Surgery-first approach for correction of class III dentofacial deformity with Le Fort I osteotomy; is it advantageous?

Abstract

The surgery-first approach (SFA) to orthognathic treatment aims to reduce its duration without compromising the outcome. However, the objective assessment of the achieved occlusion has been limited. This study was designed to assess the treatment duration, outpatient appointment number, and quality of occlusal outcomes for two groups of patients; one treated with the SFA and the other with an orthodontics-first approach (OFA). We carried our a retrospective cohort study of case records for twenty consecutive SFA, and 23 consecutive OFA, cases with class III malocclusions, treated with Le Fort I maxillary osteotomy only. Pre-and post-treatment study models were assessed using the Peer Assessment Rating (PAR). Significant differences (p<0.001) were found between the median active treatment durations (10.2 months for the SFA and 32.5 months for the OFA) and appointment numbers (14 for SFA and 24 for OFA). Median absolute PAR reductions were 40 for the SFA and 39 for the OFA. There was no significant difference between the groups regarding quality of occlusal correction. Treatment durations for the SFA group were significantly shorter than for the OFA group, with fewer outpatient appointments. The quality of occlusal outcome for both SFA and OFA groups were satisfactory and comparable.

Keywords: Occlusal outcome; Surgery-first approach; Treatment duration.