Rate of tooth movement and bone biomarkers in surgert first patients

Combination of surgery and orthodontic treatment for the correction of dentofacial deformity is called orthognathic surgery. Conventional orthognathic surgery treatment includes the orthodontic treatment phase, in which the teeth are corrected first, and then surgical phase in which the jaws are corrected and repositioned. Orthodontic treatment time is an important determinant of patient satisfaction nowadays. In the conventional method, it has been reported that the preoperative orthodontic treatment period varies between 1-2 years and the facial aesthetics and dental function of the patient gradually worsens during this period. The delayed fulfillment of the patient's main expectation and prolonged orthodontic treatment significantly reduce patient satisfaction. Surgical First approach has been developed in order to eliminate such problems and to meet aesthetic concerns earlier. In this approach, skeletal deformity is eliminated with surgical treatment first, and then orthodontic treatment is performed. The most advantage of this technique is the aesthetic expectation of the patient is provided in the early period of treatment due to the elimination of the orthodontic preparation phase. In addition, it has been reported in different studies that the acceleration of tooth movement increases and the treatment period is shortened with the Surgical First approach. In a study evaluating bone formation and resorption biomarkers, an increase in osteoclastic activity was found in the first 3 - 4 months after surgery, and this increase was associated with the regional acceleration phenomenon (RAP). RAP has been defined as increased metabolic activities in bone tissue after trauma. It has been suggested that this increase in metabolic activities also accelerates tooth movement. In our study, it was aimed to compare the rate of tooth movement and bone metabolism markers of the patients treated with the Surgical First approach and the patients treated with fixed orthodontic treatment with upper first premolar tooth extraction. Records were collected from patients in the surgery group before and 1, 2, 3, 4 months postoperatively and in the control group before treatment, before distalization, and at the following 1, 2 and 3 months. These records include gingival crevicular fluid, photographs, and dental plaster models. The gingival crevicular fluid was collected from the distal of the canine tooth with Periopaper strip in the early hours of the day, after quantification with Periotron device, it was kept at -80 ° until the measurement was made. Then, the amount of bone resorption marker RANKL and bone formation marker OPG were determined from these samples with ELISA kits. During the same period, the plaster models taken from the patients were scanned with the 3Shape Ortho Analyzer ™ program and the amount of tooth movement was determined. While the average amount of canine distalization was 1.54 mm/month in the Surgery First group and 1.07 mm/month in the control group. The increase rate of RANKL was significantly higher in the surgery first group compared to the control group by T2 period, which distalization forces were applied. It reached the highest value in the T4 period. The decrease rate of OPG was significantly higher in the surgical group by the T2 period. It reached the lowest value in the T4 period. Increase in RANKL/ OPG ratio showed significant correspondence with the increase of the amount of canine distalization According to the findings of this study, Surgery First approach accelerated orthodontic tooth movement postoperatively. RANKL/ OPG pathway, which is considered as one of the indicators of RAP after surgical intervention, had been observed by the second month when distalization forces were applied and especially the anti-inflammatory drugs were eliminated from metabolic system.