Computer planning in orthognathic surgery

ObjectiveThe use of virtual surgical planning (VSP) in orthognathic surgery is increasing. The aim of this study was to investigate which type of dentofacial deformity makes the surgeon choose VSP and if VSP influences the choice of surgical techniques. Furthermore, we sought to evaluate if use of VSP affects surgical time and blood loss during surgery.Material and methodsPatients having undergone orthognathic surgery and registered in the Swedish quality registry for orthognathic surgery (NROK) between 2018 and 2019 were eligible for inclusion in this study. An evaluation of the usage of VSP was performed together with an analysis of operation time and bleeding during surgery. A total of 862 patients were evaluated.ResultsOut of the 862 patients who had orthognathic surgery, 224 were VSP cases. Patients diagnosed with maxillary retrusion (p = 0.0024), maxillary vertical hyperplasia (p < 0.001), mandibular protrusion (p = 0.0031), laterogenia (p < 0.001) or craniofacial deformity (p = 0.0033) were more often digitally planned. Patients who underwent VSP and bimaxillary surgery showed a tendency of reduced operating time andless bleeding during surgery; however, the results were inconclusive.ConclusionThe present study shows that VSP was used more frequently in patients with maxillary retrusion, maxillary vertical hyperplasia, mandibular protrusion, laterogenia, and craniofacial deformity in comparison with other diagnoses. Alongside the findings that VSP cases had more diagnoses per patient and that a larger number of surgical procedures were performed in this group, this indicates a preference for using digital planning in more complex orthognathic cases.

Background: Digital workflows have transformed orthognathic surgery by enabling three-dimensional virtual surgical planning (VSP) and, more recently, artificial-intelligence-based predictive modeling. While skeletal accuracy has improved substantially, the clinical value of these tools increasingly depends on their ability to predict soft-tissue outcomes and support complex treatment decisions. Methods: This narrative review synthesizes evidence from 20 peer-reviewed studies, including systematic reviews, clinical cohorts, and machine-learning validations, to evaluate (i) the accuracy of digital patient modeling and VSP transfer, (ii) the performance of predictive models for postoperative outcomes and diagnostic classification, and (iii) associated ethical and governance considerations. Results: Automated craniofacial and dental modeling achieves submillimetric to low-millimetric accuracy, with landmark localization errors typically ≤2 mm and dental landmark errors near 0.4 mm. Clinical cohorts demonstrate that VSP transfers to surgery with mean translational deviations well below 2 mm in all planes. Predictive models estimate soft-tissue and aesthetic outcomes within clinically meaningful error margins and classify the need for orthognathic surgery with AUC values up to ~0.9 in high-risk malocclusion groups. Conclusions: Digital planning in orthognathic surgery has evolved into a precision-oriented, data-driven framework. When combined with predictive modeling and appropriate ethical governance, these technologies can enhance accuracy, personalize treatment strategies, and reduce diagnostic uncertainty, particularly in borderline and asymmetric cases.

Fully digital occlusion planning in orthognathic surgery – A crossover study

Virtual planning in orthognathic surgery

Time benefits of 3D planning in orthognathic surgery: a systematic review

An integrated orthognathic surgery system for virtual planning and image-guided transfer without intermediate splint

To determine if patient outcome variables differ between conventional and virtual surgical planning of orthognathic surgery for class III asymmetry. This retrospective case-control study examined 95 patients with class III asymmetry who had been consecutively treated with at least a Le Fort I osteotomy and a bilateral sagittal split osteotomy with a surgery-first approach. Two groups were examined: 51 patients treated with conventional surgical planning and 44 with virtual surgical planning. After treatment, quantitative assessment was determined with measurements of midline symmetry, contour symmetry, and overall facial symmetry using standardized frontal photographs. Subject assessments were analyzed with questionnaires regarding self-perception of overall appearance, satisfaction with appearance, and quality of life. Conventional and virtual surgical planning resulted in significant improvements in outcomes for all patients. However, facial midline and overall facial symmetry were significantly greater for the virtual compared with the conventional group. There were no significant differences in subjective measures of appearance, satisfaction with appearance, and quality of life for patients treated with conventional or virtual surgical planning; measures were high for both groups. Conventional and virtual surgical planning of surgery-first bimaxillary orthognathic surgery resulted in quantitative and qualitative improvements in facial symmetry. Although patient satisfaction was similar for both approaches, virtual surgical planning was superior to conventional surgical planning for the improvement of midline and overall asymmetry. Improvements with virtual surgical planning in facial midline, facial contour, and overall facial symmetry are as good as or better than conventional surgical planning.

