Accuracy of soft tissue prediction in surgery-first treatment concept in orthognathic surgery: A prospective study

The Accuracy of Three-Dimensional Soft Tissue Simulation in Orthognathic Surgery-A Systematic Review

Three-dimensional soft tissue simulation has become a popular tool in the process of virtual orthognathic surgery planning and patient-surgeon communication. To apply 3D soft tissue simulation software in routine clinical practice, both qualitative and quantitative validation of its accuracy are required. The objective of this study was to systematically review the literature on the accuracy of 3D soft tissue simulation in orthognathic surgery. The Web of Science, PubMed, Cochrane, and Embase databases were consulted for the literature search. The systematic review (SR) was conducted according to the PRISMA statement, and 40 articles fulfilled the inclusion and exclusion criteria. The Quadas-2 tool was used for the risk of bias assessment for selected studies. A mean error varying from 0.27 mm to 2.9 mm for 3D soft tissue simulations for the whole face was reported. In the studies evaluating 3D soft tissue simulation accuracy after a Le Fort I osteotomy only, the upper lip and paranasal regions were reported to have the largest error, while after an isolated bilateral sagittal split osteotomy, the largest error was reported for the lower lip and chin regions. In the studies evaluating simulation after bimaxillary osteotomy with or without genioplasty, the highest inaccuracy was reported at the level of the lips, predominantly the lower lip, chin, and, sometimes, the paranasal regions. Due to the variability in the study designs and analysis methods, a direct comparison was not possible. Therefore, based on the results of this SR, guidelines to systematize the workflow for evaluating the accuracy of 3D soft tissue simulations in orthognathic surgery in future studies are proposed.

Construction of a virtual reality platform for computer-aided navigation Lingnan bone setting technique

To establish a standard Traditional Chinese medicine (TCM) bone setting technique, standardize the operation and inherit the TCM bone setting technique. This project was based on the interactive tracking of bone setting techniques with a dedicated position tracker, the motion tracking of bone setting techniques based on RGBD (Red Green Blue Depth) cameras, the digital analysis of bone setting techniques, and the design of the virtual reality platform for bone setting techniques. These key technical researches were combined to construct an interactive bone setting technique. The virtual simulation system can reproduce the implementation process of the expert's bone setting technique. The user can observe the implementation of the manipulative technique from multiple angles; through human-computer interaction, the whole process of implementation of the bone setting technique can be simulated, and the movement and reduction of the affected bone can be observed at the same time. It can be used as a teaching and training system for assisting bone setting techniques. Students can use the system to carry out repeated self-training, and can instantly compare with the standard techniques of the expert database, breaking the traditional teaching mode of 'expected and unspeakable' and avoid directly using patients. Therefore, this research makes it possible to reduce teaching costs, reduce risks, improve teaching quality, and make up for the lack of teaching conditions. It is very positive for the inheritance of the traditional Chinese 'intangible culture' of bone setting techniques, and to promote the digitalization and standardization of bone setting techniques.

Application of virtual reality in dental implants: a systematic review

BACKGROUND AND OBJECTIVE

A treatment approach that is widely used as a permanent and natural replacement for missing or extracted teeth is dental implants .VR is a computer-generated simulation that creates a three-dimensional (3D) image or environment. Advances in VR -based learning allow learners and students to practice and also help professionals plan a wide variety of surgical procedures, including the correct placement of dental implants. Therefore, in this systematic review, our aim was to investigate and evaluate the available virtual reality tools for dental implants and their effectiveness.

MATERIALS AND METHODS

Studies published up to 01/30/2023 which report the applications of using virtual reality technology in dental implants, were reviewed in three databases, including PubMed, Web of Science, and Scopus. All studies with evidence reporting the role of virtual reality technology in the field of dental implants were included in our analyses, written in English and published in peer-reviewed form, are included. Theoretical articles, and letters that did not provide original data, as well as studies that reported incomplete information, were excluded. Two reviewers independently assessed search results, extracted data, and assessed the quality of the included studies, and decisive agreement was reached by discussion and consultation with the third researcher. Narrative synthesis was undertaken to summarize and report the findings.

