Orthognathic Surgery Research Articles

Establishment of Cephalometric Hard Tissue Profile among Bengali and Caucasian Populations for Orthognathic Surgery

ABSTRACT The study aimed to compare cephalometric hard tissue profile values and analysis between Bengali and Caucasian populations. The study included 100 individuals (50 males, 50 females) aged 18–35. Subjects having class I molar occlusions and well-balanced facial profiles were included in the study. Lateral cephalograms were taken with consent, and a prestructured proforma recorded relevant information and cephalometric measurements. Our study found increased posterior cranial base length in Bengali males and increased anterior cranial base length in both sexes. Bengali males had a less convex profile, while females had a more convex profile compared to Caucasians with similar mandibular features. Increased maxillary and mandibular incisor proclination was observed. Our findings indicate the necessity for separate norms for orthognathic surgery in normal ethnic Bengali adults.

Evolution of Virtual Surgical Planning Use Among Craniofacial Surgeons

Virtual surgical planning (VSP) has benefits in craniofacial surgery with growing popularity. However, while specific use cases are highlighted in the literature, no studies exist providing an overview of VSP use among craniofacial surgeons, and little is known about the extent of exposure to VSP during plastic surgery training. This study surveyed members of The American Society of Maxillofacial Surgeons (ASMS) to better characterize both the landscape of VSP use among practicing craniofacial surgeons and the extent of exposure to VSP throughout surgical training. An electronic survey was administered in the fall of 2023. Response data included surgeon demographics, VSP usage, including the use in residency/fellowship, procedures for which VSP is used, and assessment of VSP’s impact on the surgeon’s practice. Demographics and VSP use were analyzed using descriptive statistics, while categorical and continuous variables were analyzed using χ2 tests and t-tests, respectively. Of the 44 respondents, 40 (90.9%) completed a craniofacial surgery fellowship, and 18 (40.9%) utilized VSP in either residency or fellowship. In respondents’ current practice, VSP is utilized most commonly for orthognathic surgery (n=32, 91.4%), postablative reconstruction (n=23, 82.1%), and facial feminization (n=11, 73.3%). Shorter operative time and improved esthetic outcomes were frequently reported as benefits derived from VSP use. Finally, surgeons in practice for less than 10 years were significantly more likely to have used VSP in both residency (OR=20.3, P<0.01) and in fellowship (OR=40.6, P<0.01) than those practicing for more than 10 years. These findings suggest that craniofacial surgeons apply VSP more commonly for certain procedure types. Our results additionally suggest that incorporation of VSP into residency and fellowship training has become significantly more common over time, with a pivot towards integration in the last decade.

Guided versus non-guided chin repositioning: a retrospective study on accuracy

Genioplasty is a widely used surgical approach to address chin deformities by performing an osteotomy on the inferior border of the mandible to allow for comprehensive repositioning of the chin. This study aimed to compare the accuracy of freehand chin repositioning with a guided technique that employed specialised surgical guides. For this retrospective study, data from 30 adult patients who underwent orthognathic surgery to correct dentofacial deformities were analysed. All patients underwent virtual planning before surgery, with half of them treated using freehand chin repositioning and the other half using the guided technique. The surgical outcomes were measured and compared with the virtual plan to assess the positional and rotational accuracy of the techniques. In terms of translational assessment, noteworthy values that exceeded clinically acceptable limits were observed only in sagittal movement in the freehand group (0.97 mm, interquartile range (IQR) 0.73–2.29 mm). Regarding rotational accuracy, both groups exhibited an IQR that surpassed acceptable limits for pitch (3.26°, IQR 2.06–5.20 for the guided group and 2.57°, IQR 1.63–4.24° for the freehand group). The Mann-Whitney test indicated no statistical differences between the groups in any translational or rotational assessment. In conclusion, although there was no statistical difference, the guided technique proved effective in achieving clinically acceptable accuracy in all positions and almost all rotations, displaying superior results in sagittal positioning compared with the freehand technique. To fully harness the advantages of guides and to guarantee accuracy in all rotations, we recommend further research involving guides made of more rigid materials, and customised implants.

