Surgery First in Orthognathic Surgery: What Have We Learned? A Comprehensive Workflow Based on 45 Consecutive Cases

Evaluation of Postoperative Mandibular Positional Changes After Mandibular Setback Surgery in a Surgery-First Approach: Isolated Mandibular Surgery Versus Bimaxillary Surgery

“…The SFA has become a treatment option for surgical and orthodontic treatment because of its clinical success in past decades; however, postoperative stability remains a concern for surgeons and orthodontists. 1,5,10,11,16,23 Although several studies have reported similar postoperative stability in the SFA and OFA, 21,24,25 some studies also have reported less stable results. 3,11,25 Kim et al 11 evaluated postoperative stability in 60 patients who underwent mandibular setback surgery using the OFA or SFA.…”

“…9 For the patient selection for the SFA, several indications have been suggested: 1) good alignment of mildly crowded anterior teeth, 2) flat to mild curve of Spee, and 3) normal to mild proclination or retroclination of the incisor. 1,7,[10][11][12] Cases with severe crowding, vertical or transverse discrepancy, or asymmetries have been usually excluded from the SFA. However, indications for the SFA have broadened gradually with the accumulation of experience.…”

“…13 For perioperative complications, the SFA might not necessarily have greater technical complexity than the orthodontics-first approach (OFA), because surgical techniques for the SFA do not differ from those for the OFA. 10,14 However, a less stable and less predictable treatment outcome has been reported as one of the most important concerns in the SFA. 3,11,15 In contrast to the OFA, surgical occlusion in the SFA can be unstable with occlusal interference.…”

Surgery-first Approach

“…Furthermore, the operating surgeon should be capable of aligning the skeletal components to exactly match the estimated skeletal orientations and occlusion perfectly. 7 The SFA creates a semistable postsurgical occlusion in comparison with the conventional approach due to its disposition without presurgical orthodontic therapy. Hence, rigid internal fixation has been advised for preserving the occlusal stability postsurgically.…”

“…Thus, any attempt at tooth movement potentially resulted in change in the orientation of the skeletal components. 7 The SFA is executed with bilateral sagittal split osteotomy (BSSO) with or without genioplasty and LeFort I osteotomy. 5 This approach is advisable in cases that require little or no presurgical orthodontic preparation (alignment and decompensation).…”