Orthognathic Surgery: A Bibliometric Analysis of the Top 100 Cited Articles

To review the past year's literature regarding current computer-assisted reconstruction techniques and their outcomes. Current computer-assisted craniofacial reconstruction research is focused on data acquisition, planning, surgical and assessment phases. The major areas of interest among researchers include cosmetic surgery; cleft and craniofacial surgery; traumatic reconstruction, head and neck tumor reconstruction; and orthognathic surgery and distraction osteogenesis. Recent advances in the fields include facial analysis and planning in rhinoplasty, facial surface and bone graft volume analysis in cleft surgery, computer-guided tumor ablation and osteocutaneous reconstruction in tumor surgery, and preoperative planning and surgical assistance in orthognathic and distraction osteogenesis surgery. Research in computer-aided craniofacial surgery is progressing at a rapid rate. Rather than just the latest innovation, sound research studies are proving computer assistance to be invaluable in producing superior outcomes, especially in the fields of head and neck surgery, orthognathic surgery, and craniomaxillofacial trauma surgery. Further outcome studies and cost-benefit analyses are still needed to show the superiority of these methods to contemporary techniques.

Three-dimensional accuracy of virtual planning in orthognathic surgery

This study aimed to compare the clinical accuracy of maxillary positioning in bimaxillary orthognathic surgery based on the method of virtual surgical planning (VSP) implementation, specifically contrasting the use of the wafer-only versus the customized guide-plate system. Thirty-four patients who underwent bimaxillary orthognathic surgery were retrospectively analyzed and divided into 2 groups: a control group (wafer-only, n=17) and a study group (wafer+guide+plate, n=17). Surgical accuracy was quantitatively evaluated by comparing the 3-dimensional coordinates of 5 maxillary landmarks between the virtual surgical plan (Tv) and postoperative cone-beam computed tomography (T1) using dedicated 3D analysis software. In addition, postoperative skeletal stability was evaluated by comparing T1 and T2. The study group showed significantly better accuracy in transverse (0.36mm versus 0.86mm) and anterior vertical dimensions (0.51mm versus 1.45mm). Both groups experienced challenges with posterior vertical positioning and sagittal accuracy. Six-month stability analysis revealed no significant differences between groups, with mean absolute changes of 0.39-1.41mm (study) and 0.44-1.39mm (control). The guide-plate system offers a clinically meaningful improvement in maxillary positioning accuracy over the wafer-only approach, particularly in complex cases requiring high precision. Both methods demonstrated comparable 6-month stability, indicating that the enhanced initial accuracy does not compromise postoperative stability.

Virtual planning in orthognathic surgery: our experience in valparaíso, Chile

The primary objective of this study was to evaluate how the utilization of virtual surgical planning (VSP) and the epidemiological profile of patients undergoing orthognathic surgery (OGS) have changed in the past decade. The records of patients who had undergone orthognathic surgery at a national dental hospital were reviewed. Trends in VSP, epidemiological data, presentation of dentofacial deformity, and management details were recorded. A total of 1184 patients were included in this study. The majority of the patients seeking treatment in this dental hospital were young Chinese adults with dentofacial deformities requiring bimaxillary surgeries. Most patients presented with a skeletal Class III pattern (79.0%), and asymmetry was diagnosed in 80.8% of all cases. There was an initial slow pick-up rate for VSP, but this rapidly increased to a high adoption rate of 98.7-100% between 2019 and 2021. Together with an increasing body of evidence suggesting greater accuracy in VSP, utilization in this technology can be enhanced with greater familiarity with the technology and improvements in the VSP services.

Virtual Surgical Planning in Orthognathic Surgery in Cleft Patients

First results with complete 3D planning in orthognathic surgery