Management of skeletal class III malocclusion by surgery-first approach: A case report
-
Amir Hosein Mirhashemi
,
Mohammad Sadegh Akhoundi
,
Hannaneh Ghadirian
,
Alireza Parhiz
,
Rashin Bahrami
,
Seyyed Morteza Samimi
Abstract
The purpose of Dentofacial Deformity Treatment is to achieve the proper aesthetic and functional occlusion results. Conventional orthognathic surgery involves a long-term orthodontic phase before surgery for about 18 months, in which patients’ facial appearance worsens and their motivation decreases. In the SFA (surgery first approach) method, the surgery is performed before orthodontics and orthodontic therapy is performed to improve dental occlusion and final settlement. Two main advantages of this method are the reduction of the therapy period and the initial improvement in the patient’s facial appearance. The SFA has certain benefits, especially in Class 3 malocclusion. In this case report, a 19-year-old girl with a relatively severe Class 3 malocclusion with skeletal discrepancy due to a mandibular prognathism and maxillary retrognathism, and asymmetrical face with chin deviation to left is presented with a unilateral posterior cross bite which was effectively treated using the SFA protocol. The SFA therapy was performed by removing orthodontics before surgery, followed by maxillary advancement surgery, and posterior maxillary impaction and postoperative orthodontic sets to dental alignment and settling the occlusion. Despite the overall reduction in the orthodontic therapy period to less than 9 months, good results and functional occlusion were obtained. Keywords: Surgery first; Orthognathic surgery; Skeletal class III; Malocclusion; Orthodontictreatment.
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21. Park H-M, Lee Y-K, Choi J-Y, Baek S-H. Maxillary incisor inclination of skeletal Class III patients treated with extraction of the upper first premolars and two-jaw surgery: conventional orthognathic surgery vs surgery-first approach. Angle Orthodontist. 2014;84(4):720-9. DOI:10.2319/072113-529.1.
22. Wang T, Han JJ, Oh H-K, Park H-J, Jung S, Kook M-S. Comparison of orthodontics-first and surgery-first approach in positional changes of the condyle after mandibular setback surgery using three-dimensional analysis. Journal of Oral and Maxillofacial Surgery. 2016;74(12):2487-96 DOI:10.1016/j.joms.2016.07.015.
23. Jeong WS, Choi JW, Lee JY, Kwon SM. Can a surgery-first orthognathic approach reduce the total treatment time? International journal of oral and maxillofacial surgery. 2017;46(4):473-82 DOI:10.1016/j.ijom.2016.12.006.
24. Song H-S, Choi S-H, Cha J-Y, Lee K-J, Yu H-S. Comparison of changes in the transverse dental axis between patients with skeletal Class III malocclusion and facial asymmetry treated by orthognathic surgery with and without presurgical orthodontic treatment. The korean journal of orthodontics. 2017;47(4):256-67. DOI:10.4041/kjod.2017.47.4.256.
25. He X, He J, Yuan H, Chen W, Jiang H, Cheng J. Surgery-First and Orthodontic-First Approaches Produce Similar Patterns of Condylar Displacement and Remodeling in Patients With Skeletal Class III Malocclusion. Journal of Oral and Maxillofacial Surgery. 2019;77(7):1446-56. DOI:10.1016/j.joms.2019.01.061.
26. Liao Y-F, Chiu Y-T, Huang C-S, Ko EW-C, Chen Y-R. Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgical-orthodontic correction for skeletal class III open bite. Plastic and reconstructive surgery. 2010;126(6):2074-83. DOI:10.1097/prs.0b013e3181f52710.
27. Lee J, Kim Y-I, Hwang D-S, Kim KB, Park S-B. Effect of occlusal vertical dimension changes on postsurgical skeletal changes in a surgery-first approach for skeletal Class III deformities. American Journal of Orthodontics and Dentofacial Orthopedics. 2014;146(5):612-9. DOI:10.1016/j.ajodo.2014.07.024.
28. Hernández-Alfaro F, Guijarro-Martínez R, Peiró-Guijarro MA. Surgery first in orthognathic surgery: what have we learned? A comprehensive workflow based on 45 consecutive cases. Journal of Oral and Maxillofacial Surgery. 2014;72(2):376-90. DOI:10.1016/j.joms.2013.08.013. 10.1016/j.joms.2013.09.033.
