Beyond Sequential Treatment: Surgery-First Orthognathic Approach with Canine Substitution for Comprehensive Skeletal and Esthetic Resolution of Lateral Incisor Agenesis: A Case Report

The surgery-first approach (SFA) to orthognathic treatment has emerged as a compelling alternative to conventional protocols, offering immediate skeletal correction without prolonged presurgical orthodontics. A key biological advantage is the regional acceleratory phenomenon (RAP), a post-surgical response that accelerates orthodontic tooth movement and reduces overall treatment duration significantly. The present case involved a patient presenting with a concave facial profile, retrusive upper lip, reverse overjet and overbite of 3 mm, proclined maxillary incisors, retroclined mandibular incisors as dental compensation, Class I molar relationship, maxillary arch spacing, mild mandibular anterior crowding, and congenitally absent maxillary lateral incisors. This constellation of findings, combined with the patient’s desire for early aesthetic improvement and the anticipated benefit of RAP-driven accelerated tooth movement, guided the decision toward SFA as the most appropriate patient-centred strategy. Le Fort I maxillary advancement was performed, followed by expedited postoperative orthodontics. Canine substitution addressed the congenitally missing lateral incisors and restored smile harmony. Treatment was completed in seven months, substantially shorter than conventional protocols. At the 24-month follow-up, Class I occlusion with ideal overjet and overbite was maintained, facial profile improvement remained stable, and functional outcomes were consistent.