Evidence-Based Patient Selection for Surgery-First Orthognathic Treatment

Objectives: The aim of this work is to report a case of orthognathic surgery and to discuss the contraindications for the surgery-first approach. A literature review on the topic was performed to highlight some key points. Case Report: A 22-year-old female patient sought treatment. The patient was clear on orthognathic surgery indication due to aesthetic and functional reasons. The discussion was not related to orthognathic surgery itself, but if there was a clear indication for surgery-first approach. Results: A literature review was conducted on contraindications for surgery-first approach. There are 3 main types of contraindications: related to the patient, to clinical conditions, and to occlusal or skeletal disorders. Each contraindication was discussed individually. Information on case reports and contraindications from the literature was compared. Conclusions: There are 2 clear contraindications for surgery-first approach: unreasonable patients expectations and surgery first protocol implies a change in the surgical plan. Further studies are needed to highlight or delist other contraindications when virtual planning is possible.