Surgery-first Orthognathic Surgery Research Articles

Addressing Acromegaly-Related Malocclusion With Surgery-First Orthognathic Surgery: A Clinical Case Report

Addressing Acromegaly-Related Malocclusion With Surgery-First Orthognathic Surgery: A Clinical Case Report

The top 100 highly cited articles on surgery-first orthognathic surgery between 2009 and 2022: a bibliometric and visualized analysis

ObjectivesTo reveal research focuses on surgery-first orthognathic surgery by a bibliometric and visualized analysis of the top 100 highly cited articles. Study DesignPublished papers related to surgery-first orthognathic surgery were retrospectively retrieved from the Web of Science Core Collection from 2009 to 2022. The number of articles, journals, countries/regions, institutions, authors, keywords were assessed and visualized using CiteSpace software. ResultsThe top 100 cited articles included 89 research papers and 11 reviews. The average total citation was 21. The most influential article with 146 citations was published by Liou EJW in 2011. The most common level of evidence was level IV (36 articles). The Journal of Oral and Maxillofacial Surgery had the largest number of papers and the highest total citation frequency. The most productive countries and institutions were Korea/China, and Chang Gung Memorial Hospital, respectively. Chen Yu-ray and Choi Jong Woo published 13, 11 articles with 434, 299 total citations, respectively. Research interests shifted from skeletal class III malocclusion, accuracy, stability, relapse to quality of life and virtual surgical planning. ConclusionOur bibliometric analyses provide comprehensive landscape of the influential topics and developmental trends in surgery-first orthognathic surgery and inspire future studies in this booming field.

Chang Gung Forum: An Exemplary Strategy for Implementing a Multidisciplinary Network of Experts in Craniofacial Anomalies.

The Chang Gung Forum has been dedicated to the care of craniofacial anomalies since 2000. This annual continuing medical education program focuses on orofacial cleft and surgery-first orthognathic surgery by providing up-to-date information and management guidelines. This study explored how the Chang Gung Forum has influenced medical perspectives, decisions, and practices in a multidisciplinary craniofacial team. Between 2000 and 2022, 20 Chang Gung Forums have been held. A questionnaire was distributed among 170 attendees who had participated in the forum more than once. The questionnaire collected information on the participants' experiences and levels of satisfaction with the educational program and whether or how it had influenced their clinical practice. Valid responses from 86 attendees (response rate, 50.6%) who had participated more than once were collected and analyzed. The overall satisfaction rate of the Chang Gung Forum based on the respondents' most recent visits was 4.28 ± 0.63 out of 5. Of the respondents, 90.9% acknowledged changes in their clinical practice, with modifications in surgery plans and decisions being the most notable (48.5%). In addition, comprehension increased throughout years of attending the annual forum (P < 0.001). The Chang Gung Forum has contributed markedly to the community of congenital craniofacial anomalies. The program will continue providing updated information and influencing the clinical decision-making of health care professionals.

Precise Prediction of Transitional Occlusion Using Reverse Engineering in Surgery-first Orthognathic Surgery Case

With surgery-first approach, the skeletal discrepancy is corrected with orthognathic surgery at the start of treatment, but the teeth remain in their original compensated positions. This change in treatment sequence means clinicians have to determine what the occlusion immediately after the surgery, which is called transitional occlusion, should look like during the planning process. This report describes the surgical and orthodontic planning for a surgery-first case that corrected a large Cl III malocclusion. Virtual planning was used to reverse engineer the transitional postsurgical occlusion from the final ideal position. A multiplatform software can be a powerful tool for analyzing problems in finishing a surgery-first case, predicting outcomes, and improving the accuracy in planning surgery-first approach.

Skeletal stability after bimaxillary surgery with surgery-first approach for class III asymmetry is not related to virtual surgical occlusal contact.

