Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery

Computer-assisted planning and surgery for the treatment of orthognathic deformities have been extensively documented over the last decade. Computerized and customized wafers have lacked to improve the accuracy of maxillary positioning, resulting in a drawback of computer-assisted orthognathic surgery. The aim of this study was to determine the accuracy of a new technique of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis implants in bimaxillary orthognathic surgery. 22 consecutive patients were evaluated prospectively by fusing preoperative planning and postoperative outcome using CT scan evaluation. The median deviation of the maxilla position between the preoperative plan and the surgical result was 0.39 mm. The accuracy of left-right-positioning was median 0.30 mm at a range of 0-0.95 mm. Up-down-positioning showed a median accuracy of 0.33 mm at a range of 0-1.22 mm. Higher values were determined for the anterior-posterior-positioning of the maxilla with median 0.7 mm at a range of 0-2.0 mm. The results demonstrate the high predictability of maxillary positioning by CAD/CAM fabricated customized surgical guides and patient specific osteosynthesis. Use of this new digital approach may achieve surgeon independent accuracy of maxillary positioning, facilitating resident training even in the treatment of complex malformations. The high costs, however, may restrict routine use of this technique.