Evaluation of structured training in osteotomy and splitting for BSSO using a 3D-printed mandibular model

BMC Medical Education, vol. 26

Abstract

BACKGROUND: The teaching of bilateral sagittal split osteotomy (BSSO) requires the utilisation of practical training methods to optimise the surgical result and prevent complications such as bad splits or damage to the inferior alveolar nerve. The objective of the present study was to evaluate a structured training program using a cost-effective, 3D-printed mandibular model to improve osteotomy and splitting performance in BSSO. MATERIAL & METHODS: The study was registered in the German Clinical Trials Register (DRKS00034369, registration date: 20/11/2024). A lower jaw model was fabricated using a semi-professional Prusa XL Multi-Tool 3D printer and a combination of colours and materials. The model also incorporated the inferior alveolar nerve, which was fabricated from a flexible material. The model was modified to facilitate its dynamic integration into a phantom head by modification of the condyles. Twenty participants performed two repetitions of the osteotomy and splitting steps of BSSO. The participants received feedback after the first run and during the second run. The experiments were recorded and assessed using a validated questionnaire (OSATS). Furthermore, the distance between the inferior alveolar nerve and the fracture surface, as well as the number of bad splits, was determined. RESULTS: Participants significantly improved their surgical skills as measured by the OSATS between the first and second run from 23.7 points ± 4.3 (mean ± sd) to 27.2 points ± 3.9 (p < 0.001). In addition, the minimal distance between the nerve and the fracture surface increased from 0.2 ± 0.38 mm to 1.12 ± 1.04 mm (p = 0.012). The number of bad splits decreased from 15 to 4 (p = 0.044). The estimated material cost of the lower jaw is approximately US$4 with a printing time of an estimated 9.5 h. CONCLUSION: It is possible to develop a cost-effective and realistic training model, that can be used within structured repeated practice sessions for BSSO training and is associated with improved performance in this setting. Further studies are needed to validate the simulator and assess its impact on real-life surgical outcomes.

Authors 9

1. Leonhard Gerich Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, 52074, Germany

2. Oliver Vladu Aachen Department of Oral and Maxillofacial Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany

3. Moritz Bregenzer Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, 52074, Germany

4. Kunpeng Xie Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, 52074, Germany

5. Jan Egger

   University of Duisburg-Essen

   Affiliation as printed

   Institute for Artificial Intelligence in Medicine, University of Duisburg-Essen, Essen, 45131, Germany

6. Rainer Röhrig Aachen Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, 52074, Germany

7. Frank Hölzle Aachen Department of Oral and Maxillofacial Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany

8. Behrus Puladi corresponding Aachen Department of Oral and Maxillofacial Surgery Institute of Medical Informatics

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, GFO Kliniken Mettmann-Süd, St. Josefs Krankenhaus Hilden, Hilden, 40724, Germany. bpuladi@ukaachen.de

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany. bpuladi@ukaachen.de

   Institute of Medical Informatics, University Hospital RWTH Aachen, Aachen, 52074, Germany. bpuladi@ukaachen.de

9. Ashkan Rashad Aachen Department of Oral and Maxillofacial Surgery

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of Oral and Maxillofacial Surgery, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany