Predictability of Mandibular Autorotation After Maxillary Repositioning in Orthognathic Surgery: A Systematic Review with Exploratory Quantitative Synthesis

This systematic review aimed to evaluate the available evidence on methods used to predict mandibular autorotation after maxillary repositioning in orthognathic surgery. A systematic search of PubMed/MEDLINE, Cochrane Library, Scopus, Google Scholar, and EMBASE covering the period from 1970 to 2026 was performed to identify studies reporting on prediction methods for mandibular autorotation after maxillary repositioning. Data on study design, sample size, surgical setting, prediction method, and prediction error were extracted. Because of substantial heterogeneity and incomplete reporting, quantitative synthesis was considered exploratory. Risk of bias was assessed using the ROBINS-I tool. A total of six studies met the inclusion criteria. The available evidence showed marked heterogeneity in study design, outcome definitions, anatomical landmarks, and reporting format. Earlier studies mainly used 2D cephalometric or geometric methods, whereas more recent investigations relied on 3D virtual planning and simulation-based workflows. In the exploratory subgroup meta-analysis, 3D approaches were associated with a lower pooled mean prediction error (0.57 mm, 95% CI: 0.05–1.08) than 2D methods (2.13 mm, 95% CI: 0.65–4.92), although the subgroup difference was not statistically significant (p = 0.2772). Leave-one-out sensitivity analysis showed that the direction of effect consistently favoured 3D methods. Overall, the available evidence suggests that 3D approaches may show lower mandibular autorotation prediction errors than 2D methods; however, this finding should be interpreted cautiously because of the small number of studies, substantial methodological heterogeneity, and the exploratory nature of the quantitative synthesis.