Digital workflow in orthognathic surgery

Abstract

This is to share our eight years experience in gradually adopting, modifying and improving the digital workflow in orthognathic workup for our patients in a private maxillofacial surgical centre. Cone-beam computed tomography gives three-dimensional (3D) information about the skeletal and dental tissue. Combining the scanned dental casts using laser or optical scanner augments the accuracy at the occlusal level. This has been recently replaced by using intraoral scanner directly. The surface texture of the soft tissue mask is further improved by fusing with image taken by 3D photogrammetry. The combined result is a digital copy of our patient. We can perform 3D cephalometric analysis to quantify the deformity. Different commercially available software have been tried to do the virtual surgical planning. Digital wafers can be designed and produced by 3D printing for transferring of our surgical plan to the operating theatre. Similarly cutting templates can also be fabricated. Physical models of the preoperative or operated facial skeleton can be produced if necessary for better communication. Soft tissue simulation helps our patients to understand the effect of our surgical movements on their appearance besides the change in their occlusion. Clinical audit of the surgical outcome comparing with the surgical plan and the monitoring of the stability of the surgery can be achieved in a more comprehensive way using 3D data. The digital workflow also facilitates multidisciplinary collaboration in providing better and more predictable outcome for our patients.