Orthognathic SurgeryNCT05009056
Functional Appliance for Orthognathic Surgery
A study testing Postsurgical computer guided functional appliance in people with Orthognathic Surgery, run by Cairo University at 1 site in Egypt.
Trial summary
The unstable condylar position in the glenoid fossa is a critical problem for postsurgical instability after mandibular advancement with subsequent mandibular relapse. The habitual forward occlusion in class II patients creates unstable condyle to glenoid fossa relationship making it hard for clinicians to determine… Read more about this study
- Who is it for?
- Ages 18 to 50 yearsHealthy volunteers can take part
- Conditions the study is for
- Orthognathic Surgery
- What is being tested?
- Postsurgical computer guided functional appliance
- Type of treatment
- Medical device
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 18 participants
- Where
- 1 siteEgypt
- Study dates
- 1 Jun 2021to 1 May 2024
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 50 years
- All sexes
- Healthy volunteers accepted
- Adult
Who may be able to join
- Age of the patient above 18 years
- Patients in need of bilateral sagittal split osteotomy for mandibular advancement.
- All patients are free from any systemic disease that may affect normal bone healing.
- Sufficient dentition to reproduce the occlusal relationships
- Patient's consent to participate
Who cannot join
- Patients with any systemic disease that may affect normal healing
- Intra-bony lesions or infections that may interfere with surgery
- Previous orthognathic surgeries
Trial locations and contacts
1 site in 1 country.
Egypt1 site
outpatient clinic of Oral and Maxillofacial Surgery department- Cairo University
Cairo, 11553
About this study
Official title: Post-surgical Stability in Mandibular Advancement Using Postsurgical Versus Presurgical Computer Guided Functional Appliance. (RANDOMIZED CLINICAL TRIAL)
The unstable condylar position in the glenoid fossa is a critical problem for postsurgical instability after mandibular advancement with subsequent mandibular relapse. The habitual forward occlusion in class II patients creates unstable condyle to glenoid fossa relationship making it hard for clinicians to determine the amount of mandibular advancement. Splint therapy is considered as a preoperative reversible nonsurgical condylar repositioning option in addition to its adjunctive effect for pain relief in TMJ symptomatic patients. To minimize this relapse, presurgical functional appliance therapy has been proposed and has shown promising outcomes.
Read the detailed description
The aim of this study is to compare the effect of postsurgical versus presurgical computer guided functional appliance in relapse prevention after mandibular advancement surgery.
Surgical procedure:
- Owbgeser incision will be performed to expose the buccal and lingual aspects of the ramus angle region.
- CAD/CAM generated preoperative wafer will be placed on the lower arch dentition, the guide has an extension to guide medial, vertical, oblique cuts as well as screw holes for reference landmarks for proximal segment \& tooth bearing segment.
- Drilling of all the reference landmarks on the proximal segment and locating medial, vertical, oblique cuts.
- Removal of guide, then BSSO is performed.
- The final wafer is placed, the guiding hole on the proximal segment will then be realigned with the previously drilled screw holes, fixation using mono cortical screws then drilling screw holes for plate fixation.
- Fixation of the osteotomy using 2.0 mm pre-bent mini plates.
- A positioning screw will be added to improve stability against rotational forces. b-Functional appliance
Postsurgical computer guided functional appliance:
After achieving ideal condylar poison by computer guided surgery. The distal extension of the final occlusal wafer will be cut and the appliance will be fitted to be utilized as a postsurgical functional appliance for condylar adaptation. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth.
Presurgical computer guided functional appliance:
Using the software, 3D digitized mandible will be virtually repositioned in ideal centric relation through accurate adjustment of the condyle in its glenoid fossa. Patients' dental casts will be scanned, and digitized into a virtual 3D model and superimposed to the CT cuts into the virtual plan software environment in order to produce preoperative CAD/CAM splint on the adjusted centric occlusion. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth.
c- Follow up
All patients will be advised to stay on a soft diet for 4-6 weeks to avoid any undue forces on the surgical site. Postoperative CT and lateral cephalogram will be obtained, immediately postoperative and 12 months later respectively.
