Surgery-first orthognathic approach: a narrative review of clinical rationale, comparative outcomes, digital workflow, and practical limits
Authors
Lorenzo Silenzi Ederli, Elisabetta Carli, Elvira Liotti, Mario Palermiti, Beatrice Marzo, Stefano Mummolo
Abstract
Orthognathic surgery remains the reference treatment for severe dentofacial deformities when orthodontic treatment alone cannot restore skeletal harmony, facial balance, and stable occlusal function. The surgery-first approach reverses the conventional orthodontics-first sequence by performing skeletal correction before comprehensive orthodontic decompensation, with the aim of reducing total treatment duration and providing immediate facial improvement. This narrative literature review synthesizes comparative evidence on treatment duration, skeletal stability, quality of life, digital workflow, practical limits, and patient selection. The evidence supports a clinically meaningful reduction in overall treatment time, generally without clear compromise of short- to medium-term stability in carefully selected cases. The strongest early advantages concern facial aesthetics, motivation, and oral health-related quality of life, whereas the main limitations involve occlusal instability, residual dentoalveolar compensation, relapse risk in complex patterns, and dependence on precise interdisciplinary planning. Keywords: orthognathic surgery; surgery-first approach; skeletal Class III malocclusion; dentofacial deformity; quality of life; cone-beam computed tomography; virtual surgical planning; regional acceleratory phenomenon.
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