Assessment of the accuracy of virtual surgical planning in orthognathic surgery: systematic review and meta-analysis

Aim: The objective of this study was to conduct a systematic review to test the null hypothesis that there is no difference between actual clinical outcomes and virtual surgical planning in bimaxillary orthognathic surgery. Materials and Methods: The review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A search was conducted in the MEDLINE database via PubMed, Cochrane Library, Lilacs, Web of Science, and Scopus to locate relevant published references. Controlled and uncontrolled terms were used, employing Boolean operators and previously selected and combined Health Sciences Descriptors (DeCS/MeSH). The Patient-Intervention-Comparison-Outcome (PICO) strategy was used to construct the guiding research question. Rayyan software was used to identify and remove duplicate articles, ensuring data integrity. The characteristics collected from the studies were: author, year, country, sample size, sex, age, study design, planning software, image acquisition modality, recording method, success criterion, movement performed (rotation or translation), plane (anteroposterior, vertical, transverse, yaw, pitch, roll), and difference between the result and the planning. The risk of bias was assessed using the Newcastle-Ottawa Scale. Results: After applying the search strategies and eligibility criteria, 29 references were included. After reading the full texts, the final sample of references was 16. Conclusion: Virtual surgical planning demonstrated high accuracy in predicting outcomes in bimaxillary orthognathic surgeries, with mean discrepancies within clinically acceptable limits (<2 mm and <2°). The greatest predictability was observed in translational movements, especially in the anteroposterior axis, while vertical and rotational movements showed greater variability. The certainty of the evidence ranged from very low to moderate, limited by the risk of bias and the heterogeneity of the included studies.