The changes of oral health-related quality of life and satisfaction after surgery-first orthognathic approach: a longitudinal prospective study

The top 100 highly cited articles on surgery-first orthognathic surgery between 2009 and 2022: a bibliometric and visualized analysis

OBJECTIVES

To reveal research focuses on surgery-first orthognathic surgery by a bibliometric and visualized analysis of the top 100 highly cited articles.

STUDY DESIGN

Published papers related to surgery-first orthognathic surgery were retrospectively retrieved from the Web of Science Core Collection from 2009 to 2022. The number of articles, journals, countries/regions, institutions, authors, and keywords were assessed and visualized using CiteSpace software.

RESULTS

The top 100 cited articles included 89 research papers and 11 reviews. The average total citation was 21. The most influential article with 146 citations was published by Dr. Liou E.J.W. in 2011. The most common level of evidence was level IV (36 articles). The Journal of Oral and Maxillofacial Surgery had the largest number of papers and the highest total citation frequency. The most productive countries and institutions were Korea/China and Chang Gung Memorial Hospital, respectively. Chen Yu-ray and Choi Jong Woo published 13 and 11 articles with 434 and 299 total citations, respectively. Research interests shifted from skeletal class III malocclusion, accuracy, stability, and relapse to quality of life and virtual surgical planning.

CONCLUSION

Our bibliometric analyses provide a comprehensive landscape of the influential topics and developmental trends in surgery-first orthognathic surgery and inspire future studies in this booming field.

Masticatory performance and oral health related to quality of life before and after orthodontic treatment: a systematic review and meta-analysis

Masticatory performance is considered an important step in the beginning of the digestive process and considering the patient's aesthetic and functional factors, it is necessary to choose appropriate treatments. Based on the evidence during orthodontic treatment, the restoration of the physiological function of masticatory performance should not be neglected. The present study aimed to evaluate the association between orthodontic treatment and improved masticatory performance and oral health related to quality of life. In the present study, all articles published till the end of August 2023 were extracted by two trained researchers independently through a search in databases like PubMed, Scopus, Science Direct, ISI, Web of Knowledge, Elsevier, Wiley, and Embase, and Google Scholar search engine using keywords and their combinations. Data analysis was done using the fixed effects model in a meta-analysis, by STATA (version 17); a P-value of less than 0.05 was considered significant. Based on the results, the mean difference in masticatory performance between pre-treatment and post-treatment was 2.23 (MD: 2.23; 95CI, 2.17, 2.29. p<0.01; I2= 99.98%; p<0.01). The mean difference in oral health related to quality of life between pre-treatment and post-treatment was -32.23 (MD: -32.23; 95CI, -33.35, -31.11. p<0.01; I2= 97%; p<0.01). Orthodontic treatment had a positive effect on masticatory performance and improved the quality of life of patients after treatment.

Effect of surgery-first approach on quality of life and mental health of orthognathic patients: A systematic review and meta-analysis

Objectives

This study intends to explore the effects of the surgery-first approach (SFA) on quality of life and mental health of patients who undergo orthognathic surgery compared to the conventional three-stage approach (CTA).

Data

The analysis included eight studies with a total of 307 patients, of which one was randomized controlled trial (RCT), one was clinical controlled trial (CCT), and six were non-randomized studies of interventions (NRSIs).

Sources

Electronic databases such as Medline, Embase, Scopus, and Web of Science were searched for eligible trials up to April 2023.

Study selection

RCTs, CCTs, and NRSIs, which compared the quality of life or mental health of orthognathic patients treated with SFA and CTA, were included in this study. The meta-analysis showed that the standardized mean differences (SMD) of Oral Health Impact Profiles-14 (OHIP-14) scores and the Orthognathic Quality of Life Questionnaire (OQLQ) between SFA and CTA were -1.58 (P = 0.05) and -2.99 (P < 0.00001) at the termination of the first-stage treatment, which altered to -0.94 (P = 0.54) and 0.09 (P = 0.65) after total treatment. Two studies applied the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the Beck Depression Inventory (BDI-II) to examine mental health, resulting in a trend similar to the former scales.

Conclusion

In contrast to the conventional procedure, orthognathic treatment with SFA can instantly enhance the quality of life at the end of the first-stage treatment but has similar effects after the overall treatment. Moreover, SFA has a positive impact on psychological conditions.

Clinical significance

This study first systematically reviewed the effect of SFA on patients' mental well-being. According to our findings, it is better to select SFA if possible. Otherwise, the patient's psychological condition should be monitored appropriately throughout decompensation for better well-being both physically and mentally.

