## 4 Results  
The procedure was adopted in one clinical case on a patient affected by a class III malocclusion with an associated open bite and right deviation of the mandible. The patient was a 27-year-old male already operated on 5 years prior for multiple fractures of the jaw after a car accident. Screws and plates from the previous operation were removed before new orthognathic surgery. Following our procedure, a high-definition skull CT scan was acquired and digital planning was performed. Evaluation of proper maxillary and mandibular segmentation and movements was performed considering class III, open bite, and asymmetry correction. Additionally, evaluation of gap or overlapping of the bone fragments at the osteotomy sites was acquired up to a final bone fragments positioning feasible in relation to anatomic and surgical technique limits. CAD/AM (Computer-Aided Design/Computer-Aided Manufacturing) surgical guides and custom-made fixation plates were acquired before surgery. In this special case, the standard plates were unable to be used for the particular conformation of the bones.  
The surgery to which the patient was subjected required a BSSO and a Le Fort I osteotomy.  
Digital personalized procedures with CAD/AM surgical guides and plates were particularly useful in this patient because of the poor dental conditions and difficulties for the patient to access dental care.  
Final jaw position was precisely planned and achieved even in this difficult situation.  
In the following figures, the medical images, orthopanoramic images (Figures 6 and 7) before and after an orthognathic surgery, the implanting screws (Figure 8), and a digital reconstruction (Figure 9) are shown.  
Operation was conducted without particular difficulties with the aid of the surgical guides and custom-made plates and screws fixation system. Surgical guides precisely fitted in the planned facial skeleton areas and pre-drilling holes precisely combined with custom-made plates holes resulting in proper jaw positioning and dental class I occlusion. Additionally, the amount of bone gap and overlapping at the osteotomy sites was restrained to an acceptable degree in relation to anatomic and surgical limits by proper planning combining main skeletal advancement for the upper jaw (5 mm) with a limited amount for mandibular set-back (3 mm) combined with left rotation of the lower midline up to precise fitting with the upper midline.  
In this way, we had a small gap between the two mandibular segments at the BSSO sites easily managed at the fixation time during surgery, also preserving a correct condylar position in centric relation.  
Figure 8: Implanting screws.  
Figure 9: Digital reconstruction.  
After cephalometric and occlusal evaluation, the result was considered fully satisfactory for the clinicians and for the patient.  
Additionally, masticatory function was evaluated as absolutely satisfactory 6 months after surgery with good stability at one year after x-ray cephalometric and occlusal control. The post-operative TC and the one-year-after control TC showed that the hypothesized errors in applying the proposed methodology were lower than the maximum one (0.65 mm) and acceptable for the BSSO approach.