Comparison of Surgery First Versus Orthodontics First Approaches in Management of Skeletal Class III Malocclusion: A Systematic Review

Background: This study aimed to review the articles comparing orthodontic first (OFA) and surgery first approaches (SFA) orthognathic approaches from various aspects in patients with class III skeletal malocclusion.Methods: Electronic databases were systematically searched, including PubMed, Scopus, and Web of Science. We included experimental cohort and retrospective studies that compared the orthodontics first (conventional method) and surgery first approaches in the management of patients with skeletal class III malocclusion from various aspects.Results: A total of ۲۹۴ records were found through database searching; after removing duplicates, ۱۳۱ papers were assessed. Finally, ۱۷ studies were included. The included studies evaluated a vast spectrum of outcome measures ranging from quality of life and duration of treatment to cephalometric measures. The amount of surgical movement, post-surgical change, and the relapse rate were the most prevalent assessed outcome measure in ۱۰ out of ۱۷ included studies, followed by total treatment time, which was evaluated in ۸ studies. Other less common outcome measures were temporomandibular joint (TMJ) disorders and the oral health-related quality of life (OQLQ) questionnaire.Conclusion: Two OFA and SFA orthognathic surgery approaches were not significant different in terms of the final amounts of surgical change in the mandible and maxilla. Also, these two approaches can remarkably improve the quality of life with no intergroup differences. There is no united consensus on the effects of OF and SF approaches on the outcomes of patients with class III skeletal malocclusions.