TITLE:
Knowledge, Attitudes, and Practices of Moroccan Orthodontists regarding the Surgery-First Approach
AUTHORS:
Zineb Idrissi Kaitouni, Meryem Lahlou, Amina El Khadali, Hicham El Bouri, Farid Bourzgui, Meriem Bellamine, Ihsane Ben Yahya
KEYWORDS:
Orthognathic Surgery, Orthodontics, Surgery First, Dentofacial Deformities
JOURNAL NAME:
Open Access Library Journal,
Vol.12 No.11,
November
6,
2025
ABSTRACT: This study aims to assess the knowledge of Moroccan orthodontists regarding the Surgery First Approach (SFA) in the management of dentofacial deformities, and to compare it with the conventional approach. It also seeks to confront the clinical indications reported in the Moroccan context with those described in the international literature, and to analyze practitioners’ perceptions of the advantages and limitations of this approach. A cross-sectional descriptive study was conducted among a sample of Moroccan orthodontists using an online questionnaire. The survey focused on their knowledge, attitudes, and practices concerning the SFA, as well as their perception of the conventional approach. The questionnaire was distributed to 110 practitioners, and 97 complete responses were collected. Among the orthodontists surveyed, 56.7% reported being well-informed about the SFA, but 68.4% had never applied it in practice. The most frequently reported indications were skeletal Class III (77.1%), facial asymmetry (65.1%), Class II deformities (62.7%), and anterior vertical excess (55.4%). Perceived benefits included immediate functional and aesthetic improvement (85.5%) and reduced overall treatment time (54.2%). The main limitations identified were challenges in postoperative follow-up and occlusal stability. Most respondents (76%) reported being satisfied with the outcomes of the SFA, and 84% believed their patients were as well. A majority (64.9%) felt that this approach should remain limited to carefully selected cases. Despite a generally favorable perception, the SFA remains underutilized in clinical practice. Better dissemination of protocols and enhanced continuing education could support its broader integration into routine orthodontic care.