Postoperative stability for surgery-first approach using intraoral vertical ramus osteotomy: 12 month follow-up

Mapping the evolving trend of research on Class III malocclusion: a bibliometric analysis

OBJECTIVES

This study aimed to provide visualized knowledge maps to show the evolving trends and key focal points of Class III malocclusion research through a comprehensive bibliometric analysis.

MATERIALS AND METHODS

Class III malocclusion research published between 2000 and 2023 was retrieved from the Web of Science Core Collection. VOSviewer was utilized to count the citation and publication number of authors, institutions, countries and journals. Co-occurrence, co-citation, and cluster analyses and burst detection were conducted using CiteSpace.

RESULTS

A total of 3,682 publications on Class III malocclusion were included in the bibliometric analysis. During 2000-2023, both the annual publication count and citation frequency exhibited a gradual upward trajectory, with a noticeable surge in recent years. In terms of production and citation counts of Class III malocclusion research, the core journal is the American Journal of Orthodontics and Dentofacial Orthopedics. Furthermore, apart from the primary keyword 'Class III malocclusion', 'orthognathic surgery' was identified as keyword with the most frequency. The cluster analysis of cited references reveals that the research focal points have shifted to 'skeletal anchorage' and 'surgery-first approach'. Furthermore, the burst detection identified 'quality of life' as a potential research hotspot since it has recently gained increasing scholarly attention.

CONCLUSIONS

The current study provides scholars with the knowledge maps of evolving trends and prominent topics of Class III malocclusion research and a summary of research progress on various priorities during different periods. These findings are expected to provide a valuable guidance to facilitate the future research on Class III malocclusion.

The surgery-first approach for orthognathic correction of maxillary deficiency-is it stable? Three-dimensional assessment of CBCT scans and digital dental models

The aim of this study was to determine the skeletal stability of Le Fort I maxillary advancement following the surgery-first approach, by three-dimensional (3D) assessment of cone beam computed tomography (CBCT) scans and digital dental models. CBCT scans of 25 class III patients obtained 1 week preoperatively (T0) and 1 week (T1) and 6 months (T2) postoperatively were superimposed to measure surgical movements (T0-T1) and skeletal relapse (T1-T2). The distorted dentition of the CBCT scans at T1 was replaced with 3D images of the dental models to assess the postoperative occlusion. Surgical movements of the maxilla (mean ± standard deviation values) were 6.79 ± 2.30 mm advancement, 1.28 ± 1.09 mm vertically, and 0.71 ± 0.79 mm mediolaterally. Horizontal rotation (yaw) was 1.56° ± 1.21°, vertical rotation (pitch) 1.86° ± 1.88°, and tilting (roll) 1.63° ± 1.54°. At T2, the posterior relapse was 0.72 ± 0.43 mm (P = 0.001) and relapse in pitch was 1.56° ± 1.42° (P = 0.007). There was no correlation between the size of the surgical movements and the amount of relapse. A weak correlation was noted between the number of teeth in occlusal contact immediately following surgery and relapse of maxillary roll (r = - 0.434, P = 0.030). The stability of maxillary advancement with the surgery-first approach was satisfactory and was not correlated with the quality of the immediate postoperative occlusion.

Three-dimensional evaluation of postoperative stability: a comparative study between surgery-first and surgery-late protocols

The main objective of this study was to compare the stability of the surgery-first and surgery-late approaches according to the standardized centre protocols, by three-dimensional evaluation after 1 year of follow-up. A retrospective study was designed that included a test group (surgery-first protocol) and a control group (surgery-late protocol), with a follow-up period of at least 1 year (average 14 months; range 12-24 months). Stability was evaluated using linear and angular measurements by superimposing cone beam computed tomography images obtained at specific points in time: preoperatively, 1 month after surgery, and at the end of the orthodontic treatment. A total of 56 patients with a mean age of 32.2 ± 11.1 years were included in the study. After surgery there were significant changes in all of the measurements in at least one dimension in both groups (except for the transverse maxillary dimension), which remained stable at the end of the treatment, with no statistically significant differences between the two groups. At the 1-year follow-up, both groups presented a SNA angle relapse; this relapse was more significant in the surgery-late group (P = 0.031) and was present only in Class III patients (P = 0.013). In conclusion, an equivalent three-dimensional stability between surgery-first and surgery-late protocols was demonstrated after 1 year of follow-up when eligibility criteria were strictly adhered to.

