COMPARAÇÃO DA ACURÁCIA ENTRE GUIAS APOIADOS EM ZIGOMAS PARA REPOSICIONAMENTO MAXILAR E GUIAS INTEROCLUSAIS EM CIRURGIA ORTOGNÁTICA: ENSAIO CLÍNICO RANDOMIZADO

Abstract

The optimization of accuracy in orthognathic surgery has been sought through different methods. Despite acceptable results, there is still a search for treatment methods that more accurately reproduce the planning. There is a hypothesis that methods that do not rely on the condyles to position the maxilla may obtain better accuracy. This study aimed to evaluate the accuracy of customized osteotomy and maxillary repositioning guides in orthognathic surgeries and to compare their results with virtual intermediate guides in jaw-initiated surgeries. The sample consisted of 13 individuals who were divided into a customized guide group (use of customized osteotomy and maxillary repositioning guides) and an interocclusal guide group (interocclusal guides for mandibular-initiated surgery). Pre and postoperative tomographies were performed to customize the guides and measure the movements. After superimposing the pre surgical, planning and postoperative models, the points were used: point 1 - anterior region similar to point A, point 2 - bone point above the crown of the right first molar or equivalent tooth (in case of absence) and point 3- bone point above the crown of the left first molar or equivalent tooth. Both surgical guides obtained acceptable results (<2mm error) for most measurements performed. However, the customized group obtained more accurate results in the anteroposterior direction for point 1 (1.03 mm x 2.25 mm) and point 2 (1 mm x 2.57 mm) with a significant difference (95% confidence interval), when compared with the interocclusal guide group. In addition, midline measurements in the anterior region of the maxilla obtained results lower than 0.5 mm for the customized guides group and greater than 1 mm for the interocclusal guides group. Both techniques showed acceptable results regarding the accuracy of the maxillary position. However, the use of customized guides can be a method that improves the accuracy of maxillary positioning, especially in the anteroposterior direction