Evaluation of dental, skeletal, and soft tissue changesof orthognathic surgery with clear aligners inskeletal class III patients

Orthodontic treatment before surgery is the most time-consuming phase in patients who are planned for orthognathic surgery. Contrary to the expectations of patients with skeletal anomalies who apply to the clinic with the expectation of a normal aesthetic appearance, pre-surgical orthodontic treatment ensures that the existing anomaly is revealed with all its reality. Today, with the introduction and widespread use of clear aligners, orthodontic treatment is undergoing a change. Many patients seek aesthetic and non-metallic treatment alternatives, including those that require orthognathic surgery to correct their dentofacial deformities as well. In our study, pre-surgical treatments were performed with clear plates in order to respond to the aesthetic desires and rapid treatment of Class III surgical patients, and time was saved by eliminating early contacts that prevented them from being operated with miniscrew applications. Surgical planning and splint production of the patients were performed digitally with 3D software, resulting in a more predictable surgery. By the regional acceleration phenomenon after surgery, the rate of plaque replacement was increased and a faster, more comfortable, aesthetic and hygienic treatment were offered to the patients. Cephalometric data were obtained at two different times, preoperative and postoperative, and hard and soft tissue analyzes were performed from 5 patients aged 18-20 years (mean 18.2 years) with sagittal skeletal incompatibility (ANB: 5.2°). Preoperative and postoperative 1.,2. and 3 rd month gingival crevicular fluid samples were collected. The gingival crevicular samples were collected from the mesial and distal of the right upper and lower canines with a Periopaper strip and were stored at −80° until the biochemical measurement was made by quantifying in the Periotron device. OPG, IL-1, TGF-1β and OPN, which are bone metabolism biomarkers, were determined by ELISA kits from the samples obtained later. The conformity of the quantitative variables to the normal distribution was examined using the Shapiro Wilk test. For normally distributed variables, the student's t test was used in the comparison of the mean of two independent groups, and the homogeneity of variance was examined with the Levene test. For the non-normally distributed variables, the Mann-Whitney U test was used to compare two independent means. For the normally distributed variables, the analysis of variance method was used in repeated measurements to compare the means between the periods, and the sphericity assumption was evaluated with the Mauchly's test. Friedman test was used for those not normally distributed. The statistical significance 18 level was taken as 0.05 in the calculations and the SPSS (version 28) package program was used in the analysis. In our study, statistically significant increases were found in Osteopontin and Interleukin-1b values ​​in the mandible. A significant decrease in OPG value was observed in the distal gingival groove fluid samples of the mandibular canine. In the comparison of our study between the groups, the mean OPG values in the T2 and T3 time periods were found to be statistically significantly lower in the control surgery group than in the surgery group with clear aligners. A statistically significant increase was detected in the mesial and distal gingival groove fluid samples of the maxillary canine tooth. The surgeries of early surgical patients were completed, and all individuals achieved an aesthetic and harmonious dentofacial relationship earlier than the traditional method. All study group patients were supported with miniscrew assisted biomechanics to eliminate premature contacts and resolve transverse mismatch in the preoperative period. Thus, a more and balanced surface contact was obtained in the surgical operation. The ease of providing hygiene with clear aligners and the low incidence of periodontitis in the study group patients gave biomarker increases due to the RAP phenomenon in the measurements. Orthodontic tooth movement increased due to the RAP phenomenon in the study group patients and the clear plaque change accelerated (mean 5 days).