Resumo:
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
