Surgery-First Approach in Class III Open-Bite

Abstract

Recently, surgical-orthodontic treatment without preoperative orthodontic treatment (known as the surgery-first approach or SFA) has been proposed to improve facial aesthetics from the beginning of treatment, to shorten the entire treatment period, and to take advantage of the regional accelerated phenomenon for orthodontic tooth movement. The SFA concept involves the prediction and simulation of dental alignment, incisor decompensation, and arch coordination using manual setup models. Based on this, decisions regarding the surgical movement of the maxilla and mandible can be made to correct skeletal discrepancies through manual model surgery (MMS). Although several three-dimensional (3D) virtual model surgery (VMS) programs have been introduced to reduce time-consuming manual laboratory procedures and potential errors, these programs still require three-dimensional-computed tomography data and involve complex computerized maneuvers. Because it is difficult to acquire 3D-computed tomographic scans in all cases, a 2.5-dimensional VMS program using two-dimensional lateral and posteroanterior cephalograms and 3D virtual dental models (3Txer version 2.5; Orapix, Seoul, Korea) has been introduced. In addition, because accurate prediction of postoperative orthodontic treatment is crucial for controlling dental alignment, incisor decompensation, arch coordination, and occlusal settling, a new 3D virtual orthodontic treatment system that can construct 3D virtual models, execute a 3D virtual setup, place virtual brackets at predetermined positions, and fabricate transfer jigs with customized bracket base for indirect bonding using a stereolithographic technique has also been developed. The purpose of this article was to introduce the methodology of 2.5-dimensional VMS and 3D virtual postoperative orthodontic treatment using a stereolithographic technique in SFA for a class III open-bite case.

Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review

“…The 2.5 virtual model surgery (VMS) system combines information of 2D lateral and posteroanterior cephalograms and 3D virtual models. 38 Oh et al 39 reported improved accuracy, reduced cost and duration and complexity, as compared to the manual technique using 2.5 VMS system. Uribe et al 40 and Ima et al 22 utilized the 3D VMS system consisting of 3D imaging technique and virtual models for treatment of subjects with skeletal Class III and facial asymmetry.…”

Factors Affecting Total Treatment Time in Patients Treated with Orthognathic Surgery Using the Surgery-First Approach: Multivariable Analysis Using 3D CT and Scanned Dental Casts

“…Several other studies on the SFA have reported relevant cases. Villegas reported the use of SFA in patients with facial asymmetry [20], and Oh et al reported a patient with an open bite treated using the SFA [21]. Wang et al studied the transverse dimensional changes using posteroanterior cephalograms and reported no marked differences between patients treated with the SFA and those treated with the orthodontics-first approach [22].…”

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

“…Formerly, the case with anticipated open bite after surgery would be discouraged by the SFA [7, 27]. However, it had been reported that open bite could be successfully treated by the SFA [31]. Currently, the indication barriers for the SFA are continuously changing and are sometimes overcome by technological advancements.…”