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

In general, there are not any major differences between the procedures involved in traditional orthognathic surgery and SFA. The biggest difference is that the preoperative orthodontic treatment is simulated outside the mouth, rather than being performed on the patient. Based on the modeling, surgical occlusion is established and reflected in the orthognathic surgery plan (Fig. 2.2).

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4. Care of Patients Undergoing the Surgery-First Approach and Postoperative Orthodontics Involving Temporary Anchorage Devices
5. Application of the Surgery-First Approach to Facial Asymmetry
6. Strategy for Class II Orthognathic Surgery: Orthodontic Perspective

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