Virtual Surgical Planning for Orthognathic Surgery

Abstract

Orthognathic surgery has become a sophisticated operative procedure for the correction of dentofacial deformities. Recent advances in virtual surgical planning (VSP) allow surgeons’ improved computer-assisted digital preoperative case preparation compared to traditional plaster cast analysis and model surgery with lateral cephalometric prediction tracings. VSP allows surgeons to directly visualize osteotomy cuts, actual positioning of segments, visualization of occlusion, and 3D soft tissue predictions. Precise measurements of segment movements and bone excision for osteotomies allows highly accurate presurgical planning that is superior to traditional model surgery. Rapid printing of surgical splints and cutting guides has proven to be more accurate than handmade splints based on plaster models. Optical scans of the patient’s dentition or dental tests can be merged with the CT data. Orthognathic surgery for single or double jaw can be planned with virtual intermediate and final splints visualized and then printed for clinical use. Genioplasty can also be planned using VSP with cutting and positioning guides. Studies have shown that VSP saves considerable time and cost to patients, surgeons, hospitals, and insurance companies. Distraction osteogenesis can also be planned using VSP with the creation of cutting and hardware positioning guides. VSP is utilized for the combined planning of total TMJ alloplastic replacement in coordination with orthognathic surgery. In this way separate service providers can integrate custom implant fabrication with osteotomy planning. VSP permits a team approach and improved communication through web-based treatment planning sessions. VSP aids patient education through the 3D images developed through treatment planning with visualization of the surgical plan and prediction.