Surgery-First Orthognathic Approach With 3D Virtual Planning: A Case Report

The surgery-first orthognathic approach (SFOA) is an alternative to conventional orthognathic protocols, as it prioritizes skeletal correction before orthodontic treatment. This approach enables immediate aesthetic and functional improvement, making it an attractive option for the management of dentofacial deformities. This case report describes a 39-year-old patient with severe skeletal Class III malocclusion, anterior crossbite, mild mandibular crowding, and dentoalveolar compensation. Treatment was planned using three-dimensional (3D) virtual surgical planning to accurately determine maxillomandibular repositioning. Orthognathic surgery was performed without preoperative orthodontics and involved repositioning of both the maxilla and mandible. Early postoperative outcomes demonstrated significant aesthetic and functional improvements. Postoperative orthodontic treatment was initiated shortly after surgery to refine dental alignment and ensure proper arch coordination. The SFOA is a valuable option for carefully selected patients, offering reduced overall treatment time and enhanced patient satisfaction through immediate visible results. However, its success depends on accurate 3D planning and close collaboration between the surgeon and orthodontist.