Fomm 02 27

Review Article
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Considerations for virtual surgical planning and simulation in

orthognathic surgery—a narrative review
Tae-Geon Kwon, Sung-Tak Lee, So-Young Choi, Jin-Wook Kim
Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University, Daegu, Republic of Korea
Contributions: (I) Conception and design: TG Kwon; (II) Administrative support: SY Choi, JW Kim; (III) Provision of study materials or patients: TG
Kwon, SY Choi, JW Kim; (IV) Collection and assembly of data: TG Kwon, ST Lee, JW Kim; (V) Data analysis and interpretation: TG Kwon, ST
Lee, SY Choi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Correspondence to: Tae-Geon Kwon, DDS, PhD. Department of Oral and Maxillofacial Surgery, School of Dentistry, Kyungpook National University,
2177 Dalgubeol-daero, Jung-gu, Daegu 41940, Republic of Korea. Email: kwondk@knu.ac.kr.
Abstract: 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.
Keywords: virtual surgical planning (VSP); simulation; orthognathic surgery; three-dimensional (3D)
Received: 20 August 2020; Accepted: 11 September 2020; Published: 10 November 2020.

doi: 10.21037/fomm-20-54
View this article at: http://dx.doi.org/10.21037/fomm-20-54
Introduction used in oral and maxillofacial surgery, especially in the

