Surgery first/early orthognathic approach may yield poorer postsurgical stability than conventional orthodontics first approach: a systematic review and meta-analysis

Publication date: Available online 7 March 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Hongpu Wei, Zhixu Liu, Jiajie Zang, Xudong Wang
ObjectiveThere are conflicting views on the postsurgical stability of surgery first and surgery early approach in orthognathic surgery. We systematically reviewed the literature to compare the difference of postsurgical stability between surgery first/early approach(SFEA) and conventional ortho-first approach(COA).Study DesignPubMed, Embase, and Cochrane Library were searched for studies related to the postsurgical stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted Mean Difference(WMD) with 95% CIs were pooled using a random-effects model.ResultsWe analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifest less postsurgical stability than COA group (WMD,1.50; P<0.00001), with moderate heterogeneity (I² = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis by omitting one study at a time further validated the robustness of the result.ConclusionsBased on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postsurgical stability than COA group. Patient screening and treatment plan should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.



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