Digital analysis of facial aesthetics; a comparison between the surgery-first and orthodontics-first approaches for orthognathic treatment

. Objectives This study aimed to objectively compare soft tissue morphological outcomes between the surgery-first approach (SFA) and the standard orthodontics-first approach (OFA) following orthognathic surgery. Methods Digital facial analysis was carried out at 6 months following surgery using the postoperative cone beam computed tomographic scans. The study was carried out on 26 SFA and 19 OFA cases who underwent Le Fort I maxillary advancement for correction of midface deficiency. Three-dimensional digital facial analysis was carried using five angles, three ratios, and six symmetry-related distances. The reproducibility of the method was assessed after 2 weeks on 10 randomly selected cases. Results The 3D anthropometric analysis showed good to excellent reliability with an average intra-class correlation coefficient of 0.915. No statistically significant differences were detected in the achieved facial morphology between SFA and OFA groups. This objective analysis showed comparable facial aesthetic results between SFA and OFA following Le Fort I maxillary advancement. Conclusions The 3D digital analysis confirmed the facial aesthetic results of the SFA are comparable to conventional OFA. Clinical Impact The SFA might be considered for orthognathic treatment as it provides a comparable facial aesthetic outcome to the conventional approach in addition to its other well-established advantages.