The aircraft assembly hangars look like toys from the snarled I-5 traffic. The parts for the new 787 Dreamliner are flown in by awkward, specially modified 747s (Dreamlifters) and assembled in the plant just steps from the runway in Everett (Figs 1A,B). Hundreds of suppliers from Italy, Japan, Germany, Great Britain, Israel, China, Canada, Spain, Korea, United States, and Sweden, among others, will be depended upon to create an unfailing, cost-effective, state of the art product that will become a single effective functioning aircraft, the most technologically advanced and efficient plane ever built. Each expert supplier is necessary to the completion of an integrated product. Boeing is only capable of providing the most advanced technology because it is using a myriad of companies with subspecialty expertise for each component. Once completed, at least 895 ordered planes will be painted with the colors of 58 airlines. The work of hundreds of suppliers and thousands of workers will be tested as each new 787 finally accelerates down the Everett runway, soaring over Puget Sound, to every continent.
As demonstrated by the revolutionary supplier chain used building the Dreamliner, integrated application of global technology is today's paradigm shift for industry. As you will see in this special issue of JOMS titled, “Accelerated Orthognathic Surgery and Increased Orthodontic Efficiency—A Paradigm Shift: A Special Series Part I,” application of far-flung technologies is impacting orthognathic surgical practice in the same fashion. The technologies advancing orthognathic surgery are not only as geographically diverse as the Dreamliner; they are also borrowed from computer sciences, industrial engineering, robotics, telecommunications, business/economic science, and advances in molecular biology.
These changes in our industry, the practice of surgery, offer powerful ideas that are today being implemented in clinical practice, and for oral and maxillofacial surgeons, nowhere more so than in orthognathic surgery.
Technologic Advances in Orthognathic Surgery
In this special issue, every article draws upon scientific advances and applies them to improvements in orthognathic surgical care. Consider that in this issue of JOMS are technologies that are in use today, yet they are just the beginnings of far greater advances yet to come.
Computer technology: Medical modeling, construction of rapid prototypes, robotics, computer-to-patient navigation, virtual surgical platforms, and 3-dimensional printers are some of the technologies that are today exceeding the capabilities of the conventional orthognathic workup.
Global access to surgical expertise: The ability to consult with a surgeon or biomedical engineer from your computer workstation in the development of precise treatment planning for the orthognathic patient is now a reality. Real-time communications in the operating room via telemedicine or standard Internet links can position the craniofacial skeleton in space, accurately guide the placement of implants in a bone graft (even before it is harvested), or guide a robot's osteotomy cut.
Innovative/efficient care delivery systems: Economics provides the boundaries to all technologic advances. In orthodontics and orthognathic surgery, the role of government and other third party reimbursement will drive us not only to improve care but to reduce its cost with industrial efficiency. Utilizing innovative points of service, non hospital-based platforms, speedy and more economical services, greater standardization of services, and simplification of treatment are now influencing clinical orthognathic care.
Extending the limits of biology: Just a decade ago, the clinical efficacy of craniofacial distraction osteogenesis had not been confirmed. Now its capabilities continue to be extended. In this issue of JOMS, accelerated bone response to orthodontic movement, early repair of alveolar clefts, and surgically assisted orthodontics rely upon new understandings of bone response to force and surgery, as well as better information on the patient's response to surgery and orthodontic forces during growth and development.
Utilizing the tools of orthognathic surgery to treat other conditions: Maxillomandibular advancement is unquestionably the most important new technology for the treatment of obstructive sleep apnea. Now tumor and trauma reconstruction can also benefit from advances in orthognathic technology through reconstruction of the condyle ramus with distraction osteogenesis. With the use of these new technologies, orthognathic surgery can be an adjunctive tool for the patient with missing teeth via precisely matched implant-based prosthetic restorations.
Flying the Dreamliner
After reading this special issue of JOMS, oral and maxillofacial surgeons will know that to practice orthognathic surgery today, new skills and new technologic applications are required. Who will fly our Dreamliner? How should we train contemporary orthognathic surgeons? While continuing education offers a window into this new paradigm, fundamental changes in practice will depend upon our residencies and fellowships. Partnering with industry and scientists, our OMS faculty need to incorporate this new technology and be the leaders in its further development.
Finally, Boeing is building the best product it knows how because it is the mission of the company to be the leader in aviation, and building the best aircraft is the key to its survival. Similarly, care of the orthognathic surgical patient is an essential element of our mission and being the best in orthognathic surgery is key to our survival.
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