{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T15:18:36Z","timestamp":1761664716730,"version":"build-2065373602"},"reference-count":55,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T00:00:00Z","timestamp":1722384000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>This case report presents a virtual treatment simulation of the orthodontic treatment and surgery-first orthognathic surgery employed to treat a patient with a repaired unilateral cleft lip and alveolus with Class III malocclusion and lower third facial asymmetry. The patient exhibited a negative overjet of 9 mm, a missing lower right second premolar, and a 5 mm gap between the upper right central and lateral incisors with midline discrepancy. The three-dimensional virtual planning began with virtual pre-surgical orthodontics, followed by the positioning of the facial bones and teeth in their ideal aesthetic and functional positions. The sequence of steps needed to achieve this outcome was then reverse-engineered and recorded using multiplatform Nemostudio software (Nemotec, Madrid, Spain), which facilitated both surgical and orthodontic planning. The treatment included a two-piece segmental maxillary osteotomy for dental space closure, a LeFort I maxillary advancement, and a mandibular setback with bilateral sagittal split osteotomy to correct the skeletal underbite and asymmetry. A novel approach was employed by pre-treating the patient for orthognathic surgeries at age 11, seven years prior to the surgery. This early phase of orthodontic treatment aligned the patient\u2019s teeth and established the dental arch form. The positions of the teeth were maintained with retainers, eliminating the need for pre-surgical orthodontics later. This early phase of treatment significantly reduced the treatment time. The use of software to predict all the necessary steps for surgery and post-surgical orthodontic tooth movements made this approach possible. Multi-step virtual planning can be a powerful tool for analyzing complex craniofacial problems that require multidisciplinary care, such as cleft lip and\/or palate.<\/jats:p>","DOI":"10.3390\/bioengineering11080771","type":"journal-article","created":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T08:02:27Z","timestamp":1722412947000},"page":"771","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Reverse Engineering Orthognathic Surgery and Orthodontics in Individuals with Cleft Lip and\/or Palate: A Case Report"],"prefix":"10.3390","volume":"11","author":[{"given":"Jaemin","family":"Ko","sequence":"first","affiliation":[{"name":"Craniofacial and Special Care Orthodontics, Division of Dentistry, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark M.","family":"Urata","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey A.","family":"Hammoudeh","sequence":"additional","affiliation":[{"name":"Division of Plastic and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis-Duke","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Division of Oral and Maxillofacial Surgery, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen L.-K.","family":"Yen","sequence":"additional","affiliation":[{"name":"Craniofacial and Special Care Orthodontics, Division of Dentistry, Children\u2019s Hospital Los Angeles, Los Angeles, CA 90027, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1002\/bdra.20735","article-title":"Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004\u20132006","volume":"88","author":"Parker","year":"2010","journal-title":"Birth Defects Res. A Clin. Mol. Teratol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S1010-5182(05)80092-7","article-title":"Influence of surgery on maxillary growth in cleft lip and\/or palate patients","volume":"20","author":"Normando","year":"1992","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1038\/ijos.2014.59","article-title":"The impact of cleft lip and palate repair on maxillofacial growth","volume":"7","author":"Shi","year":"2015","journal-title":"Int. J. Oral Sci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S1073-8746(97)80059-X","article-title":"Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: A prospective long-term study","volume":"3","author":"Williams","year":"1997","journal-title":"Semin. Orthod."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1177\/1055665619896675","article-title":"Efficacy of Rapid Maxillary Expansion Associated With Maxillary Protraction in Patients With Unilateral Complete Cleft Lip and Palate","volume":"57","author":"Sathler","year":"2020","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1597\/1545-1569_1994_031_0295_srtmpi_2.3.co_2","article-title":"Skeletal response to maxillary protraction in patients with cleft lip and palate before age 10 years","volume":"31","author":"Tindlund","year":"1994","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S1010-5182(89)80032-0","article-title":"Orthopaedic protraction of the midface in the deciduous dentition. Results covering 3 years out of treatment","volume":"17","author":"Tindlund","year":"1989","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1597\/03-107.1","article-title":"A new protocol for maxillary protraction in cleft patients: Repetitive weekly protocol of alternate rapid maxillary expansions and constrictions","volume":"42","author":"Liou","year":"2005","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1177\/1055665618772395","article-title":"Short- and Long-Term Effects of Late Maxillary Advancement With the Liou-Alt-RAMEC Protocol in Unilateral Cleft Lip and Palate","volume":"56","author":"Meazzini","year":"2019","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1111\/ocr.12182","article-title":"Clinical effectiveness of late maxillary protraction in cleft lip and palate: A methods paper","volume":"20","author":"Lee","year":"2017","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1597\/12-099","article-title":"Late maxillary protraction in patients with unilateral cleft lip and palate: A retrospective