The introduction of miniscrew-assisted rapid palatal expansion (MARPE) has widened the boundaries of orthodontic skeletal correction of maxillary transversal deficiency to late adolescence and adult patients. In this respect, Maxillary Skeletal Expander (MSE) is a particular device characterized by the engagement of four miniscrews in the palatal and nasal cortical bone layers. Thus, the availability of sufficient supporting bone and the perforation of both cortical laminas (bi-corticalism) are two mandatory parameters for mini-screw stability, especially when orthopedic forces are used. Virtual planning and construction of MSE based on cone-beam computed tomography (CBCT)-derived stereolithography (.stl) files have been recently described in the literature. In this manuscript we described: (a) a user-friendly digital workflow which can provide a predictable placement of maxillary skeletal expander (MSE) appliance according to the patient’s anatomical characteristics, (b) the construction of a positional template of the MSE that allows lab technician to construct the MSE appliance in a reliable and accurate position, according to the virtual project planned by the orthodontist on the patient CBCT scans. We also described a case report of an adult female patient affected by skeletal transversal maxillary deficiency treated with MSE appliance that was projected according to the described workflow.

Background: This study aimed to assess the accuracy of digital workflow for guided insertion of miniscrews in the anterior palate using restorative implant dentistry software and licensed software for orthodontic applications. Methods: Twenty subjects (8 males, 12 females, mean age = 16.7 ± 2.1 years) were prospectively selected to receive guided insertion of bicortical palatal miniscrews. Virtual planning was performed using restorative implant dentistry software (Blue Sky Plan*, version 4.7) (group 1 = 10 subjects) and licensed orthodontic software (Dolphin Imaging Software, version 11.0) (group 2 = 10 subjects). A specific 3D Imaging technology was applied to permit the registration of the planned and achieved position of the miniscrews based on the superimposition of maxillary models. The angular deviation (accuracy error) between the planned and the achieved positions of the miniscrews were recorded. Independent Student’s test was used with statistical significance set at p value < 0.05. Results: The mean accuracy error recorded in group 1 was 7.15° ± 1.09 (right side) and 6.19 ± 0.80 (left side) while the mean error in group 2 was 6.74° ± 1.23 (right side) and 5.79 ± 0.95 (left side). No significant differences were recorded between the two groups (p > 0.05); instead, miniscrews placed on the right side were almost one degree higher than the left side (p < 0.05) in both groups. Conclusions: The clinical accuracy error was similar when using generic and licensed orthodontic software for guided systems.

The implementation of a digital workflow in cranio-maxillofacial surgery has revolutionized the management of skeletal Class III malocclusion. This chapter outlines a comprehensive approach that integrates orthodontic and orthognathic interventions with advanced digital planning tools. Post-treatment records demonstrate significant skeletal and dentoalveolar improvements, including normalization of hyperdivergent skeletal patterns and enhanced facial esthetics adhering to the golden facial proportions. Detailed cephalometric analysis confirms the achievement of optimal sagittal and vertical relationships, alongside a well-balanced soft tissue profile. The combination of traditional and digital approaches, including three-dimensional (3D) imaging, virtual surgical planning, and customized surgical guides, ensures predictable outcomes tailored to patient-specific anatomical and functional needs. This protocol facilitates not only precise execution of complex interventions but also minimizes procedural errors, reduces operative time, and enhances patient satisfaction. Post-operative follow-up protocols are essential to monitor skeletal stability, soft tissue adaptation, and long-term occlusal harmony. The integration of cone beam computed tomography (CBCT), digital models, and advanced imaging aids in evaluating the alignment between surgical outcomes and preoperative plans. Studies underscore the role of personalized surgical guides and digital tools in reducing relapse rates and improving stability in Class III cases. Advances in artificial intelligence (AI), augmented reality, robotics, and imaging technologies further extend the capabilities of cranio-maxillofacial surgery, paving the way for more personalized, minimally invasive, and precise interventions. This paradigm shift underscores the ongoing evolution in surgical practice, fostering outcomes that are functional, esthetic, and sustainable over time.