Changes in the quality of life in patients undergoing orthognathic therapy - A systematic review

The aim of this study was to investigate the impact of orthognathic therapy on patients' quality of life. Therefore, a systematic review was conducted including all prospective studies that compared pretherapeutic and posttherapeutic Oral Health Impact Profile (OHIP) or Overall Quality of Life (OQOL) questionnaire scores. Studies in patients with congenital deformities, clefts, or posttraumatic or cancer-associated deformities were excluded. Overall, 23 prospective studies were included; 8 used OHIP, 9 used OQOL and 6 used both questionnaires. A total of 1039 patients were identified (60.29% women, 39.71% men), with a mean age of 45.17 years. All analyzed studies showed in both OHIP and OQLQ an improvement of the quality of life in patients after orthognathic therapy. While improved scores could be observed in all investigated criteria, the studies demonstrated that social and aesthetic aspects showed the most prominent impact. Comparison of different Angle Classes showed, furthermore, that Class III patients had an even greater advantage over those with a Class II deformity. The review confirms that the quality of life in patients with orthognathic therapy improves significantly in all observed aspects. With regard to Angle Classes, Class III patients showed an even greater improvement than Class II patients.

Assessing change in quality of life using the Oral Health Impact Profile in patients undergoing orthognathic surgery: A before and after comparison with a minimal follow-up of two years

PURPOSE

Here we evaluated how orthognathic surgery impacted oral health-related quality of life among patients with dentofacial deformities in the immediate postoperative period and during ≥2 years of follow-up, using the OHIP-14-NL questionnaire.

METHODS

This prospective study included 86 patients. Quality of life was assessed using the Dutch version of the Oral Health Impact Profile questionnaire (OHIP-14-NL) preoperatively (T0, baseline), over 7 days postoperatively (T1-T7), and at 4 weeks (T8), 6 months (T9), 1 year (T10), and ≥2 years (T11) postoperatively. Total OHIP score was determined for each patient. Lower OHIP scores indicated higher oral health-related quality of life. Patients also answered questions regarding self-care, discomfort, and experienced pain at all time-points, starting from T1.

RESULTS

Compared to baseline (T0), median OHIP scores were significantly higher from T1 to T8. However, at T9 to T11, OHIP scores were significantly lower compared to baseline (T0) (p < 0.01). OHIP scores were not correlated with gender, age, or blood loss; and did not significantly differ according to surgery type or surgery indication (p > 0.01). Pain scores were positively correlated with OHIP scores for all time-points, except T6 and T10. Pain was not correlated with sex, age, blood loss, surgery duration, surgery indication, or surgery type. Compared to at T1, pain was significantly decreased at T9-T11.

CONCLUSION

Among patients who underwent orthognathic surgery, oral health-related quality of life was decreased in the immediate postoperative period, but improved at ≥6 months postoperatively. The improvement was significant 2 years after orthognathic surgery.

Three-Dimensional Evaluation of Skeletal Stability following Surgery-First Orthognathic Approach: Validation of a Simple and Effective Method

Background  The three-dimensional (3D) evaluation of skeletal stability after orthognathic surgery is a time-consuming and complex procedure. The complexity increases further when evaluating the surgery-first orthognathic approach (SFOA). Herein, we propose and validate a simple time-saving method of 3D analysis using a single software, demonstrating high accuracy and repeatability. Methods  This retrospective cohort study included 12 patients with skeletal class 3 malocclusion who underwent bimaxillary surgery without any presurgical orthodontics. Computed tomography (CT)/cone-beam CT images of each patient were obtained at three different time points (preoperation [T0], immediately postoperation [T1], and 1 year after surgery [T2]) and reconstructed into 3D images. After automatic surface-based alignment of the three models based on the anterior cranial base, five easily located anatomical landmarks were defined to each model. A set of angular and linear measurements were automatically calculated and used to define the amount of movement (T1-T0) and the amount of relapse (T2-T1). To evaluate the reproducibility, two independent observers processed all the cases, One of them repeated the steps after 2 weeks to assess intraobserver variability. Intraclass correlation coefficients (ICCs) were calculated at a 95% confidence interval. Time required for evaluating each case was recorded. Results  Both the intra- and interobserver variability showed high ICC values (more than 0.95) with low measurement variations (mean linear variations: 0.18 mm; mean angular variations: 0.25 degree). Time needed for the evaluation process ranged from 3 to 5 minutes. Conclusion  This approach is time-saving, semiautomatic, and easy to learn and can be used to effectively evaluate stability after SFOA.

Comparison of the quality of life changes of patients receiving sagittal split ramus osteotomy or intraoral vertical subsigmoid osteotomy for mandibular prognathism

OBJECTIVE

To investigate and compare the effect of two orthognathic procedures for mandibular setback, namely, sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO), on oral health, mental- and physical health-related quality of life across time.

MATERIALS AND METHODS

Patients with mandibular prognathism and planned for orthognathic surgery were recruited in this study. Patients were randomized into two groups (IVRO and SSRO groups). Quality of life (QoL) was assessed with the 14-item Short-Form Oral Health Impact Profile (OHIP-14) and the 36-item Short-Form Health Survey (SF-36) preoperatively (T₀), postoperative 2 weeks (T₁), 6 weeks (T₂), 3 months (T₃), 6 months (T₄), 12 months (T₅), and 24 months (T₆). A comparison of OHIP-14 and SF-36 scores between two groups was conducted.

