Less Invasive Surgery First Approach Jungi Sugawara. AAO June 2021. Episode 121

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Farooq Ahmed

A Less Invasive Surgery First Approach Jungi Sugawara


Difference in Junji’s surgery first approach to conventional surgery first

·      Before operation Kaplin hooks

·      BSSO

·      Bone borne plates upper molar and lower canine region

·      Surgical splint placed – as occlusion can be unstable

·      Guiding elastics

·      Pre-adusted appliances placed

·      Posterior bite blocks with composite

·      Orthodontic mechanics

o   Upper arch decompensated using upper bone plate


First publication of surgery first Nagasaka 2009


2 types of surgery first

1.     Surgery driven

a.     Surgery based approach to resolving the skeletal and dental problem

2.     Orthodontic driven

a.     Surgery to resolve the skeletal problem, orthodontics to resolve the dental problem


Surgery driven problems

·      Correct to class 1 molars

·      Tripod occlusion

·      Difficult to decompensate incisors

o   Solution – clockwise rotation – 2 jaw surgery


Orthodontic driven – Sendai approach

·      Reveal true extend of decompensation after occlusion

·      Unstable occlusion after OGN in AOB cases

o   Orthodontic treatment Solution intrusion and distalisation of molars and mesialisation of lower molars i


Sendai Surgery First approach

·      73% single jaw (S/R 85% bimaxillary surgery Perio-Guijarrow 2016)

·      75% miniplates


SF limited to patients with minimal arch length discrepancy , however Junji disagrees that significant archlength discrepency can be treated Mahmood 2018



Case Class 3 AOB

·      Miniplates to distalise and intrude molars

·      Miniplates to distalise lower molars


SF depends on surgeon and orthodontics experience and no contraindications Kwon 2019


Mean time SF Perio-Guijarrow 2016

·      14.2 months

·      Less evasive = less bimax due to MP assisted orthodontics


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