Orthognathic procedures require extensive preoperative planning to maintain high fidelity of fabricated
splints to anticipated skeletal and soft tissue changes. The authors report their use of the computer-assisted surgical simulation modeling system in preoperative planning and
splint fabrication and the significant reduction in their overall preoperative time. Upper and lower
bite registrations were sequentially created on a single
bite jig with fast-drying bis-acryl material, which was then mounted to a fiducial-based facebow for facial skeleton indexing. Indexing data were submitted, and
occlusal splints were fashioned and returned to the senior surgeon. Between September 2010 and January 2011, 10 consecutive patients were enrolled. Surgical indications included six Le Fort I advancements and four combined Le Fort I/bilateral sagittal split
osteotomy cases. Average time for
bite registration was 10 minutes 16 seconds ± 1 minute 33 seconds, with an additional 8 minutes 6 seconds ± 4 minutes 45 seconds needed for modeling and virtual
splint confirmation. Six patients required cephalometric tracings, for an additional 12 minutes 50 seconds ± 1 minute 10 seconds. Average total session time for all patients was 26 minutes 14 seconds ± 9 minutes 13 seconds. Computer-assisted surgical simulation markedly decreased the time for preoperative
splint planning and fabrication time, and had a positive impact on reimbursement rates for
orthognathic surgery, as calculated on a per-hourly basis. The improved accuracy generated may lead to decreased
operative times and improved outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.