field of orthognathic surgery (1-4). Three-dimensional
In patients with facial deformities, such as malocclusion,
(3D) VSP is widely accepted as mainstream for treatment
surgical planning and simulation of surgical outcomes
planning compared to the previous classical 2D planning or
are the most important processes in presurgical workups articulator model surgery (4,5). The accuracy and feasibility
for successful orthognathic treatment. It is necessary to of VSP for orthognathic surgery is well documented in the
correctly move the osteotomized segment and dentition literature (6-9). Using computerized treatment planning, it
to the required position in 3D space according to the is possible to perform virtual segmentation of the maxilla or
preoperatively determined surgical plan. Therefore, mandible and repositioning of the osteotomized segment
intraoperative control of precise and accurate mobilization is therefore possible. This enables precise mobilization of
of osseous segments is emphasized. Currently, computer- the horizontal, vertical, and transverse direction segments
assisted virtual surgical planning (VSP) has been widely with six degrees of freedom according to the planned
introduced in various institutions and it is commonly movements. At the same time, it is possible to visualize
© Frontiers of Oral and Maxillofacial Medicine. All rights reserved. Front Oral Maxillofac Med 2020;2:27 | http://dx.doi.org/10.21037/fomm-20-54
Page 2 of 13 Frontiers of Oral and Maxillofacial Medicine, 2020
the interosseous relationship, segment overlap or bony maxillofacial areas, publications showing important concepts
interference, and significant interosseous gaps and potential or explaining operating process of VSP were also reviewed.
sites for additional bone grafts or bone reduction. Another Although there are many benefits to using 3D VSP
advantage is that the trial of presurgical planning can be for orthognathic surgery, there are only a few reports on
performed within an unlimited time. potential errors or mistakes that can be encountered with
Technological advancements enable not only virtual VSP and simulation processes. The key questions in this
planning but also intraoperative utilization of surgical review was as follows: (I) which process during VSP can be
splints or surgical guides fabricated by a 3D computer- the source of errors? (II) what is different between in-house
aided design/computer-aided manufacturing (CAD/ and outsourced VSP? To answer these two key questions,
CAM) system. A step-by-step protocol for 3D VSP this review aims to update information on VSP and discuss
is well established at each institute even though there the various precautions and considerations in VSP for
are some minor technological differences. Overall, the orthognathic surgery.
protocol is composed of several steps: (I) acquisition of We present the following article in accordance with
computer tomography (CT) or cone-beam computed the Narrative Review Checklist (Available at http://dx.doi.
tomography (CBCT) images of maxillofacial structures org/10.21037/fomm-20-54).
and scanned maxillomandibular dental casts; (II) 3D
image segmentation, fusion, and 3D superimposition
of dental arches in CT images for virtual planning; (III) Methods
implementation of virtual treatment planning based on In these reviews, PubMed data base search was performed
the diagnosis and surgeon’s plan for the surgery; (IV) following terms: Orthognathic Surgery, Computer-assisted,
fabrication of CAD/CAM-utilized surgical splints or computer-aided, virtual planning, CAD-CAM. The
surgical guides; (V) intraoperative utilization of surgical published reports from Jan 2000 to April 2020 in English
splints or surgical guides—surgical transfer of planned were included. Study with full-text were selected and
surgical movements; and (VI) postoperative validation of reviewed.
the VSP compared to real postoperative results (1,10,11).
Recently, surgical guides accompanied by pre-bent titanium
plates (12) or patient-specific, 3D printed plates are being Discussion
used with (13) or without an intermediate splint (14). Practical advantage of computerized surgical planning in
Since the osteotomized segments of the maxilla can be orthognathic surgery
mobilized to complex degrees and directions, 3D planning
and simulation are very helpful for accurate 3D simulation. VSP can facilitate the quantitative analysis of outcomes
Previous reports have shown that the application of VSP and provide greater accuracy in orthognathic surgery (6).