RESULTS

Out of 1633 initial search results, nine were included in the present study based on the inclusion criteria. The focus of seven studies was on teaching and learning, and two studies have examined the implant planning procedure. The most commonly used hardware and software were head-mounted display and Unity3D, respectively. In almost all studies, the results showed that the use of virtual reality-based systems improves and enhances the skills of users, including dental students and specialists.

CONCLUSIONS

Our findings showed that VR is an effective method for teaching and planning the implant process. Although the use of VR technology is limited for various reasons such as cost, it can increase the skills of dental professionals in performing dental implants.

Evaluation of soft tissue prediction accuracy for orthognathic surgery with skeletal class III malocclusion using maxillofacial regional aesthetic units

OBJECTIVES

This study aimed to evaluate the soft tissue prediction accuracy of patients undergoing orthognathic surgery to correct skeletal class III malocclusion using maxillofacial regional aesthetic units.

MATERIALS AND METHODS

Pre- and postoperative cone-beam computed tomography (CBCT) and 3D facial scans were taken for 58 patients who had undergone orthognathic surgery. The preoperative 3D facial scan was integrated with the preoperative CBCT using ProPlan CMF software. The software simulated the surgery and generated postoperative soft tissue prediction. The simulated 3D facial scan was then compared with the actual 3D facial scan obtained at least 6 months after the surgery by the maxillofacial regional aesthetic units and the facial soft tissue landmark points.

RESULTS

The anatomical regions of the upper lip, lower lip, chin, right external buccal and left external buccal prediction were above 2.0 mm. As for the soft tissue landmarks, at chl, chr, ls, stm and li, the position of predicted scan was higher than that of the actual postoperative scan.

CONCLUSIONS

The accuracy of 3D soft tissue predictions using ProPlan CMF software in Skeletal III patients was clinically satisfactory according to maxillofacial regional aesthetic units combined with facial soft tissue landmark points. However, the accuracy of prediction still needed improvement in some areas.

CLINICAL RELEVANCE

The accuracy of soft tissue prediction can be analyzed more clearly through maxillofacial regional aesthetic units so that clinicians have a deeper understanding of the use of the software to predict soft tissue change after orthognathic surgery.

A Quantitative and Qualitative Clinical Validation of Soft Tissue Simulation for Orthognathic Surgery Planning

The purpose of this study was to perform a quantitative and qualitative validation of a soft tissue simulation pipeline for orthognathic surgery planning, necessary for clinical use. Simulation results were retrospectively obtained in 10 patients who underwent orthognathic surgery. Quantitatively, error was measured at 9 anatomical landmarks for each patient and different types of comparative analysis were performed considering two mesh resolutions, clinically accepted error, simulation time and error measured by means of percentage of the whole surface. Qualitatively, evaluation and binary questions were asked to two surgeons, both before and after seeing the actual surgical outcome, and their answers were compared. Finally, the quantitative and qualitative results were compared to check if these two types of validation are correlated. The quantitative results were accurate, with greater errors corresponding to gonions and lower lip. Qualitatively, surgeons answered similarly mostly and their evaluations improved when seeing the actual outcome of the surgery. The quantitative validation was not correlated to the qualitative validation. In this study, quantitative and qualitative validations were performed and compared, and the need to carry out both types of analysis in validation studies of soft tissue simulation software for orthognathic surgery planning was proved.

