Surgery-First Approach; from Claims to Evidence: A Comprehensive Review
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Abstract
The main goals of treatment of dentofacial deformities are to achieve optimal esthetics and ideal functional occlusion. The conventional orthognathic surgical approach includes a long presurgical orthodontic phase, which takes about 18 months. During this phase, the patients’ appearance is deteriorated and their motivation to continue treatment significantly decreases. In the surgery first approach (SFA), orthognathic surgery is performed prior to orthodontic treatment, and orthodontic treatment is performed postoperatively to improve dental occlusion and for final settling. The SFA has two main advantages namely shortening of treatment period, and early improvement of the appearance of patient. The SFA has significant advantages especially for class III patients.
This study aimed to review the available articles on this topic published from 2012 to 2019 to achieve a comprehensive understanding of different aspects of the SFA. The databases were searched by two researchers and a total of 11 eligible articles were selected for study inclusion. The results were categorized into two categories of stability of the results of the SFA, and duration of treatment, in comparison with the conventional approach.
Although different aspects of the SFA have been previously evaluated by dental clinicians, a considerable gap of information still exists regarding the details of this approach, which calls for further research in this respect.
1. Liou EJ, Chen PH, Wang YC, Yu CC, Huang CS, Chen YR. Surgery-first accelerated orthognathic surgery: orthodontic guidelines and setup for model surgery. J Oral Maxillofac Surg. 2011 Mar;69(3):771- 80.
2. Jeyaraj P, Chakranarayan A. Rationale, Relevance, and Efficacy of "Surgery First, Orthodontics Later" Approach in the Management of Cases of Severe Malocclusion with Skeletal Discrepancy. Ann Maxillofac Surg. 2019 Jan- Jun;9(1):57-71.
3. Yang L, Xiao YD, Liang YJ, Wang X, Li JY, Liao GQ. Does the Surgery-First Approach Produce Better Outcomes in Orthognathic Surgery? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017 Nov;75(11):2422-2429.
4. Proffit WR, White RP, Sarver DM. Contemporary treatment of dentofacial deformity: Mosby St. Louis; 2003.
5. Nurminen L, Pietilä T, Vinkka-Puhakka H. Motivation for and satisfaction with orthodonticsurgical treatment: a retrospective study of 28 patients. Eur J Orthod. 1999 Feb;21(1):79-87.
6. Jeong WS, Lee JY, Choi JW. Large-Scale Study of Long-Term Vertical Skeletal Stability in a Surgery- First Orthognathic Approach Without Presurgical Orthodontic Treatment: Part II. J Craniofac Surg. 2018 Jun;29(4):953-958.
7. Sabri R. Orthodontic objectives in orthognathic surgery: state of the art today. World J Orthod. 2006 Summer;7(2):177-91.
8. Ko EW, Lin SC, Chen YR, Huang CS. Skeletal and dental variables related to the stability of orthognathic surgery in skeletal Class III malocclusion with a surgery-first approach. J Oral Maxillofac Surg. 2013 May;71(5):e215-23.
9. Luther F, Morris DO, Hart C. Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study. Br J Oral Maxillofac Surg. 2003 Dec;41(6):401-6.
10. Choi JW, Lee JY, Yang SJ, Koh KS. The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal class III dentofacial deformity. Ann Plast Surg. 2015 Mar;74(3):333-41.
11. Chen YW, Wang HC, Gao LH, Liu C, Jiang YX, Qu H, Li CY, Jiang JH. Osteoclastogenesis in Local Alveolar Bone in Early Decortication-Facilitated Orthodontic Tooth Movement. PLoS One. 2016 Apr 20;11(4):e0153937.
12. Gandedkar NH, Chng CK, Tan W. Surgeryfirst orthognathic approach case series: Salient features and guidelines. J Orthod Sci. 2016 Jan- Mar;5(1):35-42.
13. Huang CS, Chen YR. Orthodontic principles and guidelines for the surgery-first approach to orthognathic surgery. Int J Oral Maxillofac Surg. 2015Dec;44(12):1457-62.
14. Strohl AM, Vitkus L. Surgical orthodontics. Curr Opin Otolaryngol Head Neck Surg. 2017 Aug;25(4):332-336.
15. Park KR, Kim SY, Park HS, Jung YS. Surgeryfirst approach on patients with temporomandibular joint disease by intraoral vertical ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Dec;116(6):e429-36.
