Planning In Orthognathic Surgery Research Articles

The Position of the Virtual Hinge Axis in Relation to the Maxilla in Digital Orthognathic Surgery Planning-A k-Means Cluster Analysis.

The aim of this study was to investigate a possible relation between skeletal phenotypes and virtual mounting data in orthognathic surgery patients. A retrospective cohort study including 323 female (26.1 ± 8.7 years) and 191 male (27.9 ± 8.3 years) orthognathic surgery patients was conducted. A k-means cluster analysis was performed on the mounting parameters: the angle α between the upper occlusal plane (uOP) and the axis orbital plane (AOP); the perpendicular distance (AxV) from the uOP to the hinge axis; and the horizontal length (AxH) of the uOP from upper incisor edge to AxV, with subsequent statistical analysis of related cepalometric values. Three clusters of mounting data were identified, representing three skeletal phenotypes: (1) balanced face with marginal skeletal class II or III and α=8∘, AxV = 36 mm and AxH = 99 mm; (2) vertical face with skeletal class II and α=11∘, AxV = 27 mm and AxH = 88 mm; (3) horizontal face with class III and α=2∘, AxV = 36 mm and AxH = 86 mm. The obtained data on the position of the hinge axis can be applied to any digital planning in orthognathic surgery using CBCT or a virtual articulator, provided that the case can be clearly assigned to one of the calculated clusters.

Computer-assisted planning and patient-specific plates in orthognathic surgery: a global study

Using computer-assisted surgery (CAS) and patient-specific plates (PSP) in orthognathic surgery has shown improved accuracy and efficiency compared with traditional techniques. This study analyzed current global trends in planning and investigated the reasons for CAS and PSP use. A survey of 29 multiple choice questions was distributed to AO Foundation Craniomaxillofacial e-mail subscribers biweekly between July 14, 2021 and September 2, 2021. Questions focused on specifics of respondents' preoperative workup, methods of data collection, and the use of cutting guides and patient-specific plates. Objective clinical outcomes and subjective surgeon reasons for use were also investigated. Of the 557 responses, 420 (75.4%) participant responses were eligible for analyses. Most (302/420, 71.9%) respondents used CAS when performing orthognathic surgery, although regional differences were observed. Almost all respondents in North America implemented CAS in their surgery plan (44/46, 95.7%) compared with only 47.4% (18/38) in the Middle East/North Africa. Surgeons with 10 to 15 years of experience were far more likely to incorporate CAS. More than half (175/301, 58.1%) of CAS users also used PSP, of which 43% (68/158) did so for maxillary-only cases, 3.2% (5/158) used PSP for mandible-only surgeries, and 42.4% (67/158) used PSP for both. Surgeons' primary reasons for using CAS and PSP were accuracy (200/253, 79.1%), efficiency (196/253, 77.5%), and ease of preoperative planning (150/253, 59.3%). Most (77.9%) surgeons perceived that CAS was equal to or faster than traditional surgery. Our study shows differences in use regionally and with surgeon experience. Surgeons primarily use CAS and PSP in orthognathic surgery to increase accuracy and efficiency, minimize intraoperative deviations from the surgical plan, and reduce total surgical time.

Morphological Variation of the Mandible in the Orthognathic Population-A Morphological Study Using Statistical Shape Modelling.

The aim of this study was to investigate the value of 3D Statistical Shape Modelling for orthognathic surgery planning. The goal was to objectify shape variations in the orthognathic population and differences between male and female patients by means of a statistical shape modelling method. Pre-operative CBCT scans of patients for whom 3D Virtual Surgical Plans (3D VSP) were developed at the University Medical Center Groningen between 2019 and 2020 were included. Automatic segmentation algorithms were used to create 3D models of the mandibles, and the statistical shape model was built through principal component analysis. Unpaired t-tests were performed to compare the principal components of the male and female models. A total of 194 patients (130 females and 64 males) were included. The mandibular shape could be visually described by the first five principal components: (1) The height of the mandibular ramus and condyles, (2) the variation in the gonial angle of the mandible, (3) the width of the ramus and the anterior/posterior projection of the chin, (4) the lateral projection of the mandible's angle, and (5) the lateral slope of the ramus and the inter-condylar distance. The statistical test showed significant differences between male and female mandibular shapes in 10 principal components. This study demonstrates the feasibility of using statistical shape modelling to inform physicians about mandible shape variations and relevant differences between male and female mandibles. The information obtained from this study could be used to quantify masculine and feminine mandibular shape aspects and to improve surgical planning for mandibular shape manipulations.

