Orthognathic surgical accuracy and cost-efficiency of patient-specific implants using intraoperative 3D CBCT superposition: A prospective cohort study with retrospective standard miniplates controls

Orthognathic surgery is widely used to correct dentofacial deformities. Recent advancements in virtual surgical planning have enhanced the precision of these procedures. However, ensuring the surgical outcome reflects the virtual plan remains a challenge. This study aims to compare surgical accuracy and cost-efficiency between standard miniplates and patient-specific implants, using intraoperative computed tomography and 3D superposition. A total of 90 patients were included: 75 retrospective controls treated with standard implants and 15 prospective patients treated with patient-specific implants. Surgeries included Le Fort I, BSSO, and genioplasty. Intraoperative computed tomography scans were acquired and superposed with virtual plans to assess 3D accuracy. Statistical comparisons were made using the Mann-Whitney U test. The patient-specific implant group demonstrated significantly improved surgical accuracy in maxillary midline, mandibular midline, maxillary dental plane, and pogonion (p < 0.05). One patient with patient-specific implant required intraoperative replacement of mandibular plates due to condylar repositioning. Cost analysis revealed higher costs for PSI cases compared to standard, with no significant difference in surgical time. While patient-specific implants offer benefits in standardization and intraoperative precision, their higher cost and reduced adaptability in the mandible limit their application. Future studies should explore hybrid approaches and broader cost-efficiency analysis.