16. Peiró-Guijarro MA, Guijarro-Martínez R, Hernández-Alfaro F. Surgery first in orthognathic surgery: A systematic review of the literature. Am J Orthod Dentofacial Orthop. 2016 Apr;149(4):448-62.
17. Mahmood HT, Ahmed M, Fida M, Kamal AT, Fatima F. Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review. Dental Press J Orthod. 2018 May- Jun;23(3):36.e1-36.e6.
18. Sharma VK, Yadav K, Tandon P. An overview of surgery-first approach: Recent advances in orthognathic surgery. J Orthod Sci. 2015 Jan- Mar;4(1):9-12.
19. Liao YF, Chiu YT, Huang CS, Ko EW, Chen YR. Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgicalorthodontic correction for skeletal class III open bite. Plast Reconstr Surg. 2010 Dec;126(6):2074-2083.
20. Lee J, Kim YI, Hwang DS, Kim KB, Park SB. Effect of occlusal vertical dimension changes on postsurgical skeletal changes in a surgery-first approach for skeletal Class III deformities. Am J Orthod Dentofacial Orthop. 2014 Nov;146(5):612-9.
21. Hernández-Alfaro F, Guijarro-Martínez R, Peiró-Guijarro MA. Surgery first in orthognathic surgery: what have we learned? A comprehensive workflow based on 45 consecutive cases. J Oral Maxillofac Surg. 2014 Feb;72(2):376-90.
22. Joh B, Bayome M, Park JH, Park JU, Kim Y, Kook YA. Evaluation of minimal versus conventional presurgical orthodontics in skeletal class III patients treated with two-jaw surgery. J Oral Maxillofac Surg. 2013 Oct;71(10):1733-41.
23. Kim JW, Lee NK, Yun PY, Moon SW, Kim YK. Postsurgical stability after mandibular setback surgery with minimal orthodontic preparation following upper premolar extraction. J Oral Maxillofac Surg. 2013 Nov;71(11):1968.e1-1968.e11.
24. Zhou Y, Li Z, Wang X, Zou B, Zhou Y. Progressive changes in patients with skeletal Class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: A comparative study. Am J Orthod Dentofacial Orthop. 2016 Feb;149(2):244-52.
25. Park HM, Lee YK, Choi JY, Baek SH. Maxillary incisor inclination of skeletal Class III patients treated with extraction of the upper first premolars and twojaw surgery: conventional orthognathic surgery vs surgery-first approach. Angle Orthod. 2014 Jul;84(4):720-9.
26. Wang T, Han JJ, Oh HK, Park HJ, Jung S, Kook MS. Comparison of Orthodontics-First and Surgery- First Approach in Positional Changes of the Condyle After Mandibular Setback Surgery Using Three- Dimensional Analysis. J Oral Maxillofac Surg. 2016 Dec;74(12):2487-2496.
27. Jeong WS, Choi JW, Kim DY, Lee JY, Kwon SM. Can a surgery-first orthognathic approach reduce the total treatment time? Int J Oral Maxillofac Surg. 2017 Apr;46(4):473-482.
28. Song HS, Choi SH, Cha JY, Lee KJ, Yu HS. Comparison of changes in the transverse dental axis between patients with skeletal Class III malocclusion and facial asymmetry treated by orthognathic surgery with and without presurgical orthodontic treatment. Korean J Orthod. 2017 Jul;47(4):256-267.
29. He X, He J, Yuan H, Chen W, Jiang H, Cheng J. Surgery-First and Orthodontic-First Approaches Produce Similar Patterns of Condylar Displacement and Remodeling in Patients With Skeletal Class III Malocclusion. J Oral Maxillofac Surg. 2019 Jul;77(7):1446-1456.
30. Ko EW, Hsu SS, Hsieh HY, Wang YC, Huang CS, Chen YR. Comparison of progressive cephalometric changes and postsurgical stability of skeletal Class III correction with and without presurgical orthodontic treatment. J Oral Maxillofac Surg. 2011 May;69(5):1469-77.
