Surgical Occlusion Setup in Orthognathic Surgery Using Surgery-First Approach for Skeletal Class III Deformity: 82 A Systematic Review

Objective: Surgery-first orthognathic surgery is increasing in popularity because of reduced treatment time, efficient tooth decompensation, and early improvement in facial esthetics. However, it remains difficult due to the surgical occlusion setup. We systematically reviewed the literature in order to determine the guidelines used for surgical occlusion setup in orthognathic-first surgery for skeletal Class III deformity. Material and Methods: The literature was searched using PubMed, Medline (Ovid), Cochrane Library, Web of Science and Google Scholar databases from January 1931 to June 2017. We limited the search to publications in English. Two independent investigators used specific inclusion and exclusion criteria to extract and analyze the data. Study quality was assessed objectively. Results: Of 288 papers retrieved, 13 met the inclusion and exclusion criteria. All studies were of low quality. The occlusion was suggested to be set as Class I, II or III molar relationship, deep bite or posterior open bite, little or no posterior crossbite or no complete posterior dental or skeletal crossbite, and stable posterior occlusion or at least three occlusal stops. Conclusions: The results should be interpreted with caution due to the low number, poor quality, and heterogeneity of the included studies. Due to contradictory results and poor study quality, the scientific evidence is too weak to show the guidelines of surgical occlusion setup in surgery-first orthognathic surgery for skeletal Class III deformity. Further quantitative studies are required.