Utilizing Virtual Surgical Planning With Dentures for Edentulous and Asymmetry Jaw With Cleft Lip and Palate in Orthognathic Surgery

Orthognathic surgery (OGS) is a transformative procedure that enhances function and aesthetics. Recent advancements in virtual surgical planning (VSP) of OGS, particularly with 3-dimensional (3D) simulation and intraoral scanning, have improved surgical accuracy and postoperative stability. However, complex cases, such as edentulous jaws, present significant challenges. These cases may lead to increased complications and difficulties in surgical planning. This report introduces an innovative VSP method that incorporates dentures into 3D simulation for challenging cases of edentulous and asymmetric jaws. The composition of dentures into VSP is achieved by performing intraoral scans while the patient is wearing the dentures. Skeletal evaluations are based on bone-derived reference points (Sella, Nasion, Point A, Point B) independent of teeth. Postoperative evaluations using cone beam computed tomography showed a close alignment between the planning of VSP and actual outcomes, validating the accuracy of the VSP method that includes dentures. The differences in displacement of point A and point B between the planned and postoperative results were each <2 mm in 3 axes. ANB was markedly improved compared with preoperative. The advancement at point A was slightly insufficient due to the influence of the pharyngeal flap, leading to smaller SNA and ANB than planned. Root-mean-square deviation and color map were also <2 mm. This study confirms that integrating dentures into VSP significantly enhances the precision and effectiveness of the surgical procedure, ultimately improving mastication and facial aesthetics in complex craniofacial cases.