Effective pre- and post-surgical orthodontic treatment is essential in achieving esthetic and stable outcomes from orthognathic surgery. In conventional surgical orthodontic treatment, pre-surgical orthodontic treatment generally takes relatively long, while post-surgical orthodontic treatment is usually straightforward, focusing on the refinement and retention of the orthodontic and surgical results. The concept of “surgery-first protocol” is not new, however, the re-emergence of this concept and general acceptance by both surgeons and orthodontists have resulted in increased options and flexibility in orthodontic treatment. The so-called “minimal presurgical orthodontic treatment” may be more appropriate term than the strict “surgery-first protocol” for describing contemporary orthodontic treatment combined with orthognathic surgery.

When surgery is performed earlier, it is crucial to 1) clearly set and efficiently execute the pre- and post-surgical orthodontic treatment goals due to limited time; 2) predict and prepare for the dynamic and somewhat different post-surgical occlusal changes according to the timing of the surgery should be understood and prepared in advance; and 3) coordinate all objectives and sequencing with maxillofacial surgeons to develop a comprehensive treatment plan and to gain sufficient understanding. In contemporary orthodontic sequencing for orthognathic surgery, the importance of appropriate orthodontic treatment increases. Therefore, I would like to present some insights on efficient pre- and post-operative orthodontic treatment with minimal pre-surgical orthodontic treatment.