Surgery driven Surgery First Orthognathic Approach in a patient with mandibular osteosclerosis – Case report with review of literature

Idiopathic Osteosclerosis/dense bone island/enostosis is defined as an asymptomatic, non-expansible, radiopaque lesion in the jawbone. It is classified on the basis of location and is diagnosed incidentally in most cases. Orthodontic treatment is usually delayed when the lesion is present in proximity to the tooth roots. Since its introduction in 2009, Surgery First Orthognathic Approach (SFOA) has been popular for facilitating faster overall treatment time through Frost’s biological theory as well as improving patient comfort. We report a case wherein osteosclerosis of mandible was observed in the premolar region bilaterally. Considering potential complications during pre-orthodontics, we opted for surgery driven SFOA which was then followed by orthodontic treatment. Post-operative orthodontic treatment was completed 11 months after surgery. Surgery driven SFOA allowed for reduction of total treatment duration by enabling faster anterior teeth retraction, space closure and achievement of the preferred facial feature with desired occlusion.