Surgery First (SF) anticipates the aesthetic and functional breathing benefits derived from surgery at an early stage of treatment. It does not alter the surgical technique but rather the orthodontic approach. In SF, dental decompensations are carried out in the post-surgical period, leveraging the accelerated tooth movement at this stage to achieve significant decompensations. The Class III malocclusion is often converted into Class II, and the post-surgical orthodontic biomechanics aim to treat Class II. This can be managed with fixed appliances or aligners. Miniplates are typically employed to ensure the planned dental movement is executed. The main reason for using mini plates instead of mini implants is that most large hospitals do not permit the use of materials not listed as surgical materials, meaning the surgeon cannot bring a mini implant into the operating room and install it in the patient.

SF offers advantages over traditional orthodontic preparation for orthognathic surgery, such as improved quality of life during treatment and shorter orthodontic treatment durations. This approach necessitates meticulous and complex overall treatment planning, requiring careful coordination between the surgical and orthodontic treatments, as one depends on the other.

Due to the acceleration of orthodontic movement after surgery, substantial dental movements are performed more efficiently, making SF particularly beneficial for patients requiring pronounced dental decompensations. In this lecture, framed by an evidence-based approach, we will present our 20 years of experience utilizing SF in a private practice setting to achieve excellence in finishing with both fixed appliances and aligners.