A 5-Year Clinical Management of the Surgery-First Approach in Severe Class III Malocclusion Treatment

The surgery-first approach is a modern protocol that eliminates the preoperative orthodontic phase in dentofacial anomalies requiring orthognathic surgery, thereby optimizing treatment duration and accelerating aesthetic outcomes. This case report presents the treatment and 5-year follow-up of a 25-year-old female patient with a severe skeletal class III anomaly, managed using the surgery-first approach. The patient presented to our clinic with complaints of a concave facial profile and prominent mandibular prognathism. Intraoral examination revealed an angle class III molar and canine relationship, while cephalometric analysis demonstrated a severe skeletal class III anomaly (ANB: -12.26 degrees, Wits: -19.29 mm). Given the patient's esthetic-driven concerns and the prediction of a stable final occlusion based on surgical setup analysis, the surgery-first approach was selected as the treatment modality. Following 9 months of postoperative orthodontic treatment, a skeletal and dental class I relationship, along with ideal overjet and overbite values, were achieved. Radiographic measurements at the 5-year follow-up confirmed the stability of the results, with no evidence of relapse. These findings demonstrate that, in appropriately selected cases, the surgery-first approach is not only effective in significantly reducing overall treatment time, but also provides predictable, long-term stable outcomes while enhancing patient satisfaction.