Every year thousands of patients elect to undergo combined surgical-orthodontic treatment to ease correction of severe jaw deformities [1–5]. Due to the complex nature of the dentofacial anatomy, orthognathic surgery often requires extensive presurgical planning [6–8]. In recent years, the rapid development of fast and affordable digital computer has revolutionized medical surgery . This revolution has affected orthodontics in many ways and the best improvement was given using surgical planning tools. In the years, the advent of imaging software programs has proved to be useful for diagnosis, treatment planning, and outcome measurement. Therefore, over the years, the use of Virtual Surgery Planning software for education, pre-operative assessment, pre- surgical planning, and measurement have become very prevalent as, in recent days, market gives various options for the surgeon to choose, Dentofacial Planner Plus (Dentofacial Software, Toronto, Ontario, Canada) (DFP), IPS (IPSCaseDesigner KLS Martin Group) Quick Ceph (Quick Ceph Systems, San Diego, Calif), and Dolphin Imaging (Dolphin Imaging Software, Canoga Park, Ca) (DI), among others.
The aim of our study is to make a comparison between two surgical planning software on the market for the study and planning of orthognathic surgery: the well-known and proven Dolphin Imaging, and the emerging IPS. Willinger et al discussed a comparison on these two VPS based on accuracy of soft tissue prediction of 2 in patients undergoing an intraoral quadrangular Le Fort II osteotomy  and a comparison based on feasibility, time consumption, and costs in a standardized workflow for a modified intraoral quadrangular Le Fort II osteotomy (IQLFIIO) . As we know, in the actual literature there is any work who compares the VPS Dolphing Imaging and IPS discussing items as Accuracy, Validity, Time and Usability in the surgical planning of Dentoskeletal Dismorfia.
Analysis of the results on the measurements of the acquisition times
Analyzing the measurements, the first difference in performance is evident regarding the acquisition times of the CBCT data, with an average difference in the acquisition to be in favor of the Dolphin software with more effective imaging in both single acquisition and long run. Moreover, it is interesting to note how data acquisitions of the 10 CBCTs are much more heterogeneous in the case of the IPS software, a sign of greater variability. Analyzing the data acquisition time records of the intraoral scans of both Dolphin Imaging and IPS software, the first result is the variation of the acquisition times that sees Dolphin Imaging software to be more performing, thereby faster than IPS in the ten measurements.
Both software have comparable data homogeneity, demonstrated both in the ten measurements of the two individual software and in the comparison between the two software acquisition times, specifying that this homogeneity can also be correlated to the relative " lightness” of the intraoral scan data. The analysis of the results related to the acquisition of 3D facial scans offers interesting insights, confirming once again how the Dolphin Imaging software proves to be more performing. The analysis of the acquisition times highlights a relative heterogeneity of the IPS software alone, both in the single ten measurements, and in the comparison with the recordings of the Dolphin Imaging software, which also in this case proves to be faster. It would therefore seem that Dolphin Imaging software is more powerful in managing a large amount of data.
Analysis of the results related to the study of the linearity of the programming path
The analysis of the results related to the number of open windows to determine the linearity of the planning path demonstrates similarity.
The number of windows required by the operator to complete a planning with the Dolphin Imaging software is 17 windows, greater than the 14 windows required to complete a planning with the IPS software. In addition to the number of windows, the intrinsic difference of the specific purposes was also evaluated: the Dolphin Imaging software uses the first 3 windows to load the patient data sheet, unlike the 2 used by the IPS software.
The IPS software requires one less window to ensure the occlusion overview, integrated in the next window to load the occlusion scan, a missing step in the planning of the Dolphin Imaging software. Bigger " saving" for the IPS software is given by the latter not needing to use the radiographic data (orthopantomography and telecranium).
The phases inherent to the actual planning can be absolutely overwritten for the two software.
Each software requires eight windows to plan the osteotomies and design the occlusal splints. The difference in the number of open windows in planning would suggest greater ease to use of the IPS software. Ultimately, the investigation into the linearity of the planning path does not see the predominance of one software over the other, bringing out overlapping results in terms of performance and usability.
Analysis of the results of the accuracy of the surgical transfer
The analysis of the results shows, according to the evaluations carried out by the operators, that the effectiveness of the surgical planning appears to be comparable between the two software Dolphin Imaging and IPS, with a slight preference towards the latter software, with an average evaluation value of 7.4 against the average value of 7.3 attested to the Dolphin Imaging software. A difference of 0.1 is less than the value of the SD (0.75), making the differential itself statistically irrelevant. The analysis of the results referred to the evaluation of occlusal splints in the operating room shows an absolute comparability, attesting to each software an average value of 7.25.
Analysis of the results regarding the fundamental investigations
Both software require 3D facial scans, CBTC and intraoral scans. The only difference comes from the occlusal scans as this tool is only required by the IPS. Both software do not require the execution and download of radiographic data, (Rx Orthopantomography and Rx Telecranium in the Antero-Posterior and Latero-Lateral projections) which for IPS are not necessary for planning, while for Dolphin Imaging they can be extrapolated directly from the CBTC data.
Analysis of the results regarding the specifications and basic costs
the two software have slightly different costs for the purchase of the license, with the Dolphin Imaging software proving being slightly cheaper. The basic specifications are comparable, with the only major difference being that the Dolphin Imaging software does not have a version available for the Mac OS operating system