Surgery-first orthognathic approach: A “scoping review” for mapping outcomes and plausible recommendations to develop core outcome sets

Abstract

Aims and Objectives The aim of this scoping review was to identify the type of outcomes measured in surgery- first orthognathic approach (SFOA). The objectives were to classify the outcomes into predetermined domains and explore the degree of representation of each domain. Furthermore, to identify which domains are over- or under-represented and determine whether the findings of this scoping review could be employed to provide a template for core outcome sets (COS). Five outcomes were identified, and all the research pertinent to SFOA were assigned to these outcomes. Materials and Methods Electronic databases and additional records were searched from January 2009 to March 2019 to source the data, and 525 records were identified. Results The initial database and additional search resulted in 525 records, of which 54 potentially relevant articles were retrieved in full. 35 studies met the selection criteria following screening and were included in the scoping review with the results of the search depicted in the preferred reporting items for systematic reviews and meta-analyses. Domains such as morphological features or changes in maxillofacial skeleton and occlusion (n = 25, 71.42%) and psychosocial well-being including quality of life outcome (n = 8, 22.85%) were well represented while functional status (n = 1, 2.85%), health resource utilization (n = 0), and adverse effects (n = 1, 2.85 %) were under-represented. Conclusions Limited research on SFOA precludes development of COS. However, future SFOA clinical trials should consider underrepresented outcome domains to address the SFOA treatment modality comprehensively.

Surgery-as-soon-as-Feasible: A Challenge to One Major Premise of the Surgery-First Approach

“…The socalled Rapid Acceleratory Phenomenon (the RAP effect) is very much considered when deciding when the appropriate amount of presurgical orthodontic preparation has been achieved [7,9]. The use of skeletal orthodontic anchorage is acknowledged to be effective in controlling movements of individual teeth, or groups of teeth-or in fact entire arches in certain surgical and non-surgical situations [1,5]. Three-dimensional imaging, planning and treatment technology will continue to be developed to the advantage of all those involved in all types of orthognathic treatment [2,18].…”

“…By all accounts, in skilled hands, Surgery-first has been shown to be an effective way in which various dentofacial problems can be managed [4]. It has also been acknowledged by its proponents, however that, at this stage, it is not necessarily appropriate for management of all surgical cases [5]. Like Surgery-as-soon-as-feasible, Surgery-first may involve extractions and/or expansion.…”

“…It has also been pointed out that the Surgery-first approach may not be appropriate anyway for all patients being considered for three-dimensional orthognathic surgery [4]. In the hands of Surgery-first-experienced orthodontists and surgeons, the published results of treatment appear to be very goodfor the surgical correction of a number of (but not all) dentofacial conditions [5].…”

Scoping studies: Should there be more in orthodontic literature?

“…Orthodontics has been a slow starter on this terrain. [1] e role of a scoping study in relation to other types of literature reviews is a topic for interesting discussions! I see many young academics wanting to teach "Evidencebased Literature" to residents focusing on published systematic reviews (which are far and few in our specialty) in orthodontic literature.…”