Surgery-First Approach in Orthognathic Surgery – Basic Principles and Concepts
Daniel Chiung-Sing Huang,D.D.S.,P.H.D.
The surgery-first approach has become a new paradigm in orthognathic surgery. For surgery-first approach, most of the patients’ teeth are in their original position, and they have not received orthodontic treatment before undergoing orthognathic surgery. A “treatable”malocclusion should be attained following orthognathic surgery. Orthodontists must ensure that they could manage “treatable” malocclusion by actively participating in their patients’ surgical plan. Therefore, orthodonticprinciples and guidelines should be established. Three-dimensional computed tomography should be used to construct the midfacial plane and then to assess discrepancies of midfacial structures as well as yaw and roll of bilateral facial structures. Orthognathic surgery should be performedto improvethe alignment of such discrepancies to attaina skeletal Class I relationship and to attainan aesthetically pleasing face. The surgery-first approach uses osteotomy to solve most skeletal and dental problems and to simplify postoperative orthodontic treatment into a treatable malocclusion for which mostly only anterioposterior orthodontic movement is required with minimal transverse or vertical orthodontic movements. Numerous studies have documented the efficacy and longterm stability. Patients receiving the surgery-first approach benefit froman immediate improvement in facial aesthetics, oral function, and self-confidence with a shorter total treatment period.