Does the Sequence of Bimaxillary Orthognathic Surgery Affect Accuracy in Skeletal Class III Patients?

BackgroundIt is necessary to determine whether the sequence of maxillary and mandibular surgeries in bimaxillary orthognathic surgery affects the accuracy of surgical outcomes. PurposeThe study aimed to measure and compare the accuracy among patients who underwent maxilla-first versus mandible-first bimaxillary surgery to correct a class III skeletal pattern. Study designThis retrospective cohort study included consecutive patients treated by a single surgeon at one center using Le Fort I and bilateral sagittal split osteotomy surgery. Exclusions included patients scheduled for one-jaw or maxilla-segmental surgery and those with craniofacial syndromes, such as clefts. Predictor variableThe predictor variable was operative sequence for bimaxillary operations, divided into maxilla- or mandible-first groups. Outcome variableThe outcome variable was accuracy, measured using linear discrepancies between landmarks in the virtual plan and actual operative outcomes. The measurement of linear discrepancy that was closer to 0 was considered the more accurate result. CovariatesSex, age, maxilla sagittal rotation degree, amount of posterior maxilla impaction, mandibular autorotation (°), and intermediate splint thickness (mm) were the covariates. AnalysesStatistical analysis was performed using Student’s t-test and Pearson’s correlation, with statistical significance set at P < 0.05. ResultsThe sample comprised 60 patients with a mean age of 22.8 ± 3.7 years, of whom 36 (60%) were male. In the maxilla-first group, there were 30 subjects (60% male; mean age: 23.1 ± 4.2 years), with a mean mandibular autorotation of 0.41° (range: 0°–2.5°). The mandible-first group comprised 30 patients (60% male; mean age: 22.6 ± 3.3 years), with a mean mandibular autorotation of 5.46° (range: 1.9°–9.2°). The linear discrepancies for all landmarks did not significantly differ between mandible- and maxilla-first groups (P > 0.18). The mean 3D discrepancies for all landmarks in maxilla-first group was 1.23 ± 0.5 mm and 1.23 ± 0.33 mm in mandible-first group, with no significant difference observed between the groups (P > 0.98). The amount of mandibular autorotation for intermediate splint application showed no significant correlation with the linear discrepancies (P > 0.58). ConclusionsIn patients with skeletal class III malocclusion, mandible-first surgery in bimaxillary orthognathic surgery demonstrates accurate outcomes comparable to maxilla-first surgery.

Evaluation of Soft Tissue Changes Following Orthognathic Surgery Using Virtual Surgical Planning Software.

Orthognathic surgery brings about a harmonious relationship between jaws, resulting in improved facial aesthetics. It is key to analyze if satisfactory results can be attained by using virtual surgical planning for orthognathic procedures so as to recommend it for routine clinical practice. The aims of this study were to evaluate the various soft tissue changes that take place following orthognathic surgery using three-dimensional (3D) imaging and virtual surgical planning software and quantify the accuracy of virtual surgical planning software on patients undergoing orthognathic surgery. This is an observational prospective study with a sample size of 12. In this prospective study, 12 patients undergoing orthognathic surgery were included following the inclusion and exclusion criteria. A usual pre-surgical work-up was done and a 3D replica of the facial skeleton was formulated using the software with the DICOM data acquired from the patient i.e., CT and scans of patient's dentition. Virtual surgical planning was done and splints were manufactured according to the desired newly achieved position. Patients were operated following the virtual surgical plan guided by the computer-aided design and computer-aided manufacturing (CAD-CAM) splints. Post-operative evaluation was done. As the study is more of a descriptive study to obtain detailed knowledge of a new procedure, only one group is being studied and hence there is no statistical testing included in this study. The mean discrepancy noticed after superimposition of soft tissue points was 0.92 with a standard deviation of 0.3. 3D CT virtual surgical planning is a reliable tool to achieve predictable and reliable post-operative results in orthognathic surgical cases.

