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Splintless approach improves surgical accuracy in Le Fort I osteotomies: a systematic review and meta-analysis
Darius Sandu1,2, Bianca G N Cavalcante1, Gábor Varga1,3
1Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
Background:
Accurate bone repositioning is crucial during orthognathic surgery (OS), as even slight deviations from the planned position can impact function and esthetics. As splintless techniques are rapidly evolving, patient-specific implants (PSI) and digital surgical templates (DST) are establishing new standards. This systematic review and meta-analysis aimed to assess the effectiveness of splintless OS compared to virtually planned splints.
Materials And Methods:
We conducted our study in accordance with the guidelines of the PRISMA 2020 framework. A systematic search was performed on November 15, 2024, across PubMed, Embase, and Cochrane. We included randomized controlled clinical trials and observational studies. The primary outcome was surgical accuracy, assessed by the mean linear and angular deviation across the three spatial axes.
Results:
Among the 8,563 identified studies, sixteen met inclusion criteria, and nine were subsequently pooled for meta-analysis. Findings were statistically significant for splintless OS concerning linear deviation along the anteroposterior (MD = -0.49 mm; 95% CI: [-0.73, -0.26]), vertical (MD = -0.32; 95% CI: [-0.53, -0.11]), and mediolateral (MD = -0.37; 95% CI: [-0.59, -0.15]) axes. In terms of angular deviation, PSI showed significant results with reduced discrepancies around the anteroposterior axis (roll) (MD = -0.48; 95% CI: [-0.88, -0.08]). The results did not achieve statistical significance in yaw (MD = -0.71; 95% CI: [-1.50; 0.09]) or pitch (MD = -0.57; 95% CI: [-1.45; 0.31]). However, surgical accuracy has shown consistent improvement across studies.
Conclusion:
Splintless OS consistently showed significantly lower mean deviations from the planned position, outperforming splint-based OS. These results indicate that PSI and DST may offer superior surgical accuracy compared to virtually planned splints. DST may be a valuable, potentially lower-cost alternative, providing the same clinical benefits as PSI.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD42024605292.
