Pacific Coast Society of Orthodontists Bulletin Fall 2021 - 47

Let's Talk About That
dry, or if we are uncertain about recommending a
genioplasty. Being able to see the true anatomical
movements gives us far more information than
we could ever get from casts mounted on an articulator.
This information also helps our patients
understand precisely what is being planned and
to make informed decisions about their surgery
when more than one option exists. Another
benefit of digital is that it gives the surgeon an
enormous amount of situational awareness in
the operating room (OR). We place the pages of
the surgical case report on the OR wall before
starting every case, and we refer to the images on
each page as the operation progresses. We know
exactly how the osteotomies should align, and we
know where bony interferences or unstable gaps
will occur when we reposition the jaws (Figure 7a
and b). We can move the case along swiftly when
everything is progressing as planned, and we
have a warning beacon telling us to step back and
examine things carefully when it isn't. The digital
approach also allows us to integrate the planning
of orthognathic surgery with other complex procedures
such as total temporomandibular joint
reconstruction (Figure 8a-i).
PT: Does digital technology add to the cost of
orthognathic surgery? How much does it cost?
RR: Digital technology does add to the cost of
orthognathic surgery. Surgeons who want to
have complete control of the entire process
would need to purchase a software package and
a decent 3D printer. That would be the initial
outlay, and then the primary additional cost
would be their time. The problem is that there
is a certain amount of time needed to segment
3D images and prepare things before actually
performing the virtual surgery and printing the
surgical guides. You could employ a technician
to handle this, but then you have the cost of an
additional employee. In our practice, we don't
feel that doing it ourselves is efficient because
we are doing 100 to 150 cases a year. We use a
third-party, 3D Systems, to handle all the image
processing and preparation. The added cost is
about 1,000 to 2,000 dollars per case, but we feel
that the advantages of digital that I spoke about
make this a very reasonable added cost. Redoing
an operation because of inaccurate planning is a
lot costlier. One area where the cost of digital in
orthognathic surgery can spiral upward quickly is
when surgeons are planning and operating cases
with custom plates. This technology allows the
surgeon to use a custom-fabricated rigid internal
fixation plate, or plates, to reposition the jaws,
rather than the traditional interocclusal surgical
Figure 7. Using the digital workup to predict unstable surgical movements. (a) 3D virtual surgical
planning reveals an unstable osteotomy gap. (b) Intraoperative view of the Le Fort I osteotomy modified
to preserve bony contact.
Fall 2021 PCSO Bulletin
47

Pacific Coast Society of Orthodontists Bulletin Fall 2021

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