A 3D-CBCT Volumetric Analysis of Cervical Vertebrae Angulation and Airway Dimensions

Aim: To evaluate the relationship between airway dimensions and cervical vertebrae angulations in dental patients using three-dimensional cone beam computed tomography (3D-CBCT) technology. Materials and Methods: Pre-treatment CBCT scans and cephalometric radiographs were measured for 59 patients (mean age 22±2.3yrs.) using the Dolphin3D software system (version 11.7; Dolphin Imaging &amp; Management Solutions, Chatworth, CA) to record airway dimensions and cervical vertebral angulations. All CBCT images were acquired using the same standard protocol for collection using the iCAT CBCT Unit (Imaging Sciences International, Hatfield, PA): 13cm field of view, 0.4mm voxel size, 8.9sec scan time. Intraclass Correlations (ICC) were performed on duplicate measurements of 10 CBCT scans after a two-week interval to assess reliability. P-value and Pearson correlation coefficients were used to statistically assess the relationship between vertebral angulations and airway dimensions. Results: ICC values from the reliability assessment were &gt;0.90. Pearson correlation coefficients were categorized based on confidence level as follows: high (&gt;0.75 or &lt;-0.75), moderate (0.5 to 0.74 or -0.5 to -0.74), or weak (0.3 to 0.49 or -0.3 to -0.49). No high/moderate correlations were observed. Weak correlations (p&lt;0.05) were observed between the nasopharyngeal volume and the soft tissue thickness at CV1(-0.47) and CV2(-0.34). A weak correlation was observed between the nasal cavity volume and S-N (+0.41) as well as ANS-PNS(+0.38). A weak correlation was observed between the total airway volume and the soft tissue thickness at CV2(-0.34). Conclusion: The soft tissue thickness of the posterior wall of the airway at the level of cervical vertebrae-2 appears to have a weak, negative correlation with several upper airway parameters and total airway volume. Soft tissue thickness of the posterior pharyngeal wall is crucial for dental clinicians to analyze prior to some procedures such as orthognathic surgery and orthodontic treatment that involve growth modification and jaw positioning, as it may have an association with decreased airway volume. Clinical Significance: The relationship between cervical vertebrae angulation, airway, and craniofacial morphology is a complex aspect of human anatomy. In dentistry, it is crucial that clinicians recognize the vital role cervical vertebrae angulation and airway interact in relation to craniofacial morphology. Knowledge of these interconnections will significantly inform treatment planning for multiple oral health conditions such as malocclusions, jaw discrepancies, and temporomandibular joint disorders.

Pre- and Post-Operative Cone Beam Computed Tomography Assessment of the Temporomandibular Joint in Patients with Orthognathic Surgery.

This study aimed to compare the pre- and post-operative temporomandibular joint (TMJ) condylar position in dentofacial deformity (DFD) patients who had orthognathic surgeries using cone beam computed tomography (CBCT). A retrospective study evaluating the pre- and post-operative CBCT for 79 DFD patients (equivalent to 158 TMJs) (mean age = 26.62 ± 9.5 years) with a bilateral sagittal split osteotomy with or without Le Fort I surgeries (n = 29 Class II DFD, n = 50 Class III DFD) was performed. This included the compartmental measurement of TMJ spaces, in addition to the measurement of intercondylar distances and angles. Condylar position centricity was assessed using the Pullinger and Hollender formula. Clinical data were analysed for DFD class, the type of surgery and post-operative CBCT timing. Pre- and post-operative measurements were compared statistically using a paired t-test, Wilcoxon signed-rank test, and Stuart-Maxwell test. TMJ condyles tended to relocate post-operatively in a posterosuperior position with internal rotation in Class II DFD and a superior position with internal rotation in Class III DFD. However, the overall changes were within <0.5 mm translation and <4° rotation and the number of concentrically positioned condyles (according to the Pullinger and Hollender formula) did not change significantly. Orthognathic surgery is associated with minor post-operative translational and rotational condylar positional changes in Class II and III DFDs.

