Digitally-processed custom plate versus conventional plate fixation in Genioplasty

Purpose: The fundamental position of the chin contributes to the aesthetic perception of the face and the subsequent esthetic disharmony when deficient or retruded. In this study, we aimed to verify differences in plate design used in fixation of chin after Genioplasty with relation to postoperative tissue relapse.
Patients and methods: Sixteen patients suffering from a retruded chin affecting the facial esthetics which needed advancement Genioplasty were included in this study. They were selected from the outpatient clinic of the departments of oral and maxillofacial surgery and Orthodontics, faculty of Dentistry, Cairo University, with a mean age of 28 years. Facial analysis was performed through clinical intra and extra-oral photographs. Preoperative data from CT scans were documented. Digital planning was done to fabricate a cutting template and a positioning chin template. The patients were then divided into two groups; eight patients each. In Group A patients, custom digital plates designed on the computer software and processed from CAD data from titanium were used to fix the chin after Genioplasty. In group B patients, conventional titanium T-shaped plate was adapted and used in fixation of the chin. Postoperative patient satisfaction and any postoperative complications were recorded. Clinical evaluation including fragment mobility and/or parasthesia was documented on one week, one month, 3 months and 6 months postoperatively. CT scan was performed immediately postoperative and on 6 months to assess fixation and/or tissue relapse through measuring the linear Antero-posterior measurements and the transverse measurements.
Results: All the patients were clinically satisfied and content about the new chin position and facial contour. All the surgeries went uneventful with no hardware exposure. Numbness of the lower lip was reported in all patients, which faded with time and reported full recovery later on. Radiographic CT scan measurements revealed the accurate postoperative measurements compared to the preoperative plan. The mean linear Pog-orbit-mental measurements showed net overall significant increase, however, with a statistical significant decrease from one period to another in each groups. In both groups, there were no statistical significant changes in mean Pog- Right mental plane and Pog- left mental plane transverse measurements. Statistical correlation between results of both groups showed no significant differences over the study period.
Conclusion: This study recommended the use of digital planning of Genioplasty and template fabrication due to the documented exact pre-to-postoperative chin alignment. The specific custom plate design and processing proved to be an insignificant hassle which can be spared by using the conventional plate for fixation after Genioplasty.