A Retrospective Cohort Study Comparing the Surgery-First and Orthodontic-First Protocols for Correcting Skeletal Class II Malocclusion.

Background

The surgery-first approach (SFA) with mandibular anterior subapical osteotomy (MASO) is increasingly utilized to overcome the limitations of conventional preoperative orthodontic decompensation and achieve earlier correction of facial deformities in skeletal class II patients. However, it also caused greater surgical trauma, and there are currently insufficient clinical data available for analyzing the surgical outcome.

Methods

We conducted a retrospective study to compare the skeletal stability, overall treatment duration, and incidence of major complications between the SFA and the orthodontics-first approach (OFA). The study included 42 patients (21 each from the SFA and OFA groups) who underwent bimaxillary orthognathic surgery. Cephalometric measurements were performed at the preoperative (T0) stage and at immediate postoperative (T1), 6-month (T2), and ≥12-month (T3) follow-ups.

Results

No significant differences in skeletal relapse at T2 or T3, blood loss, or major complications (nonunion, neurosensory deficits) were found between groups (P>0.05). While the SFA group required longer surgery time (240.7 versus 202.1 min; P<0.01), it significantly reduced total treatment duration (16.8 versus 38.1 mo; P<0.001). Due to the implementation of MASO, minor tooth injuries were more frequent in the SFA group but resulted in no long-term consequences.

Conclusion

Both SFA and OFA achieve comparable long-term skeletal stability in skeletal class II patients. While SFA significantly reduces the total treatment duration, it is associated with longer operative times and a higher incidence of minor dental injuries.