Exploring patient perspectives: orthognathic surgery outcomes and experiences assessed by patient-reported outcome measures and patient-reported experience measures

Evaluating the effectiveness of orthognathic treatment can be difficult. To address this issue, patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) have been proposed as valuable instruments for understanding the quality of healthcare from the patients’ standpoint. Therefore, the aim of this project was to employ PROMs and PREMs questionnaires to capture the patients’ perspectives regarding their experience during the orthognathic treatment process, as well as their perception of their postoperative state. Preoperative and postoperative questionnaires were offered to patients at consenting appointment and at various timepoints after the surgery. The assessment of statistical relationships was carried out by means of Fisher’s exact test. A total of 64 preoperative and 126 postoperative responses were received. The primary motivators for pursuing the surgery were the improvement of facial and dental aesthetics, as well as increased satisfaction with photographic and video appearances. These three factors were also cited as the most important postoperative benefits. Of the respondents, 58% reported experiencing altered sensation to the lower lip at the 24-month follow up (p = 0.02); however, the affected patients reported that this did not have an impact on their daily activities. The use of PROMs and PREMs to appraise the quality of life constitutes a valuable method for surgeons to gauge their treatment efficacy. Above all, such tools are particularly useful for evaluating patient satisfaction, which is the ultimate objective of any treatment.

A New Method to Design and Manufacture a Low-Cost Custom-Made Template for Mandible Cut and Repositioning Using Standard Plates in BSSO Surgery.

In this study, a new methodology for designing and creating a custom-made template for maxillofacial surgery has been developed. The custom-made template can be used both for cutting and repositioning of the mandible arches for executing a BSSO (bilateral sagittal split osteotomy) treatment. The idea was developed in order to give the possibility of using a custom-made template with standard plates, thus reducing long times, high costs and low availability of custom-made plates; this represents the proof of novelty of the proposed template, based on a well-established methodology. The methodology was completely developed in the CAD virtual environment and, after the surgeons' assessment, an in-vitro experiment by a maxillofacial surgeon was performed in order to check the usability and the versatility of the system, thanks to the use of additive manufacturing technologies. When computer-aided technologies are used for orthognathic surgery, there are significant time and cost savings that can be realised, as well as improved performance. The cost of the whole operation is lower than the standard one, thanks to the use of standard plates. To carry out the procedures, the proposed methodology allows for inexpensive physical mock-ups that enable the BSSO procedure to be performed.

Bilateral alloplastic temporomandibular joint reconstruction with orthognathic surgery: a case report of idiopathic condylar resorption

Idiopathic condylar resorption (ICR) also known as cheerleader’s syndrome, progressive condylar resorption, idiopathic condylysis, and condylar atrophy can be defined as chronic ongoing changes of condylar shape and decrease in mass. It is characterized by an excessive physical stress to the articular structures of the temporomandibular joint (TMJ) that exceeds the normal adaptive capacity. Consequently, leading to decrease condylar head volume, decrease ramus height, progressive mandibular retrusion in adults, or decreased growth rate in adolescents. A case report of a 30-year-old female based on the history, clinical, and radiographic examination has class II skeletal relationship secondary to bilateral ICR, receded chin, vertical maxillary excess (VME) and canting. Surgical treatment plan was established using 3D Systems, Inc., (“3DS”) VSP® and case was managed by bilateral total alloplastic temporomandibular joint reconstruction (BATMJR) with orthognathic surgery to do LeFort I, bilateral condylectomy, genioplasty, and inferior border osteotomy. The case report includes one-year follow-up which shows stable outcome, emphasizing long-term success of comprehensive treatment strategy in addressing skeletal class II malocclusion associated with ICR.

