Our Summary

This research paper reviews a strategy in orthognathic surgery called the surgery first approach (SFA). In this method, instead of having pre-surgery orthodontic treatment, the jaw bones (maxilla and mandible) are surgically moved to the desired position first, followed by a short orthodontic phase. While some studies suggest this method is acceptable, it’s unclear how stable the results are after surgery.

The researchers looked at various databases for studies that included specific measurements of skeletal stability after using the SFA. They found 2766 studies, but only 14 met their criteria. These studies included 560 patients with a type of misalignment of the teeth and jaws (Class III malocclusion), 339 of whom had the SFA.

The studies suggested that the SFA is as stable as the traditional method. However, the researchers noted that all the studies measured stability at a point ‘after surgery’ but not ‘after removing braces’, so it’s possible that any orthodontic treatment and subsequent jaw movements after surgery could have affected the measurements.

In conclusion, the researchers suggest that more studies are needed with longer follow-up periods and at the same time points to truly understand how stable the SFA is.

FAQs

  1. What is the surgery first approach (SFA) in orthognathic surgery?
  2. How does the stability of the surgery first approach compare to the traditional method?
  3. Why do the researchers suggest that more studies are needed to understand the stability of the SFA?

Doctor’s Tip

One helpful tip a doctor might give to a patient considering orthognathic surgery is to thoroughly discuss the surgery first approach (SFA) with their orthodontist and surgeon. While the SFA can be a viable option for some patients, it’s important to understand the potential risks and benefits, as well as the stability of the results over time. Patients should also follow all post-operative instructions carefully to ensure optimal healing and long-term success of the surgery.

Suitable For

Typically, patients recommended for orthognathic surgery are those with severe misalignments of the teeth and jaws that cannot be corrected with orthodontic treatment alone. This includes patients with Class III malocclusion, where the lower jaw protrudes significantly further than the upper jaw. Patients may also have functional issues such as difficulty chewing or speaking, as well as aesthetic concerns about the appearance of their face and smile.

Orthognathic surgery is often recommended for patients who have completed their growth, usually in their late teens or early twenties. This is because the surgery involves moving the bones of the jaws, which may not be stable if performed before growth is complete.

Overall, patients recommended for orthognathic surgery should have a thorough evaluation by a team of orthodontists and oral and maxillofacial surgeons to determine if they are good candidates for the procedure. It is important to consider the patient’s individual needs and goals, as well as the potential risks and benefits of surgery.

Timeline

Before orthognathic surgery, a patient typically undergoes a series of consultations with both an oral and maxillofacial surgeon and an orthodontist. This may include X-rays, dental impressions, and other diagnostic tests to determine the extent of the jaw misalignment and plan the surgery. The patient may also need to undergo some orthodontic treatment to align the teeth properly before surgery.

After the surgery, the patient will experience swelling, bruising, and some pain, which can be managed with pain medications. They will need to follow a liquid or soft diet for a period of time while the jaw heals. The patient will also need to attend follow-up appointments with both the surgeon and orthodontist to monitor the healing process and make any necessary adjustments to the bite.

As the jaw continues to heal, the patient will gradually transition back to a regular diet and resume normal activities. The orthodontist will work to fine-tune the bite and align the teeth properly through orthodontic treatment, which may involve wearing braces or other appliances for a period of time. Once the desired results are achieved, the braces will be removed, and the patient will continue to follow up with the orthodontist and surgeon to monitor the long-term stability of the surgical outcome.

What to Ask Your Doctor

Questions a patient should ask their doctor about orthognathic surgery using the surgery first approach (SFA) include:

  1. What are the potential risks and complications associated with the SFA compared to traditional orthognathic surgery?
  2. How long is the recovery process after the SFA and what can I expect in terms of pain and swelling?
  3. Will I still need to undergo orthodontic treatment after the SFA, and if so, for how long?
  4. What is the success rate of the SFA in correcting my specific jaw misalignment (Class III malocclusion)?
  5. How stable are the results of the SFA in the long term, and are there any factors that may affect the stability of the jaw position after surgery?
  6. Are there any alternative treatment options to orthognathic surgery for my jaw misalignment?
  7. What is the experience of the surgical team with performing the SFA, and how many procedures have they done successfully?
  8. How will the SFA impact my facial appearance and will there be any noticeable changes in my facial profile?
  9. Will I need to make any lifestyle changes or follow a specific diet after undergoing the SFA?
  10. What is the overall timeline for the SFA procedure, including consultations, surgery, orthodontic treatment, and follow-up appointments?

Reference

Authors: Soverina D, Gasparini G, Pelo S, Doneddu P, Todaro M, Boniello R, Azzuni C, Grippaudo C, Saponaro G, D’Amato G, Garagiola U, Moro A. Journal: Int J Oral Maxillofac Surg. 2019 Jul;48(7):930-940. doi: 10.1016/j.ijom.2019.01.002. Epub 2019 Jan 23. PMID: 30685226