The Surgery First (SF) method has revolutionized the surgical orthodontic treatment of jaw deformities. The benefits to patients have been many. Among them, eliminating the aggravation of facial appearance associated with decompensation of pre-surgical orthodontics, and the shortening of the treatment time are the most appreciated by patients. In addition, since our SF applies anchor plates for post-surgical orthodontics, it is possible to correct transitional occlusion with complex orthodontic problems immediately after orthognathic surgery. As a result, SF can be successfully applied to more than 90% of jaw deformities. The remaining 10% includes cases which require either pre-surgical orthodontics or two-stage orthognathic surgery. A typical example is severe facial asymmetry. Facial asymmetry is often accompanied by the canting of the maxillary occlusal plane, which is relatively easy to improve with Le Fort I osteotomy. However, if the mandibular occlusal plane is significantly tilted to the left or right due to the excessive elongation of the unilateral molars, it is not easy to reduce the molar height and improve canting by surgery alone because the proximity of the inferior alveolar canal to the root apex. In such cases, we have been trying to improve canting by intruding the mandibular molars on one side, either with the anchor plate alone or with the anchor plate combined with mandibular alveolar osteotomy. In this lecture, I will present the cases of two patients who had severe facial asymmetry and underwent this type of treatment.

1. Learn how to correct severe canting of the mandibular occlusal plane with orthodontic anchor plates in combination with orthognathic surgery.