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

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

Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Mar 07;:

Authors: Wei H, Liu Z, Zang J, Wang X

Abstract
OBJECTIVE: There are conflicting views on the postoperative stability of surgery-first and surgery-early approaches in orthognathic surgery. We systematically reviewed the literature to compare the difference in postoperative stability between a surgery-first/early orthognathic approach (SFEA) and a conventional orthodontics-first approach (COA).
STUDY DESIGN: PubMed, Embase, and Cochrane Library were searched for studies related to the postoperative stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted mean differences with 95% confidence intervals were pooled using a random-effects model.
RESULTS: We analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifested less postoperative stability than COA group (weighted mean difference, 1.50; P < .00001), with moderate heterogeneity (I2 = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis conducted by omitting one study at a time further validated the robustness of the result.
CONCLUSIONS: Based on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postoperative stability than in the COA group. Patient screening and treatment plans should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.

PMID: 29631986 [PubMed - as supplied by publisher]

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