Virtual Orthognathic Surgery Planning

Processing strategies are different among the software programs, for segmentation, integration of the STL dental model and bone reposition. Modern 3D virtual planning for orthognathic surgery has critical advantages compared to conventional planning but also some disadvantages. The main advantage of the virtual simulation is the option to “play around” and easily test the effects of various possible skeletal corrections. Once the osteotomies are defined the software allows for quickly calculating different lengths or angulations of skeletal displacements. However, new problems arise in a virtual world such as the accuracy of the integration of the STL dental model into the CBCT model, or the true virtual bite, or setting the final occlusion virtually. By working virtually, haptic feedback is lacking. It is therefore better to combine the best of both worlds, virtually and manually. Virtual planning and simulation facilitates the appraisal of any number of options, testing the effects of different surgical movements and obtaining instant net measurements after every movement. In this way, an individual treatment plan can be adapted and optimized easily. The potential for faster, cheaper and better outcomes thought this emerging technology represents a paradigm shift in surgical planning for patient with dentomaxillofacial deformities.

Learning Objectives:

Define the workflow for virtual orthognathic planning.
Discuss the advantages and disadvantages over manual planning.
Determine how to overcome the disadvantages.

Surgery-First Orthodontic Management, Planning and Execution

Since the time of Hugo Obwegeser, who is considered the father of Orthognathic surgery, we have come a long way in terms of managing patients who require Ortho-orthognathic surgery. It is common refrain amongst orthodontist when they do a consult for a patient for combined Ortho-orthognathic management that the patient will look worse first before he or she looks better. There is also a long process of treatment spanning on average 2.5 to 3 years when conventional ortho-orthognathic methods are employed. With surgery first approach becoming the treatment of choice with many orthodontist and surgeons around the world, it is good to take stock of where we are in managing such cases with both the methods. In this lecture, I would like to present my perspective on Surgery First approach with reference to conventional orthodontic-orthognathic approach.

Learning Objectives:

Recognize suitable cases for Surgery-First Orthodontics.
Manage simple Surgery-First Orthodontics cases.
Compare the pros and cons of Surgery-First Orthodontics vs Conventional Orthodontics-Orthognathic management.