Comparing the accuracy and precision of digital model transfer methods used in virtual orthognathic planning

Objectives: The hard and soft tissues of the head and neck, dentition, and temporomandibular joint are the determining elements in orthognathic surgery planning. The accuracy and precision of the relationship between the jaws at the beginning of treatment and their final position depend on an accurate dentition record. The aim of this study was to determine the simplest and most feasible virtual dental model transfer method for three-dimensional orthognathic planning according to clinical applicability, technical difficulty, effective costs, accuracy, and precision. Material and Methods: A total of ten spherical porcelain markers were placed in plaster models of the maxilla and mandible of a patient. The models were scanned using an intraoral optical scanner, an extraoral digital model scanner, and cone-beam computerized tomography. To evaluate reliability, each measurement was repeated 10 times at 1-week intervals and the distances between points were measured horizontally and vertically. The findings obtained in the study were evaluated statistically using IBM SPSS Statistics 2.2 program. Results: Measurements obtained with the extraoral model scanner did not differ from the digital caliper method (P > 0.05), while there were significant differences between the digital caliper and the other methods (intraoral 3D scanner P = 0.000; CBCT P = 0.001). Conclusion: Although all of the measurements showed high consistency among all methods, the most accurate results were obtained with the extraoral digital model scanner. (r = 0.99, P = 0.01, P < 0.05).

Accuracy of virtual surgical planning in bimaxillary orthognathic surgery with mandible first sequence: A retrospective study

The aim of this study was to verify treatment accuracy using virtual surgical planning (VSP) with a mandible-first sequence and strict surgical protocol to determine what surgical and methodological factors might influence outcomes.VSP transfer accuracy was evaluated retrospectively through a modified method involving voxel-based superimposition in patients who had undergone bimaxillary surgery with a mandible-first sequence to correct dentoskeletal deformities. Data analysis showed that the movements planned and those executed were substantially equivalent (p < 0.01), with the exception of mandibular and maxillary sagittal movements that were 0.72 ± 0.90 mm and 1.41 ± 1.04 mm smaller, respectively, than planned.This study showed that a mandible-first sequence is accurate for transferring virtual surgical planning intraoperatively. There are several factors involved in the proper transfer of virtual planning beyond the software, such as surgical technique and sequencing. Inaccurate sagittal movements and maxillary repositioning seem to depend mainly on surgical factors.

Prediction of orthognathic surgery plan from 3D cephalometric analysis via deep learning

BackgroundPreoperative planning of orthognathic surgery is indispensable for achieving ideal surgical outcome regarding the occlusion and jaws' position. However, orthognathic surgery planning is sophisticated and highly experience-dependent, which requires comprehensive consideration of facial morphology and occlusal function. This study aimed to investigate a robust and automatic method based on deep learning to predict reposition vectors of jawbones in orthognathic surgery plan.MethodsA regression neural network named VSP transformer was developed based on Transformer architecture. Firstly, 3D cephalometric analysis was employed to quantify skeletal-facial morphology as input features. Next, input features were weighted using pretrained results to minimize bias resulted from multicollinearity. Through encoder-decoder blocks, ten landmark-based reposition vectors of jawbones were predicted. Permutation importance (PI) method was used to calculate contributions of each feature to final prediction to reveal interpretability of the proposed model.ResultsVSP transformer model was developed with 383 samples and clinically tested with 49 prospectively collected samples. Our proposed model outperformed other four classic regression models in prediction accuracy. Mean absolute errors (MAE) of prediction were 1.41 mm in validation set and 1.34 mm in clinical test set. The interpretability results of the model were highly consistent with clinical knowledge and experience.ConclusionsThe developed model can predict reposition vectors of orthognathic surgery plan with high accuracy and good clinically practical-effectiveness. Moreover, the model was proved reliable because of its good interpretability.

Genioplasty in Contemporary Orthognathic Surgery.

In contemporary orthognathic surgery planning, the genium/chin constitutes an important part that contributes to the maxillofacial profile. The aesthetics of the lower face is affected by the position of the genium which makes reestablishment of genial morphology an essential component. It is hence necessary to evaluate the genium objectively on its individual merit, and any discrepancy is addressed accordingly. This review presents an overview of contemporary genioplasty techniques, their applications, and considerations on stability, osteosynthesis, complications, and the future developments.