Reliability of Anterior Nasal Spine as a Reference Point After LeFort I Surgery Using Three-Dimensional Analysis

ABSTRACT

To evaluate the stability of maxilla following orthognathic surgery, it is necessary to consider the positional change of various landmarks according to bone remodeling of the maxilla. This study aimed to evaluate the stability of the anterior nasal spine (ANS) as a reliable landmark after orthognathic surgery. Forty-seven patients with skeletal class III malocclusion who underwent bimaxillary orthognathic surgery were included. Skeletal changes were measured using cone-beam computerized tomography at 3 time points: preoperative (T0), 1-month postoperative (T1), and 12-month postoperative (T2). Linear changes of the 6 landmark points of the maxilla were measured in 3 directions: anteroposterior, vertical, and transverse. The data were analyzed with paired t tests, independent t tests, and multiple regression analysis. At 12-month postoperatively, the ANS showed mean (standard deviation) 1.23 (1.07) mm posterior movement (P = 0.00), while other landmarks did not show positional changes, implying bony resorption of ANS. Multiple regression test showed surgical forward movements of ANS (T1-0) affect the postoperative backward changes (β = -.05, P < 0.05). There was a negative correlation between the surgical movement and postoperative change of ANS by Pearson correlation test (r = -0.38, P < 0.05). The ANS is not a reliable measurement point in three-dimensional superimposition after orthognathic surgery. Therefore, in studying the stability and positional change pattern after LeFort I surgery, it is not recommended to use ANS as a reference point, as changes can occur in the measurement point itself.

Patient First: Surgery First and More

INTRODUCTION

The success of surgery first approach has been defined by the number of advantages offered and is definitively determined by the satisfaction of the patients themselves. The strength of this protocol resides in its philosophy that puts the patient at the center of the whole diagnostic-therapeutic process. The compliance of the patient, its happiness and comfort are the best guarantee of a good final results. While pursuing this philosophy we have wondered whether there was way to increase the comfort of surgery first approach even more and to make it even more appealing for the patients. For these reasons, we have decided to work on a preliminary protocol in order to reduce or even eliminate the use of orthodontic braces and wires during perioperative stages. Materials and Methods: No orthodontic braces or wires are bonded on the teeth before surgery. Intraoperatory intermaxillary fixation (IMF) is carried out with the use of IMF screws which are positioned at the beginning of the operation on the edge between keratinized and nonkeratinized gingiva. Once the osteotomies are performed IMF with IMF screws is carried out on the planned occlusion with the use of surgical splints.Discussion and Conclusions: In selected cases the postsurgical orthodontic treatment can be carried out with the use of clear aligners, completely eliminating the need of braces and wires with an additional level of comfort.

An orthodontic index assessment and its relationship with total treatment time in surgery first orthognathic approach: an observational study

BACKGROUND

The aim of this study is to highlight the connection between orthodontic difficulty before surgical treatment and in the transient malocclusion as evaluated by the mean of the ICON score and total treatment time in SFA.

MATERIALS

For each patient, the ICON score was evaluated pre-operatively and on the 3rd post-operative day in order to assess the orthodontic difficulty of pre-surgical occlusion and the transient malocclusion.

RESULTS AND CONCLUSION

Our group of patients at the preoperative stage showed score values between hard and very hard with only one patient scored as "easy" and nine "medium" patients. All scores lowered after surgical treatment. This confirms that the surgery first approach can change a malocclusion from not orthodontically treatable to an orthodontically treatable one. In our study, this was objectified by improvements in the ICON score. In the conventional three-phase approach of orthognathic surgery the total treatment time found in literature is around 18-36 months. In our study, even the most difficult cases do not have a duration of more than 15 months This demonstrates that the surgery-first approach can reduce the total treatment time even in more severe cases.

