3D planning of soft-to-hard tissue ratios in orthognathic surgery
Reviewed by Stuart Clark

This multinational systematic review examined publications over a six-year period up to December 2023, focusing on orthognathic surgery. It follows an earlier review by the same group, which had reported low validity in the use of 3D software for soft-to-hard tissue ratio planning. Eligibility criteria for inclusion required at least six months of follow-up after conventional orthognathic surgery, a sample size greater than 10 and patients older than 15 years. These criteria narrowed the review to 10 studies. The authors noted, similar to their 2016 findings, that much of the current evidence remains methodologically weak, with a high risk of bias. They highlighted the challenges of evaluating soft tissue changes due to variables such as age, BMI, initial maxillomandibular size and technical limitations in comparing hard and soft tissue imaging. The authors also observed that the midface region tends to receive less preoperative attention, whereas postoperative focus often shifts to nasal contour and perception. Soft tissue prediction following correction of asymmetry was found to have a mean error of approximately 2 mm across all facial regions. Overall, the review concludes that there remains limited evidence supporting accurate 3D analysis of soft-to-hard tissue ratios. At present, prospective studies using 2D imaging may offer greater predictability in assessing soft tissue outcomes.

Systemic review of soft-to-hard tissue ratios in orthognathic surgery; 3D analysis – update scientific evidence.
Ravelo V, Olate S, Bravo-Soto G, et al.
INT J ORAL MAXILLOFAC SURG 
2025;55(9) 819–29.