Abstract
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.
Keywords
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References
- On a definition of the appropriate timing for surgical intervention in orthognathic surgery.Int J Oral Maxillofac Surg. 2014; 43: 846-855
- Simon P. Hullihen and the origin of orthognathic surgery.J Oral Maxillofac Surg. 2004; 62: 1303-1307
- “Surgery first” skeletal Class III correction using the Skeletal Anchorage System.J Clin Orthod. 2009; 43: 97-105
- The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal Class III dentofacial deformity.Ann Plast Surg. 2015; 74: 333-341
- Surgery first in orthognathic surgery: a systematic review of the literature.Am J Orthod Dentofacial Orthop. 2016; 149: 448-462
- Patient’s satisfaction in skeletal Class III cases treated with two-jaw surgery using orthognathic quality of life questionnaire: conventional three-stage method versus surgery-first approach.J Craniofac Surg. 2015; 26: 2086-2093
- The impact of a surgery-first approach on oral health-related quality of life.Int J Oral Maxillofac Surg. 2021; 50: 1336-1341
- “Surgery first” vs “traditional sequence” surgery: a qualitative study of health experiences in 46 bimaxillary orthognathic patients.J Maxillofac Oral Surg. 2021; https://doi.org/10.1007/s12663-021-01610-4
- Current status of the surgery-first approach (part I): concepts and orthodontic protocol.Maxillofac Plast Reconstr Surg. 2019; 4110
- Current status of the surgery-first approach (part II): precautions and complications.Maxillofac Plast Reconstr Surg. 2019; 4123
- Orthodontic principles and guidelines for the surgery-first approach to orthognathic surgery.Int J Oral Maxillofac Surg. 2015; 44: 1457-1462
- Does the surgery-first approach produce better outcomes in orthognathic surgery? A systematic review and meta-analysis.J Oral Maxillofac Surg. 2017; 75: 2422-2429
- Increase in bone metabolic markers and circulating osteoblast-lineage cells after orthognathic surgery.Sci Rep. 2019; 920106
- Accelerated tooth movement by alveolar corticotomy or piezocision.Orthod Fr. 2012; 83: 155-164
- Surgery-first accelerated orthognathic surgery: postoperative rapid orthodontic tooth movement.J Oral Maxillofac Surg. 2011; 69: 781-785
- Skeletal stability in orthognathic surgery with the surgery first approach: a systematic review.Int J Oral Maxillofac Surg. 2019; 48: 930-940
- Skeletal stability of surgery-first bimaxillary orthognathic surgery for skeletal Class III malocclusion, using standardized criteria.Int J Oral Maxillofac Surg. 2016; 45: 35-40
- Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis.Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 126: 107-116
- Surgery first in orthognathic surgery: what have we learned? A comprehensive workflow based on 45 consecutive cases.J Oral Maxillofac Surg. 2014; 72: 376-390
- Redefining our protocol of the orthognathic surgery-first approach after 10 years of experience.Br J Oral Maxillofac Surg. 2022; https://doi.org/10.1016/j.bjoms.2022.04.006
- New protocol for three-dimensional surgical planning and CAD/CAM splint generation in orthognathic surgery: an in vitro and in vivo study.Int J Oral Maxillofac Surg. 2013; 42: 1547-1556
- Upper incisor to soft tissue plane (UI–STP): a new reference for diagnosis and planning in dentofacial deformities.Med Oral Patol Oral Cir Bucal. 2010; 15: e779-e781
- “Surgery first” in bimaxillary orthognathic surgery.J Oral Maxillofac Surg. 2011; 69: e201-e207
- Twist technique for pterygomaxillary dysjunction in minimally invasive Le Fort I osteotomy.J Oral Maxillofac Surg. 2013; 71: 389-392
- Cranial base superimposition of cone-beam computed tomography images: a voxel-based protocol validation.J Craniofac Surg. 2019; 30: 1809-1814
- Intraexaminer and interexaminer reliabilities of landmark identification on digitized lateral cephalograms and formatted 3-dimensional cone-beam computerized tomography images.Am J Orthod Dentofacial Orthop. 2010; 137: 598-604
- Impact of surgical maxillomandibular advancement upon pharyngeal airway volume and the apnoea–hypopnoea index in the treatment of obstructive sleep apnoea: systematic review and meta-analysis.BMJ Open Respir Res. 2019; 6e000402
- Surgery first orthognathic approach for skeletal Class III malocclusion corrections—a literature review.J Med Assoc Thailand. 2012; 95: S172-S180
- 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.J Clin Med. 2020; 9641
- Long-term outcomes of bimaxillary surgery for treatment of asymmetric skeletal Class III deformity using surgery-first approach.Clin Oral Investig. 2019; 23: 1685-1693
- Postoperative stability for surgery-first approach using intraoral vertical ramus osteotomy: 12-month follow-up.Br J Oral Maxillofac Surg. 2014; 52: 539-544
- Evaluation of postoperative mandibular positional changes after mandibular setback surgery in a surgery-first approach: isolated mandibular surgery versus bimaxillary surgery.J Oral Maxillofac Surg. 2019; 77181
- Evaluation of stability after orthognathic surgery with minimal orthodontic preparation: comparison according to 3 types of fixation.J Craniofac Surg. 2014; 25: 911-915
- Evaluation of long-term hard tissue remodelling after skeletal Class III orthognathic surgery: a systematic review.Int J Oral Maxillofac Surg. 2020; 49: 51-61
- Surgery-first approach in correcting skeletal Class III malocclusion with mandibular asymmetry.Am J Orthod Dentofacial Orthop. 2017; 152: 255-267
- Surgery-first approach in skeletal Class III malocclusion treated with 2-jaw surgery: evaluation of surgical movement and postoperative orthodontic treatment.J Craniofac Surg. 2010; 21: 332-338
- Skeletal and dental variables related to the stability of orthognathic surgery in skeletal Class III malocclusion with a surgery-first approach.J Oral Maxillofac Surg. 2013; 71: e215-e223
- Effect of occlusal vertical dimension changes on postsurgical skeletal changes in a surgery-first approach for skeletal Class III deformities.Am J Orthod Dentofacial Orthop. 2014; 146: 612-619
Article info
Publication history
Published online: July 21, 2022
Accepted:
June 27,
2022
Identification
Copyright
© 2022 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
