"Surgery first" in bimaxillary orthognathic surgery.

The general formula in traditional orthognathic treatment has consisted of a variable length of preoperative orthodontic preparation, surgery itself, and a relatively constant period of postoperative orthodontics. Patients have usually expressed high levels of satisfaction with the esthetic and functional outcomes, especially if they were accurately informed about all aspects of their treatment. However, an important percentage of patients will rate the orthodontics as the worst part of their treatment owing to the appliances’ visibility, the pain caused, and the duration. The usual estimated duration of orthodontic treatment has often tended to be too optimistic. Recently, the performance of surgery without orthodontic preparation (ie, “surgery first”), followed by regular postoperative dental alignment, was proposed by Nagasaka et al. The authors used this approach to correct skeletal Class III malocclusion with the aid of skeletal anchorage system orthodontics. The total treatment time was noticeably reduced. In addition, preoperative profile worsening owing to incisor decompensation was avoided and the immediate profile improvement after the surgery was greatly appreciated by the patient.