Surgery-first orthognathic surgery is rarely used in class III asymmetry due to concerns of reduced skeletal stability from unstable surgical occlusion. This study aimed to evaluate if skeletal stability after surgery-first orthognathic surgery is related to virtual surgical occlusal contact or surgical change. We studied 58 adults with class III asymmetry, consecutively corrected by Le Fort I osteotomy and bilateral sagittal split osteotomy using a surgery-first approach. Dental casts were manually set to measure virtual surgical occlusal contact including contact distribution, contact number, and contact area. Cone-beam computed tomography taken before treatment, 1-week post-surgery, and after treatment was used to measure surgical change and post-surgical stability of the maxilla and mandible in translation (left/right, posterior/anterior, superior/inferior) and rotation (pitch, roll, yaw). The relationship between skeletal stability and surgical occlusal contact or surgical change was evaluated with correlation analysis. Significant instability was found in the mandible but not in the maxilla. No correlation was found between the maxillary or mandibular stability and surgical occlusal contact (all p > 0.01). However, a significant correlation was found between the maxillary (roll and yaw) or mandibular (shift, roll and pitch) stability and its surgical change (all p < 0.001). In correction of class III asymmetry with surgery-first bimaxillary surgery, the skeletal stability is not related to the virtual surgical occlusal contact, but surgical skeletal change. Planned over-correction is a reasonable option for correction of severe shift or roll mandibular asymmetry in bimaxillary surgery for class III deformity.

Modern Surgery-First Approach Concept in Cleft-Orthognathic Surgery: A Comparative Cohort Study with 3D Quantitative Analysis of Surgical-Occlusion Setup.

Despite the evident benefits of the modern surgery-first orthognathic surgery approach (reduced treatment time, efficient tooth decompensation, and early improvement in facial esthetics), the challenge of the surgical-occlusion setup acts as a hindering factor for the widespread and global adoption of this therapeutic modality, especially for the management of cleft-skeletofacial deformity. This is the first study to assess three-dimensional (3D) quantitative data of the surgical-occlusion setup in surgery-first cleft-orthognathic surgery. This comparative retrospective study was performed on 3D image datasets from consecutive patients with skeletal Class III deformity who had a unilateral cleft lip/palate (cleft cohort, n = 44) or a noncleft dentofacial deformity (noncleft cohort, n = 22) and underwent 3D computer-assisted single-splint two-jaw surgery by a single multidisciplinary team between 2014 and 2018. They received conventional orthodontics-first or surgery-first approaches. 3D quantitative characterization (linear, angular, and positional measurements) of the final surgical-occlusion setup was performed and adopted for comparative analyses. In the cleft cohort, the occlusion setup in the surgery-first approach had a significantly (all p < 0.05) smaller number of anterior teeth contacts and larger incisor overjet compared to the conventional approach. Considering the surgery-first approach, the cleft cohort presented significantly (all p < 0.05) larger (canine lateral overjet parameter) and smaller (incisor overjet, maxillary intercanine distance, maxillary intermolar distance, ratio of intercanine distance, and ratio of intermolar distance parameters) values than the noncleft cohort. This study contributes to the literature by providing 3D quantitative data of the surgical-occlusion setup in surgery-first cleft-orthognathic surgery, and delivers information that may assist multidisciplinary teams to adopt the surgery-first concept to optimize cleft care.

Simultaneous Surgical Correction of Skeletal Class III Dentofacial Deformity During Acute Management of Facial Fractures: Patient Selection and Surgical Technique.

