Articles Tập 67 Số CĐ15 25/09/2026

DENTAL COMPENSATION CHARACTERISTICS AND AESTHETIC IMPROVEMENT OUTCOMES IN SKELETAL CLASS III PATIENTS TREATED WITH THE SURGERY-FIRST APPROACH

Tran Thi Bich Van
DOI: 10.52163/yhc.v67iCD15.6797
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Abstract

Objectives: To evaluate the characteristics of dental compensation prior to treatment, and to analyze the degree of axial inclination improvement, maxillo-mandibular skeletal relationships, and the functional and aesthetic efficacy following orthodontic treatment combined with orthognathic surgery using the Surgery-First Approach (SFA).

Materials and Methods: A clinical interventional study was conducted on 63 skeletal Class III malocclusion patients (17 males, 46 females) selected by convenient sampling and treated with the SFA protocol at three major hospitals in Ho Chi Minh City from 2015 to 2021. Lateral cephalometric variables regarding dental parameters and skeletal relationships were measured using SmartCeph software at three distinct time points: Pre-treatment (T1), 1–3 months post-surgery (T2), and Post-treatment completion (T3).

Results: At T1, marked dental compensation due to severe skeletal discrepancy was evidenced by the proclination of the maxillary incisors (U1-NF: 122.09° ± 5.55°) and the retroclination of the mandibular incisors (L1-MP: 81.39° ± 6.30°), accompanied by a severe negative overjet (-4.31 ± 2.48 mm). Post-surgery (T2), the maxillo-mandibular relationship was successfully restored to a Class I skeletal pattern via basal bone repositioning, correcting the overjet to a positive value (4.16 ± 1.22 mm), while the axial inclination of the teeth remained largely unchanged. At T3, optimal postoperative orthodontic decompensation was achieved: the mandibular incisors were uprighted (proclined back toward ideal positions) to 87.04° ± 4.22° (p < 0.001), and the maxillary incisors were repositioned to a harmonious sagittal prominence (5.80 ± 1.75 mm), establishing physiological overbite (1.74 ± 0.56 mm) and overjet (2.49 ± 0.49 mm).

Conclusions: The surgery-first approach offers immediate resolution of facial aesthetic disharmony from the beginning of treatment, while also achieving high stability in both occlusal function and aesthetics through effective postoperative dental decompensation aided by the RAP effect.

Keywords
Class III malocclusion, surgery-first approach, dental compensation, orthodontic decompensation, lateral cephalometric radiograph.
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