In-house digital workflow for virtual surgical planning and guide fabrication in bimaxillary orthognathic surgery...

Virtual surgical planning (VSP) has become the standard approach in orthognathic surgery, allowing more precise and predictable skeletal movements. However, many centers still rely on outsourced digital workflows for surgical planning and guide fabrication, which may increase turnaround times and costs. The development of in-house digital workflows offers an alternative that allows full control of the planning and manufacturing process.

A patient with dentofacial deformity underwent bimaxillary orthognathic surgery (Le Fort I and bilateral sagittal split osteotomy) with guided genioplasty using a "Maxilla First" protocol. DICOM files from CBCT imaging and STL models from intraoral scans were merged in IPS Case Designer to perform virtual surgical planning. Surgical splints and guides were designed using Meshmixer and manufactured in the hospital's 3D laboratory using stereolithography with biocompatible resins. Post-processing included alcohol cleaning, thermal curing, and sterilization according to hospital protocols.

The entire workflow from image acquisition to sterilized surgical guides was completed within approximately 3-5 days. Virtual planning allowed accurate simulation of skeletal movements and fabrication of patient-specific guides and splints. Intraoperative application demonstrated excellent adaptation of the guides and splints, allowing precise transfer of the virtual plan and reducing the need for intraoperative adjustments.

In-house digital workflows represent a feasible and efficient approach for orthognathic surgery planning and guide fabrication. This model improves communication between clinical and technical teams, reduces production times and costs, and increases autonomy in surgical planning.