## 1 Introduction  
Orthognathic surgery, a complex field within maxillofacial surgery, is crucial for correcting severe dentofacial deformities that cannot be resolved solely through orthodontic treatment. Traditionally, this process involved a lengthy presurgical orthodontic phase, often extending from over 12 to 18 months, followed by the surgical correction, and then a post-operative orthodontic phase. This method, known as the conventional approach, aims to decompensate the dental occlusion prior to surgery [1]. However, it has its limitations, particularly concerning patient aesthetics and comfort during the presurgical phase [2, 3]. Over the years, a shift has occurred with the reintroduction of the Surgery-First Orthognathic Approach (SFOA), coupled with advancements in orthodontic technology, most notably the use of bone anchorage systems. The concept of SFOA, though not entirely new, was revitalized in 2009 by surgical innovators who sought to address some of the inherent disadvantages of the traditional orthognathic approach. This method prioritizes the surgical intervention at the onset of treatment, allowing for post-surgical orthodontics to handle any required tooth movement after skeletal corrections have been made. The availability of modern bone anchorage systems presents a novel opportunity for this approach to succeed as they offer stability and control during the post-surgical orthodontic phase, minimizingthe need for the pre-operative decompensation of teeth [4]. The availability of bone anchorage introduces the prospect that achieving a decompensated, lower incisal position prior to surgery may not always be imperative. Research by [PERSON] et al. [5] demonstrated that patients undergoing the conventional orthognathic approach that consists of a presurgical orthodontic phase for decompensation of the teeth, prior to the orthognathic surgery followed by a post-orthodontic phase, experienced a detrimental impact on their quality of life compared to the SFOA group. This discrepancy was mainly due to the worsening of facial aesthetics during the presurgical orthodontic phase. By using the SFOA, addressing significant facial enhancements at the initiation of treatment and reduced treatment duration might lead to increased patient satisfaction [4; 6; 7]. One frequent approach of measuring the quality of life is through the use of the Oral Health-Related Quality of Life-14 (OHIP-14) questionnaire [8] and Orthognathic Quality of Life questionnaire (OQLQ) [9], where an increased score leads to the worsening of the quality of life, and a decreased score indicates an improvement. An objective way of evaluating the results is through the Peer Assessment Rating (PAR) index, where low scores indicate improved occlusion, with the weighted version prioritizing key features, and the unweighted version treating all features equally [10]. The surgery-first approach offers the advantage of utilizing the Regional Acceleratory Phenomenon (RAP) [11] and Systemic Acceleratory Phenomenon (SAP) [12], which induces accelerated tooth movement that can reduce the total treatment time. Enhancing the predictability of surgical procedures is crucial in orthognathic surgery, especially if an SFOA is chosen. Repositioning the maxillary and mandibular segments proves challenging due to the absence of prior dental decompensations, as outlined in the guidelines for surgery-first protocols [13]. It is therefore recommended to use an SFOA in cases with a mild curve of Spee, mild crowding, and mild deviations from the ideal inclination of the incisors. In recent times, orthodontic appliances have been designed with a focus on meeting the patients' preferences, as they now prioritize the aesthetics of orthodontic appliances, particularly adolescents [14] and adults [15; 16] who prefer clear aligners. As patient-centered outcomes are a key factor in contemporary treatment philosophy [17], there is evidence suggesting that clear aligner therapy (CAT) offers enhanced comfort when compared to traditional fixed appliances [18; 19].