Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis

Wei, Hongpu; Liu, Zhixu; Zang, Jiajie; Wang, Xudong

doi:10.1016/j.oooo.2018.02.018

Cited by 40 publications

(28 citation statements)

References 36 publications

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“…The various indications for the surgical approach prior to orthodontic correction include mild crowding, flat curve of spee, slight proclination/retroclination of incisors, minimal transverse discrepancies, patients with facial asymmetries and patients that may be having a cleft lip or palate [8][9][10].…”

Section: Indications and Contraindicationsmentioning

confidence: 99%

Surgery first approach in orthodontics: An updated review

Gailot¹,

Bulsara²,

Parakh³

et al. 2018

Dent Oral Craniofac Res

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Skeletal malocclusion appears to be one of the most commonly encountered problems in current orthodontics. SFA-surgical first approach in orthodontics, a fresh treatment concept has recently been seen trending in order to overcome dentofacial abnormalities. The sparking evidence of the quality treatment outcomes has created an appraisal in its use. Owing to its short-therapy time and prompt esthetic modification, SFA has turned out to be ideal treatment alternative for various complicated procedures. This article will provide an overview of the surgical first orthodontic approach.

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Section: Indications and Contraindicationsmentioning

confidence: 99%

Surgery first approach in orthodontics: An updated review

Gailot¹,

Bulsara²,

Parakh³

et al. 2018

Dent Oral Craniofac Res

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“…For example, the skeletal stability of the SFA and its difference from COST remains inconclusive. 1,24 The exact psychological effects of extended postsurgical orthodontics in the SFA need to be further investigated in the future. Emphasis should be placed on the criteria of patient selection for the SFA.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…Individuals with dental deformities often suffer from impaired oral function and inharmonious facial profile, thereby having lower quality of life (QoL). 1,2 However, it is estimated that approximately 5% of the general population have dentofacial deformities that are not amenable to orthodontic treatment only. 3 For these patients, therapy that combines orthodontic treatment and orthognathic surgery is required to obtain an ideal facial profile and stable occlusion.…”

Section: Introductionmentioning

confidence: 99%

Effect of surgery-first orthognathic approach on oral health-related quality of life:

Yao¹,

Zhu²,

Miao³

et al. 2020

The Angle Orthodontist

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Objectives To systematically evaluate the effect of the surgery-first approach (SFA) on oral health-related quality of life (OHRQoL) in patients with dentofacial deformities. Materials and Methods An electronic database search and hand search of selected journals and references were carried out. Studies investigating the OHRQoL of patients receiving SFA with or without a control group were included. The risk of bias was assessed by the Cochrane risk of bias tool in randomized clinical trials (RCTs) and the Newcastle-Ottawa Scale in non-RCTs. Results A total of seven articles met the eligible criteria and were included, of which six were cohort studies and one was an RCT, and six assessed the OHRQoL of the SFA with conventional orthodontic–surgical treatment (COST) as a control and one without. A total of 214 patients were examined, with sample sizes in studies ranging from 9 to 50. A total of 3 articles successfully measured the OHRQoL both before and after treatment in both the SFA and conventional orthodontic–surgical treatment groups. A total of six cohort studies were classified as low to moderate risk of bias, and the RCT was classified as high. Conclusions The SFA could improve the OHRQoL of patients with dentofacial deformities similar to conventional orthodontic–surgical treatment at the end of complete treatment. In addition, it increases OHRQoL immediately at the beginning of treatment without a deterioration.

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“…Albeit the success reported with this novel archetype of SFOA in the expeditious management of skeletal malocclusions and deformities/asymmetries, this procedure has been reported to be have certain disadvantages and limitations. Based on a recent meta-analysis,[28] a possible drawback of the SFOA approach could be a poorer postoperative stability as the mandible tends to rotate counterclockwise more in this group than in patients treated by the conventional triphasic approach. [19] This would indicate the importance of careful patient screening, accurate diagnosis, and careful review of the treatment plan to compensate for possible postoperative relapse when adopting SFOA.…”

Section: Discussionmentioning

confidence: 99%

Rationale, relevance, and efficacy of “surgery first, orthodontics later” approach in the management of cases of severe malocclusion with skeletal discrepancy

Jeyaraj¹,

Chakranarayan²

2019

Ann Maxillofac Surg

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A good esthetic outcome and optimal functional occlusion is the goal of management of any dentofacial anomaly. Conventional orthognathic surgery, as commonly practiced, entails a rather long-drawn management protocol comprising a triphasic treatment approach, with the surgical procedure being both preceded and followed by pre- and post-surgical orthodontics, respectively. This has numerous well-known drawbacks such as an uncertain and unpredictable patient compliance and poor motivation due to the inevitably long duration of orthodontic therapy; a transient and temporary worsening of the facial appearance brought about by presurgical orthodontic decompensation of occlusal relationships; and the inevitably prolonged time frame involved in ultimately achieving the desired esthetic and functional results. Further, unforeseen interruptions along the course of the long treatment period can result in unfavorable and even disastrous outcomes. The newer concept and technique of “Surgery First Orthodontics After” (SFOA) approach or “surgery-first approach” (SFA) entails first performing orthognathic surgery, thereafter following it up and finishing the case with postsurgical orthodontic settling and correction of the occlusion. It has two very distinct advantages over the erstwhile approach, first, an immediate and early correction of the facial deformity resulting in a remarkable improvement in facial appearance, which in most cases was what had prompted the patient to seek treatment for, in the first place. The patient, encouraged and motivated by the obvious and appreciable esthetic results, complies willingly and well with the subsequent postsurgical orthodontic treatment, even if it is lengthy or inconvenient, thus ensuring an optimal ultimate occlusion with complete functional rehabilitation as well. The second advantage of SFA is a markedly reduced overall treatment time, which is greatly appreciated by the patients. This article presents three cases of severe malocclusion with associated skeletal discrepancies, treated expeditiously and effectively using the SFA protocol. The overviews of SFA, including its rationale and relevance, indications, general and specific guidelines, different protocol variations, clinical outcome and success rate, as well as possible complications and potential problems encountered with this novel treatment protocol are also discussed.

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Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis

Cited by 40 publications

References 36 publications

Surgery first approach in orthodontics: An updated review

Surgery first approach in orthodontics: An updated review

Effect of surgery-first orthognathic approach on oral health-related quality of life:

Rationale, relevance, and efficacy of “surgery first, orthodontics later” approach in the management of cases of severe malocclusion with skeletal discrepancy

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