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

Despite the evident benefits of the modern surgery-first orthognathic surgery approach (reduced treatment time, efficient tooth decompensation, and early improvement in facial esthetics), the challenge of the surgical-occlusion setup acts as a hindering factor for the widespread and global adoption of this therapeutic modality, especially for the management of cleft-skeletofacial deformity. This is the first study to assess three-dimensional (3D) quantitative data of the surgical-occlusion setup in surgery-first cleft-orthognathic surgery. This comparative retrospective study was performed on 3D image datasets from consecutive patients with skeletal Class III deformity who had a unilateral cleft lip/palate (cleft cohort, n = 44) or a noncleft dentofacial deformity (noncleft cohort, n = 22) and underwent 3D computer-assisted single-splint two-jaw surgery by a single multidisciplinary team between 2014 and 2018. They received conventional orthodontics-first or surgery-first approaches. 3D quantitative characterization (linear, angular, and positional measurements) of the final surgical-occlusion setup was performed and adopted for comparative analyses. In the cleft cohort, the occlusion setup in the surgery-first approach had a significantly (all p < 0.05) smaller number of anterior teeth contacts and larger incisor overjet compared to the conventional approach. Considering the surgery-first approach, the cleft cohort presented significantly (all p < 0.05) larger (canine lateral overjet parameter) and smaller (incisor overjet, maxillary intercanine distance, maxillary intermolar distance, ratio of intercanine distance, and ratio of intermolar distance parameters) values than the noncleft cohort. This study contributes to the literature by providing 3D quantitative data of the surgical-occlusion setup in surgery-first cleft-orthognathic surgery, and delivers information that may assist multidisciplinary teams to adopt the surgery-first concept to optimize cleft care.

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The Comparison of Patient Satisfaction after “Surgery First” and Conventional Orthognathic Surgery: An Original Research

APOS Trends in Orthodontics ◽

10.4103/apos.apos_18_17 ◽

2017 ◽

Vol 7 ◽

pp. 123-129 ◽

Cited By ~ 1

Author(s):

Pritam Mohanty ◽

Swati Saraswata Acharya ◽

Nivedita Sahoo ◽

Sushila Sah ◽

Sanjeeb Kumar Sahu

Keyword(s):

Patient Satisfaction ◽

Orthognathic Surgery ◽

Rating Scale ◽

Common Factor ◽

Original Research ◽

Analog Scale ◽

Facial Esthetics ◽

Point Rating Scale ◽

Surgery First ◽

Open Question

Aims and Objectives We evaluated the factors which affect patient satisfaction and their expectations toward “surgery first” and conventional orthognathic surgery. Materials and Methods Questionnaires consisting of 17 questions were given to the subjects postoperatively who had undergone Le fort 1 maxillary superior impaction for skeletal gummy smile correction with conventional orthognathic surgery and “surgery first” approach. Eleven-point rating scale based on a (visual analog scale; 0 = poor; 10 = excellent) were used to answer six questions. Ten closed-form questions were also included as well as one open question for “further remarks.” Results Nineteen patients (12 females, 07 males; mean age, 23.4 ± 4.9 [standard deviation] years) gave their consent to participate in the study. The intention to undergo surgery only for esthetics was noted in 42.11% of patients; only improvement of chewing function in 21.05% and both in 36.84%. Conclusion The most common factor for patient satisfaction after “surgery first” and conventional orthognathic surgery was facial esthetics, but masticatory function and even psychological aspects should be considered equally when planning surgery. The patient satisfaction was more in “surgery first” than conventional orthognathic surgery. The timing of treatment and immediate results are important factors toward patient satisfaction.

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Surgery-first orthognathic surgery with computer assisted three-dimensional planning

Seminars in Orthodontics ◽

10.1053/j.sodo.2018.10.007 ◽

2018 ◽

Vol 24 (4) ◽

pp. 430-442

Author(s):

Jorge Faber ◽

Letícia Miranda ◽

Carolina Faber ◽

Patrícia Valim ◽

Leandro S. Bicalho ◽

...

Keyword(s):

Orthognathic Surgery ◽

Three Dimensional ◽

Computer Assisted ◽

Surgery First

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Surgery-first or orthognathic surgery approach: Psychosocial and physical changes

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.259 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S147-S147

Author(s):

E. Gambaro ◽

C. vecchi ◽

C. Gramaglia ◽

A. Losa ◽

M. Giarda ◽

...