Mandibular prognathism is a common dentofacial deformity in Asia. Treatment of such condition may vary from orthodontic camouflage to surgical orthodontics with orthognathic surgery depending on the severity of the condition. Because of the prominent position of the mandible, fractures involving different locations of the mandible commonly occur in maxillofacial trauma. Anatomical reduction of maxillofacial fractures and restoration of the pretraumatic occlusion are the primary goals of acute management of facial fractures. In patients with dentofacial deformity, simultaneous surgical correction of their malocclusion and improvement of their facial aesthetics while providing open treatment to the maxillofacial fractures are rarely reported in the literature. We reported 3 cases with combined open reduction and internal fixation and surgery-first orthognathic surgery principles to correct class III malocclusion with mandibular prognathism during acute management of maxillofacial fractures. Computer-assisted surgical simulation was used in surgical planning and fabrication of surgical splint. Two patients underwent mandibular osteotomies in addition to open reduction and internal fixation of maxillofacial fractures. One patient had both maxillary and mandibular osteotomies during facial fracture repair. Class I occlusion with satisfactory facial profile was achieved in all 3 cases. Careful patient selection with presurgical planning using computer-assisted surgical simulation is essential in achieving successful outcomes in correcting dentofacial deformities while managing maxillofacial fractures. This combined technique is a viable option in the surgical management of facial fractures in patients with dentofacial deformities.

Surgery-first orthognathic surgery with computer assisted three-dimensional planning

In silico orthognathic surgery treatment planning, or 3D planning, is already an important clinical tool. Nonetheless, several clinicians do not know how to use the available computer programs and files to properly plan the surgical orthodontic treatment. The present article presents a three-dimensional surgical orthodontic planning protocol for orthognathic surgery and illustrate this technique with the case description of a patient with class II dentofacial deformity. A computer tomography is mandatory for such procedure as well as teeth e-models. They allow the generation of a composite skull and the final impression of splints which will bridge the gap between software and clinical steps.

Surgical Occlusion Setup in Correction of Skeletal Class III Deformity Using Surgery-First Approach: Guidelines, Characteristics and Accuracy

The aims of this study were to establish guidelines for the surgical occlusion setup of surgery-first orthognathic surgery, and evaluate the resulting characteristics and accuracy. Skeletal Class III patients (N = 53) underwent Le Fort I osteotomy and bilateral sagittal split osteotomy. Study models before orthognathic surgery were set according to the guidelines. Occlusion was measured and computer-aided surgical simulation was used to evaluate the characteristics and accuracy of the surgical occlusion. The mean age of participants was 25 ± 6 years with 24 males and 29 females. The occlusion was set as positive overjet (4.4 ± 2.0 mm) and overbite (1.4 ± 1.8 mm), Class II or I molar relation, and posterior cross bite (overjet: 4.9 ± 2.0 mm and 4.4 ±1.9 mm, respectively for the right and left second molars) and open bite (overbite: −2.0 ± 1.6 mm and −1.9 ± 1.3 mm, respectively for the right and left second molars). Normal jaw relationship and symmetry were noted after virtual surgery. None of the patients required new occlusal setup. Our data contribute the use of the surgery-first approach for skeletal Class III patients by establishing guidelines for a surgical occlusion setup in three dimensions.

Accuracy of Three-Dimensional Planning in Surgery-First Orthognathic Surgery: Planning Versus Outcome.

BackgroundThe benefit of computer-assisted planning in orthognathic surgery (OGS) has been extensively documented over the last decade. This study aimed to evaluate the accuracy of three-dimensional (3D) virtual planning in surgery-first OGS.MethodsFifteen patients with skeletal class III malocclusion who underwent bimaxillary OGS with surgery-first approach were included. A composite skull model was reconstructed using data from cone-beam computed tomography and stereolithography from a scanned dental cast. Surgical procedures were simulated using Simplant O&O software, and the virtual plan was transferred to the operation room using 3D-printed splints. Differences of the 3D measurements between the virtual plan and postoperative results were evaluated, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method.ResultsThe virtual planning was successfully transferred to surgery. The overall mean linear difference was 0.88 mm (0.79 mm for the maxilla and 1 mm for the mandible), and the overall mean angular difference was 1.16°. The RMSD ranged from 0.86 to 1.46 mm and 1.27° to 1.45°, within the acceptable clinical criteria.ConclusionIn this study, virtual surgical planning and 3D-printed surgical splints facilitated the diagnosis and treatment planning, and offered an accurate outcome in surgery-first OGS.