Treatment of Class III Malocclusion with Open Bite and Macroglossia Using an Anterior Loop

General Background: Class III malocclusion is a prevalent dental anomaly characterized by the anterior positioning of the mandible relative to the maxilla, posing functional and aesthetic challenges. Specific Background: This condition may present with additional complexities such as dental crowding, open bite, and macroglossia, complicating the orthodontic treatment approach. Knowledge Gap: While conventional treatment modalities include orthognathic surgery and growth modification, there is limited documentation on the efficacy of orthodontic camouflage in non-surgical settings, particularly in adults with completed growth. Aims: This study aims to evaluate the effectiveness of orthodontic camouflage using anterior stainless steel loops in managing dentoskeletal Class III malocclusion accompanied by anterior open bite and macroglossia, without premolar extraction. Results: Over a 7-month treatment period, significant corrections in overjet, overbite, and molar relationship were achieved, demonstrating the potential of this approach as a non-surgical alternative. Novelty: This research introduces a modified technique involving stainless steel wire with specific loop placements, contributing to the orthodontic management strategies for complex Class III cases. Implications: The findings support the broader application of camouflage techniques in orthodontic practice, offering a viable option for patients opting out of surgery and highlight the need for further studies to optimize and validate such approaches.Highlights: Efficiency of Camouflage: Shows how orthodontic camouflage can effectively treat complex Class III malocclusion without surgery. Novel Technique: Introduces a new method using stainless steel loops in wires to enhance treatment outcomes. Clinical Implications: Expands non-surgical treatment options in orthodontics, offering viable alternatives to surgery. Keywords: Class III Malocclusion, Orthodontic Camouflage, Open Bite, Macroglossia

Metamorphosis of a Tall and Ugly Woman Through Plastic Surgery During a 7-Year Period: An Analysis of The Life and Loves of a She-Devil.

The aim of this study is to analyze the process of metamorphosis of a tall and ugly woman through plastic surgery as depicted in The Life and Loves of a She-Devil (1983) of Fay Weldon. The process of plastic surgeries and the psychology of the protagonist of this novel were analyzed. A highly unattractive woman (Ruth, 185cm) takes revenge on her husband (Bobbo, 175cm) and his attractive lover (Mary Fisher, 160cm). To transform her appearance, Ruth remodels her jaw, has her teeth extracted (2-jaw surgery or facial contouring surgery), straightens and trims her nose (corrective rhinoplasty), flattens her cheekbones (reduction malarplasty), reduces her breast size (reduction mammoplasty), and shortens both her arms and legs (limb reduction surgery). Following the series of surgeries, Ruth ultimately made herself look identical to Mary Fisher, her husband's lover. She believes her inadequacies stem from her body's failure to meet societal beauty standards, prompting her decision to "remake" herself. She declares, "I will be what I want, not what God ordained." Ruth's aspiration is not to acquire a new face but to attain the face of Mary Fisher. When confronted with pain and harm, Ruth does not waver but acknowledges it. "Of course it hurts. Andersen's little mermaid wanted legs instead of a tail. And, like her, I welcome it. I don't complain." In this study, we derived insights into why patients who want to change their entire bodies undergo plastic surgery, what these patients really want, and patients' attitudes toward the pain caused by surgical procedures.

Gummy Smile: A Narrative Review

Imaginary line that follows the lower superior lip is known as the grin level, and it appears to be convex. Gummy smile is caused by gingival band exposures that are 3 mm or greater throughout normal speech or smiles. Multifactorial etiology can be demonstrated by extrusion of the anterior teeth, excessive labial contraction, shorter upper lip, gingival excess, and excessive vertical maxillary growth up. In addition to being useful for orthognathic, plastic, and periodontal surgery, orthodontic therapy is also frequently interdisciplinary. Many techniques can be used to treat the issue of excessive gingival show. These operations involve both non-surgical and surgical techniques. The technique to be chosen may vary depending on the underlying reason of the gummy smile.

