Clinical Application of Surgery-First Orthognathic Surgery in Patients with Class III Dentofacial Deformities

Dentofacial deformities (DFD) presenting mainly as Class III malocclusions that require orthognathic surgery as a part of definitive treatment. Class III patients can have obvious signs such as increasing the chin projection and chin throat length, nasolabial folds, reverse overjet, and lack of upper lip support. However, Class III patients can present different facial patterns depending on the angulation of occlusal plane (OP), and only bite correction does not always lead to the improvement of the facial esthetic. We described two Class III patients with different clinical features and inclination of OP and had undergone different treatment planning based on 6 clinical features: (I) facial type; (II) upper incisor display at rest; (III) dental and gingival display on smile; (IV) soft tissue support; (V) chin projection; and (VI) lower lip projection. These patients were submitted to orthognathic surgery with different treatment plannings: a clockwise rotation and counterclockwise rotation of OP according to their facial features. The clinical features and OP inclination helped to define treatment planning by clockwise and counterclockwise rotations of the maxillomandibular complex, and two patients undergone to bimaxillary orthognathic surgery showed harmonic outcomes and stables after 2 years of follow-up.

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Surgery-First Orthognathic Approach

Oral and Maxillofacial Surgery for the Clinician ◽

10.1007/978-981-15-1346-6_67 ◽

2021 ◽

pp. 1463-1475

Author(s):

N. Viveka Vardhan Reddy ◽

Abhinand Potturi

Keyword(s):

Orthognathic Surgery ◽

Treatment Time ◽

Prolonged Treatment ◽

Overall Treatment Time ◽

Recent Advances ◽

Dentofacial Deformities ◽

Surgery First ◽

Spatial Positioning ◽

Technical Considerations

AbstractTraditionally, for correction of dentofacial deformities “orthodontics first” protocol has been universally adopted wherein the surgery is performed after the goals of the presurgical orthodontics have been achieved. The advantages of orthodontics first approach like preoperative leveling of arches and establishing overjet and overbite relationship by decompensation will help in accurate spatial positioning of maxillomandibular complex during surgery. However, prolonged treatment time and initial worsening of the deformity during decompensation has always been its shortcoming.The concept of “Surgery First Orthognathic Approach (SFOA)” challenges the traditional protocol by overcoming its principal disadvantages. In SFOA, the Orthognathic surgery is performed before any orthodontics is initiated and this will help in shortening the overall treatment time, thereby increasing the patient’s compliance and acceptance towards the treatment in a better way. This chapter is intended to apprise on the details of planning, indications, contraindications, advantages and technical considerations of SFOA and also throws light on the recent advances pertaining to SFOA.

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