- Conditions
- Orthognathic Surgery
- Being tested
- Postsurgical computer guided functional appliance
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Postsurgical computer guided functional applianceDevice
After achieving ideal condylar poison by computer guided surgery. The distal extension of the final occlusal wafer will be cut and the appliance will be fitted to be utilized as a postsurgical functional appliance for condylar adaptation. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth.
| Study group | Role | What they receive |
|---|---|---|
| postsurgical computer guided functional appliance | Experimental | After achieving ideal condylar poison by computer guided surgery. The distal extension of the final occlusal wafer will be cut and the appliance will be fitted to be utilized as a postsurgical functional appliance for condylar adaptation. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth. Receives: Device: Postsurgical computer guided functional appliance |
| Presurgical computer guided functional appliance | Active comparator | Using the software, 3D digitized mandible will be virtually repositioned in ideal centric relation through accurate adjustment of the condyle in its glenoid fossa. Patients' dental casts will be scanned, and digitized into a virtual 3D model and superimposed to the CT cuts into the virtual plan software environment in order to produce preoperative CAD/CAM splint on the adjusted centric occlusion. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth. Receives: Device: Postsurgical computer guided functional appliance |
What is being measured
The primary outcome is the main question the study is designed to answer.
Change from postoperative sagital position of the mandible at 12 months (skeletal stability)
Method of Measurement: Lateral cephalogram Unit of Measurement: mm
Measured: immediately postoperative and 12 months later
Secondary outcomes (1)
Assessment of condylar deviation
Method of Measurement: CT scan Unit of Measurement: mm
Measured: immediately postoperative and 12 months later
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted17 Aug 2021
- Study start1 Jun 2021
- Primary completion1 May 2023
- Study completion1 May 2024
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (12)Papers the sponsor has linked to this study.
- Other trials for Orthognathic SurgeryStudies of the same condition, open and under way.
- More trials run by Cairo UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 18 participants (actual)
Sponsor and investigators
- Lead sponsor
- Cairo University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Mohamed Mokhtar Elsayed Hafez, Cairo University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05009056
- Sponsor's protocol ID
- Orthognathic surgery
- Status last verified
- Nov 2024
- First submitted
- 4 Aug 2021
- Last updated
- 7 Nov 2024
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Ha N, Hong Y, Qu L, Chung M, Qu R, Cai X, Fang B, Jiang L. Evaluation of post-surgical stability in skeletal class II patients with idiopathic condylar resorption treated with functional splint therapy. J Craniomaxillofac Surg. 2020 Mar;48(3):203-210. doi: 10.1016/j.jcms.2020.01.004. Epub 2020 Jan 11.
PubMed 32008874Bailey L', Cevidanes LH, Proffit WR. Stability and predictability of orthognathic surgery. Am J Orthod Dentofacial Orthop. 2004 Sep;126(3):273-7. doi: 10.1016/S0889540604005207. No abstract available.
PubMed 15356484Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Face Med. 2007 Apr 30;3:21. doi: 10.1186/1746-160X-3-21.
PubMed 17470277Costa F, Robiony M, Toro C, Sembronio S, Polini F, Politi M. Condylar positioning devices for orthognathic surgery: a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Aug;106(2):179-90. doi: 10.1016/j.tripleo.2007.11.027. Epub 2008 Apr 16.
PubMed 18417381TRAUNER R, OBWEGESER H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol. 1957 Sep;10(9):899-909. doi: 10.1016/s0030-4220(57)80041-3. No abstract available.
PubMed 13465100Bell WH, Schendel SA. Biologic basis for modification of the sagittal ramus split operation. J Oral Surg. 1977 May;35(5):362-9.
PubMed 403263Wyatt WM. Sagittal ramus split osteotomy: literature review and suggested modification of technique. Br J Oral Maxillofac Surg. 1997 Apr;35(2):137-41. doi: 10.1016/s0266-4356(97)90691-4.
PubMed 9146874Joss CU, Vassalli IM. Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review. J Oral Maxillofac Surg. 2009 Feb;67(2):301-13. doi: 10.1016/j.joms.2008.06.060.
PubMed 19138603Epker BN, Wessberg GA. Mechanisms of early skeletal release following surgical advancement of the mandible. Br J Oral Surg. 1982 Sep;20(3):175-82. doi: 10.1016/s0007-117x(82)80035-8.
PubMed 6958313Worms FW, Speidel TM, Bevis RR, Waite DE. Posttreatment stability and esthetics of orthognathic surgery. Angle Orthod. 1980 Oct;50(4):251-73. doi: 10.1043/0003-3219(1980)0502.0.CO;2.
PubMed 6935978Angle AD, Rebellato J, Sheats RD. Transverse displacement of the proximal segment after bilateral sagittal split osteotomy advancement and its effect on relapse. J Oral Maxillofac Surg. 2007 Jan;65(1):50-9. doi: 10.1016/j.joms.2005.11.117.
