1) Oral skeletal discrepancies are common in Vietnam and the surgery-first approach has become favored over traditional orthodontics-first treatment. 2) Malocclusions are typically caused by incisor or jaw protrusion and the treatment approach depends on the specific discrepancy - orthodontics for incisors or orthognathic surgery for jaws. 3) Over 1000 orthognathic surgery cases have been performed at JW Korea Hospital using techniques like anterior segmental osteotomies, Le fort I, and BSSO to correct skeletal issues prior to orthodontic treatment.

1. SURGERY FIRST APPROACH IN
ORTHODONTICS
Dr. Nguyen Phan Tu Dung
Director of JW Korea Hospital

2. OVERVIEW
• Oral Skeletal discrepancy is a really
common oral-facial problem in
Vietnam.
• The surgery-first approach (SFA),
without presurgical orthodontic
treatment, has become favoured in
the treatment of dentomaxillofacial
deformities. This approach has been
applied in our institution since 2012
• Most people in Vietnam still believe
that oral skeletal discrepancy can
only be treated by orthodontics.

3. CLASSIFICATION
The malocclusion mostly come from:
1. Incisor protrusion
2. Jaw protrusion
3. Both of them

4. APPROACH
• In case of incisor protrusion, orthodontics is
the most suitable approach.
• For the upper/lower jaw protrusion,
orthognathic surgery is the treatment of choice.

5. ORTHOGNATHIC SURGERY TREATMENT PLANNING
• Skeletal discrepancy are of many reasons.
• First, class II skeletal discrepancy may be due to
only one jaw protrusion or both jaw protrusion.
• Second, class III skeletal discrepancy is due to
hyper-development of the mandible OR
maxillary deficiency with relative mandibular
excess growth patterns.

6. ORTHOGNATHIC SURGERY TREATMENT PLANNING
• Upper/lower jaw
protrusion, the priority is
maxillary and mandibular
anterior segmental
osteotomies (ASO).
• The technique applied is
extraction teeth number 4
on both maxillary and
mandible to create space
which is used for setting
back of both jaw bone.

7. Invivo software for ASO

8. In cases of severe
skeletal class III,
both jaw surgery is
applied: Maxillary
Le fort I osteotomy
and Mandibular
BSSO set back.
ORTHOGNATHIC SURGERY TREATMENT PLANNING

10. OUR EXPERIENCES
• Over 1000 cases of orthognathic surgery at JW Korea
Plastic Surgery Hospital.
• Evaluating before surgery is very important to decide
which is priority: orthodontics before surgery or
surgery first and then orthodontics, or only
orthognathic surgery.
• This evaluation require co-ordination from both
orthognathic surgeon and orthodontist.

11. CT Cone Beam 3D

12. THE AIM OF TREATMENT
• The standard assessment consist
of:
1. Harmonious soft-tissue.
2. Balance of skeletal.
Vietnamese:
SNA: Male 84.13 +/- 4.010
Female 83.87 +/- 2.90
SNB : Male 80.97 +/- 3.240
Female 80.8 +/- 2.41
3. Adequacy of dental restoration.

13. Severe skeletal class III, the distance between maxillary and
mandible is 2,3 cm.

14. Le fort 1

15. BSSO

16. Case 1 : Patient had orthognathic surgery for both jaws,
maxillary Le fort I and mandibular BSSO.

17. Severe upper and lower jaw protrusion. Patient was performed
maxillary and mandibular anterior segmental osteotomies (ASO)
to set back both jaws.

18. Maxillary deficiency with relative mandibular excess growth
patterns. He was performed maxillary Le fort I and mandibular
BSSO and genioplasty.

19. Lefort I & BSSO

20. Invivo software

21. The Dentofacial Deformity with deviation of midline
and a bit protrusion.

22. The patient’s surgery included maxillary Le Fort 1 osteotomy
with clockwise rotation and mandibular BSSO with clockwise
rotation.

23. The co-ordination between orthognathic surgeon and orthodontist.
The treatment was performed with the Straight wire technique, using
metallic orthodontic brackets in both arches by orthodontist. Then
maxillary Le Fort 1 osteotomy with clockwise rotation and
mandibular BSSO with clockwise rotation by orthognathic surgeon.

29. Comprehensive plastic surgery maxillary and mandibular anterior
segmental osteotomies (ASO), mandibular corpus-angle ostectomy
(MCAO), Buccal fat removal, Rhinoplasty, Blepharoplasty to open eye.
BEFORE

31. Conclusion
• The surgery-first approach (SFA), without
presurgical orthodontic treatment, has become
favoured in the treatment of dentomaxillofacial
deformities.
• Collection of patient is very imptort to decide
sucessfully
• Suitable combination of orthodontic and
surgery
• The result very promising

32. THANK FOR YOUR ATTENTION