An overview of surgery‑first orthognathic approach: History, indications and limitations, protocols, and dentoskeletal stability

Abstract

The most common orthognathic surgery approach consists of three steps: presurgical orthodontic
treatment, surgery, and postsurgical orthodontic treatment. Despite its advantages, this technique
has some disadvantages, too, including a long treatment period, problems in mastication and
articulation, temporary worsening of the patient’s appearance, and psychological problems for
the patient. The introduction of the surgery‑first orthognathic approach has been an attempt to
overcome these problems. In this article, we wish to provide a comprehensive overview on this
approach. In this approach, which consists of surgery without orthodontic preparation and a short
period of orthodontic treatment after it, the overall duration of treatment decreases and the
patient’s appearance improves. The skeletal anchorage, placed at the time of surgery, can be used to
facilitate tooth movements after surgery. Despite the advantages of this technique, it is associated
with some limitations; in particular, occlusion cannot have a guiding role during surgery. Therefore,
correct diagnosis, prediction of the outcomes, and simulating correction with the model setup are
of crucial importance. The surgeon’s knowledge and expertise have a significant role in this respect.
Key Words: Maxillofacial orthognathic surgery, orthodontics, orthognathic surgical procedure,
stability