Non-surgery Treatment with MEAW Technique in Skeletal Class III Malocclusion and Facial Asymmetry in Adults: A Case Report

Background Treating skeletal Class III malocclusions characterized by mandibular deviation, facial asymmetry, and other complex orthodontic issues is among the most demanding orthodontic procedures. Orthognathic surgery is not recommended to everyone due to the dangers involved. Hence, it is considered to be very difficult to correct face asymmetry with orthodontics alone, much less without surgery. Objective The goals of this case study were to decrease crowding in the upper teeth, manage the vertical dimension, and treat the patient's primary complaints of crossbite in the anterior teeth and facial asymmetry. Case Presentation A female patient, aged 21, came in with many concerns, including an incisor crossbite, facial asymmetry, and an insecurity that manifested only when she smiled. An adult patient with a mandibular deviation to the right and an incisor crossbite received orthodontic treatment for these issues. The patient had asymmetric molar extraction in both the lower and upper jaws to retract the lower incisors and correct the midline of the teeth using intermaxillary elastic. Fixed appliances were utilized in conjunction with overbearing lower anterior braces to manage the torque on the lower anterior teeth. As a result, she had a pleasant smile, a harmonious face, and stable dental and skeletal connections. The whole therapeutic period lasted 30 months. As a result, asymmetric molar extraction may be an acceptable option for retracting mandibular incisors in Class III malocclusion with facial asymmetry. Conclusion The most important step in treating the severe skeletal Class III malocclusion in this patient without surgery was to retract the lower arch. After using the MEAW approach, Class III elastics, posterior bite turbos, and orthopedic splint treatment, the patient reported a satisfactory achievement.

Deep learning for 3D cephalometric landmarking with heterogeneous multi-center CBCT dataset.

Cephalometric analysis is critically important and common procedure prior to orthodontic treatment and orthognathic surgery. Recently, deep learning approaches have been proposed for automatic 3D cephalometric analysis based on landmarking from CBCT scans. However, these approaches have relied on uniform datasets from a single center or imaging device but without considering patient ethnicity. In addition, previous works have considered a limited number of clinically relevant cephalometric landmarks and the approaches were computationally infeasible, both impairing integration into clinical workflow. Here our aim is to analyze the clinical applicability of a light-weight deep learning neural network for fast localization of 46 clinically significant cephalometric landmarks with multi-center, multi-ethnic, and multi-device data consisting of 309 CBCT scans from Finnish and Thai patients. The localization performance of our approach resulted in the mean distance of 1.99 ± 1.55 mm for the Finnish cohort and 1.96 ± 1.25 mm for the Thai cohort. This performance turned out to be clinically significant i.e., ≤ 2 mm with 61.7% and 64.3% of the landmarks with Finnish and Thai cohorts, respectively. Furthermore, the estimated landmarks were used to measure cephalometric characteristics successfully i.e., with ≤ 2 mm or ≤ 2° error, on 85.9% of the Finnish and 74.4% of the Thai cases. Between the two patient cohorts, 33 of the landmarks and all cephalometric characteristics had no statistically significant difference (p < 0.05) measured by the Mann-Whitney U test with Benjamini-Hochberg correction. Moreover, our method is found to be computationally light, i.e., providing the predictions with the mean duration of 0.77 s and 2.27 s with single machine GPU and CPU computing, respectively. Our findings advocate for the inclusion of this method into clinical settings based on its technical feasibility and robustness across varied clinical datasets.