Current concept of the surgery-first orthognathic approach

Traditional orthognathic surgery has long been performed after presurgical orthodontic treatment. Despite some concerns, the surgery-first orthognathic approach (SFOA) or surgery-first approach (SFA) without presurgical orthodontic treatment has gradually gained popularity. In recent years, several articles dealing with the concepts of the SFA have been published worldwide. However, the SFA has not yet been standardized, and many surgeons use slightly different protocols and concepts. This review article discusses the beginning and evolution of the SFA and its current concepts, including some opinions based on the authors’ clinical experiences over the last 15 years. According to recent investigations, the SFA could be applied effectively in several situations including class III malocclusion, class II malocclusion, and facial asymmetry. However, debate on the SFA continues and many issues remain to be resolved. This review article addresses the current issues regarding the SFOA, including its advantages and disadvantages, as well as its indications and contraindications. The authors summarize various aspects of the SFA and expect that this review article will help surgeons and orthodontists better understand the current status of the SFA.

Surgery first approach in orthognathic surgery - Considerations and clinical case report

The Rationale:

The surgery first approach is a safe and stable procedure for the correction of dentofacial deformities that requires little orthodontic correction, leading to a faster return of functions.

Patient Concerns:

Patient with facial discrepancies seeks treatment that returns function and aesthetics, requiring a less prolonged treatment with adequate results.

Diagnosis:

Clinical, facial, and radiological image analysis was used for diagnosis and treatment plan.

Treatment:

Surgery first approach was performed in a patient with facial pattern II dolichocephalic, vertical maxillary excess, mandibular growth deficiency, aesthetic, and functional complaints, with the completion of the orthodontic treatment in 15 months.

Outcomes:

Follow-up of 36 months showed no evidence of recurrence of the initial condition and occlusal stability was maintained. The patient had no more functional and aesthetic complaints.

Take-away Lessons:

Aesthetic and functional improvements were observed more rapidly due to the correction of the skeletal deformity, with improvement in behavior and self-esteem.

Positional changes in the mandibular proximal segment after intraoral vertical ramus osteotomy: Surgery-first approach versus conventional approach

Objective

To compare postoperative positional changes in the mandibular proximal segment between the conventional orthognathic surgery (CS) and the surgery-first approach (SF) using intraoral vertical ramus osteotomy (IVRO) in patients with Class III malocclusion.

Methods

Thirty-eight patients with skeletal Class III malocclusion who underwent bimaxillary surgery were divided into two groups according to the use of preoperative orthodontic treatment CS group (n = 18) and SF group (n = 20). Skeletal changes in both groups were measured using computed tomography before (T0), 2 days after (T1), and 1 year after (T2) the surgery. Three-dimensional (3D) angular changes in the mandibular proximal segment, condylar position, and maxillomandibular landmarks were assessed.

Results

The mean amounts of mandibular setback and maxillary posterior impaction were similar in both groups. At T2, the posterior portion of the mandible moved upward in both groups. In the SF group, the anterior portion of the mandible moved upward by a mean distance of 0.9 ± 1.0 mm, which was statistically significant (p < 0.001). There were significant between-group differences in occlusal changes (p < 0.001) as well as in overjet and overbite. However, there were no significant between-group differences in proximal segment variables.

Conclusions

Despite postoperative occlusal changes, positional changes in the mandibular proximal segment and the position of the condyles were similar between CS and SF, which suggested that SF using IVRO achieved satisfactory postoperative stability. If active physiotherapy is conducted, the proximal segment can be adapted in the physiological position regardless of the occlusal changes.

