TITLE:
Surgery-First or Orthodontics-First: An Orthodontic “To Be or Not to Be”—A Narrative Review
AUTHORS:
Meryem Lahlou, Zineb Idrissi Kaitouni, Meriem Bellamine, Farid Bourzgui, Ihsane Ben Yahya
KEYWORDS:
Orthognathic Surgery, Surgery-First Approach, Orthodontics-First Approach
JOURNAL NAME:
Open Access Library Journal,
Vol.12 No.11,
November
6,
2025
ABSTRACT: The decision between a Surgery-First Approach (SFA) and conventional Orthodontics-First protocols in orthognathic surgery represents a critical clinical dilemma. While SFA is sometimes perceived as a modern innovation, it revisits historical practices with renewed emphasis on patient-centered outcomes. Traditional workflows involve presurgical orthodontic decompensation, surgery, and postsurgical orthodontics, which can prolong treatment and temporarily compromise facial aesthetics, impacting patients’ psychological well-being. SFA eliminates the presurgical phase, enabling immediate skeletal correction and early aesthetic improvement, with dental alignment completed postoperatively. This narrative review synthesizes current evidence on SFA, including indications, limitations, protocols, and the influence of 3D surgical planning on treatment predictability. An electronic search of PubMed and Scopus was performed using tailored keywords for each database, including all peer-reviewed English-language studies without restriction on study design or geography, while excluding syndromic or exceptional cases. SFA is most suitable for patients with mild to moderate crowding and well-coordinated arches, with molar relationships guiding surgical planning. Key advantages include shorter overall treatment time in non-extraction cases, immediate improvement of facial profile, and enhanced patient satisfaction, supported by the Regional Acceleratory Phenomenon facilitating post-surgical tooth movement. Limitations include potential mandibular relapse and reduced postoperative stability compared with conventional protocols, particularly in complex or extraction cases. Optimal outcomes require careful case selection, precise surgical-orthodontic coordination, and appropriate fixation strategies. As advances in 3D planning continue, SFA offers an efficient, patient-centered alternative to traditional workflows, balancing treatment speed, aesthetic results, and functional stability.