PubMed 17174764Nebbe B, Brooks SL, Hatcher D, Hollender LG, Prasad NG, Major PW. Interobserver reliability in quantitative MRI assessment of temporomandibular joint disk status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Dec;86(6):746-50. doi: 10.1016/s1079-2104(98)90215-3.
PubMed 9868736
Study at a glance
From the registry record, last updated by the sponsor on 7 Nov 2024. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Post-surgical Stability in Mandibular Advancement Using Postsurgical Versus Presurgical Computer Guided Functional Appliance. (RANDOMIZED CLINICAL TRIAL)
- ClinicalTrials.gov ID
- NCT05009056
- Acronym / sponsor ID
- Orthognathic surgery
- Conditions
- Orthognathic Surgery
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 18 participants (actual)
- Lead sponsor
- Cairo UniversityUniversity, hospital or other
- Study start
- 1 Jun 2021 (actual)
- Primary completion
- 1 May 2023 (actual)
- Study completion
- 1 May 2024 (actual)
- First posted
- 17 Aug 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
The unstable condylar position in the glenoid fossa is a critical problem for postsurgical instability after mandibular advancement with subsequent mandibular relapse. The habitual forward occlusion in class II patients creates unstable condyle to glenoid fossa relationship making it hard for clinicians to determine the amount of mandibular advancement. Splint therapy is considered as a preoperative reversible nonsurgical condylar repositioning option in addition to its adjunctive effect for pain relief in TMJ symptomatic patients. To minimize this relapse, presurgical functional appliance therapy has been proposed and has shown promising outcomes.
Detailed description
The aim of this study is to compare the effect of postsurgical versus presurgical computer guided functional appliance in relapse prevention after mandibular advancement surgery.
Surgical procedure:
- Owbgeser incision will be performed to expose the buccal and lingual aspects of the ramus angle region.
- CAD/CAM generated preoperative wafer will be placed on the lower arch dentition, the guide has an extension to guide medial, vertical, oblique cuts as well as screw holes for reference landmarks for proximal segment \& tooth bearing segment.
- Drilling of all the reference landmarks on the proximal segment and locating medial, vertical, oblique cuts.
- Removal of guide, then BSSO is performed.
- The final wafer is placed, the guiding hole on the proximal segment will then be realigned with the previously drilled screw holes, fixation using mono cortical screws then drilling screw holes for plate fixation.
- Fixation of the osteotomy using 2.0 mm pre-bent mini plates.
- A positioning screw will be added to improve stability against rotational forces. b-Functional appliance
Postsurgical computer guided functional appliance:
After achieving ideal condylar poison by computer guided surgery. The distal extension of the final occlusal wafer will be cut and the appliance will be fitted to be utilized as a postsurgical functional appliance for condylar adaptation. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth.
Presurgical computer guided functional appliance:
Using the software, 3D digitized mandible will be virtually repositioned in ideal centric relation through accurate adjustment of the condyle in its glenoid fossa. Patients' dental casts will be scanned, and digitized into a virtual 3D model and superimposed to the CT cuts into the virtual plan software environment in order to produce preoperative CAD/CAM splint on the adjusted centric occlusion. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth.
c- Follow up
All patients will be advised to stay on a soft diet for 4-6 weeks to avoid any undue forces on the surgical site. Postoperative CT and lateral cephalogram will be obtained, immediately postoperative and 12 months later respectively.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| postsurgical computer guided functional appliance | Experimental | Device: Postsurgical computer guided functional applianceAfter achieving ideal condylar poison by computer guided surgery. The distal extension of the final occlusal wafer will be cut and the appliance will be fitted to be utilized as a postsurgical functional appliance for condylar adaptation. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth. |
| Presurgical computer guided functional appliance | Active comparator | Device: Postsurgical computer guided functional applianceUsing the software, 3D digitized mandible will be virtually repositioned in ideal centric relation through accurate adjustment of the condyle in its glenoid fossa. Patients' dental casts will be scanned, and digitized into a virtual 3D model and superimposed to the CT cuts into the virtual plan software environment in order to produce preoperative CAD/CAM splint on the adjusted centric occlusion. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth. |
Who may qualify
- Ages
- 18 to 50 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult
Key inclusion criteria (5 listed)
- Age of the patient above 18 years
- Patients in need of bilateral sagittal split osteotomy for mandibular advancement.
- All patients are free from any systemic disease that may affect normal bone healing.
