Orthognathic Surgery in Completely Edentulous Patients: A Systematic Review of Planning and Outcomes

The management of dentofacial deformities in completely edentulous patients remains one of the most demanding challenges in maxillofacial surgery due to the absence of occlusal references and severe bone resorption. This systematic review, conducted in accordance with PRISMA guidelines, critically analyzed available evidence on the planning and execution of orthognathic surgery in this population. A comprehensive search of 8 databases identified 8 eligible studies encompassing 34 fully edentulous patients. Le Fort I osteotomy was the predominant procedure (91%), frequently combined with bone grafting and implant-supported rehabilitation (74%). Bilateral sagittal split osteotomy, maxillomandibular advancement, and distraction osteogenesis were less frequent. Digital workflows using virtual planning, CAD/CAM guides, and patient-specific implants demonstrated high positional accuracy (≤1.5 mm) and favorable esthetic and functional outcomes. Reported complications were minimal, including 9 implant losses (7.9%) and a single corrected maxillary relapse. Despite the feasibility and promising results, current evidence remains limited and heterogeneous, precluding robust clinical recommendations. Standardized, prospective studies integrating digital and prosthetic protocols are essential to consolidate orthognathic surgery as a safe and reproducible option for the rehabilitation of edentulous patients.