"Accuracy of Bone-Borne versus Tooth-Bone-Borne Orthognathic Surgical Guides: A Systematic Review and Meta-Analysis".

Abstract

Background: Accurate repositioning of the maxilla is a crucial component of orthognathic surgery and can be facilitated by bone-borne (BB) or tooth-bone-borne (TBB) guides.

Aims: The objective of this systematic review and meta-analysis is to compare the accuracy of BB and TBB surgical guides in orthognathic surgery. Accuracy was defined as the difference between the planned and actual position of the maxilla, measured in linear and angular deviations across three axes. Relevant studies were identified up to February 2025.

Results: Twenty studies involving 332 patients (223 BB and 109 TBB) were reviewed. BB guides demonstrated slightly better accuracy at the U1 landmark, with deviations of 0.07 mm, 0.10 mm, and 0.24 mm in the X, Y, and Z axes, respectively. Conversely, TBB guides showed superior accuracy at the U6 landmark, with deviations of 0.19 mm and 0.31 mm in the X and Y axes. However, TBB guides were less accurate only in the Z-axis at U6 (deviation of 0.21 mm) when compared to BB guides. TBB guides also demonstrated higher angular accuracy, with differences of 0.35°, 0.39° and 0.02° for pitch, yaw, and roll respectively. However, these differences were generally small and clinically insignificant.

Conclusion: Both BB and TBB guides are satisfactory choices, and the decision to use one over the other should be based on regulatory and logistical factors. The available evidence suggests that clinicians can be confident that both options yield comparable results, allowing flexibility in the decision-making process.

Clinical significance: This review is the first to directly compare the effectiveness of BB and TBB guides. It provides valuable insights into how guide design influences surgical precision and supports clinical decision-making between the two types of guides.