P-67650479-350 - Do new surgeons and experienced surgeons perform virtual surgical planning in orthognathic surgery the same way?

P-67650479-350 - Do new surgeons and experienced surgeons perform virtual surgical planning in orthognathic surgery the same way?

The use of virtual planning in orthognathic surgery

The use of virtual planning in orthognathic surgery

A Novel Cephalometric Approach Aiming to Quantify a Normal Range of Bony Chin Protrusion.

Cephalometric analysis is an essential tool in the diagnostics and planning of orthognathic surgery. No objective criterion exists to facilitate decision making regarding genioplasties. Differing opinions amongst clinicians therefore leads to wide variability amongst treatment options offered to potentially suitable patients. This study has three aims. The first was to quantify the distribution of chin morphology amongst the average population using cephalometric analysis. Secondly, we sought to determine whether cephalometric parameters could be used to predict overlying soft tissue changes. Lastly, we consider the use of a new cephalometric angle, BNPg, for pre- and post-operative assessment of genioplasty patients. This study retrospectively analysed 231 lateral cephalograms. The angle between the landmarks: B point, Nasion and Pogonion was measured to generate 'BNPg' a novel unit to quantify bony chin protrusion. The mean BNPg from all 231 samples was 1.12 degrees with a standard deviation of ± 1.35. Comparison between sexes showed no significant differences between male and females (P = 0.108). Furthermore, bony chin protrusion was found to strongly positively correlate with soft tissue chin appearance (r = 0.731), however, BNPg was found not to correlate with skeletal malocclusion (ANB, r = 0.085). The novel unit BNPg may serve as a useful tool in contributing to the determination of treatment thresholds in osseous genioplasty for desirable aesthetic outcomes and may be used post-operatively to assess outcomes also. As this is a pilot study, further clinical studies would be required to validate this parameter in genioplasty patients, both pre- and post-operatively. The online version contains supplementary material available at 10.1007/s12663-022-01784-5.

Differentiable Simulation for Outcome‐Driven Orthognathic Surgery Planning

AbstractAlgorithms at the intersection of computer graphics and medicine have recently gained renewed attention. A particular interest are methods for virtual surgery planning (VSP), where treatment parameters must be carefully chosen to achieve a desired treatment outcome. FEM simulators can verify the treatment parameters by comparing a predicted outcome to the desired one. However, estimating the optimal parameters amounts to solving a challenging inverse problem. In current clinical practice it is solved manually by surgeons, who rely on their experience and intuition to iteratively refine the parameters, verifying them with simulated predictions.We prototype a differentiable FEM simulator and explore how it can enhance and simplify treatment planning, which is ultimately necessary to integrate simulation‐based VSP tools into a clinical workflow. Specifically, we define a parametric treatment model based on surgeon input, and with analytically derived simulation gradients we optimise it against an objective defined on the visible facial 3D surface. By using sensitivity analysis, we can easily explore the solution‐space with first‐order approximations, which allow the surgeon to interactively visualise the effect of parameter variations on a given treatment plan. The objective function allows landmarks to be freely chosen, accommodating the multiple methodologies in clinical planning. We show that even with a very sparse set of guiding landmarks, our simulator robustly converges to a feasible post‐treatment shape.

Artificial intelligence system for automated landmark localization and analysis of cephalometry.

Cephalometric analysis is essential for diagnosis, treatment planning and outcome assessment of orthodontics and orthognathic surgery. Utilizing artificial intelligence (AI) to achieve automated landmark localization has proved feasible and convenient. However, current systems remain insufficient for clinical application, as patients exhibit various malocclusions in cephalograms produced by different manufacturers while limited cephalograms were applied to train AI in these systems. A robust and clinically applicable AI system was proposed for automatic cephalometric analysis. First, 9870 cephalograms taken by different radiography machines with various malocclusions of patients were collected from 20 medical institutions. Then 30 landmarks of all these cephalogram samples were manually annotated to train an AI system, composed of a two-stage convolutional neural network and a software-as-a-service system. Further, more than 100 orthodontists participated to refine the AI-output landmark localizations and retrain this system. The average landmark prediction error of this system was as low as 0.94 ± 0.74 mm and the system achieved an average classification accuracy of 89.33%. An automatic cephalometric analysis system based on convolutional neural network was proposed, which can realize automatic landmark location and cephalometric measurements classification. This system showed promise in improving diagnostic efficiency in clinical circumstances.

