There is no doubt that conventional treatment planning of combined orthodontic-surgical treatment is well developed and can lead to good functional and esthetic results in patients with maxillofacial deformity.
3D imaging and 3D virtual treatment planning, however, enable enhanced diagnostics, more detailed treatment planning, and transfer of the surgical treatment plan to the patient in the operating theatre in combination with unprecedented 3D evaluation of treatment outcome as a quality control. The 3D virtual treatment approach moreover offers a digital communication tool between surgeons and orthodontists, trainer and trainees, and surgeons and engineers to cooperate in a multidisciplinary way to improve patients’ function, facial balance, and harmony.
Although 3D virtual planning has been introduced in daily clinical routine internationally and is becoming state of the art, its efficient integration into the daily clinical workflow remains a problem. In this chapter the entire imaging workflow currently used in the author’s daily practice is presented, and a 10-step protocol for 3D virtual planning of orthognathic surgery is illustrated on a patient.
7.2 Example of treatment using the 10-step protocol
The patient was a 17-year-old woman with a Class III maxillofacial deformity, midfacial hypoplasia, and mandibular asymmetry due to a hemimandibular elongation (HE) at the right side. At the age of 15, she had undergone during growth orthodontic expansion and alignment of the maxillary dental arch for approximately 6 months with braces, which were afterwards removed. She presented with a flattened midface, chin deviation to the left, and a lateral left crossbite (Figs 7-1 to 7-4). In her rest position, the patient had an incisor display of 3 mm, and during spontaneous smiling she had full incisor exposure without gingival display. She had no history of temporomandibular joint (TMJ) dysfunction or pain.
Bone scintigraphy was performed prior to the surgical work-up and did not show any active condylar growth.
The 10-step protocol for individualized 3D virtual treatment planning1 is based on clinical decision making, starting from the individual patient’s planning head position (PHP). Its aim is to provide the clinician with a standardized and systematic way of using 3D virtual treatment planning in daily clinical routine in order to optimize both the functional and esthetic outcomes of orthognathic surgery.