Pacific Coast Society of Orthodontists Bulletin Fall 2021 - 41

Clinical Practice
Let's Talk About That
Patrick Turley Interviews
Dr. Robert Relle
Dr. Patrick Turley
PCSO Bulletin Section Editor
Note: Please be aware that the PCSO Bulletin does
not endorse nor promote any brands or products.
Dentistry is undergoing a digital technological
revolution. There have been more technological
developments in the past 10 years than in the rest
of the history of our profession. Orthodontics and
oral surgery have been most profoundly impacted,
and a common union of these two specialties
is orthognathic surgery. The digital approach
to orthognathic surgery has had a direct effect
on diagnosis, treatment planning, knowledge
generation, treatment implementation, design
and fabrication of surgical guides, communication,
interdisciplinary interaction, and education.
In this article, I ask a surgeon whose career has
spanned the traditional to digital divide to share
his experience.
Dr. Robert Relle
Century City, CA
Brief Bio: Dr. Robert Relle is a board-certified oral
surgeon whose practice is limited to orthognathic
and reconstructive jaw surgery. He is a graduate
of Indiana University School of Dentistry and
received his specialty certification at Harbor-UCLA
Medical Center. He has completed more than
4,000 orthognathic surgery cases. Dr. Relle cochairs
the Dentofacial Conference at the University
of Southern California Graduate Orthodontic
Program and has a part-time voluntary academic
appointment at University of California, Los
Angeles School of Dentistry. He is a past examiner
for the American Board of Oral and Maxillofacial
Surgery and a fellow of the American College of
Surgeons.
Patrick Turley (PT): How would you define a digital
approach to orthognathic surgery?
Dr. Robert Relle (RR): A digital approach to
orthognathic surgery refers to the use of software-driven
systems and technologies that
enable or facilitate the workup and performance
of orthognathic surgery. This digital approach
generally culminates in the planning of surgery
on a high-resolution virtual three-dimensional
(3D) model, and therefore, it is often described as
3D virtual surgical planning or computer-assisted
surgical simulation.
PT: When did this technology become available,
and when did it become a routine procedure in
your practice?
RR: Digital applications in orthognathic surgery
have generally followed the same curve as
other areas of dentistry. It has been more of an
evolutionary technology rather than a disruptive
technology. In 2009, two independent surgical
groups, led by Drs. James Xia and Jaime Gateno
in Houston, Texas, and Dr. Gwen Swennen in
Bruges, Belgium, each published protocols describing
the technology. These were surely seminal
works. That same year, we were approached
by the Colorado-based Medical Modeling Corp. to
consider adopting the process as beta testers. The
concept didn't really gain a lot of traction with us,
because the protocol required a lot of steps, such
as using a special gyroscope to capture the natural
head position, and there were messy impression
materials and bite forks. One of the other
big obstacles was that we were working in a
hospital-based practice where we had access only
to medical-grade computed tomography (CT)
scanners, which necessitated sending the patient
to the radiology department for the imaging.
We did a few cases, but it just didn't work well.
The concept really took hold with my partners
and me in 2011, when we opened our practice
and purchased a cone-beam CT (CBCT) scanner.
By then, the protocols were also becoming more
user-friendly. I performed probably a half dozen
orthognathic surgery cases with both the traditional
articulator-based workflow and 3D virtual
planning just to see how everything compared.
It didn't take long to be convinced of the many
advantages of this new digital approach, and
by 2012, virtually 100% of our cases were being
digitally planned. Since then, we have done about
1,000 cases digitally.
PT: What technological advances allow for a digital
approach to orthognathic surgery?
Fall 2021 PCSO Bulletin
41
Pacific Coast Society of Orthodontists Bulletin Fall 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2021
