**3. Treatment plan in SFA**

to move in the direction of decompensation to perform the function following the surgery [46]. Postoperative orthodontic direction and function improve the efficiency of decompensation. Additionally, orthodontic movement via a more rapid natural dental adaptation by facilitating natural compensation may be performed easier with less occluded occlusion. Orthodontic treatment time depends on the complexity of case. The shortest reported treatment time is 4 months (**Figure 1a-d**, **2a**-**d**) but generally it takes 6–12 months [17, 26, 28, 33, 35, 47–50]. Tooth extraction is the factor that influences the total treatment time [13], and in some

cases, the time range was reported between 10 and 19 months [51–53].

148 Current Approaches in Orthodontics

Figure 2. a-d: Three months later after surgery. Total treatment time 3 and half months.

SFA is indicated more common in some cases like well-aligned to mildly crowded anterior teeth, flat to mildly curve of Spee, and normal to mildly proclined/retroclined incisor inclination. The protocol of presurgical orthodontics is well known in conventional approach [4, 8]; however, treatment plan including orthodontic treatment is questioned in SFA especially in complex cases. The orthodontic management and treatment plan are different in SFA compared with the conventional approaches.

In treatment plan, accurate and detailed prediction of the postoperative orthodontic treatment is required at the beginning of all treatment [50]. Following the analysis of occlusion with model mounting, of detailed clinical and cephalometrics, presurgical orthodontic setup that is useful for accurate prediction and simulation of postsurgical orthodontics and cephalometric setup may be required before the surgery [13, 51].

The model surgery is a setup according to the cephalometric and molar relationship. Three stable occlusion points between the upper and lower dentitions are required [38]. Liou et al. reported that the molar relationship could be set up in Class I in cases of nonextraction or bimaxillary first premolar extraction, Class III in cases of lower first premolar extraction, and Class II in cases of maxillary first premolar extraction [16].

Following cephalometric, model, and clinical diagnosis, the aim is to optimize the position of facial components to attain the most desirable results in esthetics, function, and stability. The skeletal movements in all anteroposterior, vertical, and transverse directions are determined to obtain good facial proportions, smile esthetics, and occlusion.

Liou et al. have made some suggestions in treatment plan of SFA [16]. In Class III cases, to correct the decompensation of maxillary incisor, first premolar extraction and retraction of anterior teeth can be done by orthodontics or by anterior segmental osteotomy. If the case has moderately retroclined and crowded lower incisors, the molars in a Class I relationship with an excessive incisor overjet can be planned. In cases with severe crowding and retroclination in mandible, first premolar extraction and lower anterior setback osteotomy can be planned. In Class III cases with deep curve of Spee, leveling of Spee can be corrected before the surgery or can be corrected with lower anterior segmental osteotomy surgically to avoid upwardforward rotation of mandible postoperatively, which is not preferred in Class III cases. The chin cap therapy may be used to prevent the skeletal postsurgical relapse after surgery for 3 months [16]. In Class II cases, in mandibular retrognathia with deep curve of Spee, mandibular advancement with surgical intrusion of anterior segment to advance mandible properly or mandibular advancement followed by orthodontically intrusion of lower incisor postsurgically is proposed to obtain a better chin profile. Otherwise, the mandible cannot be advanced properly and lower face can be longer with correction of posterior openbite after surgery, and this cannot be preferred in some long face case. But in some cases where advancements are not required much, correction of posterior openbite only with posterior extrusion can be preferred [54].
