(40) Conventional Orthodontic-Orthognathic Surgery Treatment Duration in a University Residency Program

Abstract: The lengthy treatment duration of Conventional Orthodontic-Orthognathic Surgery (COS) has been reported extensively and is often cited as a reason for pursuing other treatment approaches, such as surgery-first orthognathic surgery. The total treatment time of COS has been reported to be approximately 27-36 months,¹ but additional variables contributing to this extensive treatment time remain incompletely assessed.²

Objective: The purpose of this retrospective study is to identify variables inherent to the treatment process of COS that significantly contribute to longer treatment duration in a university-based residency program, which will aid in determining methods to improve treatment efficiency for COS patients.
Materials and

Methods: A sample of 44 patient charts (22 female, 22 male, mean age 19 ± 8.14 yrs) treated at a single residency program between 2013 and 2020 were retrospectively reviewed for 22 variables including patient factors (age, gender, occlusion pattern, growth, compliance), type of treatment performed, insurance delays, treatment outcomes, indecisiveness by patient or surgeon, presurgical orthodontics or prior orthodontic intervention, and post-surgical orthodontics. Multivariable linear regression analysis was performed to find the association between the independent and outcome variables.

Results: The mean duration of the total treatment was 42.78 ± 15.66 months, including 27.63 ± 14.81 months for the presurgical phase and 10.69 ± 7.07 months for the postsurgical phase. Decreased treatment times were associated with previous conventional orthodontics (P = .005) and not initially being planned for surgery (P = .004). Increased treatment times were associated with the presence of impacted teeth (P = .013), waiting more than 6 months for growth completion (P = .049), and missing 4 or more appointments (P = .009).

Conclusion: COS is a relatively lengthy process given the need for both presurgical and postsurgical orthodontic intervention. Treatment duration in patients receiving COS in a residency program appears to be significantly decreased with previous orthodontic intervention or not initially being planned for orthognathic surgery, and increased when patients presented with impacted teeth, required more than 6 months of additional time for growth, or missed 4 or more appointments during the presurgical period. The results of this study further elucidate factors that have a strong association with extended treatment duration with COS. The results also serve as a guide for clinicians for potential treatment delays in patients requiring COS that may be mitigated with proper management and preparation.

References:
1. Diaz PM, Garcia RG, Gias LN, et al. Time used for orthodontic surgical treatment of dentofacial deformities in white patients. J Oral Maxillofac Surg. 2010;68(1):88-92. doi: 10.1016/j.joms.2009.07.062.
2. Luther F, Morris DO, Hart C. Orthodontic preparation for orthognathic surgery: How long does it take and why? A retrospective study. Br J Oral Maxillofac Surg. 2003;41(6):401-406. doi: S0266435603001633.