[First-line surgery : indications, advantages and drawbacks]

First-line surgery offers an additional option in our orthodontic treatment arsenal. Unlike the classic three-stage orthodontic-surgical protocol, it aims to correct the skeletal discrepancies during stage one in order to restore a favorable functional environment and enable orthodontic occlusal correction during a second stage. In some cases of maxilla-mandibular malformation, and for specific indications, it involves eliminating presurgical orthodontic preparation or reducing it to a minimum. From the orthodontic point of view, it reduces overall treatment time, facilitates treatment following surgery and speeds up tooth displacement. On the patient's side, it makes for rapid esthetic improvement and a radically enhanced quality of life. The use of anchorage devices, surgical splints or set-ups makes it possible to offset the drawbacks of this technique such as postsurgical occlusal instability or restrictive treatment planning.