Three-dimensional planning of mandibular-maxillary orthognathic surgery

Introduction: 3D planning software and its application to CAD/CAM wafers for mandibular-maxillary orthognathic surgery has evolved over the last decade. The aim of this study is (a) to give an overview over the current status in literatur concerning three-dimensional planning of mandibular-maxillary orthognathic surgery, (b) the clinical application of these results and based on this (c) the developement of a 3D-planning protocall for mandibular-maxillary orthognathic surgery. Methods: Literature research was done over NCBI PubMed. Mandibular-maxillary orthognathic surgery were planned using Simplant Pro 2011 OMS (Materialise, Leuven, Belgien). Parallel conventional planning using 2D-cephalometry and plaster cast model surgery was performed. Based on this clinical expierence a planning protocol for three-dimensional planning has been developed. Results: Literatur research showed 9 patient studies using 3D-planning and CAD/CAM surgical wafers for mandibular-maxillary orthognathic surgery. 2 studies based completely in planning and performance on a 3D-concept, 1 study used CAD/CAM wafers produced with a 3D software based on 2D-cephalometric data, 1 study compared 2D- and 3D-planning for mandibular-maxillary orthognathic surgery with a surgical rating system and 4 studies compared conventional produced surgical wafers with 3D based CAD/CAM wafers on patients plaster cast models. Clinical application showed similar fitting for CAD/CAM wafers in the preoperative fitting as the conventional produced wafers. The 3D-planning protocol won from these findings is showed in graphics. Discussion: 3D-planning mandibular-maxillary orthognathic surgery is in a usable phase. Planning is easy and a accurate method for the therapie of craniofacial deformities. Clinical application seems to have similar results as conventional planning. A clinical study with an appropriate number of patients is planned for further evaluation. Keywords: 3D planning, dysgnathia, CAD/CAM surgical wafers