demonstrated acceptable surgical accuracy in one-piece Therefore, computerized planning and simulation for
maxillary osteotomy (15-18) or multipiece maxillary orthognathic surgery would allow surgeons to perform more
orthognathic surgeries (19-24). Many previous publications accurate and efficient orthognathic surgeries (8,25). There
have emphasized and highlighted the accuracy of a 3D are various advantages to VSP-modulated orthognathic
planning system using the various software programs and surgery.
hardware. However, the enthusiasm for 3D technology First, more accurate and quantitative analysis of
sometimes underestimates or ignores the potential source the various deformities is possible with VSP, which
of errors during virtual planning. Moreover, a systematic previously were impossible with 2D cephalometric
review of virtual planning in orthognathic surgery suggested analysis. Computerized planning in orthognathic surgery
that even though there has been no reported financial allows surgeons to carry out comprehensive evaluation of
conflict of interest, there is a risk of financial bias in some anatomical structures of the surgical field. In asymmetric
studies because of the possibility of financial gains from 3D patients, VSP can be used to diagnose presurgical
software development and application (7). problems and can predict the postoperative 3D position
In this narrative review, the studies suggesting of osteotomized segments, thereby predicting redundant
quantitative data is included to reduce the bias of the asymmetry after surgery (26). At the same time, the need for
publication. Since the VSP is recently shown in oral and dental decompensation after surgery can also be visualized
Frontiers of Oral and Maxillofacial Medicine, 2020 Page 3 of 13
A B C D
E F G H
Figure 1 Fabrication of a computer-aided design/computer-aided manufacturing (CAD/CAM) intermediate splint for two jaw surgery.
(A) Laser scanned dental cast data and cone-beam CT data were superimposed in virtual space. (B) Maxillary repositioning was performed
according to the surgical plan. (C) virtual fabrication of an intermediate splint and 3D printed splint. (D) Simulated position of mobilized
maxillomandibular structures.
and it is possible to reflect the magnitude of overcorrection Potential source of errors in computer-assisted planning
to VSP in advance (1). and surgical applications
Another advantage is that VSP can allow minimally
Since the actual surgical result is significantly influenced
invasive surgery. VSP follows the osteotomy line nearly the
by the simulated maxillary position in virtual surgery
same as in a real intraoperative osteotomy. Repetitive virtual
or articulator model surgery, the intermediate splint or
surgery for the best possible results in problematic cases can
minimize the surgical errors and can allow the surgeon to surgical guide is important and this core step can determine
accurately reproduce the surgical plan. At the same time, the accuracy of the surgery (Figure 1). The many steps of a
surgeons can anticipate potential intraoperative problems conventional articulator-based model surgery allow a high
and reduce complications using VSP. probability of errors. The step of taking an impression, bite
Additionally, residents can participate in the planning registration, facebow transfer, maxillary repositioning and
procedure and can have deeper insights on the surgery splint fabrication on an articulator can be sources of errors
being planned. Patients can have sufficient information on (Figure 2). However, a VSP does not directly guarantee
the surgery and can understand postoperative sequelae more surgical accuracy. Inaccuracy associated with a computerized
easily. It is very useful for patient and student education. planning procedure exists for many factors; e.g., head
Validation of the surgical outcome can be carried out positioning, 3D data integration, segment positioning, and
with postoperative assessment. Since all the data related the stereolithographic splint fabrication procedure.
to computerized surgical planning and postoperative
outcomes are stored in a database, these accumulated Errors in 3D data integration and fusion
quantitative follow-up data would be helpful for developing It is important to integrate the 3D data of dentition and the
an improved protocol or technical innovations for further skeleton from different imaging techniques to create a 3D
treatments. virtual dentofacial skeleton in the same virtual space. Because
Step 1
Pre OP
Articulator model surgery
• lmpression taking process

