Comparison of time and cost between conventional surgical planning and virtual surgical planning in orthognathic surgery in Korea

Effectiveness of Traditional and Virtual Surgical Planning in Orthognathic Surgery: A Systematic Review and Meta-Analysis

Orthognathic surgery, which corrects jaw deformities, requires meticulous planning to achieve optimal functional and aesthetic outcomes. Traditional surgical planning (TSP) relies on manual methods, whereas virtual surgical planning (VSP) uses computer-assisted simulations that may enhance accuracy and efficiency. Therefore, we conducted a systematic review to evaluate the effectiveness of VSP compared to TSP for orthognathic surgery. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered the protocol in the Prospective Register of Systematic Reviews (CRD42024618614). We searched electronic databases for studies comparing VSP and TSP. Two independent reviewers performed screening and data extraction. We assessed quality using the Cochrane Risk of Bias 2 (RoB 2) tool. We calculated the standardized mean difference (SMD) as the summary measure and used a random-effects model, considering p < 0.05 as statistically significant. We performed analyses using Review Manager (RevMan) version 5.3 (Cochrane Collaboration, London, UK). We included 10 qualitative synthesis and meta-analysis studies, evaluating data from 474 patients, of whom 244 underwent TSP and 230 underwent VSP. Included studies showed moderate to low risk of bias. We evaluated effectiveness in terms of planning time, surgical time, horizontal measurements, vertical measurements, and accuracy indicators for predicting outcomes. Meta-analysis revealed reduced planning time (SMD = 3.19 (-5.74 to 0.64)) and surgical time (SMD = -0.42 (-1.32 to 0.49)) with VSP, as well as differences in horizontal (SMD = -0.39 (-0.73 to 0.05)) and vertical measurements (SMD = -0.20 (-0.54 to 0.13)), and in accuracy indicators (SNA0: SMD = -0.15 (-0.46 to 0.16); SNB0: SMD = 0.53 (-0.82 to 1.87)). SNA0 represents the angle formed by sella (S), nasion (N), and point A (A), and SNB0 represents the angle formed by sella (S), nasion (N), and point B (B). The funnel plot showed no evidence of publication bias. VSP reduced planning and surgical times and predicted facial outcomes more accurately than TSP. These findings suggest that VSP can be an effective alternative to TSP in orthognathic surgeries.

Validation of 2D lateral cephalometric analysis using artificial intelligence-processed low-dose cone beam computed tomography

Objectives

Traditional cephalometric radiographs depict a three-dimensional structure in a two-dimensional plane; therefore, errors may occur during a quantitative assessment. Cone beam computed tomography, on the other hand, minimizes image distortion, allowing essential areas to be observed without overlap. Artificial intelligence can be used to enhance low-dose cone beam computed tomography images. This study aimed to clinically validate the use of artificial intelligence-processed low-dose cone beam computed tomography for generating two-dimensional lateral cephalometric radiographs by comparing these artificial intelligence-enhanced radiographs with traditional two-dimensional lateral cephalograms and those derived from standard cone beam computed tomography.

Methods

Sixteen participants who had previously undergone both cone beam computed tomography and plain radiography were selected. Group I included standard lateral cephalometric radiographs. Group II included cone beam computed tomography-produced lateral cephalometric radiographs, and Group III included artificial intelligence-processed low-dose cone beam computed tomography-produced lateral cephalometric radiographs. Lateral cephalometric radiographs of the three groups were analyzed using an artificial intelligence-based cephalometric analysis platform.

Results

A total of six angles and five lengths were measured for dentofacial diagnosis. There were no significant differences in measurements except for nasion-menton among the three groups.

Conclusions

Low-dose cone beam computed tomography could be an efficient method for cephalometric analyses in dentofacial treatment. Artificial intelligence-processed low-dose cone beam computed tomography imaging procedures have the potential in a wide range of dental applications. Further research is required to develop artificial intelligence technologies capable of producing acceptable and effective outcomes in various clinical situations.

