The impact of surgery-first approach on the oral health-related quality of life: a systematic review and meta-analysis

Abstract

Background The oral health-related quality of life (OHRQoL) is affected by dentofacial deformity. Patients with dentofacial deformity are normally treated with orthognathic surgery, including conventional three-stage method (CTM) and surgery first approach (SFA). The aim of this systematic review and meta-analysis was to compare the impact of SFA with CTM on the OHRQoL of patients with severe dentofacial deformity. Methods Five English databases, three Chinese databases, and six grey literature databases were searched (January 2000 to July 2018). Randomized controlled trials, controlled clinical trials, and cohort studies assessing the OHRQoL of patients who underwent SFA or CTM were included. After selecting studies, extracting data, and assessing risk-of-bias according to the Cochrane Handbook for Systematic Reviews of Interventions and the Newcastle-Ottawa Scale, meta-analysis was performed to elucidate the effects of SFA on the changes of OHRQoL of patients with dentofacial deformity at each stage and made a comparison with CTM. Results There were 4 studies with 122 participants were selected for the final analysis. Three among these studies were included in meta-analysis, 2 of which were included in each forest plot. All the included studies were graded as moderate value of evidence according to GRADE quality analysis. Over the period of 2-year follow-up after bonding, the OHRQoL of the patients in SFA group showed an improving trend and was better than those in CTM group generally. After debonding, the summary scores of the 14-item Oral Health Impact Profile (OHIP-14) (− 2.92, P = 0.12) and Orthognathic Quality of Life Questionnaire (OQLQ) (− 5.59, P = 0.01) were smaller in SFA group than CTM group. Conclusions Clinical evidence indicates that SFA can contribute to the better OHRQoL in patients with dentofacial deformity immediately and persistently.

Surgery-first for a patient with mild hemifacial microsomia: A case report and review of literature

“…Some of them are eager to improve their facial aesthetics and want to prevent the progressive deterioration of their facial appearance that can occur with presurgical orthodontics. A meta-analysis on the impact of the SFA indicated that SFA can immediately and persistently contribute to better oral health-related quality of life in patients with dentofacial deformities[ 20 ]. The SFA not only promotes rapid improvement in facial appearance but also considerably reduces the overall treatment time by eliminating the time-consuming presurgical orthodontic stage and facilitating tooth movement after surgery.…”

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

“…approach than surgery-first noncleft-orthognathic surgery approach, which clinically represents the cleft-associated dental anomalies and transverse maxillary collapse. 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].…”

“…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]…”

“…A modern orthognathic pathway (or surgery-first approach) has recently been introduced into the armamentarium of multidisciplinary teams treating dentoskeletofacial deformities [15][16][17]. Surgical intervention preceding orthodontic treatment has evident advantages over the conventional orthodontics-first approach, including immediate postoperative improvement of facial appearance and a substantial reduction of total treatment time [18][19][20]. However, the rate of surgery-first approach-related complications may be slightly higher than those associated with orthodontics-first approach [21], which should be considered by multidisciplinary teams delivering orthognathic care.…”

“…In this setting, published guidelines have directed multidisciplinary teams during the decision-making process of selecting patients for the surgery-first approach [22,23]. Most surgery-first-related studies have reported patients with Class III malocclusion with no associated congenital anomaly [18][19][20], with cleft-related deformity being considered as an exclusion criterion for the surgery-first approach [24]. Patients with repaired cleft lip and palate have a significant aesthetic impairment [25] and the main benefit of surgery-first approach is an immediate increase of the quality of life after surgery, due to the improvement of facial appearance [26].…”