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The Influence Of Virtual Surgical Planning On Surgical Decision-Making In Orthognathic Surgery
Daiven Sharma, BS1, Iris Brammer, BA
2, Eric Zeng, BS
1, Mario Blondin, MD
2, Christopher Runyan, MD, PhD
2.
1Wake Forest University School of Medicine, Winston-Salem, NC, USA,
2Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA.
PURPOSE: Orthognathic surgery balances function with aesthetics to correct dentofacial defects. Traditional two-dimensional imaging limits planning precision. Virtual surgical planning (VSP) offers three-dimensional predictive modeling, but its effect on surgeon decision-making remains unclear. This study evaluated how VSP alters operative planning among surgeons of varying experience.
METHODS: Eighteen orthognathic surgeons (median 19.5 years’ experience, IQR [9.25–25]) reviewed a standardized case, identified pertinent data (e.g., imaging, cephalometrics, exam findings), and proposed an operative plan. Plans were simulated with IPS CaseDesigner. Confidence and satisfaction (scale 1-10) and preferred operation were compared pre- and post-VSP. Binary and categorical variables used Fisher’s exact/chi-square tests; continuous variables Mann-Whitney U (R v4.5.1).
RESULTS: Surgeons prioritized mandibular midline (89%), maxillary midline (78%), incisor show (72%), and lateral cephalograms (78%). Those performing ≤5 cases/year had lowest baseline confidence (5.5/10) but greatest post-VSP satisfaction (8.4/10). High-volume surgeons (>20 cases/year) started confident (9/10) but saw reduced post-VSP satisfaction (8/10). Five surgeons preferred a VSP-generated alternative plan; all performed ≤10 cases annually (p = 0.016) (Table 1).
CONCLUSIONS: VSP’s influence on orthognathic operative planning varied inversely with case volume. Lower-volume surgeons often revised plans and gained confidence post-VSP, whereas higher-volume surgeons showed less benefit, revealing experience-dependent effects. Findings highlight VSP’s potential to narrow experience-related gaps in surgical planning and call for studies to refine training and integrate VSP into workflows to maximize clinical impact.
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