• Bite registration process Step 2
• Facebow transfer Post surgical result
• Maxillary repositioning on articulator Actual surgery
lntermediate
• Splint fabrication on articulator Splint
• Extraoral/intraoral reference-guided
positioning
• Miniplate adaptation
• Condyle/proximal segment positioning
(if mandible first)
Step 1
Pre OP
Virtual model surgery
• Laser/CT scanning of dental cast

• Virtual positioning of the casts according
to occlusion
• Virtual maxillary repositioning
• Stereolithographic splint fabication
Figure 2 Comparison of potential errors related to classical articulator model surgery vs. virtual model surgery.
orthodontic brackets, metallic restorations, and a prosthesis Complete, perfect integration of an individual maxillary or
are usually installed in many patients, metallic artifacts in mandibular dental cast to CBCT is not always possible but
CBCT images are a significant problem (27). Therefore, it has clinically acceptable accuracy with current technology.
dentition is usually determined with laser surface scanning
and it requires image fusion from skeletal CT scans. Many Errors in the virtual planning process—head
technical developments have been reported to overcome positioning, segment positioning
radiographic artifacts that can interfere with the optimal The head position in virtual space is important for
integration of maxillomandibular dentition using CT treatment planning. The vertical position reference
images. Multiple scans (28,29), fiducial markers (19,30-32), landmarks or occlusal plane are especially important
registration blocks (19,33), surface matching (34-37), voxel for maxillary mobilization (Figure 4). Moreover, the 3D
based registration (29), or a specialized algorithm using reference plane in virtual surgical movements should
a combination of various methods (38) are suggested to coincide with the real pre-postoperative head position.
improve the accuracy of 3D data integration of dentition Otherwise, validation of the 3D VSP is not possible. The
and the skeleton. Currently, the function of point or surface 3D reference plane is frequently defined by anatomical
registration in 3D planning software is used often (39). landmarks, such as Frankfort’s horizontal plan (40). The
The dental arch information STL file format is usually natural head position can also be used in VSP but has some
introduced in 3D simulation software. limitations because of reproducibility (41) or changes after
The registration process is performed by: (I) matching mandibular set-back (42) or advancement surgery (43).
corresponding reference points that are close to each other, After orienting the head position in 3D virtual space,
(II) using regional surface-based registration (3D & MPR segmentation of the individual osseous segments is carried out
images), and 3) validating the superimposition accuracy by cropping the target structure and cleaning up the artifacts
(Figure 3). However, other factors remain a concern; e.g., (I) or unnecessary 3D structures and virtual osteotomy (11).
the time interval between obtaining the dental impression During the VSP, the midline deviation, maxillary roll,
or intraoral scan vs. CBCT imaging because of potential pitch, yaw correction, and anteroposterior/vertical
effects of presurgical orthodontic movements; and (II) the transverse correction need to be thoroughly confirmed. It
intermaxillary occlusal relationship between the dental is common to use commercially available software; such as,
cast vs. CBCT (centric relation or centric occlusion bite). SimPlant O&O® (Materialise), Mimics® (Materialise N.V.,
A B
C D E
Figure 3 Step-by-step procedure for image fusion of dental model and 3D cone-beam computed tomography (CBCT) data. Creation of a
3D maxillofacial-dental model using sequential point-matching (A) and regional surface-based registration (B). Comparison of an original
3D CBCT image of the skull model (C), initial incorporation of dental arch information into the 3D CBCT skull structure (D), and finally
superimposition of the dental-skeletal data (E).
A B
Figure 4 Setting the head position is important in VSP. It is necessary to confirm the head position of the patient before starting segment
mobilization. The reference plane of the planned movement of the segment can be different for each patient.
A B
Figure 5 Segment mobilization in 3D virtual space. The anticipated position of the segments can be mobilized in virtual space (A) and the
moved position is visualized with 3D or MPR images (B).
Leuven, Belgium), Dolphin Imaging® (Dolphin Imaging yaw correction can be accompanied by any amount of roll
and Management Solutions, Chatsworth, CA, USA), correction and the midline position must be correct during
ProplanCMF ® (Materialise), and various other software canting correction of the maxilla via VSP. Therefore, after
programs developed by individual institutions or local all the planned movement is finished, the position of the
companies. According Xia et al. (2015), it is recommended osteotomized segment needs to be confirmed again for
to perform VSP following a specific algorithm; i.e., midline every x, y, z reference point (Figure 7). VSP can be used to
correction followed by roll and yaw correction, adjustment predict and manage the interosseous interference or gap
of the vertical position, pitch orientation, and horizontal and minimize surgical morbidity and operation times (45).
