Qual a acurácia da guia cirúrgica no planejamento de cirurgias ortognáticas? Uma revisão sistemática.

Abstract

The resolutive treatment of facial skeletal alterations presents, as an alternative, orthognathic surgeries associated with orthodontic treatment, aiming at achieving the ideal dental occlusion, aesthetics and facial harmony. The transfer of preoperative planning during surgery is performed by means of a surgical guide, which orient the correct positioning of the gnatic bones according to the previously planned occlusion. This study aims to evaluate through a systematic review (SR) the accuracy of the surgical guide in the planning of orthognathic surgeries. For this, articles from the Pubmed database were selected and the keywords used were: Orthognathic Surgery. Guide (splint). Rapid Prototyping (3D printing, CAD / CAM, accuracy). From the elaboration of a flowchart, through a PRISMA protocol, the articles were evaluated by title and abstract and, from this, were read in full, considering the previously defined inclusion and exclusion criteria. As the most important inclusion criteria, should be emphasized that patients should undergo computed tomography, present maxillofacial skeletal deformities and use studies that were performed in living patients or human cadavers. Exclusion criteria were the use of the surgical guide for other dental procedures, studies that did not mention the use of the guide; Patients diagnosed with malignant lesions or congenital malformations should not have undergone previous orthognathic surgery. In this manner, 7 articles were selected for analysis of their results that analyzed the accuracy of preoperative movements in relation to postoperative results, which reported error values below 2 mm, in which the maximum error presented by the studies was well controlled up to 1.73 mm and the average error was lower. 1 mm, which is considered to be within a clinically acceptable range. However, the real accuracy of the surgical guide's accuracy could not be estimated, since none of the studies presented performed the ideal statistical test, represented by the ROC curve, to evaluate such result. In addition, because they presented information from heterogeneous and unsatisfactory statistical data, it was not possible to establish a pattern of analysis between the studies, making difficult to perform SR meta-analysis. Regarding the risk of bias in the selected studies, did not meet all the quality criteria determined by QUADAS-2, evaluated in four domains: sample selection, index test (guide accuracy, difference between planning, guide, distortion and ROC curve), reference standard, flow and timing. The reproductive capacity of the three-dimensional maxillomandibular positioning can be considered adequate and with results similar to those offered by conventional planning. Although all techniques achieved precision results, is important to highlight that the virtual method presented lower error values than the other techniques, indicating a higher planning transfer precision (sic).