Introduction:
Pre-operative imaging is one of the most crucial steps in dental surgical planning. It is required during critical stages of patient assessment before performing any orthognathic surgery (surgery to correct malposition of jaws and teeth) by the maxillofacial surgeon or orthodontist. Although conventional 2D (two-dimensional) radiography has been the prevailing method for radiographic diagnosis for many years, more advanced radiographic modalities are now available. These include panoramic imaging, cephalometric analysis, and the newly developed CBCT (computed beam computed tomography). CBCT has proven to be extremely valuable in assessing surgical procedures, particularly in the fields of maxillofacial surgery and orthodontics. It is the preferred modality for preoperative planning and comprehensive evaluation before orthognathic surgery.
What Are the Disadvantages of Traditional Surgical Planning?
Currently, virtual surgical planning, or VSP is another modern concept in dentistry and in the field of maxillofacial surgery that utilizes pre-operative surgical planning and splint fabrication. Previously, when only 2D radiographic modalities were used and there was no scope to digitally evaluate or assess the patients' dental cast or models through 3D (three-dimensional). It used to bear several substantial limitations for the dental surgeon or the operator. In the field of orthognathic surgical planning, this was one of the major drawbacks. The primary disadvantages were related to the absence of 3D data regarding the anatomical structures of the patient's upper or lower jaw, as well as the inaccuracies caused by low-resolution 2D imaging. These inaccuracies can be easily transmitted to the operating theater along with the dental surgeon.
These drawbacks were attributed to the 2D imaging or preoperative planning mainly owing to the suboptimal plaster cast designs according to the opinions of modern-day maxillofacial surgeons. These drawbacks have not only just emphasized the importance of comprehensively planning the patients' recovery post-surgery, but it has also paved the way for the advent of modern-day 3D radiographic modalities like CBCT and importantly the new age modality of VSP or virtual surgical planning that can accurately record the patient anatomy. The advent of modern-day technology in the fields of dentistry and maxillofacial surgery can offer scope for both high-resolution imaging and the transfer of the anatomical landmarks onto the skeleton-dental models obtained by the dentist. Pre-operative planning also makes it much easier for the dental operator and lab technician to fabricate dental or surgical splints in a quick fashion and with accuracy. This ensures that there is less scope for operator-based errors and also post the dental or orthognathic surgery, patients can recover at a faster rate when the prosthesis is more accurate, for example, certain splints that have to be worn post-surgery or devices indicated after orthognathic surgery completion to retain the bone position and shape.
The utilization of CBCT provides an additional advantage for contemporary dental practitioners as it enables precise resolution and image capture. Moreover, patients tend to find the CBCT method more comfortable when compared to traditional 2D imaging techniques like intraoral periapical radiography or bitewings, which offer lower resolution and higher radiation exposure based on recent dental studies.
What Are the Advantages of Virtual Surgical Planning?
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The advent and implementation of 3D planning along with printing and imaging modalities in the field of orthognathic surgery have hence revolutionized the field of preoperative planning. Pre-operative 3D imaging, particularly CBCT scanning, can be called the essential pillar in the fields of dentistry and oral or maxillofacial surgery, particularly in the orthognathic surgery field that can be utilized by maxillofacial surgeons and orthodontists.
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The design prior to any dental treatment plans and the complete navigation-based guidance of the maxillofacial surgeons can ensure the scope for the success of the orthognathic surgery procedure that one is undergoing. VSP technique in the field of implant surgery is specifically one of a revolution in dentistry because it can be used clearly to visualize the patient’s craniomaxillofacial anatomy in detail and also obtain 3D models for accurate visualization of the bones, soft tissues, and other structures prior to surgery itself.
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The advantages of CBCT and VSP are that they serve the purpose of visualization and accuracy. With the advent and recent advances in the field of computer-aided virtual design software, dental surgeons can hence clearly gain a preoperative understanding as well as efficiently design the surgical templates needed. The benefit of virtual surgical planning has been hence clearly observed in modern-day dental clinical practice, mainly to that extent where coronal, apical, or angular errors that creep up during the oral surgical procedures, with the interplay of various patient issues can be significantly lessened or limited or avoided.
What Is the Role of Surgical Planning in Increasing Surgical Success?
Current dental research shows that the gingival or the soft tissue biotype is significantly impacted in high-risk population groups such as the immunocompromised, those on systemic medications, and even smokers. Chronic smoking or alcoholism is further associated with bone loss and localized tissue inflammation or gingival recession, making such individuals prey to periodontal (gum) diseases. Similarly, the thin or thickened gingival biotype varies from person to person. Also in patients affected by trismus or limited mouth opening, poor salivary control, or in systemically diseased patients, maintaining the blood field during oral surgical procedures would offer a lot of visual obstacles. In such cases, virtual planning can be helpful and may enhance the success of the surgery to a great extent.
Conclusion:
Given that each dental or oral surgery patient possesses distinct or marginally varied anatomical positions, and considering the diverse underlying medical conditions among patients, it is crucial to emphasize the significance of preoperative planning in this domain. This practice effectively assists operators in strategizing the arrangement and positioning of surgical instruments, thereby facilitating the simulation of the surgery, ensuring precise surgical outcomes, and mitigating potential surgical complications.
