A score-based predictive system for assessing the necessity of orthognathic surgery in Chinese population: a tool suitable for predicting the indication of orthognathic surgery.

OBJECTIVE

This study aimed to develop and validate a score-based predictive system for assessing the necessity of orthognathic surgery, thereby supporting clinical decision-making in patients with dentofacial or mentum deformities.

METHODS

A total of 280 patients with dentofacial or mentum deformities were retrospectively included. Lateral cephalograms, standardized facial photographs, and patient information were collected. Surgical necessity was independently assessed by four orthognathic surgeons and four orthodontists as the gold standard. A software-based prediction system was developed using four weighted domains: patient factors (10 %), esthetic/functional impact (30 %), bone tissue indicators (30 %), and soft tissue indicators (30 %). System scores were compared with expert judgments to assess agreement and performance using correlation analysis and regression modeling.

RESULTS

The predictive system showed strong agreement with expert evaluations (Kappa = 0.81) and a high correlation with surgical necessity scores (R² = 0.966). Scores ≥52.6 were identified as thresholds for recommending surgery, achieving 100 % specificity and 96 % sensitivity. Multiple linear regression confirmed significant associations between necessity and clinical parameters including media pressure, oral function, SNA, SNB, FMA, and nasolabial angle (p < 0.001).

CONCLUSIONS

The predictive system demonstrated high feasibility as a decision-support tool for clinicians. Patients' pressing desire for ideal esthetics can influence treatment decisions. By combining data-driven analysis with clinical expertise, the system improves decision-making in complex, multidisciplinary cases.

CLINICAL RELEVANCE: The system provides a reliable, data-driven approach to support clinicians in making informed treatment decisions. Future studies should validate its generalizability in multi-ethnic populations to address potential variations in esthetic preferences.