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

The use of digital technology in orthognathic surgery can be considered the most important advancement in the field of maxillofacial surgery since the advent of rigid fixation, and interest in it is reflected in the numerous articles published on the subject. Use of digital technology has determined an improvement in diagnostic accuracy, planning and traditional treatment outcomes from both functional and aesthetic points of view (Lin H-H, 2015).

Besides these advantages, a more in-depth review of the literature reveals that it is still not completely clear whether VSP is better than traditional surgical protocols as far as sagittal plane accuracy and patient satisfaction are concerned (Chen et al., 2021). The literature does not specify which surgical factors besides VSP may influence final outcomes. For instance, it is known that surgical sequencing could affect the outcomes accuracy-wise, although both sequences seem to produce similar outcomes when properly planned and executed (Borikanphanitphaisan et al., 2021; Perez and Ellis, 2016). For this reason, a mandible-first sequence has been a topic of interest in the literature in recent years, given its supposed advantages in large maxillary advancements and counter-clockwise rotation. Furthermore, various studies on VSP accuracy, with either surgical sequence, have reported limitations in interpreting their results due to weaknesses in the study design and/or to the methods used to evaluate results. Other weaknesses have involved limited information regarding planning and surgical stages (Alkhayer et al., 2020; Gaber et al., 2017).

The aim of this study was to verify the accuracy of sugery performed with digital planning using a mandible-first sequence and strict surgical protocol, and to determine which surgical and methodological factors may affect outcomes.

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