Table 1 Cardinal steps for training in aesthetic orthognathic surgical planning

I

Envisage an aesthetic outcome

This is the most important step. The main ingredient required to do this is to develop a sense of aesthetic appreciation. This includes a thorough understanding of static and dynamic facial, smile and dental aesthetics

II

Develop dental-occlusal planning objectives accordingly

Dental-occlusal objectives should be developed according to the target facial aesthetic outcome. The key ingredient is good communication between the surgeon and the orthodontist. For example, should you fully or only partially decompensate the dentition prior to surgery?

III

Planning and execution of surgery

Treatment planning is predominantly based on clinical observation of the patient; this is true whether you go on to use conventional or 3D-VSP

The effect of changing bony landmarks on soft tissues will always be variable and cannot be accurately predicted preoperatively

Therefore, there is no substitute to knowledge and well-earned experience

Virtual Surgical Planning (VSP) is extremely useful in experienced hands for the accurate planning and accurate technical execution and delivery of the planned outcome

IV

Critical appraisal of results

Without closing this loop, a clinician cannot progress in his or her work

Clinical review of all cases should be mandatory

Direct anthropometric analysis (e.g. alar base width, upper lip height etc.) is very useful for comparative purposes

Postoperative 3D analysis

Long-term follow-up of patients

V

Consideration of secondary procedures

Broad aesthetic training is highly beneficial, as secondary surgical procedures may be very useful following the primary orthognathic surgery