Prosthetic Reconstruction, Rehabilitation & Surgical Planning —
Training activity: 22

Details

Provide pre-operative orthognathic planning for a bi-maxillary procedure with computer aided design (CAD) planning, design and print surgical occlusal splints using computer aided manufacture (CAM)

Type

Entrustable training activity (ETA)

Evidence requirements

Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion. ​

Reflection at multiple timepoints on the trainee learning journey for this activity.

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

What does success look like?

• Success means accurately performing CAD planning for a bi-maxillary orthognathic procedure, and then precisely designing and 3D printing surgical occlusal splints using CAM technology. The splints must meet surgical specifications and contribute to a successful patient outcome.
• Review the learning outcomes pertaining to analysing patient investigations, preparing surgical treatment plans, and applying quality management principles.
• Seek specific guidance on the complexity of the case and the expected level of detail for the CAD/CAM output.

What is your prior experience of this activity?

• What is your existing knowledge of orthognathic planning, CAD software, 3D printing, and CAM processes, particularly for bi-maxillary procedures?
• Identify challenges like data accuracy, software proficiency, material selection for splints, or integration with surgical requirements, and how you might overcome them.
• When would you need to consult with an orthodontist, surgeon, or other specialists during the planning phase?
• How confident do you feel about leveraging advanced digital technologies for this critical pre-operative planning?

What do you anticipate you will learn from the experience?

• Focus on enhancing your expertise in CAD/CAM for surgical applications, precision in splint design, or workflow optimisation in a digital planning environment.
• What insights do you hope to gain about the accuracy of digital planning compared to analogue methods, or the impact of splint design on surgical outcomes?

What additional considerations do you need to make?

• Review any feedback or improvements identified from previous digital planning or splint manufacturing tasks.
• What critical data or imaging (e.g., CT scans, dental models) do you need to ensure accurate planning and splint production?

In action

During the activity is anything unexpected occurring?

• Are you noticing anything surprising or different from what you anticipate during the digital planning and manufacture process? Are you encountering situations such as:
  • Unexpected software glitches during CAD planning?
  • Is the CAM 3D printer malfunctioning or producing an inaccurate splint?
  • Is there an unforeseen anatomical detail that is complicating the standard planning?
• How is this experience comparing with previous experiences of similar activities?

How are you reacting to the unexpected development?

• How is this impacting your actions? For example, are you troubleshooting technical issues effectively? Are you adapting or changing your CAD planning or CAM process to address the problem? Is it affecting your ability to undertake the activity independently?
• Consider the steps you are taking in the moment, such as:
  • Are you immediately running diagnostic checks on the CAM equipment or revising the splint dimensions in the CAD software?
  • Are you consulting relevant Standard Operating Procedures (SOPs) for equipment calibration or seeking advice from a more experienced colleague regarding the complex anatomical detail?
• Consider how you feel in that moment. For instance, are you finding it difficult to adapt? Is it affecting your confidence? Do you feel positive you can reach a successful conclusion?

What is the conclusion or outcome?

• How are you working within your scope of practice?
  • Are you successfully producing the splints by ensuring the final CAM surgical occlusal splint is verified against the CAD plan for dimensional accuracy before clinical use?
  • Are you practicing within your scope by escalating the technical malfunction of the CAM equipment to the appropriate maintenance or management body (e.g., biomedical engineering)?
  • Are you ensuring that the CAD planning software being used is a validated system aligned with local clinical governance policies?
• What are you learning as a result of the unexpected development?
  • Are you gaining a new, efficient workflow for quickly troubleshooting a specific CAM printer error (e.g., layer separation or inaccurate print geometry) to reduce manufacturing delay?
  • Are you learning a clearer method for modifying CAD planning parameters in real-time to successfully accommodate an unforeseen anatomical variation or complex dental asymmetry?

On action

What happened?

• Summarise the key points of the experience, focusing on the pre-operative orthognathic planning, the CAD planning, and the design and CAM printing of surgical occlusal splints.
• Consider specific events, actions, or interactions that felt important. Did you encounter specific challenges with software, printer accuracy, or complex anatomical considerations?
• Include any ‘reflect-in-action’ moments where you adapted to the situation as it unfolded. For example, how did you troubleshoot unexpected software glitches during CAD planning or address an issue with the CAM 3D printer producing an inaccurate splint?