Accuracy of mandibular anterior subapical osteotomy by virtual planning in orthognathic surgery using patient-specific implants

IntroductionMandibular anterior subapical osteotomy (MASO) is a complementary procedure during orthognathic surgery to correct proclination or extrusion of the anterior incisors when orthodontic movements fail. The increasing use of patient-specific implants (PSI, titanium plates) in orthognathic surgery has extended to this procedure. Digital orthognathic surgery planning involves manufacturing cutting/drilling guides and specific implants to provide better accuracy and allow complex movement with reduced surgical times compared to conventional planning. This study aimed to assess the accuracy of computer-aided surgery with patient-specific implants in mobilising the MASO segment according to planning. MethodsEleven consecutive patients with mean age 26.82 years (15–41, SD = 10.65) were treated with MASO in addition to other conventional orthognathic procedures incorporating digital planning and patient-specific implants. A three-dimensional “stl” format file of the mandibular dental arch was obtained using an intraoral scanner at the end of the surgical procedure. The accuracy of the MASO segment displacement imposed by PSI was assessed by comparing preoperative 3D-planned mandibular dental arch with the immediate postoperative 3D-measured arch, using surface superimposition and 7 standard dental landmarks. Deviations between the preoperative and postoperative landmarks were calculated and compared to determine whether MASO segment repositioning is sufficiently accurate to be safely used to reposition the incisor/canine axis. ResultsQuantitative analysis revealed an absolute linear difference of 0.66 mm (SD = 0.51) between preoperative 3D digital dental arch impression and postoperative planned 3D dental arch. Overall, the median absolute discrepancies in the x-axis (right-left direction), y-axis (antero-posterior direction), and z-axis (supero-inferior direction) were respectively 0.56 mm (SD = 0.42), 0.77 mm (SD = 0.45) and 0.65 mm (SD = 0.61). ConclusionA high degree of accuracy between the virtual plan and the immediate postoperative result was observed. According to our results, PSI can be used safely with accuracy in MASO as an adjunct to other conventional orthognathic procedures.

An Automatic Voxel-Based Method for Optimal Symmetry Plane Generation for the Maxillofacial Region in Severe Asymmetry Cases.

Symmetry is representative of aesthetics and health in all kinds of vertebrates, especially the human face. Therefore, to automatically locate the appropriate symmetry plane is crucial. The aim of this study was to develop an automatic and reliable method to determine the symmetry plane of the maxillofacial region. We compared the proposed method of determining the symmetry plane by assessing landmark-based and surface-based methods by way of quantitative symmetry assessments. Statistical analysis was applied to evaluate whether significant difference existed among these three kinds of symmetry planes. Twenty cases who had a diagnosis of severe facial asymmetry were evaluated retrospectively. The results showed that searching for the symmetry plane using a voxel-based method, named the optimal symmetry plane (OSP), achieved the most representative symmetry according to the outcomes of the trials. The OSP was significantly more symmetrical than the other two planes, as determined by other methods. The paired-voxel computation method proposed in this research is a robust and reliable method for identifying the unique symmetry plane for patients with severe facial asymmetry. Symmetry is of crucial significance for all kinds of vertebrates, including its clinical implications for surgical planning in orthognathic surgery.

Virtual Surgical Planning in Orthognathic Surgery: Two Software Platforms Compared

Over 70% of patients suffering from dentofacial deformities mention esthetics as the biggest issue pushing them to look for orthodontic and orthognathic treatment. At present, several pieces of software for computer-aided surgery have been released on the market. This surgical planning software allows surgeons to manipulate digital representations of hard and soft tissue profile tracings and subsequently morph the pretreatment image to produce a treatment simulation. The aims of this study were to investigate and find the difference between two of the most used pieces of digital software in pre-surgical planning for patients affected by dentofacial deformities by using the following parameters: usability, validity, timing, accessibility, efficacy, and predictability of the pre-surgical planning. Analyzing the results obtained from our study, it is correct to define both software tools useful and valid in digital surgical planning for the treatment of patients with dentofacial deformities. Each software has negligible differences in performance that do not in any way affect the success of surgical planning. The IPS software represents a valid alternative to the most popular and tested Dolphin Imaging software, and we are even inclined to evaluate it as better in terms of accuracy, effectiveness, and reliability.