Psychological Impact and Influence of Animation on Viewer’s Visual Attention and Cognition: A Systematic Literature Review, Open Challenges, and Future Research Directions

Animation is an excellent method to associate with the audience in a fun and innovative manner. In recent span, animation has been employed in various fields to enhance knowledge, marketing, advertisement, and age groups from infants to adults. The present communication expounds the systematic review on the impact created by animation on the viewer’s visual attention. For this review, a database such as Google Scholar, ScienceDirect, Taylor & Francis, and IEEE Xplore were pursued for publications on the impact of animation on viewer’s visual attention from January 2015 to December 2021. The search results showcased 175 titles with 114 full articles, out of which 35 were related to viewers’ visual attention towards animation. These reviewed studies comprised of physical outcome ( $n=9$ ), psychological outcome ( $n=15$ ), and cognitive outcome ( $n=11$ ) from which the attention-related factors, physical effects, and cognitive effects of animation were assessed. The animation has influenced the viewer’s visual attention through the integration of the different stimuli and the highly organized presentation. Furthermore, the animation has also aided the viewer in attaining greater conceptual understanding, thereby facilitating their cognitive response. As a result, the animation was found to be helpful in enhancing learning skills, food marketing, and teaching strategy. Furthermore, the drawbacks and future recommendations of the studies were elaborated. In addition, challenges and open issues faced during the studies were discussed. Finally, the priority areas in animation identified for promising future directions to visualize large pool data, provide smart communication, and design 3D modeling structures were highlighted.

Reduction Malarplasty Using Customized Surgical Stent Based on 3D Virtual Surgery, CAD/CAM, and 3D Printing Technology: Case Series

ABSTRACT

The zygomatic bone is a structure that protrudes symmetrically on both sides of the midface and plays an important role in the overall aesthetic appearance of the face. Unlike Caucasians, the mesocephalic facial shape is predominant in Asians, and therefore, many people have a relatively laterally developed zygomatic bone. In Asians, when the zygomatic bone is excessively developed, it gives a strong and stubborn image, and aesthetically, many people want to reduce the zygomatic bone because they prefer an oval and slim face.To reduce the excessive zygomatic bone, a reduction malarplasty through an intraoral and preauricular approach has been performed. Although reducing the zygomatic bone is not a big problem in most cases of symmetric reduction malarplasty, it is not easy to produce surgical results as intended by the surgeon in asymmetric malar patients or patients requiring a three-dimensional (3D) change of zygoma. In addition, because of the mobility of the zygoma segment, it may be difficult to drill holes and fix plate after osteotomy. Moreover, these factors can increase the possibility of malunion or nonunion.In this study, cutting guides made with the aid of 3D virtual surgery, 3D printing, and customized titanium plates manufactured with the computer-aided design/computer-aided manufacturing technology are used for 8 patients to maximize the recovery of 3D symmetry and minimize complications through accurate fixation after surgery. During the surgical procedures, screw hole drilling and osteotomy were performed using a cutting guide, and then, the malar segment was fixed by matching the premade customized plates with the predrilled holes. As a result of checking the accuracy of the surgery by superimposing the postoperative 3D cone beam computed tomography image and virtual surgery data based on the skull base, the 2 images almost overlapped and no significant differences were observed, so it was confirmed that the operation was performed exactly as plannedWhen using the 3D technology, it is possible to perform a more accurate surgery in patients with asymmetry due to congenital anomalies or trauma as well as simple asymmetry, so it can be concluded that using the 3D technology can overcome the limitations and disadvantages of the conventional method as in the cases in this study. The accurate prediction of soft tissue is still insufficient, and further research is needed to overcome this limitation.

Significance of Haptic and Virtual Reality Simulation (VRS) in the Dental Education: A Review of Literature

The significance of haptic and virtual reality (VR) has been acknowledged by eminent dental professionals and has transformed dental teaching in the modern dental world. With this novel technological concept, students can interact with digital simulation on the screen and learn treatment skills before transferring them to real situations. This is helpful for gaining skills confidence, revising exercises again and again without the waste of materials, and for student assessment controlled by a teacher or tutor. It is a promising technology to enhance dental education for the new era of post COVID-19 practice due to noncontact patient training environments. It can create a safe learning environment for the teacher and learner or participant. The prospect of this literature review is to highlight the significance and clinical applications of virtual reality and simulations in undergraduate dental education.

