Surgery-First Approach; from Claims to Evidence: A Comprehensive Review.

The main goals of treatment of dentofacial deformities are to achieve optimal esthetics and ideal functional occlusion. The conventional orthognathic surgical approach includes a long presurgical orthodontic phase, which takes about 18 months. During this phase, the patients' appearance is deteriorated and their motivation to continue treatment significantly decreases. In the surgery first approach (SFA), orthognathic surgery is performed prior to orthodontic treatment, and orthodontic treatment is performed postoperatively to improve dental occlusion and for final settling. The SFA has two main advantages namely shortening of treatment period, and early improvement of the appearance of patient. The SFA has significant advantages especially for class III patients. This study aimed to review the available articles on this topic published from 2012 to 2019 to achieve a comprehensive understanding of different aspects of the SFA. The databases were searched by two researchers and a total of 11 eligible articles were selected for study inclusion. The results were categorized into two categories of stability of the results of the SFA, and duration of treatment, in comparison with the conventional approach. Although different aspects of the SFA have been previously evaluated by dental clinicians, a considerable gap of information still exists regarding the details of this approach, which calls for further research in this respect.

Concerns and Problems of Orthodontic Patients during the COVID-19 Pandemic.

OBJECTIVES: We aimed to find the main concerns of patients undergoing active orthodontic treatments and their orthodontic treatment-related (OTR) problems during the coronavirus disease-2019 (COVID-19) pandemic. MATERIALS AND METHODS: A researcher-made questionnaire addressing several aspects of the effects of COVID-19 pandemic on treatment was distributed among 181 orthodontic patients receiving active treatment. Anxiety, concern, problems, and willingness to attend orthodontic appointments and to undergo other dental procedures was questioned. The correlation of gender, age, COVID-19-related anxiety and OTR anxiety was statistically analyzed. Patient satisfaction level with different aspects of dental-clinic performance was also evaluated. RESULTS: The participants included 117 females and 64 males, of which 94% adhered to the pandemic restrictions. The mean COVID-19-related- and OTR-anxiety were 51.7% and 52.7%, respectively. Higher COVID-19-related anxiety was significantly correlated with higher OTR anxiety (P<0.001). There was an inverse correlation between general COVID-19-related anxiety and OTR anxiety and willingness to attend orthodontic appointments (P<0.05). A positive insignificant (P=0.07) correlation existed between age and willingness to attend appointments. The main concern was prolongation of treatment and the most common problem was irritation of oral soft tissues by appliances. The majority (65.3%) were willing to attend their orthodontic appointments. Orthognathic surgery (62%) had the highest while, dental restorations and radiography had the lowest refusal rates (9.9%). CONCLUSION: COVID-19 pandemic significantly affected orthodontic treatment. The level of COVID-19-related anxiety was moderately high and patients were concerned about the impact of lockdown on their orthodontic treatment outcome. Young adults demonstrated higher levels of stress than other age-groups.