Advertisement

Recent protocol of the sendai surgery-first (SSF) approach: Clinical and scientific perspectives

Published:December 02, 2022DOI:https://doi.org/10.1053/j.sodo.2022.11.005

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Seminars in Orthodontics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nagasaka H
        • Sugawara J
        • Kawamura H
        • et al.
        Surgery first’ skeletal Class III correction using the skeletal anchorage system.
        J Clin Orthod. 2009; 43: 97-105
        • Faber J.
        Anticipated benefit: a new protocol for orthognathic surgery treatment that eliminates the need for conventional orthodontic preparation.
        Dental Press J Orthod. 2010; 15: 144-157
        • Baek SH
        • Ahn HW
        • Kwon YH
        • et al.
        Surgery-first approach in skeletal class III malocclusion treated with 2-jaw surgery: evaluation of surgical movement and postoperative orthodontic treatment.
        J Craniofac Surg. 2010; 21: 332-338
        • Villegas C
        • Uribe F
        • Sugawara J
        • et al.
        Expedited correction of significant dentofacial asymmetry using a ‘surgery first’ approach.
        J Clin Orthod. 2010; 44: 97-103
        • Sugawara J
        • Aymach Z
        • Nagasaka H
        • et al.
        Surgery first’ orthognathics to correct a skeletal class II malocclusion with an impinging bite.
        J Clin Orthod. 2010; 44: 429-438
      1. Yu CC, Chen PH, Liou EJ, et al. A Surgery-first approach in surgical-orthodontic treatment of mandibular prognathism–a case report. Chang Gung Med J 33: 699–705.

