Accuracy of upper jaw positioning with intermediate splint fabrication after virtual planning in bimaxillary orthognathic surgery

The purpose of the study is to present and discuss a workflow regarding computer-assisted surgical planning for bimaxillary surgery and intermediate splint fabrication. This study describes a protocol starting from wax bite registration to fabrication of the necessary intermediate splint. The procedure is a proof of concept to replace not only the model surgery but also facebow registration and transfer from facebow to articulator. Three different modalities were utilized to obtain this goal: cone beam computed tomography (CBCT), optical dental scanning, and 3-dimensional printing. A universal registration block was designed to register the optical scan of the wax bite to the CBCT data set. Integration of the wax bite avoided problems related to artifacts caused by dental fillings in the occlusal plane of the CBCT scan. Fifteen patients underwent bimaxillary orthognathic surgery. The printed intermediate splint was used during the operation for each patient. A postoperative CBCT scan was taken and registered to the preoperative CBCT scan. The difference between the planned and the actual bony surgical movement at the edge of the upper central incisor was 0.50 ± 0.22 mm in sagittal, 0.57 ± 0.35 mm in vertical, and 0.38 ± 0.35 mm in horizontal direction (midlines). There was no significant difference between the planned and the actual surgical movement in 3 dimensions: sagittal (P = 0.10), vertical (P = 0.69), and horizontal (P = 0.83). In conclusion, under clinical circumstances, the accuracy of the designed intermediate splint satisfied the requirements for bimaxillary surgery.