Surgery First vs. Orthodontic First Orthognathic Surgery Approaches in Management of Skeletal Class III Malocclusion: A Systematic Review

Introduction: This study aimed to review the articles comparing orthodontic first (OFA) and surgery first approaches (SFA) orthognathic approaches from various treatment aspects of patients with class III skeletal malocclusion. Methods: Electronic databases were systematically searched, including PubMed, Scopus, and Web of Science. We included experimental cohort and retrospective studies that compared the orthodontics first (conventional method) and surgery first approaches in the management of patients with skeletal class III malocclusion in various aspects. Results: Overall, 294 records were found through database searching and after removing duplicates, 131 papers were investigated. Finally, 17 studies were included in this study. The included studies have evaluated vast spectroum of outcome measures ranging from quality of life and duration of treatment to cephalometric measures. The amount of surgical movement, post-surgical change, and the relapse rate was the most prevalent assessed outcome measure in 10 out of 17 included studies, followed by total treatment time, which was evaluated in 8 studies. Other less common outcome measures were temporomandibular joint (TMJ) disorders and the oral health-related quality of life (OQLQ) questionnaire. Conclusion: Two OFA and SFA orthognathic surgery approaches are not different in terms of the final amounts of surgical change in the mandible and maxilla. Also, these two approaches can remarkably improve the quality of life with no intergroup differences. It was realized that there are no united agreements on the effects of two OF and SF approaches on the outcomes the patients with class III skeletal malocclusions.