How accurate is digital-assisted Le Fort I maxillary osteotomy? A three-dimensional perspective

Area of Science:

• Oral and Maxillofacial Surgery
• Orthodontics
• Medical Imaging

Background:

• Skeletal class III malocclusion often requires bimaxillary surgery for correction.
• Three-dimensional (3D) virtual planning is increasingly used to guide complex surgical procedures.
• Evaluating the accuracy of 3D virtual planning against surgical outcomes is crucial for refining techniques.

Purpose of the Study:

• To assess the surgical accuracy of Le Fort I osteotomy in bimaxillary surgery for skeletal class III malocclusion.
• To compare the achieved maxillary positioning with the pre-operative 3D virtual surgical plan.
• To identify specific translational and rotational movements with the highest discrepancies.

Main Methods:

• Retrospective analysis of 55 patients with skeletal class III malocclusion undergoing bimaxillary surgery.
• Utilized a validated 3D accuracy assessment tool to quantify maxillary positioning errors.
• Compared planned surgical movements with postoperative results for translational (anteroposterior, superoinferior, mediolateral) and rotational (pitch, roll, yaw) parameters.

Main Results:

• Mediolateral translation demonstrated the least error.
• Anteroposterior and superoinferior translations tended towards posterior and inferior positioning of the maxilla.
• Pitch rotation showed the highest discrepancy.
• Increased advancement correlated with greater inaccuracy in anteroposterior, superoinferior, and pitch movements.

Conclusions:

• 3D virtual surgical planning for Le Fort I osteotomy in skeletal class III patients is generally accurate.
• Specific translational and rotational movements require careful attention to minimize discrepancies.
• Further refinement of 3D planning and surgical execution may improve accuracy, particularly for larger advancements.