Customized virtual surgical planning in bimaxillary orthognathic surgery: a prospective randomized trial.

Abstract

The aim of the present study was to compare conventional (CSP) versus customized virtual surgical planning (VSP) in bimaxillary orthognathic surgery. The primary goal was to compare the accuracy of defined angles. The secondary purpose was to analyze the accuracy of the splints, the time required for surgery, and the costs of both methods. A total of 21 patients (nCSP = 12; nVSP = 9) treated by two-jaw orthognathic surgery were analyzed prospectively between the years 2014 and 2016. Customized VSP consisted of virtual planning as well as CAD/CAM printing of splints and pre-bent osteosynthesis plates. The evaluated parameters were the difference between planned and postoperative situation (SNA/SNB/ANB), accuracy of splints, time required for surgery (min), and total costs of planning (€). When compared to CSP, VSP appears to be a more accurate method for orthognathic treatment planning with significant differences in the angle outcome (SNA p < 0.001; SNB p = 0.002; ANB p < 0.001). There were significant differences in splint accuracy in favor of CAD/CAM splints (p = 0.007). VSP significantly reduced the duration of operation (p = 0.041). Nevertheless, VSP increased the total costs (481.80€ vs. 884.00€). When using virtual 3D technology in combination with printed acrylic splints, 3D models of the jaws and pre-bent osteosynthesis, there is a noticeable reduction in the duration of the operation in conjunction with an improvement in accuracy. Virtual model surgery and the prefabrication of splints and plates may replace traditional orthognathic surgery as it becomes cost-effective.