title: How Many Oral and Maxillofacial Surgeons Does It Take to Perform Virtual Orthognathic Surgical Planning?
abstract: OBJECTIVE
  Virtual surgical planning (VSP) has become routine practice in orthognathic treatment planning; however, most surgeons do not perform the planning without technical assistance, nor do they routinely evaluate the accuracy of the postoperative outcomes. The purpose of the present study was to propose a reproducible method that would allow surgeons to have an improved understanding of VSP orthognathic planning and to compare the planned surgical movements with the results obtained.
  
  
  METHODS
  A retrospective cohort of bimaxillary orthognathic surgery cases was used to evaluate the variability between the predicted and obtained movements using craniofacial landmarks and McNamara 3-dimensional cephalometric analysis from computed tomography scans. The demographic data (age, gender, and skeletal deformity type) were gathered from the medical records. The data analysis included the level of variability from the predicted to obtained surgical movements as assessed by the mean and standard deviation. For the overall sample, statistical analysis was performed using the 1-sample t test. The statistical analysis between the Class II and III patient groups used an unpaired t test.
  
  
  RESULTS
  The study sample consisted of 50 patients who had undergone bimaxillary orthognathic surgery. The overall evaluation of the mean values revealed a discrepancy between the predicted and obtained values of less than 2.0 ± 2.0 mm for all maxillary landmarks, although some mandibular landmarks were greater than this value. An evaluation of the influence of gender and deformity type on the accuracy of surgical movements did not demonstrate statistical significance for most landmarks (P > .05).
  
  
  CONCLUSIONS
  The method provides a reproducible tool for surgeons who use orthognathic VSP to perform routine evaluation of the postoperative outcomes, permitting the identification of specific variables that could assist in improving the accuracy of surgical planning and execution.
authors.affiliation: Researcher, Master of Science Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiabá, Cuiabá, Brazil; Postdoctorate Researcher, Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil; and Visiting Researcher, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL.
authors.forename: Alexandre Meireles
authors.initials: AM
authors.lastname: Borba
authors.affiliation: Chief Resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL.
authors.forename: Dustin
authors.initials: D
authors.lastname: Haupt
authors.affiliation: Dental Undergraduate Student, Faculty of Dentistry of the Federal University of Minas Gerais, Belo Horizonte, Brazil; Summer Course Student, Science Without Borders Program, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL.
authors.forename: Leiliane Teresinha
authors.initials: LT
authors.lastname: de Almeida Romualdo
authors.affiliation: Former Master of Science Student, Master of Science Program on Integrated Dental Sciences, Faculty of Dentistry of the University of Cuiabá, Cuiabá, Brazil.
authors.forename: André Luis Fernandes
authors.initials: AL
authors.lastname: da Silva
authors.affiliation: Associate Professor, Department of Oral and Maxillofacial Surgery, Traumatology and Prosthesis, Faculty of Dentistry of the University of São Paulo, São Paulo, Brazil.
authors.forename: Maria
authors.initials: M
authors.lastname: da Graça Naclério-Homem
authors.affiliation: Professor, Department Head, and Program Director, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL. Electronic address: mmiloro@uic.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Miloro
mesh_terms: D000293:Adolescent; D000328:Adult; D059925:Anatomic Landmarks; D002508:Cephalometry; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D056948:Orthognathic Surgical Procedures; D010347:Patient Care Planning; D066231:Surgeons / Q000706:statistics & numerical data*; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed; D014584:User-Computer Interface