Surgery-first/early-orthognathic approach may yield poorer postoperative stability than conventional orthodontics-first approach: a systematic review and meta-analysis

    loading  Checking for direct PDF access through Ovid



There are conflicting views on the postoperative stability of surgery-first and surgery-early approaches in orthognathic surgery. We systematically reviewed the literature to compare the difference in postoperative stability between a surgery-first/early orthognathic approach (SFEA) and a conventional orthodontics-first approach (COA).

Study Design.

PubMed, Embase, and Cochrane Library were searched for studies related to the postoperative stability of SFEA. The primary outcome was the horizontal relapse at the pogonion. Weighted mean differences with 95% confidence intervals were pooled using a random-effects model.


We analyzed 12 studies (total of 498 participants). The pooled estimate suggested that the SFEA group manifested less postoperative stability than COA group (weighted mean difference, 1.50; P < .00001), with moderate heterogeneity (I2 = 53%). The result of subgroup analysis yielded no subgroup difference. Sensitivity analysis conducted by omitting one study at a time further validated the robustness of the result.


Based on the meta-analysis, the mandible tends to rotate counterclockwise more in the SFEA group, which indicate a poorer postoperative stability than in the COA group. Patient screening and treatment plans should be reviewed carefully to compensate for possible postoperative relapse when adopting SFEA.

Related Topics

    loading  Loading Related Articles