Surgery first: an alternative approach to ortho-surgical patients

Miguel, José Augusto M.; Gava, Eveline Coutinho Baldoto

doi:10.1016/j.pio.2012.04.001

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…These limitations of the conventional three-stage model of orthosurgical management have given rise to the resurgence of the SFA,[13] akin to the practices prior to 1960s, however now, better equipped with improved diagnostics, concepts, techniques, and surgical skill. [14] This approach involves orthognathic surgery being carried out first to correct the skeletal discrepancies, followed by orthodontic treatment to align the teeth and attain a functional occlusion, all carried out with the prime objective of reducing the overall time taken to complete the entire treatment.…”

Section: Discussionmentioning

confidence: 99%

Rationale, relevance, and efficacy of “surgery first, orthodontics later” approach in the management of cases of severe malocclusion with skeletal discrepancy

Jeyaraj¹,

Chakranarayan²

2019

Ann Maxillofac Surg

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A good esthetic outcome and optimal functional occlusion is the goal of management of any dentofacial anomaly. Conventional orthognathic surgery, as commonly practiced, entails a rather long-drawn management protocol comprising a triphasic treatment approach, with the surgical procedure being both preceded and followed by pre- and post-surgical orthodontics, respectively. This has numerous well-known drawbacks such as an uncertain and unpredictable patient compliance and poor motivation due to the inevitably long duration of orthodontic therapy; a transient and temporary worsening of the facial appearance brought about by presurgical orthodontic decompensation of occlusal relationships; and the inevitably prolonged time frame involved in ultimately achieving the desired esthetic and functional results. Further, unforeseen interruptions along the course of the long treatment period can result in unfavorable and even disastrous outcomes. The newer concept and technique of “Surgery First Orthodontics After” (SFOA) approach or “surgery-first approach” (SFA) entails first performing orthognathic surgery, thereafter following it up and finishing the case with postsurgical orthodontic settling and correction of the occlusion. It has two very distinct advantages over the erstwhile approach, first, an immediate and early correction of the facial deformity resulting in a remarkable improvement in facial appearance, which in most cases was what had prompted the patient to seek treatment for, in the first place. The patient, encouraged and motivated by the obvious and appreciable esthetic results, complies willingly and well with the subsequent postsurgical orthodontic treatment, even if it is lengthy or inconvenient, thus ensuring an optimal ultimate occlusion with complete functional rehabilitation as well. The second advantage of SFA is a markedly reduced overall treatment time, which is greatly appreciated by the patients. This article presents three cases of severe malocclusion with associated skeletal discrepancies, treated expeditiously and effectively using the SFA protocol. The overviews of SFA, including its rationale and relevance, indications, general and specific guidelines, different protocol variations, clinical outcome and success rate, as well as possible complications and potential problems encountered with this novel treatment protocol are also discussed.

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Section: Discussionmentioning

confidence: 99%

Rationale, relevance, and efficacy of “surgery first, orthodontics later” approach in the management of cases of severe malocclusion with skeletal discrepancy

Jeyaraj¹,

Chakranarayan²

2019

Ann Maxillofac Surg

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“…However, without preoperative orthodontics, the occlusal relationship of the teeth cannot be used as a reference for designing the surgical plan, and dental arch compensation and unstable occlusal relationship affect intraoperative bone movement, so direct orthognathic surgery not only has inherent limitations in predicting the position of the jaws and occlusal relationship after the jaws are moved, but also requires a high degree of precision in surgical operation. In recent years, with the development of computer-assisted technology and the improvement of internal fixation technology, 3D virtual occlusion design and other technologies can better predict the position and occlusal relationship after bone movement, and "surgery first" has entered the vision of modern medicine [9] .…”

Section: Development Of the Basic Concept Of The Sfamentioning

confidence: 99%

Advances in the surgery-first orthognathic approach for the treatment of patients with malocclusion

2023

FMSR

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Combined orthognathic and maxillofacial treatment is the main approach to correct severe dentofacial deformities, which includes conventional orthognathic surgery (COS) and surgery first approach (SFA).The COS model consists of 3 different treatment phases: preoperative orthodontic debridement, orthopaedic surgery and postoperative orthodontic occlusal adjustment. In order to prevent the deterioration of transient facial deformities caused by preoperative orthodontics and to shorten the overall treatment time as well as to improve patient satisfaction, the surgical first approach (SFA) has been proposed, in which the patient undergoes orthognathic surgery without preoperative orthodontics, or with as little preoperative orthodontics as possible, and then undergoes postoperative orthognathic occlusal refinement. SFA has obvious advantages over traditional combined orthodontic and orthognathic treatment, but at the same time, the selection of indications and contraindications is more stringent. SFA, as an alternative to traditional orthodontic orthognathic treatment, has been one of the hottest research topics in recent years, with increased surgical design and complexity for the operator. This article reviews the advantages, disadvantages, indications, and contraindications of surgical priority orthognathic modalities and orthognathic treatment in traditional modalities, in the hope of providing clinicians with some reference value when choosing treatment modalities.

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