Accuracy of Orthognathic Surgical Planning using Three-dimensional Virtual Techniques compared with Conventional Two-dimensional Techniques: a Systematic Review

Abstract

Objectives:The objective was to assess the accuracy of orthognathic surgical planning using three-dimensional virtual planning compared with conventional two-dimensional planning. Material and Methods: MEDLINE (PubMed), Embase and Cochrane Library search combined with hand-search of relevant journals was conducted to identify randomized controlled trials (RCTs) published in English through August 2 nd , 2022. Primary outcomes included postsurgical accuracy of hard and soft tissue. Secondary outcomes included treatment planning time, intraoperative time, intraoperative blood loss, complications, financial expenses, and patient-reported outcome measures (PROMs). Quality and risk-of-bias assessment were evaluated by Cochrane risk of bias tool and GRADE system. Results: Seven RCTs characterised by low, high, and unclear risk of bias fulfilled inclusion criteria. Included studies disclosed conflicting results regarding accuracy of hard and soft tissue as well as treatment planning time. The intraoperative time was shortened, and financial expenses were increased with three-dimensional virtual surgical planning (TVSP), while no planningrelated complications were revealed. Comparable improvement in PROMs were reported with TVSP and two-dimensional planning. Conclusions: Future orthognathic surgical planning will indisputable be performed by three-dimensional virtual planning. The financial expenses, treatment planning time, and intraoperative time will therefore probably decrease due to further development of three-dimensional virtual planning techniques. The hard and soft tissue accuracy between planned position and achieved surgical outcome seems to be improved by three-dimensional virtual planning compared with two-dimensional planning, although results are inconsistent. Further development of three-dimensional virtual planning involving cutting guides and patient-specific osteosynthesis plates are therefore needed to improve the accuracy of orthognathic surgical planning.

Discrepancies in Cephalometric Analysis Results between Orthodontists and Radiologists and Artificial Intelligence: A Systematic Review

“…Nowadays, orthodontic treatment relies significantly on precise radiographic diagnostics [1]. Traditional panoramic radiographs (dental X-ray of the upper and lower jaw) and lateral cephalograms (standardized lateral view X-ray of the head and neck for the evaluation of bony and soft tissue structures) serve as fundamental tools for assessing jaw, teeth, and dento-alveolar discrepancies [1].…”

“…Nowadays, orthodontic treatment relies significantly on precise radiographic diagnostics [1]. Traditional panoramic radiographs (dental X-ray of the upper and lower jaw) and lateral cephalograms (standardized lateral view X-ray of the head and neck for the evaluation of bony and soft tissue structures) serve as fundamental tools for assessing jaw, teeth, and dento-alveolar discrepancies [1]. Additionally, modern techniques, like CBCT (cone-beam computed tomography) and 3D facial evaluation, play supplementary roles in the comprehensive assessment of both facial soft and hard tissues, and become crucial in cases of doubt about the position of cephalometric points (landmarks, defined points found in the area of the human head) or a large defect that may require surgical intervention [1,2].…”

“…While some dento-alveolar discrepancies may stem solely from dental issues, others may involve skeletal abnormalities. In such cases, thorough and improved diagnostics become imperative [1,2]. CBCT is an advanced imaging modality that offers a radiation exposure dose that is 10 times less than that of conventional CT scans during maxillofacial exposure and enables three-dimensional imaging of hard tissue structures [3].…”

“…Despite the utilization of various diagnostic and orthodontic tools, certain anatomical reference points remain pivotal in establishing basic patient characteristics and, thus, in choosing the right treatment. Classic orthodontic approaches mostly use a standard lateral cephalometric radiograph to evaluate the patient's profile, bite, and occlusion [1][2][3]. The socalled 3D individual approach for each patient is currently regarded as the method of choice for several reasons [4][5][6][7].…”

“…While orthodontic evaluations typically rely on individual landmark assessments by each clinician, specialized software can offer automatic features to find these reference points according to a predefined algorithm. During manual examination and evaluation of these cephalometric points, difficulties in finding their position and the angulation of selected variables may be observed [1,2,12,13]. Each orthodontist should enhance their treatment approach and leverage the benefits of new technologies, particularly the recent advances in 3D-CBCT.…”