Keyword(s):

Quality Of Life ◽

Orthognathic Surgery ◽

Orthodontic Treatment ◽

Short Form ◽

Self Esteem ◽

Care Quality ◽

Surgical Approaches ◽

Facial Esthetics ◽

Surgery First

IntroductionTwo surgical approaches exist for malocclusion: in the surgery-first approach the orthognathic surgery precedes the orthodontic treatment, treating facial esthetics first and then occlusion, whereas in the conventional approach (the orthodontics-first approach) the orthodontic treatment precedes the orthognathic surgery, treating occlusion first and then facial esthetics. The advantages of the surgery-first approach include the fact that patient's dental function, and facial esthetics are restored and improved soon after the beginning of treatment. Moreover, the entire treatment lasts only 1 to 1.5 years or less and orthodontic management is easier to achieve.AimsOur study aims to compare patients undergoing surgery-first or orthognathic surgery approach as for as self-esteem, satisfaction with their appearance in the pre- and postoperative care, quality of life and psychosocial changes, are concerned.MethodsWe recruited 50 patients undergoing surgery-first or orthognathic surgery approach at SC Maxillo-Facciale of Novara between October 2014 and December 2017. Assessment were performed at baseline (T0) and at follow-up (T1: 5 weeks; T2: 5–6 months), with Rosenberg Self-Esteem Scale (RSES), Temperament and Character Inventory (TCI: only at T0), Short Form Health Survey 36 (SF-36), Beck Depression Inventory (BDI-II), Resilience Scale for Adult (RSA), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), Oral Health Impact Profile (OHIP-14).ResultsData collection is still ongoing. We expect to find a better quality of life and higher self-esteem in patients undergoing surgery first approach.ConclusionSatisfaction is crucial for patients’ adherence to treatment and to avoid revolving door. Clinical implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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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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Differential Diagnosis of Skeletal Class II: Orthodontic-Surgical Approach with Surgery First

Journal of Health Sciences ◽

10.17921/2447-8938.2021v23n4p257-263 ◽

2021 ◽

Vol 23 (4) ◽

pp. 257-263

Author(s):

Jessica Rico Bocato ◽

Daiara Paula Pacheco ◽

Mauro Toma ◽

Ricardo Lima Navarro ◽

Thais Maria Freire Fernandes ◽

...

Keyword(s):

Orthognathic Surgery ◽

Treatment Time ◽

Class Ii ◽

Class Ii Malocclusion ◽

Facial Profile ◽

Skeletal Class ◽

Angle Class Ii ◽

Main Complaint ◽

Skeletal Class Ii ◽

Surgery First

AbstractOrthodontic-surgical treatment with the “Surgery First Approach” provides immediate facial aesthetic improvements and significantly reduces the patient's orthodontic treatment time, avoiding the transient worsening of the facial profile due to dental decompensation that occurs in surgical cases. Thus, this clinical case describes the retreatment of a 22-year-old female leukoderma patient, whose main complaint was related to the proclination of upper and lower incisors. The patient used a mio-relaxing plate for 30 days, which evidenced the skeletal mandibular deficiency and the ½ bilateral Class II malocclusion. Orthognathic surgery first approach associated with the extraction of the 4 premolars was chosen considering the patient’s aesthetic demand. The use of a mio-relaxing plate in the diagnostic stage was essential for the real diagnosis of mandibular deficiency and the technique employed made it possible to conclude the treatment avoiding aesthetic commitment, with excellent results. Keywords: Malocclusion, Angle Class II. Orthognathic Surgery. Orthodontics, Corrective. ResumoO tratamento ortodôntico-cirúrgico por meio do benefício antecipado proporciona melhorias estéticas faciais imediatas e reduz de maneira significativa o tempo de tratamento ortodôntico do paciente, evitando a piora transitória do perfil facial devido à descompensação dentária que ocorre em casos cirúrgicos. Assim, este caso clínico descreve o retratamento de uma paciente com 22 anos de idade, leucoderma, sexo feminino, que apresentava queixa principal relacionada à inclinação vestibular dos dentes anteriores. Após uso de placa miorrelaxante por 30 dias, verificou-se a presença de Classe II esquelética com deficiência mandibular e ½ Classe II dentária bilateral. Considerando a demanda estética da paciente, optou-se pela abordagem ortodôntico-cirúrgica com Benefício Antecipado associada à extração de 4 pré-molares para correção da inclinação dentária anterior. O uso da placa miorrelaxante foi fundamental para o diagnóstico real da deficiência mandibular e a técnica empregada possibilitou concluir o tratamento evitando o comprometimento estético pré-cirúrgico, com obtenção de excelentes resultados. Palavras-chave: Maloclusão Classe II de Angle. Cirurgia Ortognática. Ortodontia Corretiva.

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Factors Affecting Total Treatment Time in Patients Treated with Orthognathic Surgery Using the Surgery-First Approach: Multivariable Analysis Using 3D CT and Scanned Dental Casts

Journal of Clinical Medicine ◽

10.3390/jcm9030641 ◽

2020 ◽

Vol 9 (3) ◽

pp. 641

Author(s):

Jun-Young Kim ◽

Jin Hoo Park ◽

Hwi-Dong Jung ◽

Young-Soo Jung

Keyword(s):