A nomogram prediction of gingival recession in mandibular incisors of orthodontic-orthognathic treated skeletal class III malocclusion with or without PAOO: A retrospective cohort study

BackgroundTo assess the alterations in gingival thickness and the occurrence gingival recession subsequent to orthodontic-orthognathic treatment of mandibular incisors in skeletal Class III and identify risk factors associated with gingival recession. MethodsIn this retrospective cohort study, we enrolled 33 patients exhibiting skeletal Class III malocclusion, totaling 131 mandibular incisors, who were undergoing orthodontic- orthognathic treatment that did not involve extraction of mandibular teeth. The subjects were categorized into surgery group (S; n = 17; ANB = −5.55 ± 3.26; IOFTN = 4.60 ± 0.51, scores ranging: 4.3–5.3) and non-surgery group (NS; n = 16; ANB = −3.00 ± 4.08; IOFTN = 4.63 ± 0.50, scores ranging: 4.3–5.4), based on if they had history of Periodontally Accelerated Osteogenic Orthodontics surgery (S) or not (NS). Patients in S group received orthognathic surgery about 1–1.5 years after Periodontally Accelerated Osteogenic Orthodontics surgery. Alterations in gingival thickness, gingival recession, and keratinized gingival width were compared before and after orthodontic-orthognathic treatment. Logistic regression analysis was used to construct a gingival recession prediction model and draw nomograms. ResultsAfter orthodontic-orthognathic treatment, the gingival thickness and keratinized gingival width in NS group decreased by 0.15 ± 0.21 mm and 0.74 ± 0.91 mm, whereas those in the S group increased by 0.32 ± 0.28 mm and 2.09 ± 1.51 mm (P < 0.05). After orthodontic-orthognathic, the percentage of gingival recession increased by 47.62 % in NS group, which was 14.77 times that of S group (P < 0.05). Multivariate regression analysis indicated that skeletal Class III patients with a gingival thickness below 0.72 mm, an alveolar bone height exceeding 2.36 mm, and an alveolar bone thickness under 0.45 mm might be at elevated risk for developing gingival recession following orthodontic - orthognathic therapy. ConclusionsDrawing on the findings of our investigation, we concluded the risk of gingival recession of mandibular anterior teeth increased after orthodontic-orthognathic treatment in skeletal Class III, whereas Periodontally Accelerated Osteogenic Orthodontics surgery could significantly improve the periodontal phenotype and prevent gingival recession.

Predicting the Future Focus of Orthognathic Surgery: Outcome-Driven Planning and Treatment With Function, Esthetics, and Occlusion as Key Indicators

As we reflect on the last 7decades since the first descriptions of modern orthognathic surgery (OGS) by Trauner and Obwegeser, we ponder what the next "game-changers" will be over the upcoming decades. We certainly recognize the prior contributions of Hullihen in 1849 and others in the 1920s and 1930s, and the pioneering work of Tessier, Obwegeser, and Bell in the 1960s and 1970s. Although there have been some changes in osteotomy design, as well as the landmark game-changing introduction of rigid internal fixation in the 1970s and 1980s, many of the more recent major changes have occurred only in the past decade or 2. The use of personalized and precision medicine with virtual surgical planning, and patient-specific implants has been transformational. Certainly, there will be more advances in the realm of diagnosis, surgical techniques and protocols, biomaterials and tissue engineering, and surgeon and patient education. But, as an international group of orthognathic surgeons, we believe that the most significant "next big thing" will be a clinical and research focus on patient-oriented outcomes and an improved quality of life. This will require outcome-driven planning and treatment with function, esthetics, and occlusion as key outcome indicators. Here we identify some shared visions and objectives for OGS with the aim to delineate future advancements to enhance the care of patients with dentofacial deformities. While we have organized the sections to cover key areas, the fundamental concepts include advances in these areas: diagnosis and treatment planning (eg, imaging, virtual surgical planning, artificial intelligence, and point-of-care workflows); materials development (eg, patient-specific implant, three-dimensional printing, tissue engineering, biodegradable implants, bone cements, titanium and magnesium implants, and developmental and regenerative medicine); and patient management (eg, minimally-invasive surgery, clear aligner therapy, temporary anchorage devices, outpatient OGS, age-centered treatment, and augmented reality/virtual reality).