Surgery-first orthognathic approach vs conventional orthognathic approach: A systematic review of systematic reviews

Surgery-first approach (SFA) has been introduced as an alternative for conventional orthognathic approach (COA) in the treatment of patients with dentoskeletal deformities. This review aimed to evaluate skeletal stability, treatment time, surgical complications, and quality of life in SFA and COA. Six databases were accessed up to May 2020 to obtain all systematic reviews (SRs). After title and abstract reading, data extraction was performed from eligible SRs. The methodological quality was calculated for the included SRs using the last version of A Measurement Tool to Assess Systematic Review (AMSTAR-2). Ten SRs were included in this review. A good stability of the jaws was assessed both with SFA and COA by most of low- or critically low-quality SRs. Less treatment time was reported for SFA than COA with a moderate quality level. Slightly higher complications rate was recorded with SFA than COA by SRs with low or moderate quality. A better quality of life with SFA than COA was reported by moderate- or low-quality SRs. SFA may represent a reasonable alternative to COA. However, for the heterogeneity of the included SRs, well-designed studies with a long term follow-up are needed to clarify the findings of this analysis.

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

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.

Retreatment of a patient: Orthognathic surgery-first approach with customized lingual appliances combined with miniplate anchorage

Orthognathic surgery is necessary when a patient's major complaints include skeletal discrepancies that cannot be corrected with orthodontic treatment alone. Currently, orthognathic surgery can be performed through conventional and surgery-first approaches. Some advantages are attributed to the surgery-first approach, such as shortened treatment time and immediate esthetic improvement. The aim of this case report is to present the retreatment of a patient presenting with a skeletal Class III malocclusion, with maxillary retrusion and mandibular protrusion, who was successfully treated with the surgery-first approach and customized lingual appliances, combined with miniplate anchorage in the postoperative orthodontic treatment. The total orthodontic treatment time was 8 months.

Rationale, Relevance, and Efficacy of "Surgery First, Orthodontics Later" Approach in the Management of Cases of Severe Malocclusion with Skeletal Discrepancy

A good esthetic outcome and optimal functional occlusion is the goal of management of any dentofacial anomaly. Conventional orthognathic surgery, as commonly practiced, entails a rather long-drawn management protocol comprising a triphasic treatment approach, with the surgical procedure being both preceded and followed by pre- and post-surgical orthodontics, respectively. This has numerous well-known drawbacks such as an uncertain and unpredictable patient compliance and poor motivation due to the inevitably long duration of orthodontic therapy; a transient and temporary worsening of the facial appearance brought about by presurgical orthodontic decompensation of occlusal relationships; and the inevitably prolonged time frame involved in ultimately achieving the desired esthetic and functional results. Further, unforeseen interruptions along the course of the long treatment period can result in unfavorable and even disastrous outcomes. The newer concept and technique of “Surgery First Orthodontics After” (SFOA) approach or “surgery-first approach” (SFA) entails first performing orthognathic surgery, thereafter following it up and finishing the case with postsurgical orthodontic settling and correction of the occlusion. It has two very distinct advantages over the erstwhile approach, first, an immediate and early correction of the facial deformity resulting in a remarkable improvement in facial appearance, which in most cases was what had prompted the patient to seek treatment for, in the first place. The patient, encouraged and motivated by the obvious and appreciable esthetic results, complies willingly and well with the subsequent postsurgical orthodontic treatment, even if it is lengthy or inconvenient, thus ensuring an optimal ultimate occlusion with complete functional rehabilitation as well. The second advantage of SFA is a markedly reduced overall treatment time, which is greatly appreciated by the patients. This article presents three cases of severe malocclusion with associated skeletal discrepancies, treated expeditiously and effectively using the SFA protocol. The overviews of SFA, including its rationale and relevance, indications, general and specific guidelines, different protocol variations, clinical outcome and success rate, as well as possible complications and potential problems encountered with this novel treatment protocol are also discussed.

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

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.

Current status of the surgery-first approach (part I): concepts and orthodontic protocols

The "surgery-first" approach, defined as a team approach between surgeons and orthodontists for orthognathic surgery without preoperative orthodontic treatment, is aimed at dental decompensation. A brief historical background and indications for the surgery-first approach are reviewed. Considering the complicated mechanism of postoperative orthodontic treatment, the proper selection of patients is a vital component of successful surgery-first approach.