RESULTS

Ninety-eight patients (49 SSRO group, 49 IVRO group) participated in this study. There was no significant difference in OHIP-14 scores between SSRO and IVRO throughout the treatment process. SSRO group had significant reduction of OHIP-14 score (i.e., improving oral health-related QoL) since postoperative 2 weeks, whereas IVRO group had significant reduction since postoperative 6 weeks. Starting from postoperative 3 months, the oral health-related QoL of both groups was already significantly better than the baseline level and continued to steadily improve afterwards. For SF-36, both groups had increased physical health summary score starting from postoperative 2 weeks, indicating an early and gradual recovery of physical health-related QoL. The mental health summary score of the SSRO group began to increase from postoperative 2 weeks, but that of the IVRO group only began to increase from postoperative 6 weeks. Patient age at the time of surgery was positively correlated with OHIP scores in the postoperative period.

CONCLUSIONS

The study concludes that both SSRO and IVRO contributed to the improvement of QoL in the long term, but oral health- and mental health-related QoL of SSRO groups showed earlier improvement.

CLINICAL RELEVANCE

Undergoing orthognathic surgery at early ages is advised, as older age of patients appeared to have worse QoL.

TRIAL REGISTRATION

Clinical trial registration number: HKUCTR-1985. Date of Registration: 14 Apr 2015.

"Surgery First" vs "Traditional Sequence" Surgery: A Qualitative Study of Health Experiences in 46 Bimaxillary Orthognathic Patients

Introduction

Orthognathic patients are advocating an active role in selecting their appropriate ortho-surgical treatment, between the surgery first (SF) and the traditional sequence (TS) approaches. The aim of this study was to evaluate, through qualitative analysis, the subjective perceptions of the outcomes of each protocol.

Methods

In-depth interviews were conducted with 46 (10 male and 36 female) orthognathic patients (23 SF and 23 TS) treated with bimaxillary orthognathic surgery by the same surgeon, between 2013 and 2015. Average treatment duration was 6.5 months for SF and 12 months for TS. Inclusion criteria were: the presence of Class III or Class II asymmetries and open bite. Patients were excluded if they refused interviews or stopped attending post-treatment follow-up. Investigated health experiences included overall satisfaction with appearance, self-confidence after surgery, perceived treatment time, functional recovery, and diet restrictions.

Results

All SF and TS patients showed overall satisfaction with their appearance (though TS showed more enthusiastic tones) and approved their degree of functional recovery after surgery. Class III SF patients had earlier improvements in self-confidence after surgery. Orthodontics was considered enduring by both SF and TS patients.

Conclusions

SF patients expressed a higher degree of satisfaction with the reduction in overall treatment time and with the early psychological benefit deriving therefrom. Both SF and TS patients completely approved of the aesthetic outcomes and the functional recovery from which they benefitted due to the entire procedure.

Comparison of short-term condylar positional changes in mandibular prognathism after surgery-first approach: Symmetric setback versus asymmetric setback

The aim of this study was to compare how the displacement of the mandibular condyle changed after symmetric or asymmetric mandibular setback surgery using the surgery-first approach (SFA). Patients who underwent mandibular setback surgery using the SFA were selected and divided into a symmetry group (n = 18) with differences of less than 2 mm between the right and left setback, and an asymmetry group (n = 18) with a difference of greater than 2 mm. Cone-beam computed tomography (CBCT)-generated cephalograms were obtained after three-dimensional superimposition of CBCT images taken before surgery (T0), within one week after surgery (T1), and seven months after surgery (T2). The condylar positions were measured. Condylar positional changes according to time were compared between the two groups and correlation analysis was performed. There were significant positional changes in mandibular condyles over time in both groups. However, most of these changes returned to their initial state. In the asymmetry group, there was a greater internal rotation of the mandibular condyle on the lesser setback side. The correlation analysis results revealed that only the setback difference was associated with rotational displacement of the condyle on the lesser setback side at two time points (T1-T0, T2-T0). In the SFA, significant condylar displacement occurred immediately after both symmetric and asymmetric mandibular setback surgery, and the right/left difference in mandibular setback showed a significant positive correlation with rotational displacement. Although more significant rotational displacement of the mandibular condyle was observed after asymmetric mandibular setback surgery, the amount was not large enough to be clinically significant.

Impact of orthognathic surgery on quality of life in patients with different dentofacial deformities: longitudinal study of the Oral Health Impact Profile (OHIP-14) with at least 1 year of follow-up

OBJECTIVE

The objective of this study was to assess the impact of orthognathic surgery for dental facial deformities on oral health-related quality of life (OHRQoL) in the immediate postoperative period up to at least 1 year after surgery.

STUDY DESIGN

This prospective study evaluated data from 85 patients. OHRQoL was assessed using the Dutch version of the Oral Health Impact Profile questionnaire (OHIP-14NL) preoperatively (T0), each day for 7 days postoperatively (T1-T7) and 4 weeks (T8), 6 months (T9), and at least 1 year (T10) after surgery. The total OHIP score was calculated for each patient, with higher OHIP scores indicating a worse impact on oral health. Patients also completed an extra questionnaire about self-care, discomfort, and experienced pain (rated on a 10-point scale) in the postoperative period (T1-T10).

