Current concept of the surgery-first orthognathic approach

Abstract

Traditional orthognathic surgery has long been performed after presurgical orthodontic treatment. Despite some concerns, the surgery-first orthognathic approach (SFOA) or surgery-first approach (SFA) without presurgical orthodontic treatment has gradually gained popularity. In recent years, several articles dealing with the concepts of the SFA have been published worldwide. However, the SFA has not yet been standardized, and many surgeons use slightly different protocols and concepts. This review article discusses the beginning and evolution of the SFA and its current concepts, including some opinions based on the authors’ clinical experiences over the last 15 years. According to recent investigations, the SFA could be applied effectively in several situations including class III malocclusion, class II malocclusion, and facial asymmetry. However, debate on the SFA continues and many issues remain to be resolved. This review article addresses the current issues regarding the SFOA, including its advantages and disadvantages, as well as its indications and contraindications. The authors summarize various aspects of the SFA and expect that this review article will help surgeons and orthodontists better understand the current status of the SFA.

Surgery-First Approach in Orthognathic surgery: Literature review

“…The indications for surgery-first are broad and this approach can be used to treat most skeletal discrepancies, taking advantage of a virtual precision planning with the orthodontist, there are excellent results and in a short period of time when compared to the conventional approach. (Choi & Lee, 2021) As it is a virtual simulation of postoperative orthodontic correction, the SFA could theoretically be applied to all surgical cases, however, clinically, we can find certain limitations regarding the indication of the technique that makes it infeasible. Mostly, we found applicability in the literature for the technique in class III patients.…”

Current trends in orthognathic surgery

“…The definition of the surgery-first approach is orthognathic surgery followed by postoperative orthodontic treatment without preoperative orthodontic treatment [ 12 , 13 ]. If the period of preoperative orthodontic treatment is minimized to less than 6 months, it is defined as the modified-surgery approach [ 14 , 15 ].…”

“…If the period of preoperative orthodontic treatment is minimized to less than 6 months, it is defined as the modified-surgery approach [ 14 , 15 ]. Although there are disagreements about the chronology, the first report of the surgery-first approach in Asia is thought to have been published in the Korean Journal of Clinical Orthodontics in 2002 [ 13 , 16 ]. The fundamental concept of the current surgery-first approach is well described in this publication.…”

“…The surgery-first approach is usually indicated for patients who do not need much preoperative treatment, including those with (1) well-aligned to mildly crowded anterior teeth, (2) a flat to mild curve of Spee, (3) normal to mildly proclined or retroclined incisors, and (4) a minimal transverse discrepancy [ 13 , 17 ]. In recent years, the range of indications has been further expanded; according to Choi and Lee [ 13 ], if stable surgical occlusion is achieved through a simulation of postoperative orthodontic movement, the surgery-first approach could theoretically be applied to all patients who need orthognathic surgery. The orthodontist’s experience and expertise are important, as well as the plastic surgeon’s experience, for application of the surgery-first approach [ 20 ].…”

“…The advantages of the surgery-first approach described in previous papers are shortening the total treatment time, a favorable direction of postoperative orthodontics (identical to the direction of natural compensation), early improvement of facial aesthetics, and early correction of OSA [9,[17][18][19]. The surgeryfirst approach is usually indicated for patients who do not need much preoperative treatment, including those with (1) wellaligned to mildly crowded anterior teeth, (2) a flat to mild curve of Spee, (3) normal to mildly proclined or retroclined incisors, and (4) a minimal transverse discrepancy [13,17]. In recent years, the range of indications has been further expanded; according to Choi and Lee [13], if stable surgical occlusion is achieved through a simulation of postoperative orthodontic movement, the surgery-first approach could theoretically be applied to all patients who need orthognathic surgery.…”