Large-Scale Study of Long-Term Vertical Skeletal Stability in a Surgery-First Orthognathic Approach Without Presurgical Orthodontic Treatment: Part II

The surgery-first approach (SFA) is a new paradigm in orthognathic surgery. In our experience over the last 10 years, SFA, particularly for the correction of the class III dentofacial deformity and facial asymmetry, has demonstrated high success rates without any major complications. However, many craniofacial surgeons remain concerned about the skeletal stability of SFA. In the present study, the authors aimed to compare the traditional and SFA with regard to the long-term outcomes of vertical skeletal stability using large-scale data. The authors enrolled patients with skeletal class III dentofacial deformities who had undergone and completed orthognathic surgery between December 2007 and December 2015. The inclusion criteria were based on the presurgical simulation of the dental model, and the authors predicted the potential of the SFA based on this preoperative simulation model. Patients with cleft-related syndromes, and those who had undergone orthognathic surgeries for facial asymmetry or class II deformity were excluded. A total of 104 and 51 class III patients were enrolled in the surgery-first and traditional orthodontics-first groups, respectively. Satisfactory results were achieved in all 155 patients with dentofacial deformity. The initial preoperative measurements of cephalometric analysis, particularly vertical skeletal stability, were similar and well maintained after the procedure in both groups. In conclusion, the SFA without any presurgical orthodontic treatment for correcting dentofacial deformities can achieve similar long-term vertical stability results to the orthodontic treatment-first approach.

Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review

In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative preparation, surgical procedures and post-surgical orthodontics with pertinent literature survey are also discussed.

Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis

OBJECTIVE

There are conflicting views on the postoperative stability of surgery-first and surgery-early approaches in orthognathic surgery. We systematically reviewed the literature to compare the difference in postoperative stability between a surgery-first/early orthognathic approach (SFEA) and a conventional orthodontics-first approach (COA).

STUDY DESIGN

PubMed, Embase, and Cochrane Library were searched for studies related to the postoperative stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted mean differences with 95% confidence intervals were pooled using a random-effects model.

RESULTS

We analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifested less postoperative stability than COA group (weighted mean difference, 1.50; P < .00001), with moderate heterogeneity (I² = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis conducted by omitting one study at a time further validated the robustness of the result.

CONCLUSIONS

Based on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postoperative stability than in the COA group. Patient screening and treatment plans should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.

Orthognathic Surgery: A Review of Articles Published in 2014-2015

OBJECTIVES

We did a retrospective study and reviewed some of the orthognathic surgery related papers that were published between January 2014 and December 2015 in a leading International Maxillofacial Surgery Journal. It was conducted to ascertain the trends of articles being published.

METHOD

A total of around 57 articles were reviewed, of which most of the full length articles were on post operative outcomes and obstructive sleep apnoea.

RESULTS

Bulk of the studies were retrospective, and less interest was shown onto experimental researches.

CONCLUSION

A thorough review and analysis thus gives an impression that there is a high requirement of well designed clinical studies.

The Medical Legal Aspects of Surgery First and a New Model of Consent Form

The introduction of "surgery first" has resulted in a new requirement to compare and resolve medical legal problems which previously did not exist in traditional orthognathic surgery. The first issue relates to the relationship between the doctor and the patient and, in particular, the need to create a new informed consent form for surgery first. The second problem that has arisen with the arrival of surgery first concerns the relationship between health workers, namely the surgeon, and the orthodontist. The authors of this article propose a new template for informed consent specifically created for surgery first and also a model for the new working relationship between surgeons and orthodontists which will facilitate and improve co-operation between them. This will improve results, and guarantee a greater level of protection for the surgeon. It will also enable the identification the individual responsibilities of each person.

Evaluation of stability after pre-orthodontic orthognathic surgery using cone-beam computed tomography: A comparison with conventional treatment

OBJECTIVE

The aim of this study was to evaluate the skeletal and dental changes after intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontics by using cone-beam computed tomography (CBCT).

METHODS

This retrospective cohort study included 24 patients (mean age, 22.1 years) with skeletal Class III malocclusion who underwent bimaxillary surgery with IVRO. The patients were divided into the preorthodontic orthognathic surgery (POGS) group (n = 12) and conventional surgery (CS) group (n = 12). CBCT images acquired preoperatively, 1 month after surgery, and 1 year after surgery were analyzed to compare the intergroup differences in postoperative three-dimensional movements of the maxillary and mandibular landmarks and the changes in lateral cephalometric variables.

