The evolution of orthognathic surgery through digital innovations has greatly enhanced precision and predictability. Traditional free-hand techniques depend heavily on the surgeon’s skill, often producing inconsistent outcomes. Fully guided systems merge computer-assisted technologies—such as virtual surgical planning (VSP), CAD/CAM fabrication, and dynamic navigation—to improve accuracy and workflow efficiency. This review contrasts these methods and evaluates their effects on surgical accuracy, time efficiency, and clinical results. A scoping review was performed using PubMed, MEDLINE, Scopus, Cochrane Library, and Embase databases, focusing on clinical trials and cohort studies. Key aspects analyzed were accuracy, procedural efficiency, complication incidence, and functional/aesthetic performance. Fully guided methods demonstrated sub-millimetric precision, with mean linear deviations from 1.3 mm to 2.4 mm and angular deviations between 2.29° and 3.51°. These techniques also shortened operating time—averaging 34 minutes to 1.7 hours—and reduced postoperative risks. Digital integration improved workflow, consistency, and aesthetic predictability. Although free-hand surgery remains economical, it requires extensive expertise and tends to yield greater variability and prolonged recovery. Computer-guided orthognathic surgery surpasses manual methods in precision, predictability, and efficiency. Free-hand techniques remain practical for straightforward cases, yet fully guided systems deliver optimized outcomes. Future investigations should examine hybrid models that merge digital precision with manual flexibility to further enhance surgical performance.
