Point-Counterpoint: Surgery-First Orthodontics Point - The Case for Surgery-First Orthodontics Junji SUGAWARA Sendai, Japan 2014 Winter Conference February 7-9, 2014 Las Vegas, Nevada ~1950 1960 1970 1980 2000 2010 1990 Surgery- First Orthodontics Prosthodontics Dental / Oral Implantology TADs (SAS) Surgical Orthodontics Minimum Pre-Surgical Orthodontics Orthognathic Surgery Oral Maxillofac / Plastic Surgery No Pre-surgical Orthodontics No Pre-surgical Orthodontics Pre-surgical Orthodontics Sugawara 2014 How We Got Here Why Surgery-First? Conventional Surgical Orthodontics Initial Imm. before OGS Presurgical Orthodontic Treatment At debonding Orthognathic Surgery (LF1 + BSSO) •The worsening facial profile, some masticatory discomfort during presurgical orthodontics, and long-term low QOL were cited as problems. (Proffit, White, Sarver 2003) •Presurgical orthodontic treatment was time- consuming, taking as long as 24 months. (Luther, Morris, Hart 2003) •Overall treatment duration was longer than commonly expected, with a mean length of 32.8 months. (O’Brien et al. 2009) What are the Problems? Imm. after surgery At debonding Initial Postsurgical Orthodontics (SAS) Orthognathic Surgery (BSSO) Surgery-First
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Point-Counterpoint: Surgery-First Orthodontics
Point - The Case for Surgery-First Orthodontics
Junji SUGAWARASendai, Japan
2014 Winter ConferenceFebruary 7-9, 2014 Las Vegas, Nevada
~1950 1960 1970 1980 2000 20101990
Surgery- First
Orthodontics
Prosthodontics
Dental / OralImplantology
TADs (SAS)
Surgical Orthodontics
Minimum Pre-Surgical Orthodontics
OrthognathicSurgery
Oral Maxillofac / Plastic Surgery
NoPre-surgicalOrthodontics
NoPre-surgicalOrthodontics
Pre-surgicalOrthodontics
Sugawara 2014
How We Got Here
Why Surgery-First?Conventional
Surgical Orthodontics
Initial Imm. before OGSPresurgical Orthodontic Treatment
At debondingOrthognathic
Surgery(LF1 + BSSO)
•The worsening facial profile, some masticatory discomfort during presurgical orthodontics, and long-term low QOL were cited as problems. (Proffit, White, Sarver 2003)
•Presurgical orthodontic treatment was time-consuming, taking as long as 24 months. (Luther, Morris, Hart 2003)
•Overall treatment duration was longer than commonly expected, with a mean length of 32.8 months. (O’Brien et al. 2009)
What are the Problems?
Imm. after surgery At debondingInitial
PostsurgicalOrthodontics
(SAS)
OrthognathicSurgery(BSSO)
Surgery-First
Styles of Surgery-First
Surgery-DrivenTo solve both skeletal and
dental problems using OGS (Baek et al. 2010, Liou et al. 2011,
Hernández et al. 2011, Kim et al. 2012)
Ortho-DrivenTo solve skeletal problems
with OGS and dental problems using SAS
(Nagasaka et al. 2009, Villegas et al. 2010, Faber 2010, Sugawara et al. 2010)Surgery-
First
Facial Types of Our Surgery-First Cases (N=162)
87%
5%8%
Class III (141)Class II (13)Class I (8)
As of December 31, 2013
Class III patients seem to benefit more from the
Surgery-First than Class II cases.
(Kim, Mahdavie, Evans 2012)
A Recent Surgery-First Case Ortho-Driven
Indications of Surgery-First: Most jaw deformities are indications except for a few specific types of cases.
(Sugawara 2012)
Point 1: Case SelectionSurgery-Driven
Indications of Surgery-First:1) Crowding: no~mild2) Curve of Spee: no~mild3) U1 and L1: normal~mild4) Asymmetry: no~mild