RESULTS

Baseline demographics (sex and age) were similar between the two groups (6 men and 6 women in each group). During the postsurgical period, the POGS group showed more significant upward movement of the mandible (p < 0.05) than did the CS group. Neither group showed significant transverse movement of any of the skeletal landmarks. Moreover, none of the dental and skeletal variables showed significant intergroup differences 1 year after surgery.

CONCLUSIONS

Compared with CS, POGS with IVRO resulted in significantly different postsurgical skeletal movement in the mandible. Although both groups showed similar skeletal and dental outcomes at 1 year after surgery, upward movement of the mandible during the postsurgical period should be considered to ensure a more reliable outcome after POGS.

Surgery first in orthognathic surgery: A systematic review of the literature

INTRODUCTION

Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking.

METHODS

A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally.

RESULTS

The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible.

CONCLUSIONS

The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups.

Progressive changes in patients with skeletal Class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: A comparative study

INTRODUCTION

In this study, we aimed to compare treatment efficacy and postsurgical stability between minimal presurgical orthodontics and conventional presurgical orthodontics for patients with skeletal Class III malocclusion.

METHODS

Forty patients received minimal presurgical orthodontics (n = 20) or conventional presurgical orthodontics (n = 20). Lateral cephalograms were obtained before treatment, before orthognathic surgery, and at 1 week, 3 months, 6 months, and 12 months after surgery.

RESULTS

Changes of overjet and mandibular incisal angle before surgery were greater in the conventional presurgical orthodontics group than in the minimal presurgical orthodontics group. Postsurgical horizontal changes in Points A and B, overjet, and mandibular incisal angle showed significant differences among the time points. Most of the horizontal and vertical relapses in the maxilla and the mandible occurred within the first 6 months in both groups.

CONCLUSIONS

Minimal presurgical orthodontics and conventional presurgical orthodontics showed similar extents and directions of skeletal changes in patients with Class III malocclusion. However, orthodontists and surgeons should preoperatively consider the postsurgical counterclockwise rotation of the mandible when using minimal presurgical orthodontics. Close and frequent observations are recommended in the early postsurgical stages.

Stability of Pre-Orthodontic Orthognathic Surgery Using Intraoral Vertical Ramus Osteotomy Versus Conventional Treatment

PURPOSE

Postoperative skeletal and dental changes were evaluated in patients with mandibular prognathism who underwent mandibular setback surgery using an intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontic treatment.

MATERIAL AND METHODS

This retrospective cohort study included consecutive patients with skeletal Class III malocclusions who underwent IVRO. Patients treated with pre-orthodontic orthognathic surgery (POGS) were compared with patients treated with conventional surgery (CS) with presurgical orthodontics (control) using lateral cephalograms (taken preoperatively, 7 days postoperatively, and 12 months postoperatively). Predictor (group and timing), outcome (cephalometric measurements over time), and other (ie, baseline characteristics) variables were evaluated to determine the differences in postoperative horizontal and vertical positional changes of the mandible, such as point B. Baseline demographics were similar between the groups (N = 37; CS group, n = 17; POGS group, n = 20). The data were analyzed with an independent t test, the Mann-Whitney U test, the Fisher exact t test, Pearson correlation analysis, and simple linear regression analysis.

RESULTS

The mean setback of the mandible at point B was similar, but the mandible of the POGS group, particularly the distal segment, moved superiorly during the postoperative period in conjunction with the removal of premature occlusal contacts (P < .001). In the CS group, the mandible had significantly more backward movement 12 months after surgery compared with the POGS group (P < .01). In the POGS group, horizontal and vertical postsurgical changes were linearly correlated with the amount of setback and vertical movement of the mandible.

CONCLUSIONS

Mandibular setback surgery using IVRO without presurgical orthodontics leads to considerably different postoperative skeletal and dental changes compared with conventional treatment, with more superior movement being observed at point B during the 1-year postoperative period.