Abstract

Post Surgery Skeletal Stability Control in «Surgery First» (Can We Exceed the Limits of Indications and Contraindications?)

by De Nuccio Federico

The "Surgery First" approach (SFA), i.e. Surgery without pre-surgical orthodontic preparation, is not a recent protocol, but it certainly has a precise date coinciding with the publication of a paper by Nagasaka and Sugawara dated February 2009. The approach "Surgery First" offers undeniable advantages demonstrated by the literature: the overall treatment is shorter than the conventional approach, there is no classic worsening of the profile due to presurgical orthodontics, the immediate improvement of facial aesthetics and patient satisfaction and by the same orthodontist. The scope of patients who can access the "Surgery First", described by the indications and contraindications coming from the works of numerous authors, is extremely restrictive, the Author therefore wonders if it is not possible to expand this scope so as to be able to enroll the greater number of patients who can access the "Surgery First" protocol. Numerous authoritative Authors point out that there are two critical points of the SFA: the post-surgical stability, which due to a poor interdigitation of the dentition can result in a skeletal relapse, and the difficulty for the orthodontist to find the right post-operative occlusion procedure on the basis of which to construct the surgical splint. After having reviewed some scientific works by eminent Authors, the Author concludes that the possibility of overcoming the aforementioned limits is possible and demonstrates this by showing many cases carried out in about a decade of experience on SFA. The Author shows how by resorting above all to segmental surgery, skeletal anchorage and the dynamic use of splints it is possible to treat cases with a high index of complexity. It also highlights how with the help of the virtual orthodontic set-up, with the 3D analysis and with the CAD-CAM manufacturing of the surgical splints, it is able to obtain a high level of predictability.

Learning Objectives

After this lecture, you will be able to evaluate the surgical cases in which it is possible to adopt the Surgery First protocol
After this lecture, you will be able to evaluate which are the cases in which it is possible exceed the limits of the indications and contraindications
After this lecture, you will be able to define a correct Surgery First diagnosis and treatment program