2. Yang L, Xiao Y-d, Liang Y-j, Wang X, Li J-y, Liao G-q. Does the surgery-first approach produce better outcomes in orthognathic surgery? A systematic review and meta-analysis. Journal of Oral and Maxillofacial Surgery. 2017;75(11):2422-9. DOI:10.1016/j.joms.2017.06.002.
3. Proffit WR, White RP, Sarver DM. Contemporary treatment of dentofacial deformity: Mosby St. Louis; 2003.
4. Nurminen L, Pietilä T, Vinkka-Puhakka H. Motivation for and satisfaction with orthodontic-surgical treatment: a retrospective study of 28 patients. The European Journal of Orthodontics. 1999;21(1):79-87. DOI:10.1093/ejo/21.1.79.
5. Jeong WS, Lee JY, Choi JW. Large-scale study of long-term vertical skeletal stability in a surgery-first orthognathic approach without presurgical orthodontic treatment: Part II. Journal of Craniofacial Surgery. 2018;29(4):953-8. DOI:10.1097/scs.0000000000004433
6. Sabri R. Orthodontic objectives in orthognathic surgery: state of the art today. World journal of orthodontics. 2006;7(2).
7. Ko EW-C, Lin SC, Chen YR, Huang CS. Skeletal and dental variables related to the stability of orthognathic surgery in skeletal Class III malocclusion with a surgery-first approach. Journal of Oral and Maxillofacial Surgery. 2013;71(5):e215-e23. DOI:10.1016/j.joms.2012.12.025.
8. Luther F, Morris D, Hart C. Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study. British Journal of Oral and Maxillofacial Surgery. 2003;41(6):401-6 DOI:10.1016/s0266-4356(03)00163-3.
9. Choi JW, Lee JY, Yang SJ, Koh KS. The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal class III dentofacial deformity. Annals of plastic surgery. 2015;74(3):333-41. DOI:10.1097/sap.0b013e318295dcce.
10. Chen Y-W, Wang H-C, Gao L-H, Liu C, Jiang Y-X, Qu H, et al. Osteoclastogenesis in local alveolar bone in early decortication-facilitated orthodontic tooth movement. PloS one. 2016;11(4). DOI:10.1371/journal.pone.0153937.
11. Gandedkar NH, Chng CK, Tan W. Surgery-first orthognathic approach case series: Salient features and guidelines. Journal of orthodontic science. 2016;5(1):35. DOI:10.4103/2278-0203.176657
12. Huang C, Chen Y-R. Orthodontic principles and guidelines for the surgery-first approach to orthognathic surgery. International journal of oral and maxillofacial surgery. 2015;44(12):1457-62. DOI:10.1016/j.ijom.2015.05.023.
13. Strohl AM, Vitkus L. Surgical orthodontics. Current opinion in otolaryngology & head and neck surgery. 2017;25(4):332-6. DOI:10.1097/moo.0000000000000371.
14. Park K-R, Kim SY, Park H-S, Jung Y-S. Surgery-first approach on patients with temporomandibular joint disease by intraoral vertical ramus osteotomy. Oral surgery, oral medicine, oral pathology and oral radiology. 2013;116(6):e429-e36. DOI:10.1016/j.oooo.2011.11.038.
15. Peiro-Guijarro MA, Guijarro-Martinez R, Hernandez-Alfaro F. Surgery first in orthognathic surgery: a systematic review of the literature. American Journal of Orthodontics and Dentofacial Orthopedics. 2016;149(4):448-62. DOI:10.1016/j.ajodo.2015.09.022.
16. Mahmood HT, Ahmed M, Fida M, Kamal AT, Fatima F. Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review. Dental press journal of orthodontics. 2018;23(3):36. e1-. e6. DOI:10.1590/2177-6709.23.3.36.e1-6.onl.
17. Sharma VK, Yadav K, Tandon P. An overview of surgery-first approach: recent advances in orthognathic surgery. Journal of orthodontic science. 2015;4(1):9. DOI:10.4103/2278-0203.149609.
