Background and objectives: Traditional orthognathic treatment comprises a variable length of presurgical orthodontics, surgery itself and a relatively constant period of postoperative orthodontics. Alternatively, the so-called ‘surgery first’ (SF) approach proceeds directly with surgery and is followed by regular postoperative dental alignment. Total treatment time is significantly reduced. The aim of this abstract is to share our experience with our first long series of SF patients, describe our specific protocol and update the indications and limitations of this technique.

Patients and methods: Cases following a SF sequence were prospectively analyzed during a two-year period. Selected patients presented skeletal malocclusions requiring combined orthodontic-surgical treatment without the need of extractions, provided informed consent, and were orthodontically managed by an experienced orthodontist. Bracket bonding (without arches) was performed one week before surgery. Together with the orthognathic procedure itself, bimaxillary corticotomies were performed and 4–8 miniscrews were placed. After a healing period of 2 weeks, orthodontic treatment began. Arches were changed every 2–3 weeks. At one-year follow-up, orthodontist and patient satisfaction were assessed with a visual analogue scale (VAS).

Results: The study comprised 27 females and 18 males ( n = 45). Patients’ main motivation for treatment was the desire for esthetic improvement (37 cases). The most commonly indicated procedure (26 cases) was bimaxillary surgery with a one-piece Le Fort I. Mean length of orthodontic treatment was 37.8 weeks. On average, 22 orthodontic appointments were performed. Patient satisfaction at 12 months post-surgery was 9.4 on average. Orthodontists’ average satisfaction was 9.7.

Conclusions: SF reduces total treatment time significantly and is very well accepted by patients. High orthodontic efficiency responds to early correction of the skeletal bases and accelerated tooth movement due to increased postoperative metabolic turnover. Careful patient selection and detailed orthodontic-surgical planning may render the SF approach appropriate for a good proportion of our routine cases.