Search Results (57)

Three-dimensional (3D) facial scanning integrated with cone-beam computed tomography (CBCT) has improved digital planning and postoperative assessment in orthognathic surgery. This retrospective pilot study evaluated the accuracy of digital surgical planning, skeletal and soft-tissue movements, and postoperative edema evolution in 12 patients undergoing bimaxillary orthognathic surgery. Pre- and postoperative CBCT scans, facial scans, and virtual surgical plans were analyzed. Planning accuracy was assessed by comparing predicted and postoperative cephalometric measurements. Skeletal and soft-tissue displacements were evaluated using corresponding landmarks, while postoperative edema was evaluated through 3D facial scan superimposition. Before Bonferroni correction, significant differences were observed for the SNB angle (p = 0.005) and the Mandibular Plane Angle (p = 0.008); after adjustment, only the SNB angle remained statistically significant. Significant positive correlations between skeletal and soft-tissue displacements were found for Point B along the x-axis (ρ = 0.769, adjusted p = 0.048) and y-axis (ρ = 0.797, adjusted p = 0.032), and for Pogonion along the z-axis (ρ = 0.988, adjusted p < 0.016). No statistically significant differences in postoperative edema remained after Bonferroni correction. Overall, digital surgical planning showed good agreement between planned and postoperative outcomes, while 3D facial scanning proved useful for evaluating soft-tissue response. Full article

Background/Objectives: Postoperative remodeling and positional deviations of the mandibular coronoid process (CP) after orthognathic surgery remain insufficiently characterized, particularly in three-dimensional analyses. The aim of this study was to evaluate qualitative and quantitative CP changes following bimaxillary orthognathic surgery using a deep learning-assisted three-dimensional workflow. Methods: This retrospective study included 75 patients treated with combined orthodontic–surgical therapy, including 25 patients with skeletal Class II malocclusion and 50 patients with skeletal Class III malocclusion. Preoperative and 6-month postoperative computed tomography scans were analyzed. Automatic segmentation and three-dimensional reconstruction were performed using a convolutional neural network based on the nnU-Net architecture. Qualitative assessment included evaluation of CP displacement patterns and visualization of local surface differences using heat maps. Quantitative analysis included volumetric assessment of preoperative and postoperative CP models, calculation of apposition-compatible (Vapo) and resorption-compatible (Vres) volumetric changes, and mixed-effects modeling accounting for within-patient correlations. Results: Medial displacement of the CP predominated in both skeletal classes and was more frequent in Class III patients. Qualitative surface analysis demonstrated a consistent location-dependent remodeling pattern, characterized by predominant apposition-compatible changes on the lateral and medial surfaces and predominant resorption-compatible changes along the anterior border. Quantitative analyses revealed an overall positive remodeling balance, although substantial inter-individual variability was observed. Mixed-effects analyses demonstrated no significant overall effects of side or skeletal class on volumetric remodeling; however, a significant interaction between side and skeletal class was identified for net remodeling balance. A significant random patient effect indicated considerable variability in remodeling response among individuals. Conclusions: AI-assisted three-dimensional analysis enables a reproducible assessment of postoperative CP remodeling following orthognathic surgery. Coronoid process remodeling is characterized by heterogeneous, location-dependent surface changes and substantial inter-individual variability. The observed remodeling patterns are compatible with adaptive responses to altered postoperative biomechanical conditions, although the underlying biological mechanisms remain to be clarified. Full article

Background and Clinical Significance: Severe skeletal Class II malocclusion associated with periodontal compromise and posterior edentulism requires a carefully sequenced interdisciplinary treatment approach integrating orthodontic, surgical, periodontal, and prosthetic rehabilitation. Case Presentation: This case report describes the comprehensive interdisciplinary management of a 21-year-old female patient presenting with skeletal Class II malocclusion, severe mandibular retrognathia, vertical maxillary excess, labial incompetence, temporomandibular joint (TMJ) dysfunction and periodontal deficiencies. The treatment sequence involved occlusal splint therapy, pre-surgical orthodontic decompensation, bimaxillary orthognathic surgery using a segmental Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), postoperative orthodontic refinement with aligners, periodontal plastic surgery using the Zucchelli technique and guided bone regeneration (GBR) with implant placement in the posterior mandible. At the four-year follow-up, the patient demonstrated complete root coverage, stable skeletal correction, and satisfactory implant integration, with maintenance of functional and aesthetic outcomes over time. Conclusions: This report highlights the importance of precise preoperative planning and the synergy between orthodontics, orthognathic surgery and periodontics in achieving optimal functional and aesthetic results. Full article