Soft-Tissue Simulation for Computational Planning of Orthognathic Surgery

Simulation technologies offer interesting opportunities for computer planning of orthognathic surgery. However, the methods used to date require tedious set up of simulation meshes based on patient imaging data, and they rely on complex simulation models that require long computations. In this work, we propose a modeling and simulation methodology that addresses model set up and runtime simulation in a holistic manner. We pay special attention to modeling the coupling of rigid-bone and soft-tissue components of the facial model, such that the resulting model is computationally simple yet accurate. The proposed simulation methodology has been evaluated on a cohort of 10 patients of orthognathic surgery, comparing quantitatively simulation results to post-operative scans. The results suggest that the proposed simulation methods admit the use of coarse simulation meshes, with planning computation times of less than 10 seconds in most cases, and with clinically viable accuracy.

Accuracy of 3-dimensional soft tissue prediction for orthognathic surgery in a Chinese population

OBJECTIVES

This study aims to determine the validity of a 3D planning software in predicting the soft tissue outcome of Chinese patients undergoing orthognathic surgery for correction of Skeletal III dentofacial deformity.

METHODS

Pre- and post-operative 3D facial stereophotogrammetric scans and cone beam computed tomography were taken for 10 Chinese patients who had underwent orthognathic surgery. The pre-operative 3D facial scan was integrated with the pre-operative CBCT using the ProPlan CMF software. The simulated soft tissue 3D face was then compared with the actual 3D facial scan obtained at least 6 months postoperatively. Two outcome measures were computed as follows (i) mean absolute difference between meshes (ii) percentage of points where the distance between the two meshes is 2mm or less.

RESULTS

The mean absolute difference between the predicted and actual soft tissue surface meshes for the full face and the 6 anatomic regions ranged from 0.72mm to 1.42 mm. The mean absolute distance between the meshes for all the anatomic regions were within 2 mm (p<0.05). The percentage of mesh points with less than 2mm error ranged from 72.5% to 92.5%. The accuracy of soft tissue prediction, assessed using mean absolute distance for the full face, was significantly correlated to the amount of sagittal surgical movement (r=0.707, p=0.022). The lower lip was also found to be the least accurate.

CONCLUSIONS

Using ProPlan CMF, the accuracy of 3D soft tissue predictions for bimaxillary orthognathic surgery in Chinese Skeletal III patients were clinically satisfactory.

A comparison of postoperative, three-dimensional soft tissue changes in patients with skeletal class III malocclusions treated via orthodontics-first and surgery-first approaches

The aim of this retrospective study was to compare three-dimensional (3D) soft tissue and hard tissue changes between orthodontics-first approach (OFA) and surgery-first approach (SFA) after mandibular setback surgery. All patients underwent bilateral sagittal split osteotomy, and were examined by lateral cephalograms and 3D optical scanner before surgery (T0) and 1 (T1), 3 (T2), and 12 (T3) months after surgery. Three standard angles (FMA, U1 to FH, IMPA) were measured as hard tissue change and the 2 sets of 3D data were superimposed, and volumetric differences were calculated as soft tissue change. Statistical analyses were performed by using unpaired t-tests. Differences with P < 0.05 were considered significant. A total of 39 patients with mandibular prognathism were included in this study. The OFA group consisted of 24 patients and the SFA group of 15 patients. The SFA group exhibited more labial inclination from T1 to T2 (p = 0.008) and T2 to T3 (p = 0.003) than did the OFA group. There were no significant changes at maxilla and mandible at each term of T0, T1, T2 and T3 (p > 0.05), but compared to before surgery, mandibular volume in SFA group significant increased at 1year (p = 0.049) after surgery. We found that the soft tissue changes after the SFA differed significantly from those after the OFA; thus, soft tissue predictions require more care. An analysis of our data compared with OFA and SFA for the patient with mandibular prognathism confirm that the mandibular soft tissue changes by postoperative orthodontic treatment and occlusal relationship in SFA.

