Increasing orthodontic and orthognathic surgery treatment efficiency with a modified surgery-first approach

• Surgery-first is a new option to expedite treatment for orthognathic surgical patients.
• This approach is impossible in some patients because of occlusal interferences.
• We present a presurgical orthodontic phase to selectively eliminate anterior dental interferences.
• Significant crowding was resolved with temprorary anchorage devices to control maxillary incisor inclinations.
• This approach can be an alternative to reduce total treatment time in orthognathic surgery.

This case report describes the treatment of a 33-year-old white man who had a skeletal Class III and dental Class II subdivision malocclusion caused by a retrognathic maxilla, with severe maxillary crowding, a highly placed maxillary left canine, mild mandibular crowding, and a bilateral posterior crossbite. Treatment was performed with a modified surgery-first approach, which included a short presurgical alignment phase for the correction of the significant maxillary crowding while controlling the incisal angulation, followed by LeFort I maxillary advancement surgery. The short presurgical orthodontic phase aimed at eliminating the anterior dental interferences before the maxillary advancement, and the use of the inherent increased bone turnover in the postsurgical phase helped to reduce the total orthodontic treatment time to 12 months. Pleasing esthetic results and a good functional occlusion were achieved.