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.

The purpose of Dentofacial Deformity Treatment is to achieve the proper aesthetic and function- al occlusion results. Conventional orthognathic surgery involves a long-term orthodontic phase before surgery for about 18 months, in which patients’ facial appearance worsens and their mo- tivation decreases. In the SFA (surgery first approach) method, the surgery is performed before orthodontics and orthodontic therapy is performed to improve dental occlusion and final settle- ment. Two main advantages of this method are the reduction of the therapy period and the initial improvement in the patient’s facial appearance. The SFA has certain benefits, especially in Class 3 malocclusion. In this case report, a 19-year-old girl with a relatively severe Class 3 malocclu- sion with skeletal discrepancy due to a mandibular prognathism and maxillary retrognathism, and asymmetrical face with chin deviation to left is presented with a unilateral posterior cross bite which was effectively treated using the SFA protocol. The SFA therapy was performed by removing orthodontics before surgery, followed by maxillary advancement surgery, and posterior maxillary impaction and postoperative orthodontic sets to dental alignment and settling the occlusion. De- spite the overall reduction in the orthodontic therapy period to less than 9 months, good results and functional occlusion were obtained.