium mini- plates in Lefort 1 osteotomies: principles, procedure and clini- cal insights. International Jour- nal of Oral and Maxillofacial Surgery 2013; 42:1001-1006 3) B. Philippe. Chirurgie max- illo-faciale guidée: simulation et chirurgie assistée par guides stéréolithographiques et mini- plaques titane préfabriquées. Rev de Stomatol Chir Maxillofac Chir Orale 2013; 114:228-46 4) R. Seeberger, D. Rolf, K. Wolf- gang, O.C. Thiele. Use of Stereo- lithographic Drilling and Cutting guides in bilateral distraction The Journal of Craniofacial Surgery & Volume November 2011;22; 6 1-5 5) R. Olszewski, K. Tranduy, H Reychler, Innovative pro- cedure for computer-assisted genioplasty: three-dimensional cephalometry, rapid-prototyping model and surgical splint Int. J. Oral Maxillofac. 2010; 39:721- 724 For more information call 043881313 or visit www.drrozedentalclinic.com 2011;22; 61-5

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