Orthognathic Surgery: Full-Digital Workflow Protocol for the Selection of Patients Eligible for Single-Jaw Surgery

Orthognathic surgery has undergone considerable evolution, marked by increasing prevalence and improved patient experience. Key advancements include shifting aesthetic ideals, the integration of digital technologies for surgical planning, and a growing emphasis on minimally invasive techniques. This study aimed to promote single-maxillary orthognathic surgery by implementing a novel, fully digital workflow protocol to reduce invasiveness. A 2-phase study was conducted: a retrospective analysis of single-jaw surgeries (2019-2021) and a prospective study (2021-2023) of 38 orthognathic surgery patients. Comprehensive evaluations included 3D-photography, cone beam computerized tomography (CBCT), and dental scans for virtual models. A virtual orthodontic setup at baseline (T0) assessed single-jaw surgery feasibility. If the orthodontic setup confirms the feasibility of performing single-jaw treatment, then orthodontic treatment is initiated. At this stage, following the planned orthodontic treatment, a new CBCT scan was acquired, and a subsequent surgical simulation was performed to evaluate its superimposition with the simulation conducted at T0. The retrospective analysis conducted confirmed that the proportion of single-jaw cases before the introduction of the protocol was comparable to that described in the literature. The prospective cohort comprised 73% Class III, 10% Class II, and 17% asymmetric Class III malocclusions. All preorthodontically identified single-jaw candidates received this treatment. Genioplasty was performed in 100%, rhinoplasty in 17%, and other procedures in 24%. The protocol's implementation increased single-jaw surgery by 26.5%. In conclusion, this full-digital workflow effectively identifies single-maxillary surgery candidates and increases its application in our cohort.