Inferior subapical osteotomy for dentoalveolar decompensation of class III malocclusion in 'surgery-first' and 'surgery-early' orthognathic treatment

Increasing experience with alternative timing protocols in orthognathic surgery has given way to new surgical and orthodontic techniques to shorten treatment times, reduce biological costs, and improve the final outcome. A prospective evaluation of class III patients who received an inferior segmental osteotomy (ISO) for decompensation of significantly retroclined lower incisors in the context of 'surgery-first' (SF) or 'surgery-early' (SE) timing protocols was performed. Treatment was planned virtually. A thorough periodontal assessment was performed at baseline and periodically until debonding. A minimally invasive surgical technique including selective interdental corticotomies and elective bone augmentation was used. Patient and orthodontist satisfaction with the treatment was evaluated. Eight patients (mean age 26.3 years) underwent surgery. One had isolated maxillary surgery and seven had bimaxillary surgery in combination or not with additional cosmetic procedures. The periodontal status of all patients remained stable throughout the observation period. The mean duration of orthodontic treatment was 8.7 months in the SF group and 10.5 months in the SE group. Satisfaction with treatment was extremely high. The ISO is a safe, reliable technique for dentoalveolar decompensation in timing protocols with a short or no orthodontic preparatory phase. This methodology may represent a reasonable approach in selected class III patients.