Effectiveness of Traditional and Virtual Surgical Planning in Orthognathic Surgery: A Systematic Review and Meta-Analysis.

Orthognathic surgery, which corrects jaw deformities, requires meticulous planning to achieve optimal functional and aesthetic outcomes. Traditional surgical planning (TSP) relies on manual methods, whereas virtual surgical planning (VSP) uses computer-assisted simulations that may enhance accuracy and efficiency. Therefore, we conducted a systematic review to evaluate the effectiveness of VSP compared to TSP for orthognathic surgery. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered the protocol in the Prospective Register of Systematic Reviews (CRD42024618614). We searched electronic databases for studies comparing VSP and TSP. Two independent reviewers performed screening and data extraction. We assessed quality using the Cochrane Risk of Bias 2 (RoB 2) tool. We calculated the standardized mean difference (SMD) as the summary measure and used a random-effects model, considering p < 0.05 as statistically significant. We performed analyses using Review Manager (RevMan) version 5.3 (Cochrane Collaboration, London, UK). We included 10 qualitative synthesis and meta-analysis studies, evaluating data from 474 patients, of whom 244 underwent TSP and 230 underwent VSP. Included studies showed moderate to low risk of bias. We evaluated effectiveness in terms of planning time, surgical time, horizontal measurements, vertical measurements, and accuracy indicators for predicting outcomes. Meta-analysis revealed reduced planning time (SMD = 3.19 (-5.74 to 0.64)) and surgical time (SMD = -0.42 (-1.32 to 0.49)) with VSP, as well as differences in horizontal (SMD = -0.39 (-0.73 to 0.05)) and vertical measurements (SMD = -0.20 (-0.54 to 0.13)), and in accuracy indicators (SNA0: SMD = -0.15 (-0.46 to 0.16); SNB0: SMD = 0.53 (-0.82 to 1.87)). SNA0 represents the angle formed by sella (S), nasion (N), and point A (A), and SNB0 represents the angle formed by sella (S), nasion (N), and point B (B). The funnel plot showed no evidence of publication bias. VSP reduced planning and surgical times and predicted facial outcomes more accurately than TSP. These findings suggest that VSP can be an effective alternative to TSP in orthognathic surgeries.