Articles Tập 67 Số CĐ13-HNKH Bệnh viện 19-8 09/09/2026

COMPARISON OF ANTEROPOSTERIOR FACIAL AESTHETIC IMPROVEMENT IN SKELETAL CLASS III PATIENTS TREATED WITH SURGERY-FIRST AND ORTHODONTICS-FIRST APPROACHES

Tran Thi Bich Van1,2
1 Faculty of Odonto-Stomatology, University of Medicine and Pharmacy at Ho Chi Minh City
2 Khoa Răng Hàm Mặt, ĐHYD TP.HCM
DOI: 10.52163/yhc.v67iCD13.6501
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Keywords
Surgery-first approach, Class III malocclusion, facial aesthetics, NVL axis, orthodontic decompensation.
Abstract

Objectives: To compare the sagittal displacements of hard and soft tissue structures following treatment with the Surgery-First Approach (SFA) versus the traditional Orthodontics-First Approach (OFA), evaluating the sagittal profile aesthetic outcomes of the SFA protocol.

Materials and Methods: A prospective, non-randomized comparative clinical study was conducted on 83 adult patients with skeletal Class III malocclusion due to mandibular prognathism. The sample consisted of 63 patients treated via the SFA protocol and 20 patients via the conventional OFA for mandibular setback. Digital lateral cephalograms were analyzed using SmartCeph software at pre-treatment (T1) and post-orthodontic completion (T3) to evaluate the sagittal displacement (anterior-posterior) of maxillofacial hard and soft tissues. This displacement was quantified by calculating the perpendicular distance from the anatomical landmarks to the Nasion Vertical Line (NVL).

Results: Post-treatment outcomes demonstrated profile improvement through significant retrusion of the mandibular structures in both groups. Statistical analysis of overall sagittal displacement amplitudes (T1-T3) along the NVL axis revealed no statistically significant differences (p > 0.05) between the SFA and OFA groups regarding lower incisors (NVL-L1: -7.17 ± 2.80 mm vs. -8.04 ± 3.28 mm), Point B (NVL-B: -8.47 ± 3.32 mm vs. -8.78 ± 3.36 mm), and bony chin (NVL-Pog: -7.30 ± 4.06 mm vs. -6.74 ± 4.00 mm). Similarly, the soft tissue retrusive response showed no significant differences (p > 0.05) for the lower lip (NVL-Li: -7.52 ± 3.01 mm vs. -6.99 ± 3.25 mm), mentolabial sulcus (NVL-B': -7.57 ± 3.01 mm vs. -7.31 ± 3.48 mm), and soft tissue chin (NVL-Pog': -6.84 ± 3.93 mm vs. -6.57 ± 3.94 mm).

Conclusions: The Surgery-First Approach (SFA) resulted in posterior displacement of the mandibular skeletal and soft-tissue structures, with no statistically significant differences compared with the conventional Orthodontics-First Approach (OFA) within the study sample. SFA has the advantage of eliminating the need for presurgical orthodontic decompensation, thereby allowing orthognathic surgery to be performed at an early stage of treatment.

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