ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title A Surgery-First Approach to Orthognathic Surgery Does Not Significantly Improve a Patient’s Quality of Life Compared to an Orthodontic First Approach
Clinical Question In patients with malocclusion undergoing orthognathic surgery, does a surgery-first approach improve the patient’s quality of life more than the conventional three-stage approach?
Clinical Bottom Line There is no significant difference in the improvement of a patient’s quality of life when a surgery first approach is compared to an orthodontic first approach when orthognathic surgery is needed to treat a malocclusion.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 26729274Huang/201650 Chinese adults requiring orthognathic procedures. Following exclusions, n=25 for surgery-first patients and n=25 for orthodontic-first patients.Prospective Cohort Study
Key resultsAlthough treatment time for the surgery-first group was significantly shorter than for the orthodontic-first group, there was no significant difference found in patient’s rating of their oral health-related quality-of-life (OHQoL) between the two groups. Researchers did note that the dental impact on daily living (DIDL) questionnaire scores were somewhat lower for the surgery-first patients as compared to the orthodontic-first patients, possibly demonstrating a higher satisfaction level for the surgery-first patients.
#2) 26468790Park/201526 Class III patients undergoing orthognathic surgery. Following exclusions, n=15 for the conventional three-stage method (CTM) group and n=11 for the surgery first approach (SFA) group.Case Control Study
Key resultsBoth the CTM group and SFA group demonstrated improved OHQoL following orthognathic surgery, however there was no significant difference in questionnaire scores in any of the domains or for any of the stages between the two groups (P>0.05).
Evidence Search ((("surgery"[Subheading] OR "surgery"[All Fields] OR "surgical procedures, operative"[MeSH Terms] OR ("surgical"[All Fields] AND "procedures"[All Fields] AND "operative"[All Fields]) OR "operative surgical procedures"[All Fields] OR "surgery"[All Fields] OR "general surgery"[MeSH Terms] OR ("general"[All Fields] AND "surgery"[All Fields]) OR "general surgery"[All Fields]) AND First[All Fields]) AND Orthognathic[All Fields]) AND Quality[All Fields]
Comments on
The Evidence
Validity: The studies were a cohort study and a case control study with a total of 76 subjects between the two. Both studies included only patients with Class III malocclusions. Each study utilized a questionnaire to obtain information on the individual patient’s self-perceived quality of life in a number of different categories and at different points in time. In both studies, the patients were similar at the start and there was adequate follow-up in both studies. Neither study had any competing interests. The study by Huang et al. used a longitudinal cohort study to collect data on the patients throughout the orthognathic treatment period. The study by Park et al. used a retrospective case control study, which required patients to recall changes in their quality of life from memory. Perspective: Due to the nature of these studies it would be difficult to perform RCTs to determine quality of life. However, it would be beneficial to conduct more research so that the patient population is larger and can give a better representation of society as a whole. The case control study by Park et al. could have errors due to recall bias.
Applicability Many people suffer from malocclusions so severe that orthognathic surgery is the only viable approach to reestablishing a correction. SFA is a relatively new approach to combine surgical/orthodontic treatment and doctors must be aware of the different options available and be able to advise their patients regarding which treatment option will fit their needs and provide the best outcome. Some patients may value the quick treatment time that the SFA approach can provide. However, there is no evidence to support improved quality of life when compared to the traditional orthodontic-first approach.
Specialty/Discipline (Oral Surgery) (Orthodontics)
Keywords Surgery first, orthodontic first, orthognathic surgery, conventional three-stage, quality of life, malocclusion
ID# 2985
Date of submission: 02/11/2016spacer
E-mail trejocb@livemail.uthscsa.edu
Author Chase Trejo
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Edward Ellis, DDS
Faculty mentor/Co-author e-mail Ellise3@uthscsa.edu
Basic Science Rationale
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