Surgery First (SFA) Approach in dento-maxillofacial alterations: a narrative review

The aim of this study was to evaluate, through a systematic review of the literature, the efficacy of Surgery First Approach (SFA) treatment in adult patients with dento-maxillo-facial alterations, observing the advantages over traditional orthodontic-surgical therapy. This review was carried out according to PRISMA and PICOS approach was used. An electronic and manual search of the Medline (PubMed) databases from 1966 to 2022, Embase from 1980 to 2022 was conducted. The electronic search was performed using the following MeSH terms and text words: [orthognatic surgery AND orthodontics] AND [surgery first approach OR surgery first]. Only studies that included a sample of adult patients (<19 years and >65 years of age) with Class II and III malocclusion, skeletal open bite, OSAS and facial asymmetries were selected. From a total of 847 articles identified, only 16 met the inclusion criteria: 2 Randomized Clinical Trials, 1 prospective non-randomized study, 2 prospective court studies, 3 prospective studies, 3 retrospective court studies, 1 retrospective case-control study, 4 retrospective studies. All 16 studies are in favor of the surgery-first approach for several reasons including: the reduction of total treatment times, an immediate improvement in the aesthetic perception and social