# Evaluation of Deviations Produced by Soft Tissue Fitting in Virtually Planned Orthopathic Surgery
## 5 Conclusions  
In conclusion, the study confirmed that, in many cases, surgeon intervention is required to modify VSP positioning due to poor soft tissue fitting. Furthermore, we found that surgical outcomes were equally favorable in cases with voluntary deviations from the VSP compared to those where the plan was strictly followed. This demonstrates that soft tissue predictions sometimes fail and that surgeon judgment should prevail over strict adherence to the virtual plan.  
The study highlights variability and reliability issues in patients with Class II dentofacial deformities, who showed significantly lower adherence to VSP (17%) compared to Class III patients (60%). On average, final mandibular advancement was 8.6 mm less in Class II patients, where Pg deviations were greater than SI deviations. These findings suggest that the virtual plan often recommends excessive advancement for Class II deformities. This raises concerns about the effectiveness of VSP in these cases, beyond its utility for occlusal splint fabrication. In practice, surgeons tend to adopt more conservative repositioning strategies that still achieve proper correction of the deformity while minimizing surgical impact. In contrast, deviations in Class III patients were comparable to those in cases where the VSP was fully followed, suggesting that VSP provides more accurate soft tissue prediction in Class III cases than in Class II cases.  
Overall, all surgeries were considered successful, and patients were generally satisfied with the results. The study confirms that VSP plays a key role in guiding occlusion and ensuring accurate correction of dentofacial deformities. However, surgeons must be aware that soft tissue adaptation may differ from predicted outcomes, potentially requiring intraoperative adjustments. We recommend using VSP for the design and manufacturing of occlusal splints in all cases of dentofacial deformity. Nevertheless, the positioning proposed by VSP for Class II patients should be regarded as a reference rather than a strict plan, whereas for Class III patients, VSP positioning can be considered reliable and followed more confidently.  
Conceptualization, P.M.F.-M. and A.P.-S.; methodology, P.M.F.-M. and I.C.A.; software, J.M.G.; validation, J.L.D.C.P.d.V., J.L.C.C. and C.N.C.; formal analysis, A.V.; investigation, I.M.L.; resources, R.F.-V.G.; data curation, A.L.L.; writing--original draft preparation, I.N.C.; writing--review and editing, M.B.; visualization, G.A.; supervision, A.P.-S.; project administration, M.B.; funding acquisition, R.P. All authors have read and agreed to the published version of the manuscript.  
This research was co-funded by the European Regional Development Fund (ERDF), \"A way to build Europe\", and by the Fundacion Rioja Salud, co-funded by the European Social Fund (ESF), \"Investing in your future\". M.B. was supported by the \"Retos Colaboracion\" project, GLOPROC561(RTC2019-007399-1), from the Ministry of Science and Innovation (Spain). A.V.-M. was supported by Regional Government Innovation Engagements.  
The study was conducted in accordance with the Declaration of Helsinki and approved by the Medical Research Ethics Committee of La Rioja (CEImlAR) (protocol code PI713 of 30 October 2023).  
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.  
The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.  
The authors declare no conflicts of interest.