RESULTS

The mean OHIP score increased sharply at T1 compared to T0 but decreased significantly in the first postoperative week. The mean OHIP score at T8 was still higher than before surgery. However, at T9 and T10, the mean OHIP score was significantly lower than at T0 (P < .05). No significant difference in OHIP score was found between gender, age, type of surgery, and indication for surgery. Pain significantly decreased from T6 to T0. The OHIP and pain scores significantly positively correlated at every time point except T9.

CONCLUSION

The findings indicate that OHRQoL is reduced from baseline in the immediate postoperative period but improves over time. By 1 year, OHRQoL improves significantly after orthognathic surgery in patients with dentofacial deformities.

Oral health-related quality of life before, during, and after orthodontic-orthognathic treatment: a systematic review and meta-analysis

OBJECTIVES

The effect of combined orthodontic-orthognathic treatment was estimated, specifically the impact of pre-surgical orthodontic treatment, on oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

The research question was formulated using the PICO method. The search was carried out in MEDLINE via PubMed, CINAHL, psychINFO, Embase, and Cochrane (until February 3, 2020). Inclusion criteria were patients aged ≥ 17 years who underwent combined orthodontic-surgical treatment, quality of life assessment, and study design of randomized controlled trial, controlled clinical trial, prospective cohort study, observational study, intervention study, or cross-sectional study. The ROBINS-1 tool was used to assess the risk of bias within studies. A random effects meta-analysis was conducted when appropriate. The quality of evidence was assessed using the GRADE approach.

RESULTS

Six studies were analyzed. The OHIP-14 and/or OQLQ-22 questionnaires were used to measure the OHRQoL. All six studies had a serious risk of bias. Two studies (87 participants) were included in a meta-analysis showing improvement of OHRQoL when comparing before and after treatment were compared (mean 14.85 scale points, 95% confidence interval 10.36;19.35).

CONCLUSIONS

Studies indicate a decrease in OHRQoL during the pre-surgical orthodontic treatment phase but improvement after orthodontic-orthognathic treatment. Data substantiating these results are limited, and the quality of evidence is low. Further research is needed to assess the impact of pre-surgical orthodontic treatment on the OHRQoL in an orthognathic trajectory.

CLINICAL RELEVANCE

Patients should be well informed about the effect facial/esthetic changes may have on their OHRQoL during sequential phases of orthodontic-orthognathic treatment.

Translation and Validation of the Dental Impact Daily Living Oral Health-related Quality of Life Questionnaire in Indonesia

Objective

The need to assess oral health-related quality of life (OHRQoL) has grown increasingly in the healthcare sector over the past few decades. The Dental Impact on Daily Living (DIDL) assessment is a tool created to measure OHRQoL. The aim of this study was to complete a cross-cultural adaptation of the DIDL to yield a valid and reliable Indonesian version for use as an official instrument to assist in further OHRQoL research in Indonesia.

Materials and Methods

The original English version of the DIDL was translated and validated. Content validity and face validity were considered. Psychometric testing for test-retest reliability was analyzed among 32 subjects, while internal consistency using Cronbach's alpha and clinical oral health status using the DMF-T index to obtain convergent validity of the questionnaire were checked among 278 subjects.

Results

The study subjects showed a good understanding of how to complete the Indonesian language version of the DIDL questionnaire, and conceptual and semantic equivalence (content and face validity) were noted. Further, test-retest reliability was noted (intraclass correlation coefficient range: 0.975-1 and Cronbach's alpha: 0.942), whereas convergent validity suggested a correlation between DMF-T and DIDL questionnaire of -0.502 with significance at alpha of 5% (P = 0.00), which means that decreasing the DMF-T outcome will increase the satisfaction using the DIDL among research subjects.

Conclusion

Cross-cultural adaptation of the DIDL yielded a valid and reliable Indonesian version. The DIDL questionnaire is a promising questionnaire that can be applied to measure OHRQoL in Indonesians.

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.

Accuracy of virtual surgical planning in segmental osteotomy in combination with bimaxillary orthognathic surgery with surgery first approach

Background

This study aimed to assess the accuracy of virtual surgical planning (VSP) in segmental osteotomy in combination with bimaxillary orthognathic surgery with surgery first approach (SFA) by means of three-dimensional (3D) measuring and superimposition, so as to promote the application of digital technology in combined orthodontic-orthognathic treatment.

Methods

20 patients treated with segmental osteotomy in combination with bimaxillary orthognathic surgery with SFA from 2018 to 2020 were included. All of them acquired VSP performed by ProPlan CMF 3.0 software (Materialise Corporation, Belgium). The preoperative (T0) 3D model of VSP and the postoperative (T1) 3D model, reconstructed by the cone-beam computed tomography (CBCT) data acquired one week after surgery, were compared by measuring the 3D coordinates of the landmarks as well as 3D model superimposition for deviation analysis. The deviation analysis was achieved by Geomagic Studio 2013 (3D Systems Corporation, USA). The differences which represented the accuracy of VSP were evaluated by the root mean square deviation (RMSD) and the Bland–Altman method.

