Your ideal orthognathic surgery workflow

Step 1: Data collection and fitting

Virtual orthognathic surgery planning begins with collecting data on the maxillofacial anatomies and their relations. When different datasets are stored into and available in one platform, like in Planmeca Romexis® software, they can be seamlessly combined to create a comprehensive understanding of the patient’s anatomy. 

For viewing and visualising the anatomies from Menton to Nasion and Sella, a CBCT image of the patient was captured with a 3D imaging unit at a resolution of 300 microns. The Planmeca Viso® G7 imaging unit can capture the entire maxillofacial area in a single scan using the Planmeca Ultra Low Dose™ imaging mode, which ensures optimal image for orthognathic treatment planning at a minimal patient dose. 

Next, digital impressions of the patient’s teeth were captured with an intraoral scanner. The intraoral scans were then automatically aligned with the CBCT image using the AI-powered Planmeca Romexis® Smart tool. The same tool also automatically segmented the teeth with their roots, as well as bones, nerves, and airways. 

Step 2: Cephalometric analysis

Cephalometric landmarks were then identified in the Planmeca Romexis® CMF Surgery module to follow cephalometric measurements, including SNA, SNB and ANB, and track jaw movements during the virtual planning through pre-defined points, such as Menton, A point and B point. Cephalometric landmarks were also used to automatically orientate the head to the Frankfort horizontal plane. 

Step 3: Virtual osteotomy, target occlusion and treatment planning

Following the automatic segmentation of the anatomies, osteotomy cutting planes were selected and fine-tuned in the Romexis CMF Surgery module. The segmented roots and nerves provided excellent visualisation and accurate placement of the osteotomy cutting planes in the upper and lower jaws. 

Next, the target occlusion was implemented into the Romexis CMF Surgery module, which incorporates multiple different workflows for achieving the target occlusion. In this case, the target occlusion was provided by a digitised plaster cast target occlusion model, into which the intraoral scans and segmented jaws of the patient were moved.

After that, the bimaxillary complex was moved into a new and better position for the patient. Subsequently, the left and right ramus segments were rotated to accommodate the new jaw positions. Cephalometric analysis and the extent of jaw movement for each jaw were monitored throughout the planning process to prevent excessive movement.

Step 4: Splint design and manufacturing

Following the virtual planning, the new jaw positions were saved together with the software-generated intermediate position. After that, intermediate and final splints were designed using the same software. The splints created with Romexis can be exported as STL files, enabling their in-house production with a 3D printer, such as Planmeca Creo® C5, which provides a smooth and straightforward printing experience.  

Step 5: Creation of patient-specific implants

Next, the whole case was exported and sent to Planmeca ProModel™ service, which manufactures patient-specific implants and cutting guides tailored to the specific needs of each orthognathic surgery case. Clinicians can review these custom implants within the original treatment plan in Romexis CMF Surgery module. 

Step 6: Predictable surgery outcome

Finally, the surgical operation was performed according to the virtual plan without any surprises. When patient-specific splints, implants and guides are used in the operation, the surgeon can be confident that the position of the jaws corresponds with the virtual plan, reducing stress in otherwise challenging cases.

The probability of success in orthognathic surgery cases can be improved with virtual planning: high-quality CBCT and intraoral scanning, virtual treatment planning and patient-specific splints, guides and implants support the surgeon’s steady hand and result in an impeccable combination. Planmeca’s products and services create a unique solution that helps us perform better and achieve our clinical goals every day.”

– Dr Sepehr Moghaddam

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