Accuracy of Three-Dimensional Planning in Surgery-First Orthognathic Surgery: Planning Versus Outcome

Area of Science:

• Oral and Maxillofacial Surgery
• Computer-Aided Surgery
• Orthodontics

Background:

• Computer-assisted planning has gained traction in orthognathic surgery (OGS) over the past decade.
• This research specifically assesses the precision of three-dimensional (3D) virtual planning within a surgery-first OGS approach.

Purpose of the Study:

• To evaluate the accuracy of 3D virtual planning in the context of surgery-first orthognathic surgery.
• To determine the reliability of transferring virtual plans to surgical execution using 3D-printed splints.

Main Methods:

• Fifteen patients with skeletal class III malocclusion underwent bimaxillary OGS using a surgery-first protocol.
• A 3D composite skull model was created from cone-beam computed tomography and stereolithography data.
• Surgical simulation was performed using Simplant O&O software, with virtual plans transferred via 3D-printed splints. Accuracy was assessed using root mean square deviation (RMSD) and Bland-Altman analysis.

Main Results:

• Virtual surgical plans were successfully implemented in the operating room.
• The mean linear difference between the virtual plan and postoperative results was 0.88 mm (maxilla: 0.79 mm, mandible: 1 mm).
• The mean angular difference was 1.16°, with RMSD values within clinically acceptable ranges (linear: 0.86–1.46 mm, angular: 1.27°–1.45°).

Conclusions:

• Virtual surgical planning and 3D-printed splints enhance the diagnostic and treatment planning process for OGS.
• This integrated approach leads to accurate outcomes in surgery-first orthognathic surgery.