Does a surgery first approach to orthognathic treatment of class III skeletal relationships result in a shorter duration of treatment? A systematic review

Abstract Objectives To review the evidence relating to treatment duration and the surgery first approach (SFA) in managing class III skeletal discrepancies. To determine whether there is sufficient evidence to show that a SFA results in a shorter duration of treatment compared to a conventional orthodontics first approach (OFA). Methods Analytical and observational studies that compared both approaches and recorded treatment duration as an outcome were included. MEDLINE, EMBASE, CENTRAL and Dental Oral Sciences Source databases were searched along with a review of reference lists. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool. Results 11 observational studies met the inclusion criteria. No experimental studies were identified. The SFA was reported to have a shorter duration of treatment in all studies. Discussion All of the included studies showed a significant risk of bias, particularly in relation to selection of participants, allocation to groups and in the measurement of treatment duration. Conclusion There is no quality evidence to suggest that using a surgery first approach to orthognathic treatment of class III skeletal patterns results in a shorter treatment duration.