Clinical significance

Replacing standard cephalograms with cone beam computed tomography (CBCT) to evaluate the craniofacial relationship has the potential to significantly enhance the diagnosis and treatment of selected patients. The effectiveness of low-dose (LD)-CBCT was assessed in this study. The results indicated that lateral cephalograms reconstructed using LD-CBCT were comparable to standard lateral cephalograms.

Accuracy of 3D Virtual Surgical Planning Compared to the Traditional Two-Dimensional Method in Orthognathic Surgery: A Literature Review

With the innovation of three-dimensional imaging and printing techniques, computer-aided surgical planning, also known as virtual surgical planning (VSP), has revolutionized orthognathic surgery. Designing and manufacturing patient-specific surgical guides using three-dimensional printing techniques to improve surgical outcomes is now possible. This article presents an overview of VSP in orthognathic surgery and discusses the advantages and accuracy of this technique compared to traditional surgical planning (TSP). A PubMed and Google Scholar search was conducted to find relevant articles published over the past 10 years. The search revealed 2,581 articles, of which 36 full-text articles specifically addressed the topic of this study. The review concludes that VSP in orthognathic surgery provides optimal functional and aesthetic results, enhances patient satisfaction, ensures precise translation of the treatment plan, and facilitates intraoperative manipulation.

Smile Management: A Discussion with the Masters

Smile design is an ongoing challenge in both dentistry and facial cosmetics surgery. Herein, some very common smile design scenarios are shared with six world known masters. Each case will be reviewed by 2 cosmetic dentists, 2 periodontists, and 2 oral and maxillofacial surgeons. At the end, contributors will describe current advances and future prospects of this evolving field.

Custom Plates in Orthognathic Surgery: A Single Surgeon's Experience and Learning Curve

BACKGROUND

Virtual surgical planning (VSP) now allows for the fabrication of custom plates in orthognathic surgery. The senior author was an early adopter, using VSP and stereolithographic splints for over a decade, before transitioning to custom plates in 2019. The authors present our experience and learning curve with this new technology and compare results to a prior cohort of orthognathic patients.

METHODS

A retrospective chart review identified patients undergoing orthognathic surgery with the senior author between 2016 and 2021. All underwent VSP and stereolithographic splint formation, and then either traditional or custom-plate fixation. Demographics, perioperative variables, and postoperative outcomes were analyzed. Traditional fixation consisted of craniomaxillofacial plates, bent intraoperatively by the surgeon to adapt to the facial skeleton. Custom plates were prefabricated and prebent to fit drill holes outlined by customized cutting guides.

RESULTS

Forty-three patients underwent surgery in the study period, 25 (58.1%) with traditional fixation hardware and 18 (41.9%) with custom plates. The surgical technique evolved throughout the custom-plate cohort, with the most recent technique involving custom maxillary plate fixation and traditional mandibular plate fixation. When comparing this group of patients to the prior cohort of traditional fixation patients, operative time significantly decreased (mean 233 minutes versus 283 minutes, P = 0.044), without significant difference in complications.

CONCLUSIONS

Patient-specific cutting guides and custom plates allow for precise spatial positioning of the osteotomized jaw in the orthognathic surgery. Unsurprisingly, obstacles must be overcome in adopting this new technology; here, we outline our experience and technical modifications that have resulted in increased surgical efficiency with comparable outcomes.

Virtual Surgical Planning: Modeling from the Present to the Future

Virtual surgery planning is a non-invasive procedure, which uses digital clinical data for diagnostic, procedure selection and treatment planning purposes, including the forecast of potential outcomes. The technique begins with 3D data acquisition, using various methods, which may or may not utilize ionizing radiation, such as 3D stereophotogrammetry, 3D cone-beam CT scans, etc. Regardless of the imaging technique selected, landmark selection, whether it is manual or automated, is the key to transforming clinical data into objects that can be interrogated in virtual space. As a prerequisite, the data require alignment and correspondence such that pre- and post-operative configurations can be compared in real and statistical shape space. In addition, these data permit predictive modeling, using either model-based, data-based or hybrid modeling. These approaches provide perspectives for the development of customized surgical procedures and medical devices with accuracy, precision and intelligence. Therefore, this review briefly summarizes the current state of virtual surgery planning.