31. Choi SH, Hwang CJ, Baik HS, Jung YS, Lee KJ. Stability of Pre-Orthodontic Orthognathic Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Treatment. J Oral Maxillofac Surg. 2016 Mar;74(3):610-9.
32. Kim C-S, Lee S-C, Kyung H-M, Park H-S, Kwon T-G. Stability of mandibular setback surgery with and without presurgical orthodontics. J Oral Maxillofac Surg. 2014 Apr;72(4):779-87.
2. Jeyaraj P, Chakranarayan A. Rationale, Relevance, and Efficacy of "Surgery First, Orthodontics Later" Approach in the Management of Cases of Severe Malocclusion with Skeletal Discrepancy. Ann Maxillofac Surg. 2019 Jan- Jun;9(1):57-71.
3. Yang L, Xiao YD, Liang YJ, Wang X, Li JY, Liao GQ. Does the Surgery-First Approach Produce Better Outcomes in Orthognathic Surgery? A Systematic Review and Meta-Analysis. J Oral Maxillofac Surg. 2017 Nov;75(11):2422-2429.
4. Proffit WR, White RP, Sarver DM. Contemporary treatment of dentofacial deformity: Mosby St. Louis; 2003.
5. Nurminen L, Pietilä T, Vinkka-Puhakka H. Motivation for and satisfaction with orthodonticsurgical treatment: a retrospective study of 28 patients. Eur J Orthod. 1999 Feb;21(1):79-87.
6. Jeong WS, Lee JY, Choi JW. Large-Scale Study of Long-Term Vertical Skeletal Stability in a Surgery- First Orthognathic Approach Without Presurgical Orthodontic Treatment: Part II. J Craniofac Surg. 2018 Jun;29(4):953-958.
7. Sabri R. Orthodontic objectives in orthognathic surgery: state of the art today. World J Orthod. 2006 Summer;7(2):177-91.
8. Ko EW, Lin SC, Chen YR, Huang CS. Skeletal and dental variables related to the stability of orthognathic surgery in skeletal Class III malocclusion with a surgery-first approach. J Oral Maxillofac Surg. 2013 May;71(5):e215-23.
9. Luther F, Morris DO, Hart C. Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study. Br J Oral Maxillofac Surg. 2003 Dec;41(6):401-6.
10. Choi JW, Lee JY, Yang SJ, Koh KS. The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal class III dentofacial deformity. Ann Plast Surg. 2015 Mar;74(3):333-41.
11. Chen YW, Wang HC, Gao LH, Liu C, Jiang YX, Qu H, Li CY, Jiang JH. Osteoclastogenesis in Local Alveolar Bone in Early Decortication-Facilitated Orthodontic Tooth Movement. PLoS One. 2016 Apr 20;11(4):e0153937.
12. Gandedkar NH, Chng CK, Tan W. Surgeryfirst orthognathic approach case series: Salient features and guidelines. J Orthod Sci. 2016 Jan- Mar;5(1):35-42.
13. Huang CS, Chen YR. Orthodontic principles and guidelines for the surgery-first approach to orthognathic surgery. Int J Oral Maxillofac Surg. 2015Dec;44(12):1457-62.
14. Strohl AM, Vitkus L. Surgical orthodontics. Curr Opin Otolaryngol Head Neck Surg. 2017 Aug;25(4):332-336.
15. Park KR, Kim SY, Park HS, Jung YS. Surgeryfirst approach on patients with temporomandibular joint disease by intraoral vertical ramus osteotomy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Dec;116(6):e429-36.
16. Peiró-Guijarro MA, Guijarro-Martínez R, Hernández-Alfaro F. Surgery first in orthognathic surgery: A systematic review of the literature. Am J Orthod Dentofacial Orthop. 2016 Apr;149(4):448-62.
17. Mahmood HT, Ahmed M, Fida M, Kamal AT, Fatima F. Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review. Dental Press J Orthod. 2018 May- Jun;23(3):36.e1-36.e6.
18. Sharma VK, Yadav K, Tandon P. An overview of surgery-first approach: Recent advances in orthognathic surgery. J Orthod Sci. 2015 Jan- Mar;4(1):9-12.
19. Liao YF, Chiu YT, Huang CS, Ko EW, Chen YR. Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgicalorthodontic correction for skeletal class III open bite. Plast Reconstr Surg. 2010 Dec;126(6):2074-2083.