Results

There was no statistically significant difference between the 3D coordinates of T1 and T0 (P > 0.05), and the mean overall RMSD was 1.37 mm, within the clinical relevance of 2 mm. The RMSD of sagittal direction (1.76 mm) was greater than that of coronal and vertical directions (1.09 mm and 1.24 mm), and the RMSD of maxillary and mandibular aspects were basically equal (1.30 mm and 1.45 mm). The Bland–Altman method showed the T0 and T1 measurements were in good agreement. The mean RMSD obtained from the deviation analysis was 1.85 mm, within the clinical relevance.

Conclusions

VSP in segmental osteotomy in combination with bimaxillary orthognathic surgery with SFA proved to acquire accurate outcome in this study.

Comparison of psychosocial and aesthetic features of class III malocclusion after orthognathic surgery: Conventional approach versus surgery-first approach

The aim of this study is to investigate and compare the changes in psychosocial status, self-esteem, and quality of life in patients treated with conventional and SF approaches. 14 patients (mean age 23.04±3.36; 9 male and 5 female) who met the inclusion criteria were included in the SF group; 18 patients with class III malocclusion (mean age 29.27±3.78; 9 male and 9 female) were included in the COS group. In the research protocol, the first questionnaires were carried out 2 weeks before surgery (T0); second survey approximately 4 weeks after surgery (T1); and the third one was done to patients after the treatment was completed (debonding) (T2). In our study, Orthognathic Quality of Life Questionnaire (OQLQ), Pyschosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), Oral Health Impact Profile (OHIP-14), Beck Depression Inventory second edition (BDI-II) and Rosenberg Self-Esteem Scale (RSES), surveys were conducted. No statistically significant difference was observed in all of the PIDAQ parameters and most of the OQLQ parameters within the COS and SF groups (P>0.05). When the BDI-II results were examined, different trends in scores were observed between the two groups, and this difference was found to be statistically significant (P<0.05). In the SF approach, progressive improvement was detected in the patients in terms of psychosocial and quality of life in the early period of treatment. The greater improvement in psychological and social characteristics in the SF approach compared to conventional orthognathic surgery may also be associated with a shorter treatment time.

The Surgery-first Approach to Orthognathic Surgery

ABSTRACT

The purpose of this study was to compare the outcomes between the conventional surgical approach (CSA) and the surgery-first approach (SFA) for both traditional orthognathic osteotomies (LeFort/BSSO) and anterior segmental osteotomies (ASO). This was a retrospective cohort study of patients treated at the Hanoi Plastic Surgery Center from January 2000 to December 2012. The study predictors were the type (LeFort/BSSO or ASO) and timing (CSA or SFA) of surgery. The study outcomes were total treatment time and the rates of complication and relapse. 146 patients were included in the study, of whom 99 (67.8%) were treated with traditional osteotomies and 47 (32.2%) were treated with ASO. In the traditional osteotomy group, there were no significant differences in complication (P = 0.84) or relapse (P = 0.77) rates between CSA and SFA. There were no complications or relapses in the ASO group. Total treatment time was significantly decreased when using the SFA for both orthognathic osteotomies (-3.9 months, P < 0.01) and ASO (-3.3 months, P < 0.01). Our results showed that the SFA was able to achieve similar clinical outcomes to CSA but in a shorter treatment time. The SFA was effective for not only traditional orthognathic osteotomies but also ASO.

Does a surgery first approach to orthognathic treatment of class III skeletal relations result in a shorter duration of treatment? A systematic review

The objective of this study was to review the evidence relating to treatment duration and the surgery first approach (SFA) in managing class III skeletal discrepancies to determine whether there is sufficient evidence to show that it results in a shorter duration of treatment compared to a conventional orthodontics first approach (OFA). Analytical and observational studies that compared both approaches and recorded treatment duration as an outcome were included. MEDLINE, EMBASE, CENTRAL and Dental Oral Sciences Source databases were searched along with a review of reference lists. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool. Eleven observational studies met the inclusion criteria. No experimental studies were identified. The SFA was reported to have a shorter duration of treatment in all studies. All included studies showed a significant risk of bias, particularly in relation to selection of participants, allocation to groups and in the measurement of treatment duration. There is no quality evidence to suggest that using a surgery first approach to orthognathic treatment of class III skeletal patterns results in a shorter duration of treatment.

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.

Micro-osteoperforation effectiveness on tooth movement rate and impact on oral health related quality of life

OBJECTIVES

To investigate the effect of micro-osteoperforation (MOP) on the rate of tooth movement (RTM), space closure duration, and oral health-related quality of life (OHRQoL) during completion of anterior retraction in patients undergoing combined orthodontic-surgical treatment after premolar extraction and decompensation with sliding mechanics.

MATERIALS AND METHODS

Twenty-four participants with indications for premolar extractions were randomly allocated to treatment with conventional sliding mechanics (control group; CG) or with to treatment in which three MOPs were performed every activation (experimental group; EG). Dental impressions were taken monthly until space closure was completed and dental casts were converted to three-dimensional models. After the anterior retraction procedure, Oral Health Impact Profile (OHIP-14) questionnaires were filled out at 4 and 72 hours.

