Virtual Surgical Planning: Accuracy and Reproducibility in Orthognathic Surgery Outcomes

Objectives: Three-dimensional (3D) virtual surgical planning (VSP) is becoming widely utilized in orthognathic surgery. The lack of a significant statistical difference between the pre-operative virtual plan and the surgical result validates the usefulness of VSP. Initial evidence from published clinical trials reports VSP to be a predictable treatment planning tool for surgeons. This systematic review analyzes the precision of orthognathic surgery 3D VSP compared to the actual surgical outcomes reported in clinical trials using computer-aided designed/computer-aided manufactured (CAD/CAM) surgical splints and intraoperative navigation surgical transfer.
Methods: A systematic, computerized database search was conducted using MEDLINE (PubMed) and the Cochrane Library for studies from 2004 until the search date, May 2014, using the medical subject heading (MeSH) keywords “virtual planning”, “orthognathic surgery”, and “accuracy”. A total of 16 papers were identified. Inclusion criteria were: a relevant sample size of five patients or more, conventional orthognathic surgery to correct dentofacial developmental abnormalities, the precision evaluated by a comparison of the 3D VSP with the actual surgical outcome in 3D with exact results. Nine articles met inclusion criteria and were included in this review.
Results: All of the studies report no significant statistical differences between the 3D virtual surgical treatment plan and the performed orthognathic surgery outcome. The table describes the details of the selected studies.
Conclusions: The results confirm 3D VSP using CAD/CAM templates and intraoperative navigation surgical transfer to be a highly precise treatment planning protocol for orthognathic surgery. The precision of the 3D VSP protocol for orthognathic surgery compares favorably to reported variations in conventional clinical orthognathic treatment planning techniques that incorporate 2-dimensional radiographic analysis, facebow transfer, plastic model surgery, and classic maxillomandibular splints.