The current state of computer assisted orthognathic surgery: A narrative review

Since cone beam computed tomography (CBCT) became available, research in the field of computer assisted orthognathic surgery (CAOS) is constantly on the rising. It is the purpose of the present paper to describe the use of the available digital technology in the workflow of CAOS and to provide insight on the advantages and limitations arising from the use of both hardware and software.

Systematic reviews, randomised controlled trials, prospective and retrospective clinical studies, case series and reports were consulted with search terms having been entered into PubMed, Google Scholar and the Cochrane database.

There is evidence that supports the use of CAOS, which is based on the lack of time-consuming preparatory steps, more accurate treatment planning and overall, better surgical results. On the contrary, there is also evidence of increased need for training and of higher costs.

The workflow of CAOS involves the acquisition of data which are manipulated to provide the virtual patient, the treatment planning with the appropriate software and the actual preparations for surgery. In case of a non-dynamically guided procedure, it also includes the 3d printing of surgical wafers, osteotomy guides and templates. Even though the native environment for any given surgical treatment planning is three-dimensional, several hurdles seem to impede the universal acceptance of CAOS amongst clinicians.

CAOS is a much desired yet sparsely employed practice for the correction of congenital, developmental or acquired pathologies in the dentomaxillofacial region. This paper addresses the small details in CAOS workflow towards an effective practice, and describes the advantages and limitations of the software and hardware currently in use.