Mastering precision: Pitfalls in orthognathic surgery 3D virtual planning and strategies for error reduction

This study aims to quantify the prevalence and clinical impact of common pitfalls associated with Virtual Surgical Planning (VSP) for orthognathic surgery, based on a large-scale case series, and to propose evidence-based strategies for error reduction. A retrospective cohort study was conducted on 3550 consecutive orthognathic surgery VSPs performed between July 2017 and July 2025. Pitfalls were identified through a structured audit process comparing pre-planning data, intraoperative records, and postoperative outcomes. The frequency of each pitfall was calculated, and its correlation with clinical outcomes, including the need for intraoperative adjustment and revision surgery, was analyzed. Twelve major pitfalls were identified. The most prevalent were "Overuse of automerging", "Lack of appropriate facial analysis" and "Head orientation error". Pitfalls related to data accuracy and protocol deviation showed a statistically significant correlation (p < 0.05) with larger discrepancies between planned and achieved surgical outcomes. Specific, identifiable pitfalls in the VSP workflow are common and have a measurable impact on surgical precision. A rigorous, protocol-driven approach with mandatory verification steps at each planning stage is essential to mitigate these errors and harness the full potential of VSP.