18. Kim J-W, Lee N-K, Yun P-Y, Moon S-W, Kim Y-K. Postsurgical stability after mandibular setback surgery with minimal orthodontic preparation following upper premolar extraction. Journal of Oral and Maxillofacial Surgery. 2013;71(11):1968. e1-. e11. DOI:10.1016/j.joms.2013.07.004.
19. Joh B, Bayome M, Park JH, Park JU, Kim Y, Kook Y-A. Evaluation of minimal versus conventional presurgical orthodontics in skeletal class III patients treated with two-jaw surgery. Journal of Oral and Maxillofacial Surgery. 2013;71(10):1733-41. DOI:10.1016/j.joms.2013.06.191.
20. Zhou Y, Li Z, Wang X, Zou B, Zhou Y. Progressive changes in patients with skeletal class III malocclusion treated by 2-jaw surgery with minimal and conventional presurgical orthodontics: a comparative study. American Journal of Orthodontics and Dentofacial Orthopedics. 2016;149(2):244-52. DOI:10.1016/j.ajodo.2015.09.018.
21. Park H-M, Lee Y-K, Choi J-Y, Baek S-H. Maxillary incisor inclination of skeletal Class III patients treated with extraction of the upper first premolars and two-jaw surgery: conventional orthognathic surgery vs surgery-first approach. Angle Orthodontist. 2014;84(4):720-9. DOI:10.2319/072113-529.1.
22. Wang T, Han JJ, Oh H-K, Park H-J, Jung S, Kook M-S. Comparison of orthodontics-first and surgery-first approach in positional changes of the condyle after mandibular setback surgery using three-dimensional analysis. Journal of Oral and Maxillofacial Surgery. 2016;74(12):2487-96 DOI:10.1016/j.joms.2016.07.015.
23. Jeong WS, Choi JW, Lee JY, Kwon SM. Can a surgery-first orthognathic approach reduce the total treatment time? International journal of oral and maxillofacial surgery. 2017;46(4):473-82 DOI:10.1016/j.ijom.2016.12.006.
24. Song H-S, Choi S-H, Cha J-Y, Lee K-J, Yu H-S. Comparison of changes in the transverse dental axis between patients with skeletal Class III malocclusion and facial asymmetry treated by orthognathic surgery with and without presurgical orthodontic treatment. The korean journal of orthodontics. 2017;47(4):256-67. DOI:10.4041/kjod.2017.47.4.256.
25. He X, He J, Yuan H, Chen W, Jiang H, Cheng J. Surgery-First and Orthodontic-First Approaches Produce Similar Patterns of Condylar Displacement and Remodeling in Patients With Skeletal Class III Malocclusion. Journal of Oral and Maxillofacial Surgery. 2019;77(7):1446-56. DOI:10.1016/j.joms.2019.01.061.
26. Liao Y-F, Chiu Y-T, Huang C-S, Ko EW-C, Chen Y-R. Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgical-orthodontic correction for skeletal class III open bite. Plastic and reconstructive surgery. 2010;126(6):2074-83. DOI:10.1097/prs.0b013e3181f52710.
27. Lee J, Kim Y-I, Hwang D-S, Kim KB, Park S-B. Effect of occlusal vertical dimension changes on postsurgical skeletal changes in a surgery-first approach for skeletal Class III deformities. American Journal of Orthodontics and Dentofacial Orthopedics. 2014;146(5):612-9. DOI:10.1016/j.ajodo.2014.07.024.
28. Hernández-Alfaro F, Guijarro-Martínez R, Peiró-Guijarro MA. Surgery first in orthognathic surgery: what have we learned? A comprehensive workflow based on 45 consecutive cases. Journal of Oral and Maxillofacial Surgery. 2014;72(2):376-90. DOI:10.1016/j.joms.2013.08.013. 10.1016/j.joms.2013.09.033.
| Files | ||
| Issue | Vol 7, No 3 (Summer 2020) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/jcr.v7i3.5288 | |
| Keywords | ||
| Surgery first; Orthognathic surgery; Skeletal class III; Malocclusion; Orthodontic treatment. | ||
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How to Cite
1.
Mirhashemi AH, Akhoundi MS, Ghadirian H, Parhiz A, Bahrami R, Samimi SM. Management of skeletal class III malocclusion by surgery-first approach: A case report. J Craniomaxillofac Res. 2020;7(3):158-164.