Orthognathic Surgery ◽

Treatment Time ◽

Open Bite ◽

3D Ct ◽

Anterior Open Bite ◽

Factors Affecting ◽

Contact Points ◽

Total Treatment Time ◽

Total Treatment ◽

Surgery First

The aim of this study was to analyze factors affecting treatment times in patients treated with the surgery-first approach (SFA) for orthognathic surgery. Fifty skeletal class III patients who had undergone SFA bimaxillary orthognathic surgery were enrolled. Retrospective chart reviews and analysis of 3D CT and digitally scanned casts were conducted to assess the total treatment time. Statistical analysis was then performed with multiple study variables. Longer treatment times were required for patients with severe maxillary or mandibular teeth crowding (p = 0.009), a preoperative anterior open bite (p = 0.021), and those undergoing orthodontic extractions (p < 0.001). Longer treatment times were also observed when setting surgical occlusion in the postoperative anterior open bite (p = 0.007) and in patients with postoperative dental midline deviation (p < 0.001) and transverse maxillary deficiencies (p = 0.035). Treatment times were shorter when a class I molar key was formed in the surgical occlusion setup (p = 0.002) and in bilateral anterior and posterior occlusion with a minimum of four contact points (p < 0.001). The number of contact points, the number of extracted teeth, and postoperative midline deviation were identified as significant predictors. These results suggest that proper patient selection is important when considering SFA and that surgeons can reduce total treatment time with an appropriate surgical occlusion setup.

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Periodontally compromised severe skeletal Class III with open bite corrected by orthodontic camouflage using temporary anchorage devices

APOS Trends in Orthodontics ◽

10.25259/apos_129_2019 ◽

2020 ◽

Vol 10 ◽

pp. 253-258

Author(s):

Adith Venugopal ◽

M. Srirengalakshmi ◽

Anand Marya ◽

Paolo Manzano

Keyword(s):

Orthognathic Surgery ◽

Treatment Options ◽

Open Bite ◽

Class Iii ◽

Class Iii Malocclusion ◽

Anterior Open Bite ◽

Skeletal Class ◽

Temporary Anchorage Devices ◽

Anterior Teeth ◽

Facial Esthetics

A variety of treatment options may be implemented on a Class III malocclusion associated with skeletal discrepancy ranging from functional orthopedics at an early age to orthognathic surgery in adults. In the current scenario, many Class III malocclusion patients are referred for orthognathic surgery without even considering the options of an orthodontic camouflage, as orthodontists do not want to burden themselves with the tedious treatment planning and risks involved with treating such cases. This case report describes a 27-year-old female diagnosed with a skeletal Class III malocclusion, severe open bite, and periodontally compromised dentition. Although orthognathic surgery was proposed as the best treatment modality, it was denied by the patient due to financial and psychological constraints. She was treated with mild upper arch expansion using archwires and upper premolar intrusion using temporary anchorage devices (TADs) alongside retraction of lower anterior teeth using TADs and intermaxillary elastics. At the end of 18 months of active treatment, a decent result was achieved with good occlusion and facial esthetics. Post-treatment results showed an improved profile and Class I canine relationships, with optimal overjet and overbite. The anterior open bite was corrected, and the overall facial balance was greatly improved. Extraoral photographs displayed a relaxed lip closure and an esthetic smile meeting the patient’s expectations. Two-year follow-up records demonstrated a stable occlusion and optimal facial esthetics.

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Surgery-first Approach

World Journal of Dentistry ◽

10.5005/jp-journals-10015-1462 ◽

2017 ◽

Vol 8 (4) ◽

pp. 343-350

Author(s):

Yash A Shah ◽

Shailesh V Deshmukh ◽

Amol S Patil

Keyword(s):

Orthognathic Surgery ◽

Tooth Movement ◽

Treatment Time ◽

Orthodontic Tooth Movement ◽

Conventional Approach ◽

Treatment Protocols ◽

Orthodontic Therapy ◽

Total Treatment Time ◽

Total Treatment ◽

Surgery First

ABSTRACT Aim This article is intended to provide an overview of the Surgery First Approach (SFA) mainly including case selection, diagnosis, treatment protocols, success rate and the potential problems encountered. Background The most important indication of the need for orthognathic surgery is usually the psychosocial effect resulting from the unaesthetic appearance of a dentofacial deformity. The conventional approach in treatment of such deformities till today has been an orthodontics-first approach. Review Results Available evidence suggest that both the SFA and the conventional approach had similar outcomes in dentofacial relationships however the relapse tendency was greater with the SFA but the total treatment duration was substantially shorter. Conclusion SFA treats facial aesthetics (and the skeletal malrelation) first and then occlusion, i.e. orthognathic surgery antecedes the orthodontic therapy. The concept of this technique is to utilize orthognathic surgery to eliminate the displeasing pre-surgical facial profile and promptly accomplish facial aesthetic enhancement that is usually the patient's chief complaint at the beginning of the treatment. SFA also facilitates accelerated orthodontic tooth movement thus reducing the length of post-surgical orthodontic therapy. Clinical Significance The optimal esthetic and functional results, significant reduction in total treatment time and high patient satisfaction led us to the postulation that SFA may represent a reasonable, cost-effective method to manage skeletal malocclusions in selected cases and that it has the potential to become a standard approach to orthognathic surgery in the future. How to cite this article Shah YA, Deshmukh SV, Patil AS. Surgery-first Approach. World J Dent 2017;8(4):343-350.

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