Development and Preliminary Technical Validation of an Interactive, Surgeon-Oriented Framework for Digital Surgical Occlusion Planning in Orthognathic Surgery

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Abstract
Objectives: To develop and validate a fully digital, surgeon-oriented interactive framework for final dental occlusion alignment in orthognathic patients. Methods: A digital framework integrating automatic alignment, using a two-dimensional Iterative Closest Point (2D ICP) algorithm with geometric corrections and optimization-based refinement, and an interactive graphical user interface (GUI) for standardized manual refinement were implemented in MATLAB. Validation was performed on preoperative digital models from 21 orthognathic patients. Obtained digital occlusions were compared with manually articulated physical models, considered the reference standard. Translational and rotational discrepancies were assessed before and after manual refinement. Results: Twenty-one patients were included. Manual refinement reduced the greatest translational directional bias along the Y-axis (MV: −2.26 ± 2.1 to −1.17 ± 0.92 mm) and significantly decreased the magnitude of corresponding error (MAV: 2.54 ± 1.73 to 1.26 ± 0.78 mm; p = 0.002). Error magnitude also decreased along the X-axis (1.12 ± 0.84 to 0.38 ± 0.31 mm; p = 0.002), whereas a small increase was observed along the Z-axis (0.93 to 1.21 mm; p = 0.02). Overall translational RMSE improved significantly (1.83 ± 0.91 to 1.09 ± 0.39 mm; p = 0.001). Among rotational components, yaw showed the greatest reduction in error magnitude (MAV: 2.61 ± 1.91° to 0.83 ± 0.71°; p = 0.001), while no statistically significant changes were detected for pitch (p = 0.09) or roll (p = 0.13). Rotational RMSE decreased from 2.00 ± 1.01° to 1.35 ± 0.25° (p = 0.01). Conclusions: The proposed pipeline was completed for all cases. Automatic alignment provided a reliable starting point, but standardized manual refinement remained essential.

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