Surgery-First Orthognathic Approach

Abstract

Traditionally, for correction of dentofacial deformities “orthodontics first” protocol has been universally adopted wherein the surgery is performed after the goals of the presurgical orthodontics have been achieved. The advantages of orthodontics first approach like preoperative leveling of arches and establishing overjet and overbite relationship by decompensation will help in accurate spatial positioning of maxillomandibular complex during surgery. However, prolonged treatment time and initial worsening of the deformity during decompensation has always been its shortcoming.The concept of “Surgery First Orthognathic Approach (SFOA)” challenges the traditional protocol by overcoming its principal disadvantages. In SFOA, the Orthognathic surgery is performed before any orthodontics is initiated and this will help in shortening the overall treatment time, thereby increasing the patient’s compliance and acceptance towards the treatment in a better way. This chapter is intended to apprise on the details of planning, indications, contraindications, advantages and technical considerations of SFOA and also throws light on the recent advances pertaining to SFOA.

Diagnosis and Treatment Planning in Surgery First Approach

“…The future of SFOA technique lies in using augmented skull models, virtual orthodontic set-up to replace the mounted study model set-up and the computer-aided design and computer-aided manufacturing fabrication of surgical splints [19]. 3D planning technologies are a clinical reality today.…”

“…Because it can predictably distalize the mandibular molars in nongrowing patients, the SAS makes it possible to correct a Class III malocclusion and lower incisor proclination without premolar extractions. At the same time mandibular arch can be leveled by extruding the premolars [19].…”