Case Report on Surgery-First Approach

The Rationale: The surgery-first approach provides immediate improvement in facial aesthetics in orthognathic cases with a shorter total treatment period. Patient Concerns: A 21-year-old male came with the chief complaint of protrusive lower front teeth and a large lower jaw. His main concern was aesthetics. Diagnosis: This was a case of skeletal Class III malocclusion with reverse overjet of 4 mm, overbite of 6 mm with a concave profile, and a protrusive chin. Treatment: The patient was treated by bilateral sagittal split setback osteotomy of the mandible with surgery first approach via nonextraction therapy. Outcome: After an active treatment of 15 months, improved facial profile, facial proportions, and a significant reduction of mandibular prognathism were much appreciated. The treatment results were stable after a 1-year follow-up of the treatment. Take-away Lesson: This case report highlights the utilization of nature's dental decompensation to achieve a desirable result, thereby attaining “more with less.”