Three-dimensional virtual planning in mandibular advancement surgery: Soft tissue prediction based on deep learning

The study aimed at developing a deep-learning (DL)-based algorithm to predict the virtual soft tissue profile after mandibular advancement surgery, and to compare its accuracy with the mass tensor model (MTM). Subjects who underwent mandibular advancement surgery were enrolled and divided into a training group and a test group. The DL model was trained using 3D photographs and CBCT data based on surgically achieved mandibular displacements (training group). Soft tissue simulations generated by DL and MTM based on the actual surgical jaw movements (test group) were compared with soft-tissue profiles on postoperative 3D photographs using distance mapping in terms of mean absolute error in the lower face, lower lip, and chin regions. 133 subjects were included - 119 in the training group and 14 in the test group. The mean absolute error for DL-based simulations of the lower face region was 1.0 ± 0.6 mm and was significantly lower (p = 0.02) compared with MTM-based simulations (1.5 ± 0.5 mm). CONCLUSION: The DL-based algorithm can predict 3D soft tissue profiles following mandibular advancement surgery. With a clinically acceptable mean absolute error. Therefore, it seems to be a relevant option for soft tissue prediction in orthognathic surgery. Therefore, it seems to be a relevant options.

First-in-man application of a cold ablation robot guided laser osteotome in midface osteotomies

The aim of the study was to assess the clinical applicability of robot guided laser osteotomy for clinical application. This is the initial report on 14 consecutive patients requiring an orthognathic procedure with a midface osteotomy (no restrictions made on the surgical indication itself) who have undergone surgery by means of the Cold Ablation Laser Osteotome CARLO® (AOT Advanced Osteotomy Tools, Basle, Switzerland), which is an integrated system, functionally comprising: an Er:YAG laser source, intended to perform osteotomies using cold laser ablation, a robot arm that controls the position of the laser source, an optical tracking device that provides a continuous and accurate measurement of the position of the laser source and of reference elements attached to instruments or bones, a navigation system (software) that is able to read preoperatively defined planned osteotomies, and - under the control of a surgeon - performs the planned osteotomies. Safety was assessed by unimpaired postoperative healing and the absence of device related injuries; performance was assessed as ability to cut the maxilla along the preoperatively planned cutting path with a rage of accuracy of 2mm. Cold ablation robot-guided laser osteotomy could successfully be performed in 14 consecutive patients. No intraoperative complications or technical failure occurred. All osteotomies were within an average deviation of 0.80 mm (±0.26 mm) of the virtually preplanned location. The registration procedure to set up the robot at the beginning of the operation required a mean time of 4.6 min (±5.3min). In this report we describe the effective and successful routine use of Cold ablation robot-guided laser osteotomy in an actual clinical setting. It is a promising technical innovation that has the potential to set new standards for accuracy and safety in orthognathic surgery.

A review on the applications of virtual reality, augmented reality and mixed reality in surgical simulation: an extension to different kinds of surgery

Background: Research proves that the apprenticeship model, which is the gold standard for training surgical residents, is obsolete. For that reason, there is a continuing effort toward the development of high-fidelity surgical simulators to replace the apprenticeship model. Applying Virtual Reality Augmented Reality (AR) and Mixed Reality (MR) in surgical simulators increases the fidelity, level of immersion and overall experience of these simulators.Areas covered: The objective of this review is to provide a comprehensive overview of the application of VR, AR and MR for distinct surgical disciplines, including maxillofacial surgery and neurosurgery. The current developments in these areas, as well as potential future directions, are discussed.Expert opinion: The key components for incorporating VR into surgical simulators are visual and haptic rendering. These components ensure that the user is completely immersed in the virtual environment and can interact in the same way as in the physical world. The key components for the application of AR and MR into surgical simulators include the tracking system as well as the visual rendering. The advantages of these surgical simulators are the ability to perform user evaluations and increase the training frequency of surgical residents.

