Residents’ journal review

Standard vs virtual surgical planning

Resnick CM, Inverso G, Wrzosek M, Padwa BL, Kaban LB, Peacock ZS. Is there a difference in cost between standard and virtual surgical planning for orthognathic surgery? J Oral Maxillofac Surg 2016;74:1827-33

Virtual surgical planning (VSP) and 3-dimensional (3D) printing of surgical splints are quickly becoming the standard of care in preparation for orthognathic surgery. Studies conducted over the past few years have shown that patients planned with virtual model surgery result in comparable or better outcomes compared with traditional 2-dimensional (2D) treatment planning using cephalometric analysis, model surgery, and manual fabrication of surgical splints. This study aimed to compare VSP and 3D printing of surgical splints with standard surgical planning and manual splint fabrication not based on their clinical merit but based on their monetary costs. This retrospective cohort study included 43 patients who were planned for bimaxillary orthognathic surgery (LeFort I osteotomy and bilateral sagittal split osteotom). The patients were divided into 3 groups: symmetric, nonsegmental; asymmetric; and segmental. Each patient was planned using both standard planning modalities (Dolphin Imaging Software, manual model surgery, and splint fabrication) and VSP/3D printing of surgical splints (Proplan CMF software). The costs for the 2 planning approaches were quantified using the time-driven activity-based microcosting analysis. The results showed that VSP was less time-consuming and at least $650 less expensive than traditional planning for all patients analyzed. This was even when the cost of purchasing the 3D printed splints was included. This cost of almost $2000 is typically billed directly to the patient’s insurance; therefore, the cost savings for the oral surgeon is actually significantly more. The study showed that the greatest opportunity for saving was eliminating the labor-intensive process of 2D planning and model surgery. The authors admitted that this study had many limitations including that the 2D planning and model surgery was completed by an oral surgery resident rather than by a more experienced surgeon who might have been able to complete these steps in less time, thereby changing the costing calculations. In addition, not all of the time that the surgeon took to plan the case was included. For example, the time that the surgeon spent reviewing the case with the orthodontist was not used in the study. Future studies can focus on comparing VSP and traditional planning with regard to the time and cost in the operating room to complete the analysis of the cost difference between the 2 planning methods.

Reviewed by Jonathan Bindiger

Gingival conditions with orthodontic fixed retainers

Buzatta LN, Shimizu RH, Shimizu IA, Pachêco-Pereira C, Flores-Mir C, Taba M Jr, et al. Gingival condition associated with two types of orthodontic fixed retainers: a meta-analysis. Eur J Orthod 2016 Sep 13 [Epub ahead of print]

There are 2 groups of orthodontic lingual fixed retainers: those that allow for unobstructed gingival flossing (waveform) and those that do not (plain). The purpose of this study was to determine whether, among patients using fixed retainers after orthodontic treatment, there is a difference in gingival parameters, brushing frequency, or patient comfort between the groups. Controlled clinical trials and cross-sectional studies were compiled from the following databases: Cochrane Library, Latin American and Caribbean Health Sciences, PubMed, Scopus, and Web of Science. After 3 phases of exclusion, only 4 studies were selected for the final review (1 cross-sectional and 3 clinical trials). The methodologic quality of the studies was evaluated using the Meta Analysis of Statistics Assessment and Review Instrument. All studies used were determined to have a moderate risk of bias. The cross-sectional study did not show any statistically significant differences regarding the plaque and gingival indexes. Two clinical trials had higher plaque and gingival index scores for the waveform fixed retainers with statistically significant differences. The other clinical trial showed no difference. The clinical trials reported that patients found plain fixed retainers to be more comfortable than waveform fixed retainers. However, regarding ease of flossing, the waveform design was preferred. The conclusion was that there is not enough scientific evidence to support or deny an association between fixed retainer design and gingival health, flossing frequency, or patient comfort. The ambiguous results of this systematic review were due to the inclusion of only 4 studies. In the future, more randomized controlled studies will be necessary to evaluate the true effect of the 2 types of fixed lingual retainers on gingival health.

Reviewed by Devin Zolnowski

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Apr 4, 2017 | Posted by in Orthodontics | Comments Off on Residents’ journal review
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