Current Surgery First (SF) approaches can be classified into two rather different styles. One is the orthodontic-driven style. In this style, skeletal problems are solved by surgery, and dental problems are fixed orthodontically. The other is the surgery-driven style. In this approach, the aim is to solve both skeletal and dental problems by orthognathic surgery (OGS) as much as possible. The concept of SF that we practice is the orthodontic-driven style, referred to as Sendai SF (SSF). This approach was made possible by the application of the Skeletal Anchorage System (SAS) which enables predictable control of the entire dentition, including the three-dimensional control of the bimaxillary molars. With SAS in combination with the multi-bracketed system, the extent of surgical intervention is significantly reduced, and complex orthodontic problems in post-surgical orthodontics can be solved. In this article, the SAS biomechanics of the post-surgical orthodontics in SSF is described.
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