Abstract
The treatment protocol of Surgery-First has gradually evolved, since our team employed
it for the first time twenty-years ago. In this article, we describe every step of
the current Sendai Surgery-First (SSF) approach protocol, in detail. Two major differences
between the recent and old protocol, exists, which are (1) In the recent protocol,
placement of brackets and passive surgical wires is no longer required before jaw
surgery, and (2) only surgical hooks are needed to be bonded to the lateral teeth.
Further, the duration of surgical splint use has been significantly shortened. Instead
of a surgical splint, a posterior build-up in the maxillary dentition is used to secure
a vertical stop. These considerations allow patients to undergo treatment in a more
comfortable manner. However, the skeletal anchorage system (SAS) using the orthodontic
miniplate for postoperative orthodontics remains unchanged. Based on many SSF approach
cases, we have confirmed that the SAS can predictably improve unstable and complicated
occlusion immediately after surgery, and reliably achieve treatment goals. Therefore,
our SSF approach has the distinguishing feature of having a wider range of indications
than other Surgery-First approaches. Furthermore, in regard to scientific perspectives,
dynamic systemic changes in bone metabolic activity of the SSF approach is also discussed.
The C-reactive protein levels increase immediately after surgery, followed by an increase
in the C-terminal telopeptide type I collagen levels, which is associated with osteoclastic
activity, indicating bone resorption. After this, alkaline phosphatase, and bone-specific
alkaline phosphatase levels, which are associated with osteoblastic activity, increase
with a peak at 1 month and then decrease gradually to preoperative levels by 6 months.
During the early postoperative period, osteocalcin-positive cells, such as osteogenic
precursors, appear in the peripheral blood and are involved in the bone healing process
after surgery through the systemic acceleration phenomenon. Therefore, orthognathic
surgery induces regional and systemic accelerated phenomena, which, in turn, causes
rapid orthodontic tooth movement, resulting in reduced treatment duration with the
SSF approach.
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Published online: December 02, 2022
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