Comparison of condylar displacement between single-jaw and double-jaw surgery-first orthognathic surgery in mandibular prognathism

Comparison of condylar displacement between single-jaw and double-jaw surgery-first orthognathic surgery in mandibular prognathism

Can a surgery-first orthognathic approach reduce the total treatment time?

Although pre-surgical orthodontic treatment has been accepted as a necessary process for stable orthognathic correction in the traditional orthognathic approach, recent advances in the application of miniscrews and in the pre-surgical simulation of orthodontic management using dental models have shown that it is possible to perform a surgery-first orthognathic approach without pre-surgical orthodontic treatment. This prospective study investigated the surgical outcomes of patients with diagnosed skeletal class III dentofacial deformities who underwent orthognathic surgery between December 2007 and December 2014. Cephalometric landmark data for patients undergoing the surgery-first approach were analyzed in terms of postoperative changes in vertical and horizontal skeletal pattern, dental pattern, and soft tissue profile. Forty-five consecutive Asian patients with skeletal class III dentofacial deformities who underwent surgery-first orthognathic surgery and 52 patients who underwent conventional two-jaw orthognathic surgery were included. The analysis revealed that the total treatment period for the surgery-first approach averaged 14.6 months, compared with 22.0 months for the orthodontics-first approach. Comparisons between the immediate postoperative and preoperative and between the postoperative and immediate postoperative cephalometric data revealed factors that correlated with the total treatment duration. The surgery-first orthognathic approach can dramatically reduce the total treatment time, with no major complications.

Application of 4-Meta Adhesive Resin to the Occlusal Surface During Surgery Facilitates Postoperative Occlusal Management.

Orthognathic surgery is generally used to correct facial deformities and establish functional occlusion. Preoperative orthodontic treatment is important for stabilizing and establishing the postoperative occlusion. However, sufficient preoperative surgical orthodontic treatment might be sometimes difficult in patients with an abnormally shaped maxilla or mandible or severe jaw deformity. We performed this technique over 10 patients with jaw deformities after insufficient presurgical orthodontic treatment. Adhesive resins are attached to the maxillary palatal cusps to during surgery for disclusion of the premolars and molars. The resins which are interfered during the postoperative orthodontic treatment can be removed gradually with a bur. Postoperative orthodontic treatment can be subsequently facilitated with a stable occlusion. This technique should be applied for surgery-first orthognathic surgery and avoidance of multi-piece Le Fort I osteotomy, and can facilitate postoperative orthodontic treatment following gradually removal of cusp interferences.

Abstract: Can a Surgery-First Orthognathic Approach Reduce the Total Treatment Time?

