Accelerated rehabilitation protocols for severe skeletal malocclusions — the synergy between minimally invasive orthognathic surgery, pre-surgical orthodontics, and rehabilitation: a narrative review

Abstract

Severe skeletal malocclusions, including Class II and III jaw discrepancies, significantly affect oral function, facial aesthetics, and psychosocial well-being. Traditional orthodontics-first approaches often require 18–36 months for completion, imposing functional, psychological, and financial burdens. Accelerated rehabilitation protocols integrating minimally invasive orthognathic surgery (MIOS), surgery-first orthodontics (SFA), and structured postoperative rehabilitation have emerged to reduce treatment time while optimizing outcomes. This narrative review synthesizes evidence from 27 studies (2015–2025) on innovations in minimally invasive orthognathic surgery, accelerated orthodontic techniques, and rehabilitation protocols, drawing from PubMed, Science Direct, and Google Scholar with inclusion criteria focused on human studies, clinical outcomes, and interdisciplinary approaches. MIOS techniques, including piezoelectric osteotomies, endoscopically assisted osteotomies, and CAD/CAM-guided procedures, minimize soft-tissue trauma, bleeding, and neurosensory complications, promoting faster recovery. SFA leverages the regional acceleratory phenomenon to expedite postoperative tooth movement, reducing total treatment time by 6–8 months without compromising stability. Structured rehabilitation, including jaw mobility exercises, physiotherapy, ERAS protocols, and technology-assisted interventions, improves functional recovery, pain management, and patient satisfaction. Integrated protocols demonstrate synergistic benefits, shortening treatment duration, enhancing aesthetics, and improving quality of life. Further large-scale, long-term studies are warranted to validate efficacy, optimize protocols, and establish standardized clinical guidelines.