RESULTS

Eighteen patients (7 men and 11 women) remained in the trial until space closure was completed (mean follow-up period = 247 days). For full space closure RTM, no significant difference (P = .492) was found between groups (0.614 mm/month for the CG; 0.672 mm/month for the EG). The RTM for different time points, groups, time frames and their interaction were statistically different (P < .05). In multiple correlation analysis, the RTM significantly decreased over time for both groups (P < .05). The OHRQoL scores were significantly higher (worse) for the EG. The psychological, physical and social disabilities, and handicap domains displayed significant differences between the two groups.

CONCLUSION

Use of MOPs did not change the full space closure RTM, while it had a negative impact on OHRQoL.

Effect of surgery-first orthognathic approach on oral health-related quality of life

OBJECTIVES

To systematically evaluate the effect of the surgery-first approach (SFA) on oral health-related quality of life (OHRQoL) in patients with dentofacial deformities.

MATERIALS AND METHODS

An electronic database search and hand search of selected journals and references were carried out. Studies investigating the OHRQoL of patients receiving SFA with or without a control group were included. The risk of bias was assessed by the Cochrane risk of bias tool in randomized clinical trials (RCTs) and the Newcastle-Ottawa Scale in non-RCTs.

RESULTS

A total of seven articles met the eligible criteria and were included, of which six were cohort studies and one was an RCT, and six assessed the OHRQoL of the SFA with conventional orthodontic-surgical treatment (COST) as a control and one without. A total of 214 patients were examined, with sample sizes in studies ranging from 9 to 50. A total of 3 articles successfully measured the OHRQoL both before and after treatment in both the SFA and conventional orthodontic-surgical treatment groups. A total of six cohort studies were classified as low to moderate risk of bias, and the RCT was classified as high.

CONCLUSIONS

The SFA could improve the OHRQoL of patients with dentofacial deformities similar to conventional orthodontic-surgical treatment at the end of complete treatment. In addition, it increases OHRQoL immediately at the beginning of treatment without a deterioration.

The impact of oro-facial appearance on oral health-related quality of life: A systematic review

Esthetics in the oro-facial region are important for perceived oral health and a common reason for treatment of discoloured, missing or crowded teeth. As one of the fundamental bricks of a patient's oral health, changes in the domain of oro-facial esthetics resides within the oral health-related quality of life (OHRQoL) of an individual. Four main dimensions, oral function, oro-facial pain, oro-facial appearance and psychosocial impact, are suggested to cover the concept of OHRQoL. The aim of this systematic review was to map the impact from oral conditions with principal impact on the oro-facial appearance dimension of OHRQoL (PROSPERO: CRD42017064033). Publications were included if they reported Oral Health Impact Profile (OHIP) mean or median domain scores for patients with esthetic treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss or tooth whitening. A search in PubMed (Medline), EMBASE, Cochrane, CINAHL and PsycINFO 8 June 2017 and updated 14 January 2019, identified 2,104 abstracts. After screening of abstracts, 1607 articles were reviewed in full text and 33 articles included. These 33 articles reported OHIP-data for 9409 patients grouped in 63 patient populations. Median oro-facial appearance impact scores on a standardised 0-8 scale, for populations with treatment need relating to tooth wear, orthodontics, orthognathic surgery, frontal tooth loss and tooth whitening, ranged from 0.13 for tooth wear to 3.04 for tooth whitening populations. In conclusion, a moderate impact for the oro-facial appearance dimension of OHRQoL was found in patients with different conditions with esthetically related treatment need.

Quality of Life and Suitability with Vietnamese Harmonious Face Index in Class III Malocclusion Patients

BACKGROUND:

Maxillary Lefort I osteotomy, mandibular bilateral sagittal split ramus was frequently used in correcting skeletal class III malocclusion. There was a lack of research on class III malocclusion patients’ quality of life (QoL) after bimaxillary osteotomy.

AIM:

Class I Intermaxillary relationship was achieved, aesthetic was significantly improved. Significant improvement in Class III skeletal patients’ quality of life was acquired. The achievement of harmonious face would be beneficial to the facial aesthetics of patients, thus improving the quality of life.

METHODS:

Harmonious face index is an effective criterion in assessing the surgery’s outcome. In this study was conducted on 30 patients at Hanoi National Hospital of Odontostomatology, Viet Duc Hospital, and Hong Ngoc Hospital from April 2017 to April 2018, and it was a quasi-experimental study with self-comparison, 12 months follow up.

RESULTS:

Orthognathic surgery effectively corrected malocclusion crossbite, dental compensation, and helped to improve facial aesthetics. 100% of patients had the quality of life improved, good quality of life consisted of 86.7%. In comparison with a harmonious facial index of Kinh ethnic in Vietnam, 70% of patients achieved skeletal harmony, 63.3% of patients achieved dental harmony, 80% achieved soft tissue harmony.