Accuracy of three-dimensional virtual simulation of the soft tissues of the face in OrtogOnBlender for correction of class II dentofacial deformities: an uncontrolled experimental case-series study

Purpose

To assess whether virtual simulations of the projection of the soft tissues of the face after class II bimaxillary orthognathic surgery, generated from 3D reconstruction of preoperative computed tomography (CT) scans, differed significantly from the actual soft tissue profile obtained in the late postoperative period (beyond 6 months). Secondarily, to validate the accuracy of a free, open-source software suite for virtual soft tissue planning in orthognathic surgery.

Methods

Helical CT scans were obtained pre- and postoperatively from 16 patients with Angle class II malocclusion who underwent bimaxillary orthognathic surgery. A comparative study between soft tissue meshes constructed for surgical simulation (M1) and the actual meshes obtained from postoperative scans (M2) was then performed. To establish the accuracy of 3D facial soft tissue simulation in a free and open-source software suite (OrtogOnBlender-OOB), 17 predetermined anatomic landmarks were measured in M1 and M2 scans after alignment of cranial structures.

Results

The mean error between preoperative simulations and actual postoperative findings was < 2 mm for all anthropometric landmarks. The overall average error for the facial soft tissues was 1.07 mm.

Conclusion

Comparison between preoperative simulation (M1) and actual postoperative findings (M2) showed clinically relevant ability of the method to reproduce actual surgical movement reliably (< 2-mm error). OOB is capable of accurate soft tissue planning for orthognathic surgery, but mesh deformation methods still require improvement.

Trial registration

RBR-88jff9. Retrospectively registered at Brazilian Registry of Clinical trials-ReBec (http://www.ensaiosclinicos.gov.br) May 06, 2020.

The application of virtual reality and augmented reality in Oral & Maxillofacial Surgery

Background

Virtual reality is the science of creating a virtual environment for the assessment of various anatomical regions of the body for the diagnosis, planning and surgical training. Augmented reality is the superimposition of a 3D real environment specific to individual patient onto the surgical filed using semi-transparent glasses to augment the virtual scene.. The aim of this study is to provide an over view of the literature on the application of virtual and augmented reality in oral & maxillofacial surgery.

Methods

We reviewed the literature and the existing database using Ovid MEDLINE search, Cochran Library and PubMed. All the studies in the English literature in the last 10 years, from 2009 to 2019 were included.

Results

We identified 101 articles related the broad application of virtual reality in oral & maxillofacial surgery. These included the following: Eight systematic reviews, 4 expert reviews, 9 case reports, 5 retrospective surveys, 2 historical perspectives, 13 manuscripts on virtual education and training, 5 on haptic technology, 4 on augmented reality, 10 on image fusion, 41 articles on the prediction planning for orthognathic surgery and maxillofacial reconstruction. Dental implantology and orthognathic surgery are the most frequent applications of virtual reality and augmented reality. Virtual planning improved the accuracy of inserting dental implants using either a statistic guidance or dynamic navigation. In orthognathic surgery, prediction planning and intraoperative navigation are the main applications of virtual reality. Virtual reality has been utilised to improve the delivery of education and the quality of training in oral & maxillofacial surgery by creating a virtual environment of the surgical procedure. Haptic feedback provided an additional immersive reality to improve manual dexterity and improve clinical training.

Conclusion

Virtual and augmented reality have contributed to the planning of maxillofacial procedures and surgery training. Few articles highlighted the importance of this technology in improving the quality of patients’ care. There are limited prospective randomized studies comparing the impact of virtual reality with the standard methods in delivering oral surgery education.

