Reconstruction of orbital fractures can be challenging. The limited exposure, involvement of several wall defects, and the variable three-dimensional (3D) anatomy result in difficulty in achieving superior outcomes in complex cases. The use of patient-specific implants for the reconstruction of orbital defects shows great promise. Yet, proper virtual planning is crucial in these cases, and thus, understanding the anatomy and the different options for the planning is essential. This protocol describes three methods for reconstructing the defects and details the indications for each method. Automated computerized reconstruction is the simplest method, yet it can be used mainly for small defects. Repositioning of the fractured segment is simple, resulting in good anatomical continuity of the fractured wall, yet it requires non-comminuted fractures. Mirroring is the method of choice in comminuted fractures. The drawback of this method is the extensive manipulation that follows the mirroring stage, thus requiring a high level of understanding of the anatomy and implications by the planner. Following a detailed description of the methods, the anatomical structures that should be the main focus when reconstructing and those overlooked are demonstrated. In addition, the pitfalls encountered are described and discussed as well as how to avoid them. These methods can be used in-house or outsourced, yet understanding them is crucial to achieving better results, even in cases where the surgeon does not plan himself.

Background: Combined orthodontic-surgical treatment includes a thorough diagnosis and analysis of dental and facial deformities. Cephalometric analysis is a common tool for this, in which measurements of specific anatomical landmarks are performed. In order to achieve a successful surgery, orthodontic teeth preparation is mandatory, including dental decompensation before surgery. This should be planned and adequately executed to allow the surgeon to move the jaws to the correct ideal position. Aim: The current study aimed to check if the orthodontic decompensation amount is influenced and compromised by the maxillomandibular difference and if there is a correlation between the deformity’s severity and the orthodontist’s difficulty in achieving an accurate result in the orthodontic decompensation preparation. Methods: The study consisted of 50 pre-operational cephalometric radiographs of patients with Class-III (prognathic) deformity. The measurements included the angles of the upper incisor (U1) longitudinal axis to the Frankfort plane (FH) and palatal plane (PP), lower incisor (L1) longitudinal axis to the lower mandibular plane (MP), overjet (OJ), effective maxillary length, effective mandibular length, and the maxilla–mandibular difference (Diff); Pearson correlation coefficient was applied. Results: There was a significant correlation between the maxilla–mandibular difference and U1 to FH angle (r = 0.254, p = 0.037), U1 to PP angle (r = 0.447, p < 0.001), OJ (r = (−0.426), p < 0.001). There was no statistical significance for Diff and L1 to MP angle (p = 0.342). Conclusions: In Class-III patients, achieving adequate decompensation is more challenging with the maxillary incisors rather than with the mandibular incisors, especially in more severe cases.

Reconstruction of orbital fractures can be challenging. The limited exposure, involvement of several wall defects, and the variable three-dimensional (3D) anatomy result in difficulty in achieving superior outcomes in complex cases. The use of patient-specific implants for the reconstruction of orbital defects shows great promise. Yet, proper virtual planning is crucial in these cases, and thus, understanding the anatomy and the different options for the planning is essential. This protocol describes three methods for reconstructing the defects and details the indications for each method. Automated computerized reconstruction is the simplest method, yet it can be used mainly for small defects. Repositioning of the fractured segment is simple, resulting in good anatomical continuity of the fractured wall, yet it requires non-comminuted fractures. Mirroring is the method of choice in comminuted fractures. The drawback of this method is the extensive manipulation that follows the mirroring stage, thus requiring a high level of understanding of the anatomy and implications by the planner. Following a detailed description of the methods, the anatomical structures that should be the main focus when reconstructing and those overlooked are demonstrated. In addition, the pitfalls encountered are described and discussed as well as how to avoid them. These methods can be used in-house or outsourced, yet understanding them is crucial to achieving better results, even in cases where the surgeon does not plan himself.