Current status of surgery first approach (part II): precautions and complications

Abstract

The choice of surgical technique in orthognathic surgery is based primarily on the surgical treatment objectives (STO), which is a fundamental component of the orthognathic treatment process. In the conventional orthodontics-first approach, presurgical planning can be performed twice, during the preorthodontic (initial STO) and presurgical phases (final STO). Recently, a surgery-first orthognathic approach (SFA) without presurgical orthodontic treatment has been introduced and combined initial and final STO at the same time. In contrast to the conventional surgical-orthodontic treatment protocol that includes preoperative orthodontics for dental decompensations to maximize stable postoperative occlusion, the SFA potentially shortens the treatment period and minimizes esthetic concerns during the decompensation period because skeletal problems are corrected from the beginning. The indications for the SFA have been proposed in the literature, but no consensus exists. Moreover, because dental occlusion of the pre-orthodontic arches cannot be used as a guide for establishing the surgical treatment plan, there are fundamental limitations in accurate prediction of postsurgical results in the SFA. Recently, the concepts of postsurgical orthodontic treatment are continuously changing and evolving to overcome this inherent limitation of the SFA. The elimination of presurgical orthodontics can change the paradigm of orthognathic surgery but still requires cautious case selection and thorough discussion and collaboration between orthodontists and surgeons regarding the goals and postoperative management of the orthognathic procedure.

Comparison of the quality of occlusion control with the use of occlusion paper and T-scan, based on the literature.

“…niewłaściwe zaopatrzenie po urazach 5 lub nieprawidłowo przeprowadzane operacje ortognatyczne, w których, niezmiernie trudno przewidzieć jak okluzja zostanie utrzymana po okresie gojenia się kości, szczególnie kiedy operacja ta przeprowadzana jest przed leczeniem ortodontycznym. 6,7 Kolejną przyczyną mogą być nieprawidłowo odtworzone kontakty okluzyjne zarówno w leczeniu zachowawczym, jak i protetycznym. 8 Częstym problem spotykanym w praktyce stomatologa są powikłania okluzyjne po leczeniu ortodontycznym.…”

Modern Surgery-First Approach Concept in Cleft-Orthognathic Surgery: A Comparative Cohort Study with 3D Quantitative Analysis of Surgical-Occlusion Setup

“…The optimal balance between esthetic and functional outcomes, significant reduction in total treatment time, and high rates of patient satisfaction have led to the postulation that the modern surgery-first orthognathic-approach concept may denote a reasonable and cost-effective pathway to manage dentoskeletofacial deformities, and has the potential to become the first-line orthognathic-surgery intervention in the future [18][19][20]. Despite published recommendation for selection of patients for the surgery-first approach [22,23], there are no unique criteria adopted by different centers and clinicians [15][16][17][18][19][20]24,[27][28][29][30][31][45][46][47][48][49][50][51][52][53]. While some patterns of presentation (e.g., Class III prognathism with open bite) have been considered as good candidates for the surgery-first approach, a wide spectrum of dental configurations have also been contemplated for surgery-first orthognathic surgery treatment [15][16][17][18][19][20][22][23][24][27][28][29][30][31][45]…”

Current Orthognathic Practice in India: Do We Need to Change?

“…The poor proprioception from such occlusal contacts can cause the patient to position the mandible in an incorrect manner. This might influence the long-term outcomes of the surgery [6][7][8].…”