Proffit W. R., Fields H. W., Sarver D. M., Ackerman J. L., 5th edn. St. Louis, Mo.: Elsevier/Mosby; 2013
Hatamleh MM, Ong J, Hatamleh ZM, Watson J, Huppa C. Developing an in-house interdisciplinary three-dimensional service: challenges, benefits, and innovative health care solutions. Journal of Craniofacial Surgery. 2018; 29:(7)1870-5
Lin HH, Lonic D, Lo LJ. 3D printing in orthognathic surgery− A literature review. Journal of the Formosan Medical Association. 2018; 117:(7)547-58
Ho CT, Lin HH, Lo LJ. Intraoral scanning and setting up the digital final occlusion in three-dimensional planning of orthognathic surgery: Its comparison with the dental model approach. Plastic and Reconstructive Surgery. 2019; 143:(5)1027e-36e
Knoops PG, Borghi A, Breakey RW, Ong J, Jeelani NU, Bruun R, Schievano S, Dunaway DJ, Padwa BL. Three-dimensional soft tissue prediction in orthognathic surgery: a clinical comparison of Dolphin, ProPlan CMF, and probabilistic finite element modelling. International Journal of Oral and Maxillofacial Surgery. 2019; 48:(4)511-8
Elnagar MH, Aronovich S, Kusnoto B. Digital workflow for combined orthodontics and orthognathic surgery. Oral Maxillofac Surg Clin North Am. 2020; 32:(1)1-4
Donaldson CD, Manisali M, Naini FB. Three-dimensional virtual surgical planning (3D-VSP) in orthognathic surgery: Advantages, disadvantages and pitfalls. Journal of Orthodontics. 2021; 48:(1)52-63
Brüllmann D, Schulze RK. Spatial resolution in CBCT machines for dental/maxillofacial applications—what do we know today?. Dentomaxillofacial Radiology. 2015; 44:(1)
Lonic D, Sundoro A, Lin HH, Lin PJ, Lo LJ. Selection of a horizontal reference plane in 3D evaluation: Identifying facial asymmetry and occlusal cant in orthognathic surgery planning. Scientific Reports. 2017; 7:(1)1-0
Liebregts J, Baan F, de Koning M, Ongkosuwito E, Bergé S, Maal T, Xi T. Achievability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery. Scientific reports. 2017; 7:(1)1-9
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Heufelder M, Wilde F, Pietzka S, Mascha F, Winter K, Schramm A, Rana M. Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery. Journal of Cranio-Maxillofacial Surgery. 2017; 45:(9)1578-85

Digital workflows part 2: applications of digital technology in orthognathic surgical planning – a case series

From Volume 16, Issue 4, October 2023 | Pages 189-194


Chris Keating

BA (Hons) FdSc MOTA

Advanced Digital OMFS & Orthodontic Technologist, Royal United Hospitals NHS Foundation Trust, Bath, United Kingdom

Articles by Chris Keating

Email Chris Keating

Jennifer Haworth


Academic post-CCST trainee in Orthodontics, Royal United Hospitals, Bath and University of Bristol

Articles by Jennifer Haworth

Email Jennifer Haworth

Joanne Bousfield


Orth Ther RCSEd – Orthodontic Therapist, Royal United Hospitals NHS Foundation Trust, Bath, United Kingdom

Articles by Joanne Bousfield

Farnaz Parvizi

MPhil, BDS, FDS RCS(Eng), MOrth RCS(Ed)

Senior Registrar (FTTA) in Orthodontics, Child Dental Health, Bristol Dental Hospital

Articles by Farnaz Parvizi


This is the second article in a two-part series considering the relevance and clinical uses of digital technologies in relation to orthodontics. The aim is to take a closer look at the application of digital technology in relation to joint orthodontic/orthognathic treatment and present two clinical cases that have undergone treatment by means of a digital workflow.

CPD/Clinical relevance: Digital technologies can enhance pre-operative orthognathic planning


For those patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgical realignment of the jaws or repositioning of dentoalveolar segments is often the only possible treatment. Successful management of combined surgical and orthodontic treatment often requires the integration of pre-surgical orthodontic, surgical and post-surgical orthodontic phases of treatment.1

The developments in three-dimensional (3D) clinical imaging and intra-oral scanning in conjunction with advances in computer-aided design (CAD), computer aided manufacture (CAM) and additive manufacturing have led to a digital workflow revolution in the management of orthognathic cases.2

The management of the joint orthodontic-orthognathic patient is a multi-disciplinary team (MDT) approach. Good collaboration between the orthodontist, surgeon and laboratory technician is critical for a successful clinical outcome.3 Traditionally an ideal occlusion is established based on two-dimensional (2D) cephalometric planning of the maxillary and mandibular segments, and by replicating the surgery using gypsum models mounted onto an articulator using a facebow transfer. An orthognathic wafer is then fabricated on the gypsum models in the laboratory using acrylic. The wafer(s) is an occlusal guide used intra-operatively that enables the surgeon to position the jaw(s) in the corrected position(s) following the osteotomy cuts.4 In recent years, the use of digital 3D surgical planning platforms for orthognathic surgery has increased. It is widely accepted that improvements in image acquisition, software capabilities, PC processing power and accuracy in 3D printing have led to precise virtual surgical simulations that are valuable in surgical planning, assessment of surgical outcome and patient communication. The 3D printing of orthognathic wafers, osteotomy cutting guides, repositioning jigs, customised fixation plates and anatomical models allows a virtual surgical plan to be transferred from the workstation into the operating theatre. Although 3D-virtual surgical planning (3D-VSP) requires a relatively high level of investment when compared to traditional planning methods, it offers clear advantages. These include the potential to improve reproducibility, clinical and laboratory efficiency, and surgical precision.3, 5, 6 The benefits and drawbacks of the use of digital technology in the joint orthodontic/orthognathic approach are listed in Table 1.

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