Orthognathic surgery: surgery first prior to orthodontic treatment in patients with Class III skeletal malocclusion

Abstract

Introduction. Orthognathic surgery is a surgical procedure used to correct deformations and asymmetries of the maxillo-mandibular complex, especially in those in which there are occlusal alterations. The surgeon and orthodontist intervene to obtain occlusal stability, facial harmony, correct bone discrepancies and improve basic functions such as chewing, phonation and breathing. The most common skeletal malocclusion in which orthognathic surgery is usually performed is Class III, which in turn is distinguished by 1) mandibular prognathism, 2) maxillary retrognathism or 3) a combination of both characteristics. Conventional treatment planning consists of three phases: pre-surgical orthodontics, orthognathic surgery and post-surgical orthodontics. The Surgery First technique, because when it is performed on indicated patients, offers advantages such as shorter treatment time, lower cost, improvement of the facial profile by correcting skeletal bases, orthodontic decompensation is effective due to the phenomenon of regional acceleration and rapid recovery of the patient. Objective.  The objective of this research is to demonstrate, through a literature review, the effectiveness of the Surgery First technique prior to orthodontic treatment in patients with class III malocclusion, comparing the effectiveness in reducing the treatment time of the technique in relation to the conventional orthognathic surgical technique. Methodology.  This research work is a descriptive bibliographic and documentary review of the use of the orthognathic surgery technique called Surgery First prior to orthodontic treatment in patients with Class III skeletal malocclusion. It was developed under the indications PRISMA (Prerrefered Reporting Items for Systemic Reviews and Meta-Analysis). Results. The surgery technique first shortens the treatment time and produces aesthetic changes instantly. Unlike the conventional orthognathic technique, which comprises 3 phases, a pre-orthodontic of approximately 12-18 months, the surgery itself and a post-surgical orthodontic phase with an estimated time of 5 to 12 months. With Surgery First, tooth movement is accelerated thanks to previous surgery, so it takes 10 months of post-orthodontics and the total treatment time decreases. Conclusion. In this work, the effectiveness of Surgery First in reducing the total treatment time compared to the conventional technique has been analyzed. It was concluded that the protocol used in SF is effective and requires less time, it is estimated that an average of ten to twelve months less than the conventional technique. Therefore, the treatment time for FS could be approximately fifteen months, while the conventional protocol has an estimated time of two years. General area of study: Dentistry. Specific area of study: Oral surgery, maxillofacial surgery, orthodontics. Type of study: Original articles.