Treatment Objectives and the Clinical Procedure for the Surgery-First Approach

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© Springer Nature Singapore Pte Ltd. 2021

J.-W. Choi, J. Y. LeeThe Surgery-First Orthognathic

2. Surgical Treatment Objectives and the Clinical Procedure for the Surgery-First Approach

Jong-Woo Choi1   and Jang Yeol Lee2  

Department of Plastic Surgery, Asan Medical Center, Seoul, Korea (Republic of)

SmileAgain Orthodontic Center, Seoul, Korea (Republic of)
Jong-Woo Choi (Corresponding author)
Jang Yeol Lee

STO (Surgical treatment objectives)Treatment planningCephalometricGoalsPaper surgeryCommunicationFlow chartClinical proceduresDentitionLandmark

There are three main goals of orthognathic surgery (Fig. 2.1). The first is the functional recovery of normal oral and maxillofacial structures. This functional recovery includes the normal positioning of the jawbones, physiological positioning of the mandibular condyle, and creating the ideal occlusal relationship. The second is the recovery of aesthetics. Abnormal or asymmetrical disharmony of the jaw causes poor esthetics, and facial esthetics can be restored through orthognathic surgery; the restoration of esthetics is the most desired surgical goal for patients. Third is recovery from psychosocial problems. Poor facial esthetics, caused by long periods of jaw discomfort, can reduce individual self-esteem. This makes the improved internal psychological state that results from orthognathic surgery a very meaningful goal [15]. Therefore, the surgical treatment objectives of orthognathic surgery patients should be determined with careful consideration of all three aspects.

Fig. 2.1

The three main goals of orthognathic surgery: improved function, aesthetics, and psychosocial state

2.1 Communication Between Surgeons and Orthodontists in the Surgery-First Approach

Communication and discussion between the attending maxillofacial surgeons and orthodontists are essential for the planning of orthognathic surgeries. In the past, the role sharing associated with conventional surgical correction involved orthodontists planning and implementing a preoperative orthodontic treatment that aimed to develop the ideal occlusion; the orthodontist determined when the preoperative orthodontic treatment was complete. During the orthognathic surgery period, the actual surgical plan was often determined by the surgeon who decided the appropriate location of the jawbones and determined the detailed surgical plan, based on the final surgical occlusion recommended by the orthodontist.

However, Surgery-First Approach (SFA) requires a slightly different approach that involves the establishment of occlusion and the final positioning of the jawbones from the beginning of treatment. In other words, the ideal occlusion and the positioning of the jawbones should be determined at the same time, requiring detailed communication between the attending surgeon and the orthodontist.

First, the clinicians need to determine whether SFA is appropriate. This may depend on whether the simulation of the final postoperative occlusion can be predicted accurately and easily, whether such predictions can be surgically achieved, and whether the simulated surgical occlusion can be managed adequately during postoperative bone segment healing and fixation. The final decision should be determined after considering whether the process interferes with postoperative stability, a determination largely made by orthodontists.

Just like in the conventional orthognathic process, the actual occlusion setting process includes occlusal simulation and predictions performed mainly by the orthodontist, with the skeletal positioning reflecting the opinions of the surgeon. However, since this process should not be disjointed, a systematic communication process between the surgeons and the orthodontists need to be established at the beginning of the case.

2.2 Surgery-First Approach Sequence

Mar 5, 2021 | Posted by in Orthodontics | Comments Off on Treatment Objectives and the Clinical Procedure for the Surgery-First Approach
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