study","volume":"51","author":"Lane","year":"2014","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Borzabadi-Farahani, A. (2023). Systematic Review and Meta-Analysis of the Index of Orthognathic Functional Treatment Need for Detecting Subjects with Great Need for Orthognathic Surgery. Cleft Palate Craniofac. J., online ahead of print.","DOI":"10.1177\/10556656231216833"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1597\/08-176.1","article-title":"The need for orthognathic surgery in patients with repaired complete unilateral and complete bilateral cleft lip and palate","volume":"46","author":"Daskalogiannakis","year":"2009","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1597\/06-075.1","article-title":"Frequency of Le Fort I osteotomy after repaired cleft lip and palate or cleft palate","volume":"44","author":"Good","year":"2007","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/S0278-2391(97)90579-6","article-title":"Facial growth and the need for orthognathic surgery after cleft palate repair: Literature review and report of 28 cases","volume":"55","author":"DeLuke","year":"1997","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1597\/15-186","article-title":"A Longitudinal Study of the Presence of Dental Anomalies in the Primary and Permanent Dentitions of Cleft Lip and\/or Palate Patients","volume":"54","author":"Suzuki","year":"2017","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1597\/08-275.1","article-title":"Prevalence of dental anomalies in a population of cleft lip and palate patients","volume":"47","author":"Rawashdeh","year":"2010","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1597\/10-043","article-title":"Prevalence of dental anomalies in nonsyndromic individuals with cleft lip and palate: A systematic review and meta-analysis","volume":"49","author":"Tannure","year":"2012","journal-title":"Cleft Palate Craniofac. J."},{"key":"ref_19","first-page":"283","article-title":"The influence of unilateral cleft lip and palate on maxillary dental arch morphology","volume":"62","author":"Ramos","year":"1992","journal-title":"Angle Orthod."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zheng, J., Kuang, W., Yuan, S., He, H., and Yuan, W. (2024). Three-dimensional Analysis of Maxillary Morphology in Infants with Unilateral Cleft Lip and Palate. Cleft Palate Craniofac. J., online ahead of print.","DOI":"10.1177\/10556656241228903"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1097\/SCS.0b013e3181cf5fd4","article-title":"Surgery-first approach in skeletal class III malocclusion treated with 2-jaw surgery: Evaluation of surgical movement and postoperative orthodontic treatment","volume":"21","author":"Baek","year":"2010","journal-title":"J. Craniofac. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"330","DOI":"10.4041\/kjod.2014.44.6.330","article-title":"Surgery-first approach using a three-dimensional virtual setup and surgical simulation for skeletal Class III correction","volume":"44","author":"Im","year":"2014","journal-title":"Korean J. Orthod."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2441.e1","DOI":"10.1016\/j.joms.2017.07.161","article-title":"Accuracy of 3-Dimensional Virtual Surgical Simulation Combined With Digital Teeth Alignment: A Pilot Study","volume":"75","author":"Kim","year":"2017","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_24","first-page":"97","article-title":"\u201cSurgery first\u201d skeletal Class III correction using the Skeletal Anchorage System","volume":"43","author":"Nagasaka","year":"2009","journal-title":"J. Clin. Orthod."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1016\/j.ajodo.2012.10.029","article-title":"Three-dimensional cone-beam computed tomography-based virtual treatment planning and fabrication of a surgical splint for asymmetric patients: Surgery first approach","volume":"144","author":"Uribe","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1016\/j.bjoms.2022.04.008","article-title":"Comprehensive virtual orthognathic planning concept in surgery-first patients","volume":"60","author":"Ebker","year":"2022","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"662","DOI":"10.2319\/0003-3219(2008)078[0662:AROTMC]2.0.CO;2","article-title":"AP relationship of the maxillary central incisors to the forehead in adult white females","volume":"78","author":"Andrews","year":"2008","journal-title":"Angle Orthod."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1563\/AAID-JOI-D-11-00022","article-title":"Orthodontic considerations in restorative management of hypodontia patients with endosseous implants","volume":"38","year":"2012","journal-title":"J. Oral Implantol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Paradowska-Stolarz, A., Mikulewicz, M., and Du\u015b-Ilnicka, I. (2022). Current Concepts and Challenges in the Treatment of Cleft Lip and Palate Patients-A Comprehensive Review. J. Pers. Med., 12.","DOI":"10.3390\/jpm12122089"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2621","DOI":"10.4103\/jfmpc.jfmpc_472_20","article-title":"Cleft of lip and palate: A review","volume":"9","author":"Vyas","year":"2020","journal-title":"J. Family Med. Prim. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101795","DOI":"10.1016\/j.jormas.2024.101795","article-title":"Complications of orthognathic surgery in patients with cleft lip and palate: A systematic review","volume":"125","author":"Zaroni","year":"2024","journal-title":"J. Stomatol. Oral Maxillofac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.ajodo.2016.10.034","article-title":"Oral health-related quality of life changes in patients with severe Class III malocclusion treated with the 2-jaw surgery-first approach","volume":"151","author":"Feu","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1097\/SCS.0000000000001972","article-title":"Patient\u2019s Satisfaction in Skeletal Class III Cases Treated With Two-Jaw Surgery Using Orthognathic Quality of Life Questionnaire: Conventional Three-Stage Method Versus Surgery-First Approach","volume":"26","author":"Park","year":"2015","journal-title":"J. Craniofac. