Abstract
Are there any limits for Surgery-first approach? the article strives to identify the
tenets of effective management of complex cases, such as facial asymmetry, with surgery-first
approach. The main purpose of the article is in attempting to itemize prerequisites
or determining factors, through various degrees of facial asymmetry severity, for
the successful management of facial asymmetry cases. The key factors such as (1) assessment
of chin deviation, (2) quantification or discernment of transverse occlusal plane
canting, (3) spatial orientation evaluation of differential anterior and posterior
region transverse occlusal canting, and (4) contemplations of six degrees of freedom
(6DoF) (translation movements combined with rotation axis - pitch, roll and yaw) are
evaluated. Furthermore, dental alignment, severity of mandibular and maxillary occlusal
(anterior and posterior) plane canting, critical cephalometric parameters, such as,
incisor mandibular plane angle, and other vital sub- components of facial asymmetry
are analysed, in detail. Subsequently, these are coherently synchronized with the
maxillomandibular complex (MMC) rotation surgery during planning for the successful
execution of facial asymmetry correction. Additionally, the article describes the
(1) usage of orthodontic arch wires, (2) selection criteria of specific surgical osteotomies,
and (3) coordination of maxillary and mandibular dentition to establish a transitional
or treatable malocclusion. In conclusion, a thorough evaluation of the determining
factors, as described in the article, for the correction of facial asymmetry with
surgery-first, aid in categorising facial asymmetry cases that require minimal pre-surgical
orthodontics or without pre-surgical orthodontic treatment, thereby defining the limits
of surgery-first.
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Article info
Publication history
Published online: January 06, 2023
Publication stage
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