Digital Workflow for Combined Orthodontics and Orthognathic Surgery Mohammed H. Elnagar, DDS, MS, PhD a, *, Sharon Aronovich, DMD, FRCD(C) b , Budi Kusnoto, DDS, MS a INTRODUCTION Dentofacial deformities affect quality of life, self- image, social behavior, and public perception, leading to a perception that the individual is less attractive, less successful, and less socially acceptable based on societal norms. The treat- ment approach using combined orthodontics and orthognathic surgery is considered to be a very powerful tool to correct functional abnormalities, but also to alter soft tissues and facial form in order to improve overall facial esthetics. 1,2 The establishment of a correct diagnosis and treatment plan is one of the most critical parts in the management of the orthognathic surgical pa- tient. Computer technology has certainly enhanced the ability of the clinician to deliver a more precise treatment outcome, reduce risk, and achieve better outcomes. Many software packages for computer-assisted surgery (CAS) are available, and some of them allow in-house CAS to be performed from the database (cone-beam computed tomography [CBCT], intraoral scans) and then transferred to the operating room with the generation of a surgi- cal splint (eg, Dolphin 3D; Dolphin Imaging 11.9 Premium, Chatsworth, CA, USA). Furthermore, there are several commercially available systems, including Medical Modeling (3D Systems Health- care, Littleton, CO, USA) and Maxilim (Medicim, Mechelen, Belgium) that can help to facilitate the process of virtual surgical planning (VSP). For a service fee, the commercial companies construct surface models from CBCT images and digital dental casts registered to the CBCT, perform the virtual surgery via Webinars with the surgeon and orthodontist, on occasion, and print the actual sur- gical splints. The various components of the digital workflow process are covered in this article. Data Acquisition In order to build an accurate model that can represent a realistic digital simulation, it must begin with proper data acquisition. Each of the end users, including the clinicians and Disclosure Statement: The authors have nothing to disclose. a Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, 801 South Paulina Street, Room 131, Chicago, IL 60612-7211, USA; b Department of Oral and Maxillofacial Surgery, University of Mich- igan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA * Corresponding author. E-mail address: melnagar@uic.edu KEYWORDS  Computer-aided surgery  3D orthognathic surgery simulation  Virtual model surgery  Digital workflow KEY POINTS  3D Data Acquisition and Processing for diagnostic and quantification of the dentofacial deformities.  Developing 3D Virtual treatment planning and orthognathic surgery.  Transfer the 3D Virtual treatment plan to Operating room.  Future of Computer-assisted surgical planning.  Teledentistry - Remote Monitoring and Follow up. Oral Maxillofacial Surg Clin N Am 32 (2020) 1–14 https://doi.org/10.1016/j.coms.2019.08.004 1042-3699/20/Ó 2019 Elsevier Inc. All rights reserved. oralmaxsurgery.theclinics.com