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.oooo.2018.02.018","article-title":"Surgery-first\/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: A systematic review and meta-analysis","volume":"126","author":"Wei","year":"2018","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/j.ijom.2019.01.002","article-title":"Skeletal stability in orthognathic surgery with the surgery first approach: A systematic review","volume":"48","author":"Soverina","year":"2019","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"23","DOI":"10.5125\/jkaoms.2017.43.1.23","article-title":"Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction","volume":"43","author":"Mah","year":"2017","journal-title":"J. Korean Assoc. Oral Maxillofac. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.ajodo.2014.07.024","article-title":"Effect of occlusal vertical dimension changes on postsurgical skeletal changes in a surgery-first approach for skeletal Class III deformities","volume":"146","author":"Lee","year":"2014","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.joms.2010.11.011","article-title":"Surgery-first accelerated orthognathic surgery: Orthodontic guidelines and setup for model surgery","volume":"69","author":"Liou","year":"2011","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1177\/27325016231211921","article-title":"Precise Prediction of Transitional Occlusion Using Reverse Engineering in Surgery-first Orthognathic Surgery Case","volume":"5","author":"Ko","year":"2024","journal-title":"FACE"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1186\/s40902-023-00409-2","article-title":"Redefining precision and efficiency in orthognathic surgery through virtual surgical planning and 3D printing: A narrative review","volume":"45","author":"Lee","year":"2023","journal-title":"Maxillofac. Plast. Reconstr. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1016\/j.jcms.2017.07.001","article-title":"Treatment outcome in orthognathic surgery-A prospective randomized blinded case-controlled comparison of planning accuracy in computer-assisted two- and three-dimensional planning techniques (part II)","volume":"45","author":"Bengtsson","year":"2017","journal-title":"J. Craniomaxillofac. Surg."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Barone, M., De Stefani, A., Baciliero, U., Bruno, G., and Gracco, A. (2020). The Accuracy of Jaws Repositioning in Bimaxillary Orthognathic Surgery with Traditional Surgical Planning Compared to Digital Surgical Planning in Skeletal Class III Patients: A Retrospective Observational Study. J. Clin. Med., 9.","DOI":"10.3390\/jcm9061840"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1097\/PRS.0000000000007160","article-title":"Avoiding Inferior Alveolar Nerve Injury during Osseous Genioplasty: A Guide for the Safe Zone by Three-Dimensional Virtual Imaging","volume":"146","author":"Lin","year":"2020","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1097\/SCS.0000000000009047","article-title":"Application of 3D-printed Surgical Cutting Guide in Anterior Mandibular Body Ostectomy","volume":"34","author":"Xie","year":"2023","journal-title":"J. Craniofac. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1186\/s13005-020-00250-2","article-title":"Accuracy of virtual planning in orthognathic surgery: A systematic review","volume":"16","author":"Alkhayer","year":"2020","journal-title":"Head Face Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1016\/j.bjoms.2022.07.007","article-title":"Virtual and traditional surgical planning in orthognathic surgery\u2014Systematic review and meta-analysis","volume":"60","author":"Alkaabi","year":"2022","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1002\/hed.27759","article-title":"Evaluating the benefit of virtual surgical planning on bony union rates in head and neck reconstructive surgery","volume":"46","author":"Sabiq","year":"2024","journal-title":"Head Neck"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1016\/j.ijom.2016.03.012","article-title":"Comparison of time required for traditional versus virtual orthognathic surgery treatment planning","volume":"45","author":"Wrzosek","year":"2016","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1177\/1465312520954871","article-title":"Three-dimensional virtual surgical planning (3D-VSP) in orthognathic surgery: Advantages, disadvantages and pitfalls","volume":"48","author":"Donaldson","year":"2021","journal-title":"J. Orthod."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2385","DOI":"10.1007\/s00784-019-03097-3","article-title":"Virtual setup in orthodontics: Planning and evaluation","volume":"24","author":"Baan","year":"2020","journal-title":"Clin. Oral Investig."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.cps.2018.11.002","article-title":"Orthognathic Surgery for Patients with Cleft Lip and Palate","volume":"46","author":"Roy","year":"2019","journal-title":"Clin. Plast. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0094-1298(03)00132-9","article-title":"Cleft-orthognathic surgery","volume":"31","author":"Posnick","year":"2004","journal-title":"Clin. Plast. Surg."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1900","DOI":"10.1097\/SCS.0000000000006626","article-title":"Trends in Utilization of Virtual Surgical Planning in Pediatric Craniofacial Surgery","volume":"31","author":"Kalmar","year":"2020","journal-title":"J. Craniofac. Surg."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Sozzi, D., Filippi, A., Canzi, G., De Ponti, E., Bozzetti, A., and Novelli, G. (2022). Surgical Navigation in Mandibular Reconstruction: Accuracy Evaluation of an Innovative Protocol. J. Clin. Med., 11.","DOI":"10.3390\/jcm11072060"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"2271160","DOI":"10.1080\/24699322.2023.2271160","article-title":"Virtual surgical planning in craniomaxillofacial surgery: A structured review","volume":"28","author":"Velarde","year":"2023","journal-title":"Comput. Assist. 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