Surgery first has been significantly highlighted as a new approach for orthognathic surgery in the last 10 years. Despite of being proposed as a method that reduces the duration of the orthodontic treatment in surgical orthodontics, its adoption to mainstream clinical orthodontic care has not occurred. The reasons for not being adopted by the majority of orthodontists and surgeons vary, and likely may be related to a potential more complex orthodontic treatment after surgery when the arches have not been aligned or leveled. Certainly, a hurdle to its adoption is a steep learning curve in the case selection and more demanding treatment planning and the need for an active interactive team (surgeon and orthodontist) that clearly understands each other’s role. Additionally, resistance of orthodontists and surgeons alike to change has been the common theme against the adoption of this approach. This lecture will highlight some of the key features in the treatment planning of surgery first and how the surgeon and orthodontist interact to achieve predictable outcomes.


Learning Objectives
After this lecture, you will be able to highlight the advantages of surgery first and illustrate how maxillary segmentation with this approach is a critical piece for its adoption.
After this lecture, you will be able to discuss case selection for this approach and potential disadvantages of using this technique in all surgical patients.
After this lecture, you will be able to describe the concept as surgery as early as feasible as a concept that could be adopted by clinicians hesitant to a purely surgery first approach.