Background: Accurate transfer of the surgical plan is essential in bimaxillary orthognathic surgery, where small discrepancies between planned and postoperative skeletal positions may influence functional and aesthetic outcomes. This study compared the three-dimensional (3D) accuracy and time efficiency of conventional and fully digital planning workflows using CBCT-based evaluation. Methods: This retrospective comparative study included 100 adult patients with skeletal Class II or III malocclusion treated by Le Fort I osteotomy combined with bilateral sagittal split osteotomy (BSSO). Patients were allocated to conventional planning (n = 50) or fully digital planning using IPS CaseDesigner (n = 50). Planned and postoperative CBCT datasets were superimposed using voxel-based cranial base registration. Linear deviations at A-point and Pogonion, total RMS error, planning time, and operative time were analyzed. Results: Mean deviations were lower in the digital group at A-point (1.28 ± 0.28 mm vs. 1.63 ± 0.36 mm) and Pogonion (1.49 ± 0.42 mm vs. 1.95 ± 0.44 mm) (p < 0.001). Total RMS deviation was reduced in the digital workflow (1.39 ± 0.39 mm vs. 1.80 ± 0.54 mm; p < 0.001). Planning and operative times were significantly shorter in the digital group (p < 0.001). Moderate correlations were observed between time variables and 3D deviations. Conclusions: Fully digital planning showed improved 3D accuracy and significantly reduced planning and operative times compared with conventional methods, while maintaining clinically acceptable deviations. Full article

Advanced cases of unilateral condylar hyperplasia might need combined joint reconstruction and orthognathic surgery. This report illustrates the feasibility of integrating digital planning, patient-specific prosthesis design, and orthognathic correction within a single-stage surgical workflow. A 23-year-old female patient presented with skeletal Class III malocclusion, facial asymmetry, and mandibular midline deviation due to left condylar hyperplasia. After preoperative orthodontic alignment, virtual surgical planning was carried out using specialised software to simulate resection of the hyperplastic condyle, with concurrent total TMJ replacement, contralateral sagittal split ramus osteotomy, and Le Fort I osteotomy. Based on this plan, patient-specific prosthetic components, surgical guides, and fixation plates were designed and manufactured. Surgery was performed according to the digital plan using a combined intraoral and extraoral approach. At 3-month follow-up, clinical and radiological assessments showed stable prosthesis positioning, improved occlusal relationships, restoration of facial symmetry, and high patient-reported satisfaction. However, given the single-case design and short follow-up, these findings should be considered preliminary, and further studies are necessary to evaluate long-term functional outcomes and reproducibility. Full article

Background/Objectives: Virtual surgical planning (VSP) allows three-dimensional assessment of complex dentofacial deformities and has become integral to modern orthognathic surgery. However, evidence remains limited regarding how skeletal characteristics and malocclusion patterns translate into surgical movement selection. This study aimed to evaluate demographic features, skeletal malocclusion patterns, and clinical treatment strategies in patients undergoing VSP-guided orthognathic surgery. Methods: This retrospective study included 158 patients who underwent VSP-assisted orthognathic surgery between 2019 and 2025. Sagittal skeletal classification, vertical growth pattern, facial asymmetry, and maxillary crossbite were evaluated together with planned maxillary and mandibular movements. Surgical procedures were analyzed according to skeletal malocclusion classes (Class I, II, and III). Group comparisons were performed using chi-square and Kruskal–Wallis tests. Multivariable logistic regression analysis was conducted to assess factors associated with bimaxillary surgery (p < 0.05). Results: Skeletal Class I malocclusion was most prevalent (46.8%), followed by Class III (29.7%) and Class II (23.4%). Hyperdivergent growth patterns were predominantly observed in Class II patients, whereas normodivergent patterns were most common in Class III cases (p < 0.05). Mandibular advancement and setback generally followed expected class-based trends but were also observed across non-corresponding skeletal classes. Maxillary impaction and mandibular autorotation were frequently incorporated. Bimaxillary surgery was performed in 84.2% of cases. Logistic regression analysis showed no independent predictors of bimaxillary surgery (p > 0.05). Conclusions: VSP-assisted orthognathic surgery demonstrates that surgical planning cannot be reduced to sagittal skeletal classification alone. Treatment decisions are shaped by combined sagittal, vertical, transverse, and patient-specific factors, supporting a multidimensional and individualized planning approach. Full article

