UVA Clinic Face Architects five steps for virtual surgical orthognathic planning; a routine protocol for functional and aesthetic outcomes

Abstract

The “5-Step” virtual surgical orthognathic planning (VSOP) protocol, has been developed by UVA Clinic Face Architects based on a daily clinical workflow. We describe a workup protocol for VSOP in an office-base concept using 5 steps. The first step consists of a cone-beam computed tomography (CBCT) scan of the patient with the alignment of fiducial markers and an appropriate calibration of the images that endorses a better surgical planning and surgical prediction. Understanding that one of the major challenge for the clinician is to incorporate three-dimensional (3D) imaging and virtual planning the second step consists in standardising the different two-dimensional virtual plannings allowing to integrate the “3D virtual treatment planning” in an efficient and non-time-consuming way. The third step is to approve the VSOP, this information is merged with the skeletal components of the CBCT providing appropriate elements for surgical planning and fabrication of an intermediate splint by computer-aided design/computer-aided manufacturing technology. The fourth step allows us to receive the surgical splints with a technique that eliminates the need for an additional dental model scan. This technique forces us to perform a mandible-first sequence. The fifth step consists in performing the surgery. This protocol provides great operative insight allowing us to improve our planning and our intraoperative efficiency. The 5-Step UVA Clinic Face Architects VSOP can be integrated in a daily clinical workflow with an efficient way providing tremendous preoperative insight anticipating bony interferences, osteotomy orientation and an idea of the condylar position.