Three-dimensional virtual surgical planning (3D-VSP) in orthognathic surgery: Advantages, disadvantages and pitfalls

Abstract

In this article, the advantages, disadvantages and pitfalls of three-dimensional virtual surgical planning (3D-VSP) compared to traditional two-dimensional (2D) planning methods in orthognathic surgery are discussed, alongside a standardised protocol that can be utilised. A skeletal Class II, skeletal Class III and an anterior open bite clinical case along with their 3D-VSP management are presented, highlighting modifications that can be made to computer-aided design/computer-aided manufacture (CAD/CAM) cutting guide and plate designs.

Application of Three-Dimensional Digital Technology in Orthodontics: The State of the Art

“…Computer technologies have improved these techniques making the capture and building systems faster, simpler and more precise [6]. Conventional orthognathic surgery planning relies on computer assisted twodimensional surgical simulation systems, which integrate photographs and cephalograms as a guide [36,37]. Along with these systems, a facial arch is used in order to adequately A B C Studies have validated the accuracy of the superimposition of stereophotogrammetry images with CBCT images to create 3D virtual models of the patient for diagnosis and development of craniomaxillofacial treatment plans.…”

“…Conventional orthognathic surgery planning relies on computer assisted two-dimensional surgical simulation systems, which integrate photographs and cephalograms as a guide [ 36 , 37 ]. Along with these systems, a facial arch is used in order to adequately register the patients’ bite in a semi-adjustable articulator.…”

“…This process allows for a simulation of surgical movements using the patients’ cast models, which is necessary for surgical splint manufacturing [ 38 ]. Although this method is well established and widely used, it has a few setbacks, since the use of a conventional articulator and planning of three-dimensional procedures using two-dimensional imaging can create imprecisions [ 36 ].…”

“…Three-dimensional simulation systems with CBCT have arisen as a solution to some of the issues previously mentioned with two-dimensional planning [ 36 , 37 , 38 ]. These techniques require a CBCT, and, to perform this exam, the patient must have the head and muscles in a natural position with a relaxed expression while biting in centric relation [ 36 , 39 ].…”

“…Three-dimensional simulation systems with CBCT have arisen as a solution to some of the issues previously mentioned with two-dimensional planning [ 36 , 37 , 38 ]. These techniques require a CBCT, and, to perform this exam, the patient must have the head and muscles in a natural position with a relaxed expression while biting in centric relation [ 36 , 39 ]. Skin texture and structures must be refined and improved in order to accurately overlay with the CBCT reconstruction, and this can be done by mapping 2D photographs, using 3D photographs or a 3D surface scan with CBCT reconstruction data.…”