CONCLUSIONS:

Vietnamese harmonious facial index should be used in planning and pre-surgical simulation.

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

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 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.

Impacts of Orthognathic Surgery on Patient Satisfaction, Overall Quality of Life, and Oral Health-Related Quality of Life: A Systematic Literature Review

Several treatments have been suggested to correct dentofacial abnormalities, including orthognathic surgery. The aim of the present systematic review was to assess the impact of orthognathic surgery on patient satisfaction, overall quality of life, quality of life related to oral health—and to orthognathic surgery in particular—among adult patients. Two investigators independently reviewed the available literature in the databases PubMed/MEDLINE, LILACS, SciELO, EMBASE, Trip, and Google Scholar (gray literature) based on the keywords “orthognathic surgery” and “quality of life.” An analysis of bias was performed based on the MINORS (methodological index for nonrandomized studies). A total of 245 relevant studies were retrieved from the databases, and 6 additional studies were located after a manual search of the references. Following selection based on titles, abstracts, and full-text analysis, 30 studies were included in the present systematic review. To evaluate quality of life before and after orthognathic surgery, 12 studies applied the surgery-related Orthognathic Quality of Life Questionnaire (OQLQ), 12 used the Oral Health Impact Profile (OHIP-14), and 4 used the Short Form Health Survey (SF-36). Orthognathic surgery results in improvements in quality of life both physically and psychosocially after surgery and is associated with high rates of patient satisfaction.

Impact of surgical orthodontic treatment on quality of life in Chinese young adults with class III malocclusion: a longitudinal study

Background

The quality of life in Class III malocclusion patients are worse than those without the disorder and previous studies have shown that surgical orthodontic treatment has a different effect on these patients compared with mild or moderate malocclusion. This study aimed to investigate the changes in quality of life in patients with Class III malocclusion during surgical orthodontic treatment in Chinese young adults.

Methods

The 14-item Short Form Oral Health Impact Profile (OHIP-14), and the 22-item Orthognathic Quality of Life Questionnaire (OQLQ) were used to assess the effect of surgical orthodontic treatment on the quality of life in 21 patients with Class III malocclusion at pre-treatment (T₀), pre-surgical orthodontic treatment (6 to 8 months, T₁) and post-surgical orthodontic treatment (6 to 8 months after surgery, T₂), and 24 healthy individuals were included as controls. The comparisons in numerical variables between patients and controls were performed using Mann-Whitney U test. The scores of the two questionnaires between T₀, T₁, T₂ and controls (Tc) were compared using generalized estimating equation.

Results

According to OHIP-14 questionnaire, the mean scores in T₀ and T₁ were higher than those in T₂ and Tc (P < 0.001), and a significant decrease was observed after post-surgical orthodontic treatment (P < 0.001), which achieved a level similar to the control group (P > 0.05). As to OQLQ questionnaire, the mean scores of all domains showed a significant increase between T₀ and T₁ except for awareness of dentofacial aesthetics (P > 0.05) and social aspects of dentofacial deformity (P > 0.05), followed by a significant decrease between T₁ and T₂.

Conclusion

Surgical orthodontic treatment may improve quality of life in patients with Class III malocclusion, but pre-surgical orthodontic treatment may have an adverse effect on quality of life.

Condition-specific Quality of Life Assessment at Each Stage of Class III Surgical Orthodontic Treatment -A Prospective Study

Surgical orthodontic treatment has been reported to improve oral health-related quality of life (OHRQL). Such treatment comprises three stages: pre-surgical orthodontic treatment; orthognathic surgery; and post-surgical orthodontic treatment. Most studies have focused on change in OHRQL between before and after surgery. However, it is also necessary to evaluate OHRQL at the pre-surgical orthodontic treatment stage, as it may be negatively affected by dental decompensation compared with at pre-treatment. The purpose of this prospective study was to investigate the influence of surgical orthodontic treatment on QOL by assessing change in condition-specific QOL at each stage of treatment in skeletal class III cases. Twenty skeletal class III patients requiring surgical orthodontic treatment were enrolled in the study. Each patient completed the Orthognathic Quality of Life Questionnaire (OQLQ), which was developed for patients with dentofacial deformity. Its items are grouped into 4 domains: "social aspects of dentofacial deformity"; "facial esthetics"; "oral function"; and "awareness of dentofacial esthetics". The questionnaire was completed at the pre-treatment, pre-surgical orthodontic treatment, and post-surgical orthodontic treatment stages. The results revealed a significant worsening in scores between at pre-treatment and pre-surgical orthodontic treatment in the domains of facial esthetics and oral function (p<0.01), and between at pre-surgical orthodontic and post-surgical orthodontic treatment in all domains except awareness of dentofacial esthetics (p<0.05, p<0.01). A significant correlation was observed between a negative change in overjet and worsening OQLQ scores at the pre-surgical orthodontic treatment stage. Significant correlations were also observed between improvement in upper and lower lip difference, soft tissue pogonion protrusion, and ANB angle and improvement in OQLQ scores at the post-surgical orthodontic treatment stage. These results indicate that morphologic change influences OHRQL in patients undergoing surgical orthodontic treatment not only after surgery, but also during pre-surgical orthodontic treatment.

