The use of virtual planning in orthognathic surgery

■ ABSTRACT

Introduction:

Orthognathic surgery involves the manipulation of facial bone architecture through osteotomies to restore form and function, correcting malocclusion, maxillomandibular disproportions, and facial asymmetries. Virtual planning in orthognathic surgery is carried out with the help of software that uses real measurements of the craniofacial skeleton and records of the patient’s occlusion through 3D analysis.

Method:

18 patients with dentofacial deformities were evaluated, according to Angle’s classification, who underwent orthognathic surgery using virtual planning between 2018 and 2019. The inclusion criteria were patients between 16 and 60 years old with maxylo-mandibular disproportions in which orthodontic treatment alone was not sufficient. Exclusion criteria were the presence of cystic or tumoral lesions in the jaw and clinical comorbidities that contraindicated surgery. Virtual planning was carried out on all patients, using Dolphin^® Imaging 11 software and surgical guides made with a 3D printer.

Results:

The intermediate surgical guide presented perfect adaptation on the occlusal surfaces, promoting great stability for the repositioning and fixation of the maxilla in intermediate occlusion. The 18 operated patients responded as “completely satisfied” in relation to the aesthetic-functional result in this series studied. A very great similarity was found between the position of the maxillofacial skeleton in the pre-operative virtual planning and that obtained post-operatively through the evaluation of teleradiography.

Conclusion:

Virtual planning in craniomaxillofacial surgery has numerous advantages, such as reduced pre-operative laboratory time, greater precision in the creation of surgical guides, and better reproducibility of simulated results.

Keywords:
Orthognathic surgery; Surgical navigation systems; Imaging; three-dimensional; Planning techniques; Software; Maxillary osteotomy; Mandibular osteotomy; Craniofacial abnormalities; Cone-beam computed tomography