Document Type : Case report/ series
MDS Orthodontics, Assistant Professor, Department of Orthodontics, Government Dental College and Hospital, Ahmedabad-380016, Gujarat, India
MDS Orthodontics, Professor & Head, Department of Orthodontics, Government Dental College and Hospital, Ahmedabad-380016, Gujarat, India
MDS Orthodontics, Professor, Department of Orthodontics, Government Dental College and Hospital, Ahmedabad-380016, Gujarat, India
Ex PG Student, Department of Orthodontics, Government Dental College and Hospital, Ahmedabad-380016, Gujarat, India
Background: Traditional orthognathic surgery typically requires prolonged and extensive orthodontic treatment prior to surgery, followed by a shorter postoperative orthodontic phase. The pre-surgical orthodontic period is lengthy and can lead to a decline in facial aesthetics due to decompensation. Consequently, patients’ mental health could decline and they could lose confidence as a result of these changes. To address the issue of deteriorating facial soft tissues during early decompensation and to reduce the risk of unstable postoperative occlusion, the surgery-first approach (SFA) or minimal pre-surgical orthodontics (MPO) has been introduced. MPO is designed to minimize occlusal interference and enhance arch coordination for surgery, thereby increasing the predictability of surgical outcomes.
Case Description: An 18-year-old male patient with skeletal class III malocclusion and an anterior open bite was treated using MPO. A modified trans-palatal arch (TPA) was applied before surgery to rectify a projected post-surgical buccal scissor-bite involving the maxillary second molar. After achieving this correction, the patient underwent bi-jaw surgery.
Conclusion: This approach, in contrast to the conventional method, involved brief orthodontic tooth movement without negatively impacting the patient's profile or decompensation. The patient was highly satisfied and delighted with the outcome.
- Poulton DR, Taylor RC, Ware WH. Cephalometric x-ray evaluation of the vertical osteotomy correction of mandibular prognathism. Oral Surg Oral Med Oral Pathol.1963;16:807-20. doi: 10.1016/0030-4220(63)90319-0. PMID: 13985783.
- Behrman SJ, Behrman DA. Oral surgeons’ considerations in surgical orthodontic treatment. Dent Clin North Am. 1988; 32:481-507. PMID: 3042475.
- Tompach PC, Wheeler JJ, Fridrich KL. Orthodontic considerations in orthognathic surgery. Int J Adult Orthodon Orthognath Surg. 1995;10(2):97-107. PMID: 9082003.
- Troy BA, Shanker S, Fields HW, Vig K, Johnston W. Comparison of incisor inclination in patients with Class III malocclusion treated with orthognathic surgery or orthodontic camouflage. Am J Orthod Dentofacial Orthop. 2009; 135:146.el-9. doi: 10.1016/ j. ajodo.2008.07.012. PMID: 19201319.
- Uribe F, Janakiraman N, Shafer D, Nanda R. Threedimensional cone-beam computed tomographybased virtual treatment planning and fabrication of a surgical splint for asymmetric patients: surgery first approach. Am J Orthod Dentofacial Orthop. 2013; 144(5):748-58. doi: 10.1016/j.ajodo.2012.10.029. PMID: 24182591.
- Luther F, Morris DO, Hart C. Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study. Br J Oral Maxillofac Surg. 2003;41(6):401-6. doi: 10.1016/s0266-4356(03)001 63-3. PMID: 14614870.
- Arnett GW, Jelic JS, Kim J, Cummings DR, Beress A, Worley Jr CM, et al. Soft tissue cephalometric analysis: diagnosis and treatment planning of dentofacial deformity. Am J Orthod Dentofacial Orthop. 1999;116(3):239-53. doi: 10.1016/s0889- 5406(99)70234-9. PMID: 10474095.
- Baek SH, Ahn HW, Kwon YH, Choi JY. 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(2):332-8. doi: 10.1097/SCS.0b013e 3181cf5fd4. PMID: 20186090.
- Ko EW, Hsu SS, Hsieh HY, Wang YC, Huang CS, Chen YR. Comparison of progressive cephalometric changes and postsurgical stability of skeletal Class III correction with and without presurgical orthodontic treatment. J Oral Maxillofac Surg. 2011;69(5):1469-77. doi: 10.1016/j. joms.2010.07.022. PMID: 21256648.
- Wang YC, Ko EW, Huang CS, Chen YR, TakanoYamamoto T. Comparison of transverse dimensional changes in surgical skeletal Class III patients with and without presurgical orthodontics. J Oral Maxillofac Surg. 2010;68(8):1807 12. doi: 10.1016/j.joms.2009. 09.089. PMID: 20493619.
- Nagasaka H, Sugawara J, Kawamura H, Nanda R. " Surgery first" skeletal Class III correction using the Skeletal Anchorage System. J Clin Orthod. 2009;43(2):97-105. PMID: 19276579.
- Choi JW, Bradley JP. Surgery first orthognathic approach without presurgical orthodontic treatment: questions and answers. J Craniofac Surg.2017;28(5):1330- 33.doi:10.1097/SCS.0000000000003733. PMID: 28582307.
- Jeong WS, Choi JW, Lee JY, Kwon SM. Can a surgery-first orthognathic approach reduce the total treatment time? Int J Oral Maxillofac Surg. 2017;46(4):473-82. doi: 10.1016/j.ijom.2016.12.006. PMID: 28043746.
- Johnston C, Burden D, Kennedy D, Harradine N, Stevenson M. Class III surgical-orthodontic treatment: a cephalometric study. Am J Orthod Dentofacial Orthop. 2006;130(3):300-9. doi: 10.1016/j.ajodo.2005.01.023. PMID: 16979487.