Application of 3D Technology for Orthognathic Surgery

The correction of dentofacial deformity greatly influences the patient’s masticatory function, facial esthetics, and social attitudes. The application of three-dimensional (3D) technology in orthognathic surgery enhances the efficiency and precision of surgical procedures and ultimately improves patient outcomes and satisfaction. Recently, 3D surgical planning completely has revolutionized orthognathic surgery. 3D technology has found various applications in orthognathic surgery, contributing to improved planning, precision, and outcomes. Specifically, computerized planning has brought about substantial changes in the preparation for orthognathic surgery. The use of cone-beam computed tomography, facial scanner, 3D software for image analysis and surgical simulation, and 3D models from printing equipment has shifted the workflow from conventional orthognathic surgery that relied on two-dimensional (2D) cephalogram and manual articulator. Even with the advanced capabilities of 3D technology, conventional 2D cephalograms are still useful as the standard when determining facial proportion and a normative database of 2D cephalometric measurements. The successful implementation of 3D technology in orthognathic surgery relies on several critical factors, such as (1) the quality and condition of baseline data (radiographic images, 3D occlusion scan, and exact registration of maxillomandibular relationship), (2) integration process of 3D skeletal and dental data, (3) feasibility of virtual surgical planning (VSP), (4) precise execution of preplanned surgical movements using splints and surgical guides generated from 3D computer-aided design/computer-aided manufacturing (CAD/CAM) system, (5) verification and repetitive feedback of postoperative outcomes, and (6) quality assurance of the 3D systems for surgical simulation and intraoperative application of equipment. Even with 3D technology, errors can occur during the digital workflow. Without close communication among 3D technicians, surgeons, and orthodontists, misunderstandings and errors may occur in executing the virtual plan. Moreover, 3D technology cannot address poor surgical experience or limitations in real-time adjustments in the operating room. Therefore, surgeons must be aware of these potential sources of errors and try hard to minimize them through careful planning, communication, and validation of the virtual plan of the patient. Moreover, surgeons must be adequately trained and familiar with the use of 3D planning and application of surgical splints and guides.