Scholarlink

Background <p>Bilateral sagittal split osteotomy (BSSO) has become the standard surgical technique for the treatment of skeletal deformities of mandible in all three planes of space. Medial ramus osteotomy requires precise identification of the lingual to avoid injury to the inferior alveolar neurovascular bundle and to prevent bad splits. Surgical guides help improve accuracy and safety during this procedure.</p> Aim <p>To compare handcrafted versus CAD/CAM—fabricated osteotomy guides in bilateral sagittal split osteotomy (BSSO) with respect to intraoperative efficiency, neurosensory outcomes, and postoperative recovery.</p> Patients and Methods <p>Twenty patients (12 males, 8 females; mean age 20 ± 2&#xa0;years, 40 sides) undergoing BSSO with handcrafted (n = 10) and CAD/CAM—fabricated guides (n = 10) were prospectively evaluated. Outcomes included bad splits, intraoperative duration (per side) and neurosensory function as assessed by visual analog scale (VAS, 0–10), two-point discrimination (TPD, mm), and pin-prick test (PPT, 0–10) at immediate postoperative period (Day 0), at 1&#xa0;week, and at 1&#xa0;month were recorded. Statistical analysis employed was independent t-tests with IBM SPSS version 20.0 (Armonk, NY, IBM Corp.) software.</p> Results <p>Handcrafted guides demonstrated significantly shorter operative times (21.9 ± 3.6&#xa0;min) than CAD/CAM guides (32.4 ± 4.1&#xa0;min; p &lt; 0.001). Postoperative pain (VAS) showed no significant differences between groups at Day 0 (9.9 vs 9.7; p = 0.29), 1&#xa0;week (8.55 vs 8.35; p = 0.27), or 1&#xa0;month (6.8 vs 6.45; p = 0.14). Handcrafted guides demonstrated better TPD at Day 0 (5.8&#xa0;mm vs. 7.35&#xa0;mm, p = 0.025) and 1&#xa0;week (4.0&#xa0;mm vs. 5.1&#xa0;mm, p = 0.015), but by 1&#xa0;month, both groups reached no rmal discrimination (2.85&#xa0;mm vs 3.05&#xa0;mm; p = 0.40). Pin-prick sensation was significantly better in the handcrafted group at 1&#xa0;week (8.9 vs. 8.3, p = 0.0035), with no significant differences at Day 0 (6.75 vs 6.1; p = 0.067) or 1&#xa0;month (9.7 vs 9.5; p = 0.26). By 1&#xa0;month, all patients in both groups demonstrated normal objective neurosensory function on two-point discrimination and pin-prick testing, with no significant between-group differences. No bad splits were observed in any of the 40 sides evaluated.</p> Conclusion <p>Handcrafted surgical guides were associated with shorter operative times compared with CAD/CAM-fabricated guides, Handcrafted guides demonstrated early neurosensory recovery during the first postoperative week, although no differences were observed at one month.Both guide types demonstrated safe and effective performance in bilateral sagittal split osteotomy. Clinical decision‑making should balance surgical efficiency against preoperative planning advantages of CAD/CAM technology.</p> Graphical Abstract <p></p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Comparative Analysis of Handcrafted and CAD/CAM Fabricated Surgical Guides in Bilateral Sagittal Split Osteotomy: Impact on Neurosensory Disturbance and Postoperative Outcomes

  • 期刊论文

  • 发表日期：

    2026年7月21日

查看全文
  • Arunkumar Kamalakaran,
  • Balaji Jayaraman,
  • Prasad Cheruvathur,
  • Kamalakannan Padmanaban,
  • Taranitha Krishnamoorthy,
  • Mital Bavadiya

摘要

Background

Bilateral sagittal split osteotomy (BSSO) has become the standard surgical technique for the treatment of skeletal deformities of mandible in all three planes of space. Medial ramus osteotomy requires precise identification of the lingual to avoid injury to the inferior alveolar neurovascular bundle and to prevent bad splits. Surgical guides help improve accuracy and safety during this procedure.

Aim

To compare handcrafted versus CAD/CAM—fabricated osteotomy guides in bilateral sagittal split osteotomy (BSSO) with respect to intraoperative efficiency, neurosensory outcomes, and postoperative recovery.

Patients and Methods

Twenty patients (12 males, 8 females; mean age 20 ± 2 years, 40 sides) undergoing BSSO with handcrafted (n = 10) and CAD/CAM—fabricated guides (n = 10) were prospectively evaluated. Outcomes included bad splits, intraoperative duration (per side) and neurosensory function as assessed by visual analog scale (VAS, 0–10), two-point discrimination (TPD, mm), and pin-prick test (PPT, 0–10) at immediate postoperative period (Day 0), at 1 week, and at 1 month were recorded. Statistical analysis employed was independent t-tests with IBM SPSS version 20.0 (Armonk, NY, IBM Corp.) software.

Results

Handcrafted guides demonstrated significantly shorter operative times (21.9 ± 3.6 min) than CAD/CAM guides (32.4 ± 4.1 min; p < 0.001). Postoperative pain (VAS) showed no significant differences between groups at Day 0 (9.9 vs 9.7; p = 0.29), 1 week (8.55 vs 8.35; p = 0.27), or 1 month (6.8 vs 6.45; p = 0.14). Handcrafted guides demonstrated better TPD at Day 0 (5.8 mm vs. 7.35 mm, p = 0.025) and 1 week (4.0 mm vs. 5.1 mm, p = 0.015), but by 1 month, both groups reached no rmal discrimination (2.85 mm vs 3.05 mm; p = 0.40). Pin-prick sensation was significantly better in the handcrafted group at 1 week (8.9 vs. 8.3, p = 0.0035), with no significant differences at Day 0 (6.75 vs 6.1; p = 0.067) or 1 month (9.7 vs 9.5; p = 0.26). By 1 month, all patients in both groups demonstrated normal objective neurosensory function on two-point discrimination and pin-prick testing, with no significant between-group differences. No bad splits were observed in any of the 40 sides evaluated.

Conclusion

Handcrafted surgical guides were associated with shorter operative times compared with CAD/CAM-fabricated guides, Handcrafted guides demonstrated early neurosensory recovery during the first postoperative week, although no differences were observed at one month.Both guide types demonstrated safe and effective performance in bilateral sagittal split osteotomy. Clinical decision‑making should balance surgical efficiency against preoperative planning advantages of CAD/CAM technology.

Graphical Abstract