INTRODUCTION: A traditional orthognathic approach requires presurgical orthodontic treatment for an average of approximately 17 months,1 followed by surgery and postsurgical orthodontic treatment for approximately 6–12 months. Therefore, the total treatment time for the conventional orthognathic approach takes approximately 18–36 months.2–4 Because traditional orthognathic surgery requires 2–3 years to complete, it is a rarely adopted procedure. Therefore, shortening the total treatment time would be extremely beneficial for patients. Although presurgical orthodontic treatment has been approved as an inevitable process for stable orthognathic correction before surgery, recent advances in the application of mini-screws and presurgical simulational orthodontic management skills on a dental model show that it is possible to perform a surgery-first orthognathic approach without presurgical orthodontic treatment.5 MATERIALS AND METHODS: We assessed 45 consecutive Asian patients with skeletal class III dentofacial deformities with surgery-first orthognathic surgery compared to 52 patients with conventional two-jaw orthognathic surgery. Using cephalometric landmark data for the patients with a surgery-first approach, we analyzed postoperative changes in vertical and horizontal facial, denture, and soft tissue patterns. Assuming that tooth extraction is a factor that affects the total treatment time, both groups were divided into two subgroups. RESULTS: The treatment duration of the surgery-first group was significantly less than that of the orthodontics-first group. Overall, the analysis revealed that the total treatment time period in the surgery-first orthognathic approach averaged 14.6 months compared to 22.0 months of treatment in an orthodontic-first orthognathic approach. Among the surgery-first cases without tooth extraction, the average treatment interval was only 13.6 months versus 24.8 months for the six that required tooth extraction (p < 0.001). In contrast, the average treatment period of traditional orthodontics-first cases without tooth extraction was roughly comparable to the nine cases that required tooth extraction (21.7 months vs. 21.6 months, respectively). The difference between immediate postoperative and preoperative, postoperative and immediate postoperative cephalometric data revealed factors that have correlation with total treatment duration. CONCLUSION: Surgery-first orthognathic surgery can dramatically shorten the total treatment time with no major complications. By analyzing the cephalometric landmark data we identified several possible factors that have an effect on the total treatment time. DISCLOSURES/FINANCIAL SUPPORT:None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. 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 41:401–406, 2003. 2. Van Sickels JE, Loftus MJ, Weiss WW, Jr: Orthognathic surgery: a team approach. Bull Phila Cty Dent Soc. 45:8–9, 1979. 3. Slavnic S, Marcusson A: Duration of orthodontic treatment in conjunction with orthognathic surgery. Swed Dent J. 34:159–166, 2010. 4. Dowling PA, Espeland L, Krogstad O, Stenvik A, Kelly A: Duration of orthodontic treatment involving orthognathic surgery. Int J Adult Orthodon Orthognath Surg. 14:146–152, 1999. 5. Choi JW, Lee JY, Yang SJ, Koh KS: The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal class III dentofacial deformity. Ann Plast Surg. 74:333–341, 2015.

A comparative study of the change of condylar position after mandibular setback using bilateral sagittal split ramus osteotomy between conventional and surgery-first orthognathic surgery

A comparative study of the change of condylar position after mandibular setback using bilateral sagittal split ramus osteotomy between conventional and surgery-first orthognathic surgery

Correction of proximal segment displacement in patients treated by the surgery-first orthognathic surgery: report of two cases

Correction of proximal segment displacement in patients treated by the surgery-first orthognathic surgery: report of two cases

A Comparative Study of the Changes in Condylar Position after Mandibular Setback Using Bilateral Sagittal Split Ramus Osteotomy between Surgery-After and Surgery-First Orthognathic Surgery

Statement of the Problem: Complication after Extraoral Vertical and Intraoral Oblique Osteotomy have been reported but in a comprehensive manner. Although intuitively the profile of complications after Intra Oral Vertical Ramus Osteotomy (IVRO) would be similar to subcondylar osteotomy, the technique of the two procedures are different, and thus unfavorable outcome after surgery also may differ. The aim of this study was evaluate the morbidity and complications following correcton of mandibular deformity by IVRO. Material and Method: A prospective study was undertaken of 271 consecutively treated orthognathic surgical patients with mandibular deformity(without mandibular deficiency). Each patients was treated by bilateral IVRO with 2 Weeks of maxillo-mandibular fixation and no interosseous fixation of proximal segment. Method of Data Analysis: Postoperative stability ,immediately after surgery ,at 6 months , and at 12 months after surgeryweremade. Complications consist of vascular complications, nerve injury, infection, condylar luxation andbonehearingwere assessedby retrospective individual chart review. Results: The mean blood loss was 47g and no severe bleeding during operation. There was no wound infection and avascular necrosis after surgery. Inferior alveolar nerve neurosensory disturbance remained 2 operative sites but was not permanent. Malocclusion after surgery was manifest by either relapse or anterior open bite occurred in 3 patients. Condylar dislocation occurred 1 patient. Conclusion: Our studies indicated that surgical correction of mandibular deformity by IVRO had a beneficial effect not only on occlusion but also upon complication after surgery.