A Quantitative and Qualitative Clinical Validation of Soft Tissue Simulation for Orthognathic Surgery Planning.

The purpose of this study was to perform a quantitative and qualitative validation of a soft tissue simulation pipeline for orthognathic surgery planning, necessary for clinical use. Simulation results were retrospectively obtained in 10 patients who underwent orthognathic surgery. Quantitatively, error was measured at 9 anatomical landmarks for each patient and different types of comparative analysis were performed considering two mesh resolutions, clinically accepted error, simulation time and error measured by means of percentage of the whole surface. Qualitatively, evaluation and binary questions were asked to two surgeons, both before and after seeing the actual surgical outcome, and their answers were compared. Finally, the quantitative and qualitative results were compared to check if these two types of validation are correlated. The quantitative results were accurate, with greater errors corresponding to gonions and lower lip. Qualitatively, surgeons answered similarly mostly and their evaluations improved when seeing the actual outcome of the surgery. The quantitative validation was not correlated to the qualitative validation. In this study, quantitative and qualitative validations were performed and compared, and the need to carry out both types of analysis in validation studies of soft tissue simulation software for orthognathic surgery planning was proved.

Clear aligner orthognathic surgery: an overview

: To assess the differences in treatment planning, surgical intervention, and post operative care between conventional orthognathic surgery and clear aligner (Invisalign) orthognathic surgery. Orthognathic surgery is surgery dedicated to the correction of skeletal maxillofacial malocclusion. Traditionally, these procedures are completed utilizing conventional orthodontic appliances (braces). More recently, with the increasing popularity of clear aligner technology to move dentition, more and more orthodontists are requesting their surgeons to complete orthognathic surgery with Invisalign. The author notes that there are some challenges, planning alternatives, and adjustments that need to be made. A retrospective review of one surgeon’s experience with clear aligner (Invisalign) orthognathic surgery, from 2016–2020. Comprehensive literature review as well as review of cases from the author’s surgical practice. There are some significant differences in the planning and treatment of Invisalign orthognathic surgery compared to conventional surgery. During the treatment planning stage, the surgeon must be aware that planning a segmental maxillary surgery is trickier when using Invisalign as compared to conventional orthodontics. Further, clear aligner surgery may require different types of occlusal splints, as well as custom plating, and novel approaches to maxilla-mandibular fixation.

Evaluation of two different imaging software programs in planning orthognathic surgery cases

Aim: In this study, we aimed to compare the two-dimensional predictions made by two computer software packages with the postoperative values, and thus to evaluate the clinical reliability of digital orthognathic surgery planning. Methodology: Orthodontic treatment was performed before orthognathic surgery, and the same surgical team performed double-jaw orthognathic surgeries. We included 20 individuals (10 females, 10 males) with skeletal Class III malocclusion. The average age of the individuals was 21.5 years. In our study, the amount of movement was determined using reference lines on lateral cephalometric radiographs obtained from the preoperative and postoperative Cone-Beam Computed Tomography (CBCT) records of 20 individuals. Prediction profiles were formed using Dolphin Imaging (Dolphin Imaging &amp; Management Solutions, Chatsworth, CA, USA) and NemoFAB 2D (Software Nemotec, S.L, Spain) computer softwares. In this way, the reliability and consistency of two-dimensional prediction software were examined. Results: The prediction profiles obtained from the computer software were compared with lateral cephalometric radiographs of the postoperative surgery results for 37 cephalometric parameters. There were no significant differences between software predictions and postoperative results in any cephalometric parameters. Conclusion: The plans and predictions made with the two computer software packages were reliable and can be used clinically. How to cite this article: Balkı M, Doğru M. Evaluation of two different imaging software programs in planning orthognathic surgery cases. Int Dent Res 2022;12(2):70-81. https://doi.org/10.5577/intdentres.2022.vol12.no2.5 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Virtual Surgical Planning versus Model Orthognathic Surgery: Can Patients Tell the Difference?

