Purpose <p>This systematic review and meta-analysis evaluated the role of 3D virtual surgical planning (VSP) in orthognathic surgery compared to traditional surgical planning (TSP).</p> Methods <p>Studies were identified from databases, including PubMed, Scopus, The Cochrane Library, Google Scholar, and ScienceDirect, using PICO eligibility criteria. Thirteen studies met the inclusion criteria, with four included in the meta-analysis. The quality of the studies was assessed using RoB-2 for RCTs and ROBINS-I for non-RCTs, and the certainty of the evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Inter-reviewer agreement was assessed with a kappa statistic of 0.82.</p> Results <p>According to the meta-analysis, in the SNA and SNB subgroups, no significant differences were observed between 3D VSP and TSP (<i>p</i> = 0.85, <i>p</i> = 0.81) with 0% heterogeneity. Similarly, no significant differences were found in the horizontal and vertical skeletal component subgroups (<i>p</i> = 0.52, <i>p</i> = 0.47) with 0% heterogeneity. These findings suggest comparable accuracy between VSP and TSP in key cephalometric measurements. RCTs were generally of good quality, while non-RCTs showed varying bias levels. The GRADE assessment indicated high certainty in outcomes.</p> Conclusion <p>The differences between VSP and TSP were not statistically significant, and both had the same outcomes. VSP is recommended for complex cases requiring enhanced visualization and interdisciplinary collaboration. Future research should aim to standardize variables for improved study comparability.</p>