What Is the Surgery-First Approach for Jaw Surgery?
A newer approach to orthognathic surgery does surgery before braces. Here is what it involves.
The surgery-first approach (SFA) is a treatment sequence where orthognathic surgery is performed first, followed by orthodontic treatment. This is the opposite of the traditional approach where braces come first.
- Traditional approach:
- Braces (12β18 months) β 2. Surgery β 3. Braces (4β6 months) Total: 18β24 months
- Surgery-first approach:
- Surgery β 2. Braces (12β18 months total) Total: 12β18 months
- Who is a candidate:
- Patients with relatively straight teeth (minimal crowding)
- Cases where the bite is the main problem, not tooth alignment
- Patients who want shorter overall treatment time
- Patients who want the aesthetic change sooner
- Certain specific bite patterns (Class II and Class III)
- Who is NOT a candidate:
- Patients with significant crowding or rotation
- Cases requiring extractions
- Patients with severe asymmetry
- Open bites with significant vertical problems
- Shorter total treatment time
- Immediate aesthetic improvement
- No "decompensation" phase where the bite looks worse
- Faster overall resolution
- More difficult surgical planning (the surgeon cannot use the bite as a reference)
- Higher risk of postoperative bite problems
- Not suitable for all patients
- Requires very precise planning with 3D technology
Advantages
Disadvantages
Clinical Guidance
The surgery-first approach is an option for carefully selected patients with straight teeth and a primarily skeletal bite problem. It reduces total treatment time by 4β6 months but requires precise 3D planning and is not suitable for everyone.