Patient-specific implants and virtual surgical planning in surgery-first orthognathic surgery: a case series and review of literature

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Virtual surgical planning (VSP) and patient-specific implants (PSIs) are increasingly used to translate digital orthognathic plans to surgery with greater precision, particularly in surgery-first orthognathic (SFO) protocols where pre-surgical orthodontics no longer absorbs planning error. We report two SFO cases managed at a single centre using VSP, customized cutting guides, and titanium PSIs. Case 1 was a 19-year-old male with maxillary hypoplasia and mandibular hyperplasia treated by Le Fort I osteotomy, vertical ramus osteotomy, and genioplasty. Case 2 was a 30-year-old female with facial asymmetry from unilateral mandibular hyperplasia treated by Le Fort I osteotomy, bilateral sagittal split osteotomy, and mandibular contouring. Both achieved satisfactory functional, occlusal, and aesthetic outcomes at six months without major complications. Maxillary PSI fixation supported predictable plan transfer in both cases, whereas mandibular management still required case-specific strategies. We discuss this pattern in light of current literature.

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