Customized 3D-printed surgical templates for maxillary repositioning: a systematic review

There is a variety of three-dimensional (3D) surgical templates to improve the precision of maxillary repositioning in orthognathic surgery. The spectrum and inconsistent terminology make it difficult to compare outcomes, practices, and selecting the most suitable templates. The aim of this systematic review was to analyse the literature on 3D-printed surgical templates used in orthognathic surgery, with the goal of mapping existing approaches and proposing a classification system based on design and reported outcomes. This review is reported in accordance with the PRISMA guidelines. A comprehensive search was conducted in PubMed, Embase, and Cochrane Library. The extracted data included template design, accuracy, operative time, complications, and reported advantages or limitations. Thirty-five studies met the inclusion criteria. A classification framework is proposed based on two main types-bone-borne and tooth-bone-borne templates-and three subtypes: (1) osteotomy guides integrated with patient-specific implants, (2) osteotomy guides used with pre-bent fixation plates, and (3) osteotomy and repositioning guides used with intraoperative bending of plates. Across studies, most templates demonstrated acceptable accuracies (≤2 mm), with minimal complications reported. However, differences in workflow, instrumentation, and intraoperative flexibility were noted. The proposed classification system encompasses the diverse range of 3D-printed surgical templates reported in the literature.