position consecutively (11). Other institutions have Severe bony interference can be corrected with the 3D
suggested using an algorithm that starts with transverse VSP procedure. However, accidental mobilization in virtual
correction of the midline and roll correction at first in a space can lead to surgical error.
frontal view, then performance of pitch correction in a VSP can overcome the potential difficulties in articulator
lateral image, and performance of maxillary yaw correction model surgery (17,46) or inaccuracy of the articulator-based
as the final stage (44). The algorithm can be modified conventional model surgery (47). For example, when a
according to the practitioner’s preference and function of maxillary down fracture or asymmetric maxillary impaction
the module in the 3D simulation software. with down fracture on the contralateral side are needed,
One of the strong advantages of 3D VSP is precise they are definitely accompanied by premature contact with
visualization of the anticipating position of the segments bilateral or unilateral molars. Therefore, intermediate splint
(Figure 5). It is easy to identify interosseous interference fabrication using minimal changes in the temporomandibular
during the VSP process. Severe interference between the joint position would be difficult with articulator-based model
proximal and distal segments of the mandibular ramus after surgery. However, mandibular autorotation is possible in
a planned surgery can be controlled by yaw correction of virtual space by centering the line connecting the center of
the maxillary osteotomy (44). For example, in a patient the bilateral condyle head (Figure 8).
with severe facial asymmetry, canting correction can be
planned with the center of rotation at the upper incisor Precision in orthognathic surgery with a surgical guide
midline. As a result, a significant gap on the deviated side and prefabricated plates
would be expected. If the yaw correction of the maxilla is There are many reports on the accuracy and feasibility
added in this position, the interosseous gap can be reduced of 3D CAD/CAM splints. It is currently an important
(Figure 6). On the contrary to this advantage, unwanted component of the orthognathic surgery process (6,48-51).
A B
Figure 6 One example of performing a yaw correction. After maxillary canting correction with the center of rotation the upper incisor
midline, there would be a significant gap on the deviated side (A). If the yaw correction of the maxilla is added, the interosseous gap can be
reduced (B).
To accurately transfer VSP to the operating room, intermediate surgical pauses to reposition the maxilla.
surgical guides can also be used with or without a surgical
splint (52). Surgical guides can aid two functions in
Digital workflow of VSP for orthognathic surgery using
surgeries; i.e., osteotomy and repositioning (53). Currently,
in-house processing vs. outsourcing
surgical guides that utilize custom titanium miniplates
showed favorable surgical accuracy (54-58). Short operating The 3D software programs for VSP are usually installed at
times have great advantages, but a limitation is the high the hospital and the surgical team can design the surgical
cost of these systems (54,56). Previously reported results plan at each institution. Surgical plans can be accessed
have suggested that CAD/CAM surgical guides and throughout the individual hospital via computer networks or
utilization of customized titanium plates are a major trend web-based connections. Residents, patients, and operators
in orthognathic surgery and can eliminate the need for have easy access to the 3D plans. This can facilitate in-
A B
Figure 7 In maxillary canting correction, right side impaction and left side down fracture is nearly the same and there is no difference in the
maxillary incisor midline (A,B). However, posterior yaw correction can be accompanied erroneously (B).
depth discussion on a surgical case and activate multiple conjunction with a third-party vendor. Many private
opinions on difficult cases, thereby minimizing potential companies offer outsourced VSP, such as 3D Systems (VSP®
mistakes. A hospital or institution that houses a laboratory Orthognathics) (59), Materialise (ProPlan CMF) (60),
that is specialized for 3D planning and CAD/CAM splint KLS Martin (IPS CaseDesigner®) (13) or other domestic
or guide fabrication is optimal for surgeons. However, companies in each country or local district. In the process
considering the various obstacles in hiring experts and the of establishing a surgical plan, surgeons confer with 3D
flexibility in the number of the operations and management technicians from the above mentioned companies. During
costs for 3D laboratories, outsourcing of VSP is adopted in an example VSP on-line meeting, a patient’s intermaxillary
many institutions. occlusion was virtually aligned and the surgeon confirmed
CAD/CAM-assisted surgical planning in orthognathic the finally expected occlusion after the surgery. The
surgery is frequently carried out by outsourcing in osteotomized segments were repositioned according to
A B
Figure 8 Virtual mandibular rotation to minimize inter-segment interference. When the maxillary downward reposition is planned (A),
autorotation of mandible hinged on TMJ center is needed to fabricate an intermediate splint (B).
the occlusion and surgical plan. Therefore, a web-based Summary

