Patient-Reported and Clinical Outcomes of a Digital Surgical Guide Workflow versus Conventional Splints in Bimaxillary Orthognathic Surgery: A Comparative Cohort Study
This comparative cohort study of 32 patients undergoing bimaxillary orthognathic surgery found that a digital surgical guide workflow resulted in higher patient satisfaction and greater improvement in overall facial appearance compared to conventional resin occlusal splints, without increasing operative time or blood loss, though the non-randomized design warrants cautious interpretation.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For decades, surgeons correcting severe misalignments of the upper and lower jaws have relied on a physical, hands-on method to guide their work. Before cutting bone, they would take plaster casts of a patient's teeth, manually cut and rearrange them on a table to simulate the desired result, and then create a custom plastic splint from this model. This splint acts like a temporary mold during surgery, helping the surgeon seat the jawbones into the new, planned position. While this traditional approach has worked well for generations, it involves many manual steps where small errors can accumulate, much like a stack of papers that shifts slightly with every movement. To improve precision, the field has recently embraced digital technology, using three-dimensional scans and computer simulations to design patient-specific surgical guides that are 3D printed. These digital tools promise to transfer the surgical plan directly from the computer to the operating room, potentially reducing human error and improving the final look and feel for the patient.
A team of researchers at the Affiliated Friendship Plastic Surgery Hospital of Nanjing Medical University set out to see if this digital shift actually changes the patient experience in a meaningful way. They compared two groups of thirty-two adults who underwent complex surgery to reposition both their upper and lower jaws. One group of sixteen patients received the traditional treatment using the manually made plaster models and plastic splints. The other group of sixteen patients underwent the same surgery but with a fully digital workflow, where the surgical plan was created on a computer and a custom guide was 3D printed for use during the operation. The researchers carefully tracked how long the surgeries took, how much blood was lost, and whether any nerves were temporarily affected. Crucially, they also asked the patients how they felt about their new faces using a detailed questionnaire that measures satisfaction with facial appearance and psychological well-being.
The study found that the new digital method did not make the surgery faster or safer in terms of immediate physical risks. The time the surgeons spent cutting and fixing the bone was nearly identical for both groups, averaging just over three hours, and the amount of blood lost was also the same. There was no significant difference in the rate of temporary numbness or tingling in the lower lip and chin, a common side effect of this type of surgery, though slightly fewer patients in the digital group reported these sensations. However, when it came to how patients felt about the results, the digital group stood out. Patients who received the digital guides reported a significantly higher level of satisfaction with their overall facial appearance compared to those who received the traditional splints. They also felt their lower face and jawline looked better, and they showed a trend toward improved psychological function, though these specific feelings were not as statistically strong as the overall satisfaction score.
The researchers suggest that this boost in satisfaction may come from the way digital planning improves communication before the surgery. Because the digital workflow allows patients to see a three-dimensional simulation of their future face, they may have a clearer understanding of what to expect, leading to better alignment between their hopes and the actual outcome. It is also possible that the digital guides allowed for subtle aesthetic refinements that the traditional method missed, even if the bone positions were technically accurate in both groups. The study authors are careful to note that their findings are not a final proof that digital guides are superior in every way, as the study was not a randomized trial and the groups were treated at different times. Nevertheless, the results offer encouraging evidence that adopting these high-tech tools can lead to happier patients who feel more confident in their new smiles and faces, without adding extra time or risk to the operating room.
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