Background: Facial asymmetry affecting the mandibular contour may significantly impact facial harmony even in patients with stable occlusion. Although orthognathic surgery remains the standard for skeletal correction, it carries substantial morbidity. In selected cases, contour-focused approaches can achieve meaningful esthetic improvement with reduced surgical burden. Objective: To describe the virtual surgical planning (VSP) workflow and clinical outcome of a unilateral Wing osteotomy for mandibular contour asymmetry. Case presentation: A 24-year-old woman presented with left-sided mandibular contour deficiency and facial asymmetry, despite stable Class I occlusion and preserved function. VSP with contralateral mirroring guided the design of the osteotomy and fabrication of a stereolithographic model and patient-specific cutting guide. Surgery was performed through a tunnelized mandibular approach using a 702 bur and reciprocating saw. Fixation was achieved with pre-bent 2.0 plates adapted to the 3D model, and Bio-Oss Collagen was interposed within the osteotomy gap. Occlusion and mental nerve function were preserved. Results: Postoperatively, the patient demonstrated improved facial symmetry, uneventful healing, preserved long-term neurosensory function, and high esthetic satisfaction. Conclusions: Unilateral Wing osteotomy guided by VSP and patient-specific instrumentation is a predictable, minimally invasive alternative to bimaxillary orthognathic surgery with genioplasty in selected patients presenting contour-focused asymmetry and stable occlusion. This case highlights a rare, underreported application of the technique. Full article

Background and Objectives: Mid-term skeletal stability after bimaxillary orthognathic surgery in patients with facial asymmetry and a relatively normal sagittal skeletal relationship (ANB ≈ 1–4°) remains underreported. This study aimed to determine the three-dimensional characteristics and temporal changes in postoperative skeletal remodeling and symmetry maintenance in such patients. Materials and Methods: This retrospective case series included 25 patients (ANB ≈ 1–4°) undergoing bimaxillary orthognathic surgery. Three-dimensional computed tomography was performed preoperatively (T0), immediately postoperatively (T1), and at 6–12 months postoperatively (T2) to quantify bilateral condylar, ramus, mandibular body, maxillary parameters, and occlusal cant. Statistical analyses were performed using appropriate statistical methods for paired and repeated-measures designs. Results: Preoperatively, the long side exhibited significantly greater condylar volume, ramus height, and mandibular body length than the short side (all p < 0.05). Postoperatively, a “long-side reduction and short-side augmentation” strategy significantly reduced or reversed most bilateral differences, with a marked improvement in occlusal plane cant (p < 0.01). At T2, only mild bone remodeling was observed, with no significant loss of postoperative skeletal symmetry. The occlusal plane remained stable. Conclusions: In patients without marked sagittal discrepancies, bimaxillary orthognathic surgery effectively restores transverse and vertical skeletal symmetry. Mid-term stability is well maintained over 6–12 months, with only mild condylar and ramus remodeling, suggesting adaptive remodeling rather than relapse. Full article

Background/Objectives: Mandibular counterclockwise (CCW) autorotation following maxillary repositioning is a common biomechanical consequence of bimaxillary orthognathic surgery. However, its effect on temporomandibular joint (TMJ) morphology remains controversial. This study aimed to evaluate whether condyle-centered CCW mandibular autorotation influences postoperative TMJ spaces and condylar morphology using cone-beam computed tomography (CBCT). Methods: A total of 24 patients who underwent combined Le Fort I osteotomy and bilateral sagittal split ramus osteotomy were included in this retrospective analysis. Patients were divided into two groups based on virtual surgical planning: those with condyle-centered CCW autorotation (4–7°) and those without autorotation. Preoperative and one-year postoperative CBCT images were analyzed. Sagittal and coronal joint spaces, condylar dimensions, and glenoid fossa thickness were measured. Intra- and intergroup comparisons were performed using nonparametric statistical tests (α = 0.05). Results: Both groups demonstrated significant postoperative reductions in condylar height, width, and depth, reflecting adaptive bone remodeling. Joint space changes were limited overall. A significant intergroup difference was observed only in the change in the right superior joint space (p = 0.024), which decreased in the non-autorotation group but was preserved or slightly increased in the autorotation group. No other joint space or fossa parameter showed significant between-group differences. Conclusions: Condyle-centered CCW mandibular autorotation during bimaxillary orthognathic surgery does not induce adverse TMJ morphological changes beyond physiological adaptation. Preservation of the superior joint space suggests that autorotation may contribute to maintaining a more favorable condyle–fossa relationship. Incorporating controlled mandibular autorotation into surgical planning may support TMJ biomechanical balance and postoperative joint stability. Full article

