## 7 Challenges and Future Directions  
Despite the immense potential of 3D printing and VSP in orthognathic and oral maxillofacial surgery, these technologies are not without their limitations. One of the major challenges in adopting these technologies is the need for extensive software training [71]. Professionals need to acquire the necessary skills to operate the software used for designing and creating 3D printed models and surgical guides [72]. This training can be time consuming and may require additional financial resources. Moreover, the software itself may have a steep learning curve, especially for those who are not familiar with CAD programs [73]. Financial constraints can also impede the widespread adoption of these technologies. The cost of acquiring and maintaining the necessary equipment and software can be significant [74]. Additionally, the materials used for 3D printing, such as biocompatible resins, can be expensive [75]. These financial considerations may limit the accessibility of these technologies to some healthcare institutions or individual practitioners. Another limitation is the reliance on high-quality digital imaging for accurate 3D printing and surgical planning [76]. The accuracy of the printed models and surgical guides depends on the quality of the initial digital scans [72]. Patient-related factors, such as movement during imaging or dental prosthetics, can affect the accuracy of the digital models [77]. Technical factors, such as image resolution and artifact interference, can also impact the quality of the digital scans [78]. Therefore, careful attention must be given to the imaging process to ensure accurate representation of the patient's anatomy. Figure 5: The utilization of surgical guides in orthognathic surgery has significantly transformed the field of surgical treatment objective (STO) and execution. This innovative combination incorporates tactile rapid prototype (RP) models that offer enhanced visualization and planning capabilities, as well as accurately designed surgical guides that facilitate precise execution of the surgical procedure. Surgical guides play a pivotal role in orthognathic surgery by providing an unparalleled means of visualizing and planning the surgical intervention. By creating tactile 3D models, surgeons can gain a comprehensive understanding of the anatomical structures involved and can assess the potential outcomes of the proposed procedure. This visual representation assists in accurate preoperative planning, allowing for increased precision and reduced surgery time. Furthermore, the ability to manipulate and examine the model from various angles ensures a more thorough analysis of the proposed treatment, ultimately resulting in improved surgical outcomes. Furthermore, the rapid advancement and adoption of 3D printing and VSP have outpaced the development of regulations and standards. As a result, there are concerns about patient safety and procedural accountability [79]. It is crucial to establish guidelines and regulations to ensure the quality and reliability of these technologies. This includes standardized protocols for imaging, software validation, and quality-control measures for 3D printing and surgical planning processes. In the context of materials used in 3D printing for medical applications, especially in oral and maxillofacial surgery, a narrative review highlighted the use of materials such as hydroxyapatite, tricalcium phosphate, bicalcium phosphate, apatite-wollastonite glass ceramics, stem cells, and collagen [80]. The review emphasized the need for further research on the modeling, efficacy, and safety of these natural materials to ensure their suitability and safety in surgical applications [80]. Another study on the personalized surgery service in a tertiary hospital discussed the method and outcomes for creating a personalized surgery service for the Oral and Maxillofacial Surgery Unit [81].