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The surgery-first orthognathic approach without presurgical orthodontic treatment was found to be predictable and applicable to treat class III dentofacial deformities, and we recommend consideration of the technique as an effective alternative for treating this condition.

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The surgery-first approach (SFA) is a new paradigm in orthognathic surgery. In our experience over the last 10 years, SFA, particularly for the correction of the class III dentofacial deformity and facial asymmetry, has demonstrated high success rates without any major complications. However, many craniofacial surgeons remain concerned about the skeletal stability of SFA. In the present study, the authors aimed to compare the traditional and SFA with regard to the long-term outcomes of vertical skeletal stability using large-scale data. The authors enrolled patients with skeletal class III dentofacial deformities who had undergone and completed orthognathic surgery between December 2007 and December 2015. The inclusion criteria were based on the presurgical simulation of the dental model, and the authors predicted the potential of the SFA based on this preoperative simulation model. Patients with cleft-related syndromes, and those who had undergone orthognathic surgeries for facial asymmetry or class II deformity were excluded. A total of 104 and 51 class III patients were enrolled in the surgery-first and traditional orthodontics-first groups, respectively. Satisfactory results were achieved in all 155 patients with dentofacial deformity. The initial preoperative measurements of cephalometric analysis, particularly vertical skeletal stability, were similar and well maintained after the procedure in both groups. In conclusion, the SFA without any presurgical orthodontic treatment for correcting dentofacial deformities can achieve similar long-term vertical stability results to the orthodontic treatment-first approach.

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Presurgical orthodontic treatment has long been known as a prerequisite in the traditional orthognathic approach. However, achieving ideal decompensation is very difficult even in the presurgical orthodontic period. For minimization of this problem, the surgery-first orthognathic concept has been introduced. The authors hypothesized that this treatment modality will be feasible for skeletal class III dentofacial deformity patients. In this study, the authors tried to compare the traditional and surgery-first approaches regarding long-term outcomes in terms of stability, based on large-scale data. The patients included in this study had skeletal class III dentofacial deformities, and all underwent, and completed, orthognathic surgery between December 2007 and December 2015. The inclusion criteria were based on presurgical simulation on the dental model, and the authors predicted the potential of the surgery-first approach by this preoperative simulation model. Patients with cleft-related syndromes, those who underwent orthognathic surgeries due to facial asymmetry or class II deformity were excluded from the study. In total, 104 class III patients were enrolled in the surgery-first group and 51 class III patients in the traditional orthodontic-first group. Satisfactory results were achieved in all 155 patients with dentofacial deformity in this study. Overall, the analysis revealed that anteroposterior skeletal long-term stability in the surgery-first approach was not different, statistically or otherwise, from that in the orthodontic-first approach. Anteroposterior skeletal stability was maintained well in the surgery-first approach. In conclusion, surgery-first approach without presurgical orthodontic treatment can achieve similar results of long-term anteroposterior stability in correcting dentofacial deformities as the orthodontic treatment-first approach.

Background: The surgery-first orthognathic approach has been applied at our institution since 2007. However, its indications remain debated. The aim of this study was to investigate the reliability of the surgery-first approach to correct facial asymmetry compared to the traditional orthodontics-first approach using a novel artificial intelligence–based cephalometric analysis. Methods: Intervention outcomes of surgery-first (n = 33) and orthodontics-first (n = 26) approaches to correct facial asymmetry were examined. Patients with facial asymmetry who had undergone orthognathic surgery from January of 2006 to January of 2019 were included in the study. In the surgery-first approach, the novel preoperative simulation process on the dental model was performed to determine the final occlusion without presurgical orthodontic treatment. Changes in cephalometric landmarks were compared using the supervised deep learning process developed at our institution. Results: The surgery-first approach without presurgical orthodontic treatment corrected facial asymmetry and yielded results similar to those of the traditional orthognathic approach. The statistical analysis revealed that changes in skeletal cephalometric landmarks were similar in the two groups. Conclusions: The surgery-first orthognathic approach without presurgical orthodontic treatment treated facial asymmetry, possibly suggesting a possible paradigm shift in treatment. In addition, artificial intelligence–based cephalometric analysis was an effective tool. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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