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

COMPARISON OF VERTICAL FACIAL AESTHETIC IMPROVEMENT IN SKELETAL CLASS III PATIENTS TREATED WITH THE SURGERY-FIRST APPROACH VERSUS THE ORTHODONTICS-FIRST APPROACH

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.v67iCD13.6512
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Keywords
Surgery-first approach, orthodontics-first, Class III malocclusion, vertical dimension, lateral cephalogram.
Abstract

Objectives: To compare the vertical displacements of bone, teeth, and soft tissue structures following treatment with the Surgery-First Approach (SFA) versus the traditional Orthodontics-First Approach (OFA), thereby evaluating vertical aesthetic outcomes and lower facial height control 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. Specifically, 63 patients were treated using the SFA protocol and 20 using 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 vertical displacement (superior-inferior) of maxillofacial hard and soft tissues. This displacement was quantified by calculating the perpendicular distance from the anatomical landmarks to the Nasion Horizontal Line (NHL).

Results: Post-treatment, both groups showed upward displacement of landmarks, reducing lower anterior facial height. Comparing overall vertical displacement amplitudes along the NHL axis between the SFA and OFA groups, no statistically significant differences (p > 0.05) were observed regarding mandibular incisors (NHL-L1: -1.43 ± 3.57 mm vs. -2.32 ± 3.51 mm), Point B (NHL-B: -4.06 ± 4.27 mm vs. -4.31 ± 3.02 mm), and bony chin (NHL-Pog: -2.58 ± 4.01 mm vs. -3.26 ± 3.11 mm). Upward displacements of soft tissue landmarks were also entirely comparable (p > 0.05) for the lower lip (NHL-Li: -0.52 ± 4.34 mm vs. -1.31 ± 4.30 mm), mentolabial sulcus (NHL-B': -2.03 ± 4.56 mm vs. -2.05 ± 3.75 mm) and soft tissue chin (NHL-Pog': -2.19 ± 4.64 mm vs. -1.85 ± 3.56 mm).

Conclusions: Both the Surgery-First Approach (SFA) and the conventional Orthodontics-First Approach (OFA) resulted in vertical displacement of the mandibular skeletal, dental, and soft-tissue structures following treatment. No statistically significant differences in the magnitude of vertical displacement were observed between the SFA and OFA groups for the evaluated parameters (p > 0.05). Successful postoperative occlusal management enables SFA to effectively control lower facial height, establishing facial harmony right from the initial phase of treatment.

References
[1]
[1] Liao Y-F, Lo SH. Surgical Occlusion Setup in Correction of Skeletal Class III Deformity Using Surgery-First Approach: Guidelines, Characteristics and Accuracy. Sci Rep [Internet]. 2018 [cited 2022 May 20];8(11673):8. https://doi.org/10.1038/s41598-018-30124-2 Google Scholar
[2]
[2] Liou EJW, Chen P-H, Wang Y-C, et al. Surgery-First Accelerated Orthognathic Surgery: Orthodontic Guidelines and Setup for Model Surgery. Journal of Oral and Maxillofacial Surgery [Internet]. 2011 [cited 2022 Jan 24];69(3):771–780. doi:10.1016/j.joms.2010.11.011 Google Scholar
[3]
[3] Ko EW-C, Huang CS, Lo L-J, et al. Longitudinal Observation of Mandibular Motion Pattern in Patients With Skeletal Class III Malocclusion Subsequent to Orthognathic Surgery. Journal of Oral and Maxillofacial Surgery [Internet]. 2012 [cited 2022 Jan 24];70(2):e158–e168. doi:10.1016/j.joms.2011.10.002 Google Scholar
[4]
[4] Cho D, Choi D-S, Jang I, et al. Changes in natural head position after orthognathic surgery in skeletal Class III patients. American Journal of Orthodontics and Dentofacial Orthopedics [Internet]. 2015 [cited 2021 Feb 28];147(6):747–754. doi:10.1016/j.ajodo.2015.01.026 Google Scholar
[5]
[5] Proffit WR, Fields HW, Larson BE, editors. Contemporary Orthodontics. 6th ed. St. Louis, Mo: Elsevier; 2019. Google Scholar
[6]
[6] Mah D-H, Kim S-G, Oh J-S, et al. Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction. J Korean Assoc Oral Maxillofac Surg [Internet]. 2017 [cited 2021 Feb 28];43(1):23. doi:10.5125/jkaoms.2024.50.4.227 Google Scholar
[7]
[7] Reyneke JP. Essentials of Orthognathic Surgery. 2nd ed. Quintessence Publishing Co, Inc; 2010. Google Scholar
[8]
[8] Choi D-S, Garagiola U, Kim S-G. Current status of the surgery-first approach (part I): concepts and orthodontic protocols. Maxillofac Plast Reconstr Surg [Internet]. 2019 [cited 2021 July 31];41(10):10. doi: 10.1186/s40902-019-0194-4. PMID: 30906735; PMCID: PMC6401009. Google Scholar
[9]
[9] Kwon T-G, Han MD. Current status of surgery first approach (part II): precautions and complications. Maxillofac Plast Reconstr Surg [Internet]. 2019 [cited 2022 Jan 24];41(23):10. doi: 10.1186/s40902-019-0206-4. PMID: 31218215; PMCID: PMC6546776. Google Scholar
[10]
[10] Ko EW-C, Lin SC, Chen YR, et al. 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 [Internet]. 2013 [cited 2022 May 2];71(5):e215–e223. https://doi.org/10.1016/j.joms.2012.12.025 Google Scholar
[11]
[11] Ko EW-C, Hsu SS-P, Hsieh H-Y, et al. Comparison of Progressive Cephalometric Changes and Postsurgical Stability of Skeletal Class III Correction With and Without Presurgical Orthodontic Treatment. Journal of Oral and Maxillofacial Surgery [Internet]. 2011 [cited 2022 Jan 24];69(5):1469–1477. doi:10.1016/j.joms.2010.07.022 Google Scholar
[12]
[12] Ngan P, Moon W. Evolution of Class III treatment in orthodontics. American Journal of Orthodontics and Dentofacial Orthopedics [Internet]. 2015 [cited 2021 Feb 28];148(1):22–36. https://doi.org/10.1016/j.joms.2010.10.035 Google Scholar
[13]
[13] Liou EJW, Chen P-H, Wang Y-C, et al. Surgery-First Accelerated Orthognathic Surgery: Postoperative Rapid Orthodontic Tooth Movement. Journal of Oral and Maxillofacial Surgery [Internet]. 2011 [cited 2022 Jan 24];69(3):781–785. https://doi.org/10.1016/j.joms.2010.10.035 Google Scholar
[14]
[14] Liao Y-F, Chiu Y-T, Huang C-S, et al. Presurgical Orthodontics versus No Presurgical Orthodontics: Treatment Outcome of Surgical-Orthodontic Correction for Skeletal Class III Open Bite: Plastic and Reconstructive Surgery [Internet]. 2010 [cited 2022 May 2];126(6):2074–2083. doi:10.1097/PRS.0b013e3181f52710 Google Scholar