Waferless Orthognathic Surgery with Customized Osteosynthesis and Surgical Guides: A Prospective Study

The purpose of this paper was to describe and to evaluate the accuracy of a protocol that involves CAD/CAM-generated cutting guides and customized titanium plates for waferless orthognathic surgery. Twenty-one patients consecutively treated between January 2021 and January 2023 were included. The preoperative virtual surgical plan (VSP) was compared with the final position determined from the postoperative CT scan and STL files. An alignment algorithm was employed to adjust the skull position in areas unaffected by the surgery. Absolute and signed deviations were calculated across all three dimensions for each maxilla, mandible and chin landmark. The accuracy analysis revealed an overall deviation of 0.93 mm (95% confidence interval [95%CI]: 0.86 to 0.99), which was < 2 mm for all assessed landmarks (p < 0.05; one-sample t-test). The mandibular landmarks showed greater deviation than the maxillary ones (p < 0.001; independent-samples t-test). Considering the deviations along the three axes, statistically significant differences were identified (p < 0.001; one-way analysis of variance). The reported protocol provides evidence on the benefit of guided orthognathic surgery when performed using a defined VSP protocol, improving accuracy in the maxilla, mandible and chin position, considered both globally and as isolated variables.