Purpose: Orthognathic surgery is a cornerstone therapeutic approach for correcting dentofacial deformities; however, its Impact on neuromuscular adaptation remains incompletely understood, particularly regarding different surgical strategies. The aim of this study was to evaluate and compare neuromuscular changes in patients undergoing monomaxillary or bimaxillary orthognathic surgery. Methods: Eighty adult patients treated with combined orthodontic–surgical therapy were included (37 monomaxillary; 43 bimaxillary). A control group of 20 healthy adult subjects with physiological occlusion and no history of orthodontic or orthognathic treatment was included. Surface electromyography (sEMG) of the masseter and anterior temporalis muscles and mandibular kinesiography were performed using standardized protocols at five treatment phases. Electromyographic symmetry indices (Percent Overlapping Coefficient—POC), muscle activity (µV), IMPACT values, and mandibular movement parameters were analyzed. Results: During the presurgical orthodontic phase, both groups showed comparable reductions in neuromuscular activity. Postoperatively, monomaxillary patients exhibited earlier stabilization of sEMG symmetry and a faster increase in IMPACT values, approaching physiological reference ranges at the final follow-up. In contrast, bimaxillary patients showed greater variability and slower functional recovery. Mandibular opening and lateral movements improved in all patients, with more stable kinesiographic patterns observed in the monomaxillary group. Conclusions: Within the limitations of this study, neuromuscular adaptation following orthodontic–surgical treatment appears to be associated with the surgical approach adopted, rather than representing a direct effect of surgical extent. These findings support the role of functional assessment as a complementary component in the management of orthognathic patients. Full article

Background/Objectives: The primary objective of this study was to evaluate the accuracy of maxillary repositioning using a two-plate patient-specific osteosynthesis system. The secondary objective was to determine whether accuracy is influenced by the number of maxillary segments. Methods: A retrospective single-centre cohort study was conducted on patients undergoing bimaxillary orthognathic surgery with a maxilla-first two-plate PSO system. Virtual Surgical Planning was performed based on the Cone-Beam Computed Tomography (CBCT) data of the patient, with patient-specific plates being designed and manufactured accordingly. Postoperative CBCT scans (7–10 days post-op) were registered to the preoperative plan, and deviations in translation and rotation between the plan and results were determined. Sub-group analyses were performed on one-, two- and three-segment maxillary osteotomy patient groups. Results: The inclusion criteria were met by 61 patients, of whom 47 were included for analysis (mean age 27.9 ± 9.4 years). Sub-millimetre median translational accuracies were found: anteroposterior 0.7 mm, transverse 0.4 mm, vertical 0.6 mm. The median rotational deviations were ≤1° for yaw and roll, and 1.6° for pitch. Accuracy was consistent across the one-, two-, and three-segment osteotomy groups. Conclusions: The two-plate PSO system is clinically accurate in bimaxillary surgery. There is no significant difference in accuracy between one-piece and segmental osteotomies of the maxilla when using the two-plate system. Full article

Background: Orthognathic surgery aims to align the jaws with the facial skeleton and correct dental occlusion. This paper introduces the concept of planning the maxillomandibular complex (MMC) as a whole, utilizing a t-forming set of landmarks: the maxillary central incisor, the chin, and the occlusal plane. Methods: The background, hypothesis, and rationale of the new T concept are explained. A case of a 28-year-old male with skeletal class III malocclusion and an open bite was used to illustrate the application of the T concept in step-by-step surgical planning. The planning encompasses four phases: Phase One involves correcting frontal deformity and various asymmetries, Phase Two involves correcting chin anterior–posterior deformity, Phase Three involves correcting anterior–posterior and vertical MMC position, and Phase Four involves correcting MMC rotation. Results: The T concept provided a structured approach to plan MMC as a whole and integrate all structures into harmony. Conclusions: The T concept provides a logical approach to MMC positioning in orthognathic surgery, addressing functional and aesthetic concerns. It acts as a checkpoint to verify MMC position, helping surgeons achieve better results and avoid compensatory procedures. Full article