<h3>Purpose</h3> The purpose of this study was to determine if the method of orthognathic surgery planning used - virtual surgical planning (VSP) versus conventional model surgery - influenced patient-perceived post-operative satisfaction. We hypothesize that there is no significant difference in subjective outcomes reported by patients planned with VSP and patients planned with conventional model surgery for orthognathic surgery. <h3>Methods</h3> This was a single-site, observational, retrospective cohort study consisting of a standardized survey aimed to be given to all patients who had orthognathic surgery at the authors' institution over a ten-year period from 2009-2019. The authors crafted an eight-question survey that utilized a five-point Likert scale for self-assessment to gauge patient satisfaction and awareness regarding the subjective outcomes of their orthognathic surgery (Figure 1). Patients were asked to complete the survey via email or telephone call. The predictor variable was method of orthognathic surgery planning utilized (VSP or conventional model surgery), and the outcome variables were the patient responses to each individual survey question. The data was analyzed for both the conventional model surgery group and the VSP group by computing the means, standard deviations, medians, and modes for each of the eight questions. A two-tailed Mann-Whitney U test was utilized for comparing the two study groups for any statistically significant difference (p < 0.05) in responses for each of the eight survey questions. <h3>Results</h3> There were 1,046 patients initially identified with 644 potential subjects meeting the inclusion criteria. The eight-question survey was successfully administered to 173 of these 644 subjects. In all, total participants included 138 conventional model surgery participants and 35 VSP participants. Patients who had their orthognathic surgery planned with VSP, rated their satisfaction with both their postoperative appearance and occlusion similarly (4.60, SD 1.06 and 4.69, SD 0.96, respectively) to those patients who were planned with conventional model surgery (4.40, SD 1.06 and 4.47, SD 0.98, respectively). Additionally, patients from both the model surgery group (3.75, SD 1.33) and VSP group (3.77, SD 142) had similar neurosensory outcomes. There was no statistically significant difference in the patient satisfaction scores between the two groups, including cosmetic, neurosensory and occlusion results (p > 0.05). However, there was a statistically significant difference between the two groups' responses for the question that asked patients whether or not their surgeon utilized VSP for their respective surgeries (p = 0.0041). <h3>Conclusion</h3> We fail to reject the null hypothesis. This study demonstrates that the method of orthognathic surgery planning utilized (VSP vs conventional model surgery) does not significantly impact patient-perceived post-operative satisfaction regarding cosmetic, neurosensory, and occlusion outcomes. In addition, this study showed that patients planned with VSP were significantly more likely to correctly identify that their orthognathic surgery had been planned with VSP when compared to the conventional model surgery patients. VSP has proven to be an accurate, timesaving, and potentially cost-saving tool for surgeons, but the surgical planning method does not appear to have a significant impact on patient-perceived subjective outcomes following orthognathic surgery

A Look Back: A Single Surgeon's Experience Using Virtual Surgical Planning in Adult Orthognathic Surgery.

The evolution of virtual surgical planning (VSP) in the last 2 decades has led to improved precision and efficiency for orthognathic surgery, both pre- and intraoperatively. This study evaluates a single surgeon's experience with this technology over the past 6 years. Patients undergoing orthognathic surgery using VSP with the senior author between 2015 and 2021 were retrospectively reviewed. Virtual surgical planning -specific data including incidence of midline/cant correction, occlusal equilibration, serial splints, segmental osteotomies, and custom plates were recorded and analyzed. Sixty patients undergoing orthognathic surgery using simulated VSP in the study period were retrospectively reviewed. Mean age at time of surgery was 23.5±7.9 years. Forty-nine patients (81.7%) underwent LeFort I osteotomy combined with at least 1 additional procedure (eg,unilateral or bilateral sagittal split osteotomy, condylectomy, genioplasty, etc.). Twenty-six (43.3%) of patients in the studied cohort underwent maxillary midline correction, 30.0% required occlusal equilibration, 36.7% underwent maxillary molar cant correction, 30.0% underwent mandibular cant correction, and 21.7% required both maxillary and mandibular cant correction. Three patients required serial splinting, and 15 patients (25.0%) required modification of splint design. Custom plates were utilized in 15 patients (25.0%). This study demonstrates the utility of VSP in accurately detecting occlusal cants, asymmetry, and occlusal interferences. Virtual surgical planning also allows for a dynamic preoperative planning process, offering the surgeon a high degree of versatility in splint design, and the ability to fabricate multiple customized splints for each case. This is particularly useful in patients with limited or unpredictable soft tissue elasticity.