How has this experience contributed to your developing practice?

• Identify what learning you can take from the experience. What strengths did you demonstrate in utilising CAD/CAM for orthognathic planning and splint production? What skills and/or knowledge gaps were evident (e.g., unfamiliarity with new developments in digital analysis or specific CAM printer maintenance)?
• Compare this experience against previous engagement with similar activities. Has your practice improved in digital surgical planning, such as improving CAD precision or CAM efficiency?
• Identify any challenges you experienced and how you reacted to these. Did these challenges affect your ability to undertake the activity independently?
• Identify anything significant about the activity. Did you need to seek advice or clarification on complex planning details or ensuring the splints adhered to safe clinical standard?
• Acknowledge any changes in your own feelings now that you are looking back on the experience.

What will you take from the experience moving forward?

• Identify the actions / ‘next steps’ you will now take to support the assimilation of what you have learnt.
• What will you do differently next time? For example, routinely create a STL file from DICOM data and print a 3D model or establish a robust troubleshooting protocol for technical challenges.
• Do you need to practise any aspect of this activity further?

Beyond action

Have you revisited the experiences?

• Have you revisited your previous reflections (reflect-before-action, reflect-in-action, and reflect-on-action) for this specific activity (CAD/CAM orthognathic planning)?
• When reviewing these past reflections, what actions for improvement did you previously identify you would need to take to improve your practice related to CAD planning accuracy, CAM workflow efficiency, or troubleshooting digital planning glitches?
• Have you completed these previously identified actions? If not, what are the barriers? If so, how did completing them impact your subsequent performance of this activity? Are you ready to demonstrate this new learning confidently and consistently when performing this task?
• Have you engaged in professional storytelling or discussed your experiences of digital orthognathic surgical planning with peers, near peers, or colleagues? Has discussing these experiences with others changed your view or understanding of new developments in digital analysis or the principles of image-guided surgery?

How have these experiences impacted upon current practice?

• Considering your cumulative experiences and reflections on this activity, how will the learning you have gained support you in preparing for relevant observed ‘in-person’ assessments for the module? For example, how does your cumulative experience in CAD planning and CAM support your ability to discuss the provisional surgical plan during a Case-based Discussion (CBD)?
• How has your practice related to preparing surgical treatment plans for complex head and neck surgery and ensuring regulatory compliance developed and evolved over time across multiple instances of undertaking this training activity?
• Can you identify specific examples of improvement or increased confidence in verifying the accuracy of 3D models and surgical occlusal splints?
• Based on your experiences, how has your ability to recognise when something related to digital surgical planning is beyond your scope of practice improved?
• Do you have a clearer understanding of when and from whom (e.g., Consultant Orthodontist, biomedical engineer) you need to seek advice or clarification regarding complex segmental orthognathic cases or persistent CAM equipment failure?

Relevant learning outcomes

#	Outcome
# 1	Outcome Deliver quality patient centred care with the best interests of patients in all elements of practice.
# 2	Outcome Practice in accordance with local and national health and safety policies, regulatory requirements and overall service governance.
# 3	Outcome Communicate effectively with patients, relatives, healthcare professionals and other stakeholders.
# 5	Outcome Analyse and interpret patient investigations, multimodal imaging and information.
# 6	Outcome Perform clinical investigations, formulate treatment plans and manufacture medical devices to a safe clinical standard.
# 7	Outcome Prepare surgical treatment plans for complex head and neck surgery.
# 8	Outcome Select appropriate biomedical materials and components/instrumentation used in the treatment of patients and the manufacture of custom-made medical devices.
# 9	Outcome Practice in partnership with other clinical specialisms as part of a multidisciplinary team and understand their roles and their impact on patient care and pathway.
# 10	Outcome Apply the principals of a quality management system to their professional practice.
# 12	Outcome Assess and interpret patients’ needs to provide customised treatment dependent on medical, physical, social and psychological requirements.