Patient-Specific, In-House Surgical Guides in Surgery-First Approach in Orthognathic Surgery: A Technical Note

Abstract Aim of the study: This article introduces an in-house workflow implementing patient-specific surgical cutting guides and spacers combined with pre-adapted osteosynthesis in two Surgery First Orthognathic Approach (SFOA) scenarios. Background: The integration of three-dimensional virtual surgical planning (VSP) in combination with computer aided design and computer aided manufacturing (CAD/CAM) has advanced the field of orthognathic surgery. With the use of surgical guides and patient specific implants (PSI) the accuracy of the surgical outcome could potentially increase. While PSI approaches offer advantages, commercial PSIs are characterized by a prolonged turnaround time and high costs.These drawbacks linked with commercial PSIs might restrict their utilization and acceptance. Technical note: The VSP was completed in Dolphin Imaging software. 3-Matic software was used to design the cutting guides and spacers. The anterior spacers where specifically designed to utilize the wedge-technique during positioning of the anterior segment in segmented Le Fort I osteotomy. The surgical guides and spacers were manufactured in Form 3B 3D printer with BioMed Clear V1 Resin with 0.100 mm layer thickness. Titanium plates 2.0 from Biomet were customized based on a 3D-model of the planned postsurgical outcome based on the VSP. Conclusion: The in-house methodology for developing and employing personalized surgical guides, spacers and pre-adapted titanium plates offers a viable workflow for SFOA, with the potential to enhance the reliability and precision of maxillary repositioning.