Considerations for virtual surgical planning and simulation in orthognathic surgery—a narrative review

Although there are many benefits to use 3D virtual surgical planning (VSP) for orthognathic surgery, there are only a few reports on the potential errors or mistakes that can occur with VSP and simulation processes. This narrative review updates information on VSP and discusses the various precautions and considerations for VSP in orthognathic surgery. Application of VSP allows visualization of the interosseous relationship, segment overlap or bony interference, and significant interosseous gaps. Potential sites for additional bone grafts or bone reduction can be anticipated. Additionally, presurgical planning can be performed with unlimited time. Since most VSP is performed by an outsourced company, quality assurance in VSP depends on a third-party, and sometimes there is lack of clarity when delineating the responsibilities for surgical outcomes. To increase the precision of 3D planning and simulation, surgeons need to be aware that the VSP cannot automatically ensure the success of surgical outcomes. Errors can occur at every step, such as integration of 3D dentition to skull data, segment identification and mobilization, computer-aided surgical simulation, fabrication of splint and surgical guides, 3D image superimposition, and determination of occlusion in virtual space. Thorough understanding of the source of errors in VSP can lead to successful surgical outcomes in orthognathic surgery performed with VSP.