Introduction: This manuscript addresses the limitations of traditional orthognathic surgery in achieving both functional and aesthetic correction in patients with Class II malocclusion and severe mandibular retrusion. Current techniques often struggle to simultaneously address mandibular deficiency and inadequate transverse dimension, leading to unsatisfactory outcomes. Methods: Seven male patients underwent bimaxillary osteotomy with mandibular advancement. A novel surgical plate, Implate, was used, which was designed to facilitate precise osteotomy and stabilization. Pre-surgical planning included CBCT scanning, 3D modeling, and surgical simulation. Postoperative assessments included clinical examinations, CT and OPT scans. Results: Implate successfully addressed the challenges of conventional techniques, minimizing the formation of bony steps and achieving a more harmonious facial profile. The minimally invasive procedure, with careful periosteal and muscle management, contributed to stable outcomes, and no complications were reported. At the 6-month follow-up, OPT analysis showed a mean mandibular width increase of 18.1 ± 6.2 mm and vertical ramus height gains of 6.0 ± 3.1 mm (left) and 5.8 ± 1.7 mm (right). Conclusions: According to our preliminary experience, the integration of Implate into surgical practice offers a significant improvement in treating complex Class II malocclusions. By simultaneously correcting mandibular retrusion and width while minimizing complications, Implate provides a superior solution compared to traditional methods. This innovative approach highlights the potential of combining advanced surgical techniques with personalized 3D-printed implants to achieve optimal functional and aesthetic outcomes. Further prospective studies with controls and longer follow-up are needed to validate the efficacy and reproducibility of Implate in wider clinical use. Full article

Background/Objectives: The aim of this study was to investigate the accuracy of implementing a virtual treatment plan in orthognathic surgery. Methods: The study included 30 patients (11 males and 19 females with a mean age of 23.7 years) with a digital surgical plan. All patients underwent bimaxillary orthognathic surgery: LeFort I osteotomy of the maxilla combined with bilateral split sagittal osteotomy (BSSO) of the mandible. Eleven landmarks on the pre-surgical (planned) model and the same landmarks on the post-surgical model were used for comparison and linear difference measurements between the real and predicted outcomes in all three planes—transversal, sagittal, and vertical. Results: All median values fell within the 2 mm range in the transversal plane, and the mean displacement was 0.57 mm. In the sagittal and vertical planes, the treatment outcome in the maxilla was more precise than in the mandible. The mean displacement in the sagittal plane was −0.88 mm and that in the vertical plane was 0.44 mm. All deviations were less than 2 mm. Conclusions: The data obtained in this study show that the digital surgical plan for orthognathic surgery is clinically reliable in all planes. Full article

Background: Bimaxillary (BiMax) advancement surgeries are one of the most frequently performed procedures in the orthognathic subspecialty of craniomaxillofacial surgery. The growing digitalization of the planning process and the shift from physical to virtual settings in procedure design have allowed, among other things, for better visualization of surgeries, improved preparation, and a more profound understanding of individual anatomy. Therefore, the question of the accuracy of performed virtual planning (VP) as well as the available methods of its evaluation arises naturally. The aim of this study was to determine the accuracy of performed BiMax advancement surgeries and propose a new planning accuracy coefficient (PAC). Methods: A group of 35 patients who underwent BiMax surgery were included in the study. Computed tomography (CT) of the head and neck region was performed 2 weeks preoperatively and 6 months postoperatively. Acquired Digital Imaging and Communications in Medicine (DICOM) files were used to perform a VP and a 3-dimensional (3D) cephalometry analysis using IPS CASE DESIGNER^® software, v2.5.7.1 (KLS Martin Group, Tuttlingen, Germany). Statistical significance evaluation and basic measures of central tendency and dispersion of the analyzed variables were calculated. The accuracy of the performed planning was assessed based on the mean absolute error (MAE) between the planned and achieved cephalometric data variables. Additional assessment was performed based on the proposed PAC. Results: VP was found to be accurate in terms of cephalometric data assessing the height of the maxilla and mandible, the inclination of the occlusal plane, the position of the jaws in relation to the skull base, as well as overjet and overbite. There was a discrepancy in results between the classic and proposed methods of accuracy assessment in the case of several of the evaluated variables. Conclusions: The accuracy of the VP of BiMax advancement surgeries can be evaluated based on 3D cephalometry, and it is accurate in the assessment of the previously mentioned variables. There is a need for further analysis and potential development of the proposed PAC; however, the data obtained based on PAC are promising, and by taking into account the magnitude of planned movements, it can facilitate a fair comparison of results presented in different studies based on various assessment methods. Full article