- Sufficient dentition to reproduce the occlusal relationships
- Patient's consent to participate
Key exclusion criteria (3 listed)
- Patients with any systemic disease that may affect normal healing
- Intra-bony lesions or infections that may interfere with surgery
- Previous orthognathic surgeries
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Postsurgical computer guided functional applianceAfter achieving ideal condylar poison by computer guided surgery. The distal extension of the final occlusal wafer will be cut and the appliance will be fitted to be utilized as a postsurgical functional appliance for condylar adaptation. Patients will be instructed to wear the splints continuously for 3 months, only being allowed to remove them when eating and brushing their teeth. | Device | Presurgical computer guided functional appliance, postsurgical computer guided functional appliance |
Primary outcome
Change from postoperative sagital position of the mandible at 12 months (skeletal stability)
Time frame: immediately postoperative and 12 months later
Method of Measurement: Lateral cephalogram Unit of Measurement: mm
1 secondary outcome
Assessment of condylar deviation
Time frame: immediately postoperative and 12 months later
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Nov 2024.
- Background: PubMed 32008874Ha N, Hong Y, Qu L, Chung M, Qu R, Cai X, Fang B, Jiang L. Evaluation of post-surgical stability in skeletal class II patients with idiopathic condylar resorption treated with functional splint therapy. J Craniomaxillofac Surg. 2020 Mar;48(3):203-210. doi: 10.1016/j.jcms.2020.01.004. Epub 2020 Jan 11.
- Background: PubMed 15356484Bailey L', Cevidanes LH, Proffit WR. Stability and predictability of orthognathic surgery. Am J Orthod Dentofacial Orthop. 2004 Sep;126(3):273-7. doi: 10.1016/S0889540604005207. No abstract available.
- Background: PubMed 17470277Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation: an update and extension. Head Face Med. 2007 Apr 30;3:21. doi: 10.1186/1746-160X-3-21.
- Background: PubMed 18417381Costa F, Robiony M, Toro C, Sembronio S, Polini F, Politi M. Condylar positioning devices for orthognathic surgery: a literature review. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008 Aug;106(2):179-90. doi: 10.1016/j.tripleo.2007.11.027. Epub 2008 Apr 16.
- Background: PubMed 13465100TRAUNER R, OBWEGESER H. The surgical correction of mandibular prognathism and retrognathia with consideration of genioplasty. II. Operating methods for microgenia and distoclusion. Oral Surg Oral Med Oral Pathol. 1957 Sep;10(9):899-909. doi: 10.1016/s0030-4220(57)80041-3. No abstract available.
- Background: PubMed 403263Bell WH, Schendel SA. Biologic basis for modification of the sagittal ramus split operation. J Oral Surg. 1977 May;35(5):362-9.
- Background: PubMed 9146874Wyatt WM. Sagittal ramus split osteotomy: literature review and suggested modification of technique. Br J Oral Maxillofac Surg. 1997 Apr;35(2):137-41. doi: 10.1016/s0266-4356(97)90691-4.
- Background: PubMed 19138603Joss CU, Vassalli IM. Stability after bilateral sagittal split osteotomy advancement surgery with rigid internal fixation: a systematic review. J Oral Maxillofac Surg. 2009 Feb;67(2):301-13. doi: 10.1016/j.joms.2008.06.060.
- Background: PubMed 6958313Epker BN, Wessberg GA. Mechanisms of early skeletal release following surgical advancement of the mandible. Br J Oral Surg. 1982 Sep;20(3):175-82. doi: 10.1016/s0007-117x(82)80035-8.
- Background: PubMed 6935978Worms FW, Speidel TM, Bevis RR, Waite DE. Posttreatment stability and esthetics of orthognathic surgery. Angle Orthod. 1980 Oct;50(4):251-73. doi: 10.1043/0003-3219(1980)0502.0.CO;2.
- Background: PubMed 17174764Angle AD, Rebellato J, Sheats RD. Transverse displacement of the proximal segment after bilateral sagittal split osteotomy advancement and its effect on relapse. J Oral Maxillofac Surg. 2007 Jan;65(1):50-9. doi: 10.1016/j.joms.2005.11.117.
- Background: PubMed 9868736Nebbe B, Brooks SL, Hatcher D, Hollender LG, Prasad NG, Major PW. Interobserver reliability in quantitative MRI assessment of temporomandibular joint disk status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Dec;86(6):746-50. doi: 10.1016/s1079-2104(98)90215-3.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Postsurgical computer guided functional appliance in people with Orthognathic Surgery, run by Cairo University at 1 site in Egypt.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 5 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 7 Nov 2024. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Egypt. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Change from postoperative sagital position of the mandible at 12 months (skeletal stability) (time frame: immediately postoperative and 12 months later). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05009056, which also lists 12 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Nov 2024.