Comparison of Accuracy of Maxilla Between Virtual and Conventional Surgical Planning in Bimaxillary Orthognathic Surgery

Study Title Comparison of Maxillary Accuracy Between Virtual and Conventional Surgical Planning in Bimaxillary Orthognathic Surgery: A Randomized Controlled Trial Study Design * Type: Prospective, single-center, randomized, blinded, case-controlled trial * Location: National Hospital of Odonto-Stomatology, Ho Chi Minh City * Period: August 2023 - February 2025 * Sample size: 20 patients * Ethical approval: Granted by the University of Medicine and Pharmacy at HCMC (Approval No. 647/HĐĐĐ-ĐHYD) Inclusion Criteria * Patients aged 18-30 years * Diagnosed with malocclusion requiring bimaxillary orthognathic surgery * Completed presurgical orthodontic treatment Exclusion Criteria * Cleft lip/palate, craniofacial syndromes * Deformities due to trauma, tumors, or iatrogenic causes * TMJ disorders * History of previous orthognathic surgery * Planned multipiece Le Fort I osteotomy Randomization and Blinding * All patients underwent both 2D and 3D surgical planning. * Two splints (CSP and VSP) were fabricated for each patient. * Intraoperative randomization was performed by an OR nurse. * The surgical team and data analysts were blinded to group allocation. * Groups were revealed only after data analysis. Groups * Test group (VSP): 3D virtual planning, simulation, and 3D-printed splints * Control group (CSP): 2D cephalometric planning, model surgery, conventional resin splints Surgical Procedure * All patients underwent Le Fort I and BSSO * Maxilla-first approach with fixation using 4 miniplates * Mandibular repositioning using final splint and fixed with 2 miniplates per side * All surgeries performed by a single experienced surgeon Data Collection \& Measurements * CT scans before and 2 weeks after surgery * Superimposition using Invivo 7.0 software (voxel-based registration) * Measured landmark changes (A point, ANS, U1, U3, U6) in X (medial-lateral), Y (anterior-posterior), and Z (vertical) directions * Compared: * 2D plan (P2D) vs. 3D plan (P3D) * P3D vs. actual pos