María A Peiró-Guijarro1, Raquel Guijarro-Martínez2, Federico Hernández-Alfaro3. 1. Fellow, International University of Catalonia, Barcelona, Spain. 2. Oral and maxillofacial surgeon, Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain; assistant professor, Department of Oral and Maxillofacial Surgery, International University of Catalonia, Barcelona, Spain. Electronic address: guijarro.raq@gmail.com. 3. Director, Institute of Maxillofacial Surgery, Teknon Medical Center Barcelona, Barcelona, Spain; chairman, Department of Oral and Maxillofacial Surgery, International University of Catalonia, Barcelona, Spain.
Abstract
INTRODUCTION: Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking. METHODS: A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally. RESULTS: The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible. CONCLUSIONS: The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups.
INTRODUCTION: Compared to the conventional approach to orthognathic surgery, "surgery first" protocols could be advantageous in terms of shortened treatment times and immediate esthetic improvement. However, consensus regarding patient selection, technical protocol, and stability is still lacking. METHODS: A systematic review of the scientific literature on surgery-first treatment (January 2000 to January 2015) was performed. The PubMED and Cochrane Library databases were accessed. Patient selection criteria, specific surgical-orthodontic protocol, treatment duration, patient and orthodontist satisfaction, and stability of results were compared with a similar population treated conventionally. RESULTS: The search yielded 179 publications. The application of strict selection criteria gave the final group of 11 articles. In total, 295 patients were managed with a surgery-first approach. A Class III malocclusion was the most prevalent underlying malocclusion (84.7%). Total treatment duration was shorter in surgery-first patients than in those treated conventionally. There was substantial heterogeneity among articles and high reporting bias regarding the inclusion and exclusion criteria, the orthodontic and surgical protocols, and the stability of results. A meta-analysis of combined data was not possible. CONCLUSIONS: The surgery-first approach is a new treatment paradigm for the management of dentomaxillofacial deformity. Studies have reported satisfactory outcomes and high acceptance. However, the results should be interpreted with caution because of the wide varieties of study designs and outcome variables, reporting biases, and lack of prospective long-term follow-ups.
Authors: Victorine E H W Brouns; Anne-Lieke M L de Waal; Ewald M Bronkhorst; Anne Marie Kuijpers-Jagtman; Edwin M Ongkosuwito Journal: Clin Oral Investig Date: 2022-02-23 Impact factor: 3.573
Authors: Juan Fernando Aristizábal; Rosana Martínez-Smit; Cristian Díaz; Valfrido Antonio Pereira Filho Journal: Dental Press J Orthod Date: 2018 May-Jun