Introduction

The first orthognathic surgery procedure was performed by Hullihen in 1848. Until the 1960’s,

orthognathic surgeries were usually performed without any pre-surgical orthodontic treatment.

In fact, when Hullihen performed the first mandibular sub-apical osteotomy on a burn victim,

he was able to correct the prognathism but created an edge-to-edge occlusion anteriorly (Aziz,

2004).

The three stage philosophy of orthognathic surgery was later adapted and is still valid today in

the majority of cases. These stages involve pre-orthognathic orthodontic treatment to relieve

the dental compensations followed by the orthognathic surgical procedure and finally post-

surgical orthodontics to finish the case and settle the occlusion.

Conventional orthognathic surgery

pre-surgical orthodontics is to alleviate

• the dental crowding

• level the curve of Spee

• decompensate the dental inclinations,

• coordinate the upper and lower arches

Challenges associated with orthognathic surgery

The pre-surgical orthodontic treatment of patients requiring orthognathic surgery has been

criticized to be the most time consuming stage of treatment (O’Brien et al., 2009). The mean

length of this stage has been reported anywhere between 7 to 47 months (Luther et al., 2003).

The longer pre-operative treatment phase can potentially aggravate the dental caries and
periodontal problems and negatively influence patient compliance. The worsening of facial

profile prior to surgery which results from dentoalveolar decompensation is also a great

disadvantage. This is even more so noticeable in Class III patients. The removal of natural

dental compensation in these patients often results in advancement of the lower lip as well as

retrusion of the upper lip which together accentuate the soft tissue disharmony. Considering

the fact that patients who desire to undergo orthognathic surgery are often very concerned about

facial esthetics, the long pre-surgical orthodontic preparation delays addressing the patient’s

chief complaint.