Virtual surgical planning in orthognathic surgery with the use of patient-specific plates compared with conventional plates. A systematic review focusing on complications, financial expenses, professional and patient-reported outcome measures

Kesmez, Özlem; Valls-Ontañón, Adaia; Starch‐Jensen, Thomas; Haas-Junior, O-L; Hernández–Alfaro, Federico

doi:10.4317/medoral.25424

Cited by 6 publications

(7 citation statements)

References 41 publications

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“…Over our study period, VSP also arose as a prevalent and lasting tool in the orthognathic surgery landscape, with the first publications on VSP in orthognathic surgery emerging in 2011 and multiplying since then 34 . Although VSP consistently demonstrates advantages over traditional surgical planning in operative efficiency and accuracy, conclusions on VSP’s ability to reduce postoperative complications remain mixed 16,18,19,25 . As a result of these technological advances, we hypothesized that rates of ROH would fall over time.…”

Section: Discussionmentioning

confidence: 99%

“…Second, virtual surgical planning (VSP) has emerged as a popular tool in orthognathic surgery and has become increasingly prevalent due to its potential to improve accuracy and efficiency in jaw repositioning 8,16–24 . Researchers have theorized that VSP may reduce the odds of reoperation for multiple reasons, including for ROH 25 …”

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confidence: 99%

“…8,[16][17][18][19][20][21][22][23][24] Researchers have theorized that VSP may reduce the odds of reoperation for multiple reasons, including for ROH. 25 Few inquiries, however, have tracked how these shifts have impacted rates of ROH following orthognathic surgery over time. Moreover, there is a paucity of literature examining complication rates and risk factors in orthognathic surgery with a national scope and substantial sample size.…”

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confidence: 99%

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Risk Factors for Hardware Removal Following Bimaxillary Surgery: A National Database Analysis

Shah,

Silverstein,

Cevallos

et al. 2024

Journal of Craniofacial Surgery

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Orthognathic surgery typically relies on the rigid fixation of fracture fragments using metal hardware. Though hardware is usually intended to be implanted permanently, the removal of hardware (ROH) is sometimes indicated for a variety of reasons. The authors sought to identify risk factors for ROH following orthognathic surgery. The authors conducted a retrospective analysis of the Merative MarketScan Research Databases, 2007–2021 using Current Procedural Terminology (CPT) and International Classification of Disease (ICD-9 and ICD-10) codes to identify patients who underwent an index Le Fort 1 osteotomy and bilateral sagittal split osteotomy operation on the same day. Statistical analysis involved χ2, Shapiro-Wilk, Wilcoxon-Mann-Whitney, Poisson regression, and multivariable logistic regression tests. 4698 patients met the inclusion criteria. The mean age at surgery was 25 years, and 57% were female. ROH occurred in 5.9% of patients. The mean time to hardware removal was 190.5±172.4 days. In a multivariate logistic regression, increased odds of ROH were associated with older patient age [OR: 1.02 (1.01–1.03), P=0.046], sleep apnea [OR: 1.62 (1.13–2.32), P=0.018], and craniofacial syndrome and/or cleft diagnoses [OR: 1.88 (1.14-2.55), P<0.001]. In the same model, postoperative oral antibiotic prophylaxis was not associated with ROH (P=0.494). The incidence of all-cause complications [IRR: 1.03 (1.01–1.05), P<0.001] rose over the study period, while the incidence of ROH did not change significantly (P=0.281). Patients at elevated risk should be counseled on the increased possibility of a second operation for ROH before having orthognathic surgery to ensure expectations and health care utilization decisions align with the evidence.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Risk Factors for Hardware Removal Following Bimaxillary Surgery: A National Database Analysis

Shah,

Silverstein,

Cevallos

et al. 2024

Journal of Craniofacial Surgery

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“…The surgical accuracy of positioning the maxilla following TVSP with the use of cutting guides and patient-specific osteosynthesis have been assessed in various studies demonstrating a mean difference less than 1 mm between the treatment plan and the actual surgical outcome [43][44][45]. Moreover, a resent systematic review reported that the required treatment planning and intraoperative time were shortened by approximately one third following TVSP involving cutting guides and patient-specific osteosynthesis compared with TSP and conventional plate osteosynthesis [46]. Consequently, TVSP with the use of cutting guides and patient-specific osteosynthesis seems to beneficially improve the predictability and accuracy of orthognathic surgical planning.…”

Section: Discussionmentioning

confidence: 99%

“…A recent published systematic review concluded that the financial expenses were significantly increased following orthognathic surgical planning using TVSP, cutting guides, and patient-specific osteosynthesis compared with TSP and conventional plate osteosynthesis [ 46 ]. The higher financial expenses may possibly restrict routine use of TVSP in orthognathic surgery.…”

Section: Discussionmentioning

confidence: 99%

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

Starch‐Jensen¹,

Hernández–Alfaro²,

Kesmez³

et al. 2023

JOMR

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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.

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‘Puzzle’ cutting guides for minimally invasive Le Fort I: technical note

Hernández-Alfaro,

Saavedra,

Duran-Vallès

et al. 2024

International Journal of Oral and Maxillofacial Surgery

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Virtual surgical planning in orthognathic surgery with the use of patient-specific plates compared with conventional plates. A systematic review focusing on complications, financial expenses, professional and patient-reported outcome measures

Cited by 6 publications

References 41 publications

Risk Factors for Hardware Removal Following Bimaxillary Surgery: A National Database Analysis

Risk Factors for Hardware Removal Following Bimaxillary Surgery: A National Database Analysis

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

‘Puzzle’ cutting guides for minimally invasive Le Fort I: technical note

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