Journal of Contemporary Dentistry

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VOLUME 9 , ISSUE 3 ( September-December, 2019 ) > List of Articles

CASE REPORT

“Surgery-first Orthognathic Approach” for Correction of Skeletal Class III with Open Bite

Reshme Radha Divakar, Ratna Parameswaran, Janani Jayapal, Devaki Vijayalakshmi

Keywords : Orthognathic surgery, Rapid acceleratory phenomenon, Surgery-first orthognathic approach,Class III skeletal base

Citation Information : Divakar RR, Parameswaran R, Jayapal J, Vijayalakshmi D. “Surgery-first Orthognathic Approach” for Correction of Skeletal Class III with Open Bite. J Contemp Dent 2019; 9 (3):144-149.

DOI: 10.5005/jp-journals-10031-1266

License: CC BY-NC 4.0

Published Online: 25-03-2021

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: This case report illustrates the treatment of a skeletal class III patient with the surgery-first orthognathic approach (SFOA) protocol. Background: “Surgery-first orthognathic approach” is a growing trend that provides an immediate facial change. The SFOA protocol utilizes dentoalveolar compensation as the key advantage to effect immediate facial change, which in conjunction with the rapid acceleratory phenomenon (RAP) augments the intended tooth movement, thereby reducing the total treatment duration. Case description: A 24-year-old male presented with forwardly placed lower jaw with associated difficulty during eating. Clinical examination revealed severe lip incompetency, mandibular excess, class III skeletal malocclusion, severe bimaxillary incisor proclination, posterior crossbite, and lower midline shift toward right on an average mandibular plane angle. Conclusion: The SFOA protocol involving bilateral sagittal split osteotomy (BSSO) mandibular setback along with the correction of the pitch and yaw was performed and the orthodontic phase was followed. Clinical significance: The total treatment time was 5 months and 15 days, following which excellent facial transformation and stable occlusion was achieved.


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  1. Kiyak A, McNeil RW, West RA. The emotional impact of orthognathic surgery and conventional orthodontics. Am J Orthod 1985;88(3): 224–234. DOI: 10.1016/S0002-9416(85)90217-9.
  2. Baek SH, Ahn HW, Kwon YH, et al. 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):332–338. DOI: 10.1097/SCS.0b013e3181cf5fd4.
  3. Nagasaka H, Suguwara J, Kawamura H, et al. “Surgery first” skeletal class III correction using the skeletal anchorage system. J Clin Orthod 2009;43(2):97–105.
  4. Villegas C, Uribe F, Sugawara J, et al. Expedited correction of significant dentofacial asymmetry using a “Surgery first” approach. J Clin Orthod 2010;44(2):97–103.
  5. Sugawara J, Nagasaka H, Yamada S, et al. The application of orthodontic miniplates to Sendai surgery first. Sem Orthod 2018;24(1):17–36. DOI: 10.1053/j.sodo.2018.01.003.
  6. Alfaro FH, Martínez RG, Coral AM, et al. “Surgery first” in bimaxillary orthognathic surgery. J Oral Maxillofac Surg 2011;69(6):201–207. DOI: 10.1016/j.joms.2011.01.010.
  7. Brachvogel P, Berten JL, Hausamen JE. Surgery before orthodontic treatment: a concept for timing the combined therapy of skeletal dysgnathias. Dtsch Zahn Mund Kieferheilkd Zentralbl 1991;79(7): 557–563.
  8. Huang CS, Hsu SS, Chen YR. Systematic review of the surgery-first approach in orthognathic surgery. Biomed J 2014;37(4):184–190. DOI: 10.4103/2319-4170.126863.
  9. Nuccio FD, D’Emidio MM, Pelo S. Surgery-first: a new approach to orthognathic surgery. Oral Implantol 2016;9(1):98–102. DOI: 10.11138/orl/2016.9.1S.098.
  10. Behrman SJ, Behrman DA. Oral surgeons’ considerations in surgical orthodontic treatment. Dent Clin North Am 1988;32(3):481–507.
  11. Sharma VK, Yadav K, Tandon P. An overview of surgery-first approach: recent advances in orthognathic surgery. J Orthod Sci 2015;4(1):9–12. DOI: 10.4103/2278-0203.149609.
  12. Choi DS, Garagiola U, Kim SG. Current status of the surgery-first approach (part I): concepts and orthodontic protocols. Maxillofac Plast Reconstr Surg 2019;41(1):10. DOI: 10.1186/s40902-019-0194-4.
  13. Liao YF, Lo SH. Surgical occlusion setup in correction of skeletal class III deformity using surgery-first approach: guidelines, characteristics and accuracy. Sci Rep 2018;8(1):11673. DOI: 10.1038/s41598-018- 30124-2.
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