Oral health-related quality of life changes in patients with severe Class III malocclusion treated with the 2-jaw surgery-first approach

INTRODUCTION

In this nonrandomized prospective study, we compared the effects of the surgery-first approach with conventional 2-jaw orthognathic surgery on skeletal Class III patients' oral health-related quality of life (OHRQoL), quality of the orthodontic outcome, and average treatment duration.

METHODS

The sample consisted of 16 patients with severe skeletal Class III malocclusion, who needed 2-jaw orthognathic surgery: 8 were treated with the surgery-first approach, and 8 were treated with the traditional orthodontic-surgical approach. OHRQoL was assessed by using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Oral Health Impact Profile-short version (OHIP-14). Malocclusion severity and esthetic self-perception were assessed with the Index of Orthodontic Treatment Need. Dental health status was determined using the Decayed, Missing and Filled Teeth Index. Tests were repeated at 7 times: baseline, 1 month after appliance placement, and 3 months, 6 months, 1 year, and 2 years after the beginning of the treatment; and for both groups, there was an also evaluation stage after the orthognathic surgery.

RESULTS

After 2 years, the surgery-first group showed a significant decrease in malocclusion severity (P <0.001) and had significant reductions in OQLQ (P <0.001) and OHIP-14 scores (P <0.001). These changes began after the orthognathic surgery and were progressive throughout the evaluation periods. In the traditional orthodontic-surgical approach group, after 2 years of monitoring, all patients were still in the preoperative orthodontic preparation phase, and their malocclusion severity increased significantly, thereby resulting in a not statistically significant worsening of their OHRQoL (OHIP-14, P = 0.89; OQLQ, P = 0.11).

CONCLUSIONS

OHRQoL improved significantly in a linear trend of progressive improvements in all severe Class III patients who had the surgery-first approach after the surgical procedure through 2 years of follow-up, as their malocclusion and esthetic self-perception also improved.

Does the Surgery-First Approach Produce Better Outcomes in Orthognathic Surgery? A Systematic Review and Meta-Analysis

PURPOSE

The surgery-first approach (SFA) in orthognathic surgery, performed without presurgical orthodontic treatment, has gained attention, but the results remain controversial. The purpose of this study was to assess the current evidence on stability, efficacy, and surgical results of SFA versus conventional 3-stage method (CTM) orthognathic surgery.

MATERIALS AND METHODS

A comprehensive search in PubMed and Web of Science was conducted. A systematic review and cumulative meta-analysis of all comparative studies were performed to assess the 2 strategies (SFA and CTM) using a random- or a fixed-effects model. Outcomes included treatment duration, postoperative stability, surgical movement, and postoperative occlusion.

RESULTS

Ten nonrandomized controlled studies including 513 patients were identified. Compared with CTM, patients in the SFA group benefited from shorter total treatment duration (weighted mean difference [WMD], -5.25; 95% confidence interval [CI], -8.21 to -2.29; P = .0005), similar postoperative stability of the mandible (WMD, 0.35 mm; 95% CI, -0.24 to 0.94; P = .55) and maxilla (WMD, 0.13 mm; 95% CI, -0.35 to 0.60; P = .60), similar surgical movements, and other surgical results.

CONCLUSIONS

SFA offers an efficient alternative to CTM with shorter total treatment duration, similar postoperative stability, and other surgical results but longer postoperative orthodontic time.

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

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.

Cone-beam computed tomography evaluation on the condylar displacement following sagittal split ramus osteotomy in asymmetric setback patients: Comparison between conventional approach and surgery-first approach

OBJECTIVE

To compare the condylar displacement following sagittal split ramus osteotomy (SSRO) in asymmetric setback patients between the conventional approach and surgery-first approach and to determine whether the condylar displacement is affected by asymmetric setback in SSRO patients.

MATERIALS AND METHODS

This was a retrospective study. The subjects consisted of patients with facial asymmetry who underwent SSRO and had cone-beam computed tomography taken before and 1 month after surgery. They were allocated into the conventional (n = 18) and surgery-first (SF) groups (n = 20). Descriptive, independent t-tests and Pearson correlation analysis were computed.

RESULTS

The amount of condylar displacement in x-, y-, and z-directions and Euclidean distance showed no statistically significant differences between the conventional and SF groups. Comparing the postoperative condylar position with the preoperative position, the condylar displacement occurred in posterior (P < .05) and downward (P < .05) directions in both groups except on the deviated side in the conventional group. The condylar displacement occurred in a posterior (P < .05) direction on the deviated side of the conventional group. However, the condylar displacement in three dimensions showed no statistically significant differences between the two groups. In the correlation analysis, the condylar displacement in both the deviated and contralateral sides showed no significant correlation with asymmetric setback in either group.

CONCLUSION

The condylar displacement in three dimensions and the distance of condylar displacement in SSRO patients with facial asymmetry showed no significant difference between conventional and SF groups. Condylar displacement was not associated with asymmetric setback.