meeting or interactive discussion is important to minimize
VSP plays an important role in orthognathic surgery in
the knowledge gap between the surgeon and technician.
the era of digital technology. It has been suggested that
The use of outsourced VSP systems is advantageous in
VSP would be an opportunity rather than a risk factor for
many clinics. However, there are limitations in outsourcing,
surgery because there is significant evidence of decreased
such as the high cost of processing, prolonged delivery time
preparation times, operation times, increased accuracy,
before surgery, and necessity for multiple web-meetings
and enhanced satisfaction of practitioners. Updates in the
or conference calls for manufacturing outsourced CAD/
CAM-splints or surgical guides. Therefore, the need latest advances in computerized planning is important for
for processing VSP using in-house workflow has been surgeons who treat patients with dentofacial deformities.
suggested (61-63). 3D printed models can be fabricated Understanding the benefit vs. limitations and cost and time
from commercially available 3D printers at the clinician’s efficiency vs. inefficiency can enhance the understanding of
institution and can reduce the preparation phase and trends in VSP and can determine the best possible clinical
minimize delivery time and can be used to train residents settings in individual institutions.
to understand 3D processing and simulation. It is still Currently, many institutions perform VSP using
a demanding situation for a surgical department to hire outsourced companies. This has inherent risk of exposure
professionals who can work faster with reasonable costs of patient information and intellectual resources. This
compared to an outsourced company. information also has a significant relationship with the
There are limitations and quality of research reviewed. development of better VSP. Moreover, all the quality
There can be inherent publication bias. Because of recent assurance in VSP steps depend on the third-party and there
strong enthusiasm for application of VSP in orthognathic is a gray zone to determine the exact responsibility for the
surgery, most of the problems are not seriously screened. surgical outcomes. To overcome the problems of outsourced
Moreover, the scientific evidence are relatively low in VSP, in-house planning is considered to minimize
previous literatures and there is not so many well-designed communication gaps and reduce the cost and time for VSP
randomized control data. Studies using more objective planning. However, the decision can be made depending on
inclusion/exclusion criteria with large number of data need the medical environment of individual institutions.
to be investigated further in future research. Since there are many factors determining the precision
of 3D planning and simulation, the surgeons need to be dimensional treatment planning of orthognathic surgery
aware that the VSP cannot automatically ensure successful in the era of virtual imaging. J Oral Maxillofac Surg
surgical outcomes. Errors can be encountered at every 2009;67:2080-92.
step. Integration of 3D dentition to skull data, segment 2. Xia JJ, Shevchenko L, Gateno J, et al. Outcome study
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virtual space are factors that need consideration. Thorough 3. Borba AM, Haupt D, de Almeida Romualdo LT, et al.
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to successful surgical outcomes in orthognathic surgery to Perform Virtual Orthognathic Surgical Planning? J Oral
performed with VSP regardless of in-house or outsourced Maxillofac Surg 2016;74:1807-26.
virtual planning procedures. 4. Xia J, Ip HH, Samman N, et al. Three-dimensional
virtual-reality surgical planning and soft-tissue prediction
for orthognathic surgery. IEEE Trans Inf Technol Biomed
Acknowledgments
2001;5:97-107.
Funding: None. 5. Xia J, Ip HH, Samman N, et al. Computer-assisted three-
dimensional surgical planning and simulation: 3D virtual
osteotomy. Int J Oral Maxillofac Surg 2000;29:11-7.
Footnote
6. Haas OL Jr, Becker OE, de Oliveira RB. Computer-aided
Reporting Checklist: The authors have completed the planning in orthognathic surgery-systematic review. Int J
Narrative Review reporting checklist. Available at http:// Oral Maxillofac Surg 2014;44:329-42.
dx.doi.org/10.21037/fomm-20-54 7. Stokbro K, Aagaard E, Torkov P, et al. Virtual planning
in orthognathic surgery. Int J Oral Maxillofac Surg
Conflicts of Interest: All authors have completed the ICMJE 2014;43:957-65.
uniform disclosure form (available at http://dx.doi. 8. Schendel SA. Computer simulation in the daily practice
org/10.21037/fomm-20-54). TGK serves as an unpaid of orthognathic surgery. Int J Oral Maxillofac Surg
editorial board member of Frontiers of Oral and Maxillofacial 2015;44:1451-6.
Medicine from Apr 2020 to Mar 2022. The other authors 9. Shaheen E, Shujaat S, Saeed T, et al. Three-dimensional
have no conflicts of interest to declare. planning accuracy and follow-up protocol in orthognathic
surgery: a validation study. Int J Oral Maxillofac Surg
Ethical Statement: The authors are accountable for all 2019;48:71-6.
aspects of the work in ensuring that questions related 10. Zinser MJ, Mischkowski RA, Sailer HF, et al. Computer-
to the accuracy or integrity of any part of the work are assisted orthognathic surgery: feasibility study using
appropriately investigated and resolved. multiple CAD/CAM surgical splints. Oral Surg Oral Med
Oral Pathol Oral Radiol 2012;113:673-87.
Open Access Statement: This is an Open Access article 11. Xia JJ, Gateno J, Teichgraeber JF, et al. Algorithm for
distributed in accordance with the Creative Commons planning a double-jaw orthognathic surgery using a
Attribution-NonCommercial-NoDerivs 4.0 International computer-aided surgical simulation (CASS) protocol.
License (CC BY-NC-ND 4.0), which permits the non- Part 1: planning sequence. Int J Oral Maxillofac Surg
commercial replication and distribution of the article with 2015;44:1431-40.
the strict proviso that no changes or edits are made and the 12. Xue C, Xu H, Tian Y, et al. Precise control of maxillary
original work is properly cited (including links to both the multidirectional movement in Le Fort I osteotomy using
formal publication through the relevant DOI and the license). a surgical guiding device. Br J Oral Maxillofac Surg
See: https://creativecommons.org/licenses/by-nc-nd/4.0/. 2018;56:797-804.
13. Rückschloß T, Ristow O, Muller M, et al. Accuracy of
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doi: 10.21037/fomm-20-54
Cite this article as: Kwon TG, Lee ST, Choi SY, Kim JW.
Considerations for virtual surgical planning and simulation in
orthognathic surgery—a narrative review. Front Oral Maxillofac
Med 2020;2:27.

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Review Article

Considerations for virtual surgical planning and simulation in

Received: 20 August 2020; Accepted: 11 September 2020; Published: 10 November 2020.

Introduction used in oral and maxillofacial surgery, especially in the

• lmpression taking process

• Laser/CT scanning of dental cast

the occlusion and surgical plan. Therefore, a web-based Summary

2019;47:847-53. Orthop 2010;138:361-71.

dimensional, CAD/CAM-assisted, virtual surgical an In-house Interdisciplinary Three-Dimensional

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