3D Soft-Tissue Prediction Methodologies for Orthognathic Surgery—A Literature Review

Three-dimensional technologies have had a wide diffusion in several fields of application throughout the last decades; medicine is no exception and the interest in their introduction in clinical applications has grown with the refinement of such technologies. We focus on the application of 3D methodologies in maxillofacial surgery, where they can give concrete support in surgical planning and in the prediction of involuntary facial soft-tissue changes after planned bony repositioning. The purpose of this literature review is to offer a panorama of the existing prediction methods and software with a comparison of their reliability and to propose a series of still pending issues. Various software are available for surgical planning and for the prediction of tissue displacements, but their reliability is still an unknown variable in respect of the accuracy needed by surgeons. Maxilim, Dolphin and other common planning software provide a realistic result, but with some inaccuracies in specific areas of the face; it also is not totally clear how the prediction is obtained by the software and what is the theoretical model they are based on.

How accurate is the soft tissue prediction of Dolphin Imaging for orthognathic surgery?

PURPOSE

The purpose of this retrospective study is to evaluate the accuracy of soft tissue prediction models with Dolphin Imaging.

MATERIALS AND METHODS

Preoperative and 1-year postoperative Lateral cephalograms (LCG) of patients undergoing Le Fort I, bilateral sagittal split osteotomy (BSSO) or bimaxillary osteotomy (Bimax) between 2006 and 2009 were retrospectively collected. A hard tissue virtual surgery was performed on the preoperative LCG to match the hard tissue of the 1-year postoperative LCG. The soft tissue changes were then modelled by Dolphin Imaging (version 11.5b) and the differences in x- and y-coordinates of 11 hard tissue and 14 soft tissue landmarks between the predicted model and 1-year postoperative LCG were determined. Statistical analyses were performed using a one-tailed, one-sample t-test for both soft- and hard tissue differences, and a Bland-Altman plot for interobserver bias.

RESULTS

A total of 108 patients were included, the mean age was 30 years and 23% were male. The virtual treatment was considered accurate; all hard tissue landmark differences were less than 1mm. The soft tissue model by Dolphin Imaging showed significant differences of more than 2mm for several landmarks, including the vertical positioning of Stomion Inferius (P=0.007), Lower lip (P=0.005) and Pogonion (P=0.03) in the Bimax group and horizontal positioning of Stomion Inferius (P<0.001) in the BSSO group.

CONCLUSIONS

Dolphin Imaging gives reasonable predictions of postoperative outcome. There is, however, room for improvement, especially regarding the vertical prediction in the lower lip region.

Surgery-first orthognathic approach: A “scoping review” for mapping outcomes and plausible recommendations to develop core outcome sets

Aims and Objectives

The aim of this scoping review was to identify the type of outcomes measured in surgery- first orthognathic approach (SFOA). The objectives were to classify the outcomes into predetermined domains and explore the degree of representation of each domain. Furthermore, to identify which domains are over- or under-represented and determine whether the findings of this scoping review could be employed to provide a template for core outcome sets (COS). Five outcomes were identified, and all the research pertinent to SFOA were assigned to these outcomes.

Materials and Methods

Electronic databases and additional records were searched from January 2009 to March 2019 to source the data, and 525 records were identified.

Results

The initial database and additional search resulted in 525 records, of which 54 potentially relevant articles were retrieved in full. 35 studies met the selection criteria following screening and were included in the scoping review with the results of the search depicted in the preferred reporting items for systematic reviews and meta-analyses. Domains such as morphological features or changes in maxillofacial skeleton and occlusion (n = 25, 71.42%) and psychosocial well-being including quality of life outcome (n = 8, 22.85%) were well represented while functional status (n = 1, 2.85%), health resource utilization (n = 0), and adverse effects (n = 1, 2.85 %) were under-represented.

Conclusions

Limited research on SFOA precludes development of COS. However, future SFOA clinical trials should consider underrepresented outcome domains to address the SFOA treatment modality comprehensively.