20. Lee J, Kim YI, Hwang DS, Kim KB, Park SB. Effect of occlusal vertical dimension changes on postsurgical skeletal changes in a surgery-first approach for skeletal Class III deformities. Am J Orthod Dentofacial Orthop. 2014 Nov;146(5):612-9.
21. Hernández-Alfaro F, Guijarro-Martínez R, Peiró-Guijarro MA. Surgery first in orthognathic surgery: what have we learned? A comprehensive workflow based on 45 consecutive cases. J Oral Maxillofac Surg. 2014 Feb;72(2):376-90.
22. Joh B, Bayome M, Park JH, Park JU, Kim Y, Kook YA. Evaluation of minimal versus conventional presurgical orthodontics in skeletal class III patients treated with two-jaw surgery. J Oral Maxillofac Surg. 2013 Oct;71(10):1733-41.
23. Kim JW, Lee NK, Yun PY, Moon SW, Kim YK. Postsurgical stability after mandibular setback surgery with minimal orthodontic preparation following upper premolar extraction. J Oral Maxillofac Surg. 2013 Nov;71(11):1968.e1-1968.e11.
24. Zhou Y, Li Z, Wang X, Zou B, Zhou Y. Progressive changes in patients with skeletal Class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: A comparative study. Am J Orthod Dentofacial Orthop. 2016 Feb;149(2):244-52.
25. Park HM, Lee YK, Choi JY, Baek SH. Maxillary incisor inclination of skeletal Class III patients treated with extraction of the upper first premolars and twojaw surgery: conventional orthognathic surgery vs surgery-first approach. Angle Orthod. 2014 Jul;84(4):720-9.
26. Wang T, Han JJ, Oh HK, Park HJ, Jung S, Kook MS. Comparison of Orthodontics-First and Surgery- First Approach in Positional Changes of the Condyle After Mandibular Setback Surgery Using Three- Dimensional Analysis. J Oral Maxillofac Surg. 2016 Dec;74(12):2487-2496.
27. Jeong WS, Choi JW, Kim DY, Lee JY, Kwon SM. Can a surgery-first orthognathic approach reduce the total treatment time? Int J Oral Maxillofac Surg. 2017 Apr;46(4):473-482.
28. Song HS, Choi SH, Cha JY, Lee KJ, Yu HS. Comparison of changes in the transverse dental axis between patients with skeletal Class III malocclusion and facial asymmetry treated by orthognathic surgery with and without presurgical orthodontic treatment. Korean J Orthod. 2017 Jul;47(4):256-267.
29. He X, He J, Yuan H, Chen W, Jiang H, Cheng J. Surgery-First and Orthodontic-First Approaches Produce Similar Patterns of Condylar Displacement and Remodeling in Patients With Skeletal Class III Malocclusion. J Oral Maxillofac Surg. 2019 Jul;77(7):1446-1456.
30. Ko EW, Hsu SS, Hsieh HY, Wang YC, Huang CS, Chen YR. Comparison of progressive cephalometric changes and postsurgical stability of skeletal Class III correction with and without presurgical orthodontic treatment. J Oral Maxillofac Surg. 2011 May;69(5):1469-77.
31. Choi SH, Hwang CJ, Baik HS, Jung YS, Lee KJ. Stability of Pre-Orthodontic Orthognathic Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Treatment. J Oral Maxillofac Surg. 2016 Mar;74(3):610-9.
32. Kim C-S, Lee S-C, Kyung H-M, Park H-S, Kwon T-G. Stability of mandibular setback surgery with and without presurgical orthodontics. J Oral Maxillofac Surg. 2014 Apr;72(4):779-87.
| Issue | Vol 19 (Continuously Published Article-Based) | |
| Section | Review Article | |
| DOI | https://doi.org/10.18502/fid.v19i23.10594 | |
| Keywords | ||
| Surgery first approach(SFA) Minimal presurgical orthodontic treatment surgery first orthodontic approach (SFOA) | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mirhashemi A, Ghadirian H, Samimi SM. Surgery-First Approach; from Claims to Evidence: A Comprehensive Review. Front Dent. 2022;19.
