management of skeletal class iii malocclusion by surgery-first approach: a case report

The purpose of dentofacial deformity treatment is to achieve the proper aesthetic and functional occlusion results. conventional orthognathic surgery involves a long-term orthodontic phase before surgery for about 18 months, in which patients’ facial appearance worsens and their motivation decreases. in the sfa (surgery first approach) method, the surgery is performed before orthodontics and orthodontic therapy is performed to improve dental occlusion and final settlement. two main advantages of this method are the reduction of the therapy period and the initial improvement in the patient’s facial appearance. the sfa has certain benefits, especially in class 3 malocclusion. in this case report, a 19-year-old girl with a relatively severe class 3 malocclusion with skeletal discrepancy due to a mandibular prognathism and maxillary retrognathism, and asymmetrical face with chin deviation to left is presented with a unilateral posterior cross bite which was effectively treated using the sfa protocol. the sfa therapy was performed by removing orthodontics before surgery, followed by maxillary advancement surgery, and posterior maxillary impaction and postoperative orthodontic sets to dental alignment and settling the occlusion. despite the overall reduction in the orthodontic therapy period to less than 9 months, good results and functional occlusion were obtained.