“Surgery First Approach” for Skeletal Class II Correction Combined With Temporary Anchorage Device.

“Surgery First Approach” (SFA) is a growing trend that provides an immediate facial change. The SFA protocol utilizes the dentoalveolar compensations as an advantage to effect immediate facial changes, which in conjunction with the Regional Acceleratory Phenomenon enhances the tooth movement thereby reducing the total treatment duration. The post-surgical orthodontic phase is often complicated by rapid accelerated tooth movement producing a non-predictable nature of tooth movements. With the combined application of temporary anchorage devices these movements are made predictable in three dimensions. This case report illustrates the treatment of a skeletal Class II patient with a combination of the SFA protocol and TAD aided orthodontic treatment. A 19-year-old female presented with proclined upper anteriors and retrusive lower jaw. Clinical examination revealed a severe lip incompetency, mandibular deficiency, Class II skeletal malocclusion, severe bimaxillary incisor proclination, severely crowded mandibular arch on a low mandibular plane angle. The SFA protocol involving BSSO advancement and genioplasty was performed, followed by an orthodontic phase involving TADs. The total treatment time was 14 months, following which excellent facial change and stable occlusion was achieved. A three year follow up is also presented.