Three-Dimensional Evaluation of Soft Tissues in Orthognathic Surgery: A Pilot Study of Digital Planning Predictability

Three-dimensional (3D) facial scanning integrated with cone-beam computed tomography (CBCT) has improved digital planning and postoperative assessment in orthognathic surgery. This retrospective pilot study evaluated the accuracy of digital surgical planning, skeletal and soft-tissue movements, and postoperative edema evolution in 12 patients undergoing bimaxillary orthognathic surgery. Pre- and postoperative CBCT scans, facial scans, and virtual surgical plans were analyzed. Planning accuracy was assessed by comparing predicted and postoperative cephalometric measurements. Skeletal and soft-tissue displacements were evaluated using corresponding landmarks, while postoperative edema was evaluated through 3D facial scan superimposition. Before Bonferroni correction, significant differences were observed for the SNB angle (p = 0.005) and the Mandibular Plane Angle (p = 0.008); after adjustment, only the SNB angle remained statistically significant. Significant positive correlations between skeletal and soft-tissue displacements were found for Point B along the x-axis (ρ = 0.769, adjusted p = 0.048) and y-axis (ρ = 0.797, adjusted p = 0.032), and for Pogonion along the z-axis (ρ = 0.988, adjusted p < 0.016). No statistically significant differences in postoperative edema remained after Bonferroni correction. Overall, digital surgical planning showed good agreement between planned and postoperative outcomes, while 3D facial scanning proved useful for evaluating soft-tissue response.