Discussion: Comparative Assessment of Orthodontic and Aesthetic Outcomes after Orthognathic Surgery with Clear Aligner or Fixed Appliance Therapy.

Discussion: Comparative Assessment of Orthodontic and Aesthetic Outcomes after Orthognathic Surgery with Clear Aligner or Fixed Appliance Therapy.

Characteristics of rehabilitation for patients with severe asymmetric jaw deformities resulting from temporomandibular joint pathology

Relevance. Temporomandibular joint (TMJ) pathology, along with the resultant facial asymmetry, is a common condition within maxillofacial disorders. Addressing the rehabilitation of these patients within specialised medico-social care is a crucial and challenging task.Purpose. To develop a comprehensive rehabilitation protocol for patients with severe asymmetric jaw deformities caused by TMJ pathology.Materials and methods. From 2018 to 2023, ten patients with defects and deformities of the TMJ condylar process, presenting with severe asymmetric jaw deformities, were treated. An assessment of subjective and objective facial aesthetic parameters was conducted based on photographic protocols, as well as 2D and 3D cephalometric facial measurements. Comprehensive preparation for orthognathic surgery with simultaneous endoprosthesis replacement was performed based on the collected data. A regimen of postoperative therapeutic procedures was prescribed following the surgery.Results. All patients achieved the intended statistically significant outcomes: in the sagittal plane, an improvement in facial profile was noted based on the position of the chin (Pog) relative to the true vertical line passing through the subnasale point. In the frontal plane, alignment of the occlusal plane and normalization of the central line of the upper and lower incisors relative to the midline of the face were observed.Conclusion. The algorithm for the comprehensive preparation of patients with asymmetric jaw deformities, developed during growth, prior to performing orthognathic surgery with simultaneous TMJ endoprosthesis replacement should include: orthodontic treatment aimed at aligning teeth position and dental arches, eliminating rotations and pathological inclinations of teeth using a bracket system, fully restoring interocclusal height with temporary implant-supported structures, using occlusal splints and temporary composite restorations, as well as employing separating orthodontic plates. These stages enabled the achievement of good aesthetic results and improved patients' quality of life.

Assessment of cone-beam CT technical image quality indicators and radiation dose for optimal STL model used in visual surgical planning.

The aim of this study was to identify cone-beam computed tomography (CBCT) protocols that offer an optimal balance between effective dose (ED) and 3D model for orthognathic virtual surgery planning, using CT as a reference, and to assess whether such protocols can be defined based on technical image quality metrics. Eleven CBCT (VISO G7, Planmeca Oy, Helsinki, Finland) scan protocols were selected out of 32 candidate protocols, based on ED and technical image quality measurements. Next, an anthropomorphic RANDO SK150 phantom was scanned using these 11 CBCT protocols and 2 CT scanners for bone quantity assessments. The resulting DICOM (Digital Imaging and Communications in Medicine) files were converted into Standard Tessellation Language (STL) models that were used for bone volume and area measurements in the predefined orbital region to assess the validity of each CBCT protocol for virtual surgical planning. The highest CBCT bone volume and area of the STL models were obtained using normal dose protocol (F2) and ultra-low dose protocol (J13), which resulted in 48% and 96% of the mean STL bone volume and 48% and 95% of the bone area measured on CT scanners, respectively. The normal dose CBCT protocol "F2" offered optimal bone area and volume balance for STL. The optimal CBCT protocol can be defined using contrast-to-noise ratio and modulation transfer function values that were similar to those of the reference CT scanners'. CBCT scanners with selected protocols can offer a viable alternative to CT scanners for acquiring STL models for virtual surgical planning at a lower effective dose.