        • Liao YF
        • Chiu YT
        • Huang CS
        • et al.
        Presurgical orthodontics versus no presurgical orthodontics: treatment outcome of surgical-orthodontic correction for skeletal class III open bite.
        Plast Reconstr Surg. 2010; 126: 2074-2083
        • Liou EJ
        • Chen PH
        • Wang YC
        • et al.
        Surgery-first accelerated orthognathic surgery: orthodontic guidelines and setup for model surgery.
        J Oral Maxillofac Surg. 2011; 69: 771-780
        • Liou EJ
        • Chen PH
        • Wang YC
        • et al.
        Surgery-first accelerated orthognathic surgery: postoperative rapid orthodontic tooth movement.
        J Oral Maxillofac Surg. 2011; 69: 781-785
        • Hernández-Alfaro F
        • Guijarro-Martínez R
        • Molina-Coral A
        • et al.
        Surgery first’ in bimaxillary orthognathic surgery.
        J Oral Maxillofac Surg. 2011; 69: e201-e207
        • Kim JH
        • Mahdavie NN
        • Evans CA
        Guidelines for “surgery first” orthodontic treatment.
        (editor)in: Bourzgui F Orthodontics-basic Aspects and Clinical Considerations. In Tech Publishing, New York2012: 265-300
        • Villegas C
        • Janakiraman N
        • Uribe F
        • et al.
        Rotation of the maxillomandibular complex to enhance esthetics using a ‘surgery first’ approach.
        J Clin Orthod. 2012; 46: 85-91
        • Aymach Z
        • Sugawara J
        • Goto S
        • et al.
        Nonextraction ‘surgery first’ treatment of a skeletal Class III patient with severe maxillary crowding.
        J Clin Orthod. 2013; 47: 297-304
        • Ko EW
        • Lin SC
        • Chen Y
        • et al.
        Skeletal and dental variables related to the stability of orthognathic surgery in skeletal Class III malocclusion with a surgery-first approach.
        J Oral Maxillofac Surg. 2013; 71: e215-e223
        • Uribe F
        • Chugh VK
        • Janakiraman N
        • et al.
        Treatment of severe facial asymmetry using virtual three-dimensional planning and a ‘surgery first’ protocol.
        J Clin Orthod. 2013; 47: 471-484
        • Kim JY
        • Jung HD
        • Kim SY
        • et al.
        Postoperative stability for surgery-first approach using intraoral vertical ramus osteotomy: 12 month follow-up.
        Br J Oral Maxillofac Surg. 2014; 52: 539-544
        • Park HM
        • Lee YK
        • Choi JY
        • et al.
        Maxillary incisor inclination of skeletal Class III patients treated with extraction of the upper first premolars and two-jaw surgery: conventional orthognathic surgery vs surgery-first approach.
        Angle Orthod. 2014; 84: 720-729
        • Hernández-Alfaro F
        • Guijarro-Martínez R.
        On a definition of the appropriate timing for surgical intervention in orthognathic surgery.
        Int J Oral Maxillofac Surg. 2014; 43: 846-855
        • Hernández-Alfaro F.
        • Guijarro-Martínez R.
        • Peiró-Guijarro M.A.
        Surgery first in orthognathic surgery: what have we learned? A comprehensive workflow based on 45 consecutive cases.
        J Oral Maxillofac Surg. 2014; 72: 376-390
        • Choi JW
        • Lee JY
        • Yang SJ
        • et al.
        The reliability of a surgery-first orthognathic approach without presurgical orthodontic treatment for skeletal Class III dentofacial deformity.
        Ann Plast Surg. 2015; 74: 333-341
        • Sugawara J
        • Nagasaka H
        • Yamada S
        • et al.
        The application of orthodontic miniplates to Sendai surgery fi rst.
        Semin Orthod. 2018; 24: 17-36
        • Dr Sugawara J.
        Junji Sugawara on the skeletal anchorage system. Interview by Dr. Larry W. White.
        J Clin Orthod. 1999; 33: 689-696
        • Sugawara J.
        A bioefficient skeletal anchorage system.
        (editor)in: Nanda R Biomechanics and Esthetic Strategies in Clinical Orthodontics. Elsevier Saunders, St. Louis2005: 295-309
        • Sugawara J
        • Umemori M
        • Takahashi I
        • Nagasaka H
        • Kawamura H.
        The skeletal anchorage system.
        (editor)in: Cope BJ OrthoTADs The Clinical Guide and Atlas. LP. Under Dog Media, Dallas, TX2007: 449-532
        • Sugawara J
        • Nishimura M
        • Nagasaka H
        • Kawamura H.
        Skeletal anchorage system using orthodontic miniplates.
        (editor)in: Nanda R Temporary Anchorage Devices in Orthodontics. Mosby, Elsevier, St. Louis2009: 317-341
        • Umemori M
        • Sugawara J
        • Mitani H
        • et al.
        Skeletal anchorage system for open-bite correction.
        Am J Orthod Dentofac Orthop. 1999; 115: 166-174
        • Sugawara J
        • Baik UB
        • Umemori M
        • et al.
        Treatment and posttreatment dentoalveolar changes following intrusion of mandibular molars with application of a skeletal anchorage system (SAS) for open bite correction.
        Int J Adult Orthodon Orthognath Surg. 2002; 17: 243-253
        • Sugawara J
        • Daimaruya T
        • Umemori M
        • et al.
        Distal movement of mandibular molars in adult patients with the skeletal anchorage system.
        Am J Orthod Dentofacial Orthop. 2004; 125: 130-138
        • Sugawara J
        • Kanzaki R
        • Takahashi I
        • et al.
        Distal movement of maxillary molars in nongrowing patients with the skeletal anchorage system.
        Am J Orthod Dentofacial Orthop. 2006; 129: 723-733
        • Sugawara J.
        • Soya T.
        • Kawamura H.
        Analysis of craniofacial morphology using craniofacial drawing standards (CDS): application for orthognathic surgery.
        J Jpn Orthod Soc. 1988; 47: 394-408
        • Reyneke JP
        • Tsakiris P
        • Becker P.
        Age as a factor in the complication rate after removal of unerupted/impacted third molars at the time of mandibular sagittal split osteotomy.
        J Oral Maxillofac Surg. 2002; 60: 654-659
        • Schwartz HC.
        Simultaneous removal of third molars during sagittal split osteotomies: the case against.
        J Oral Maxillofac Surg. 2004; 62: 1147-1149
        • Mehra P
        • Castro V
        • Freitas RZ.
        Complications of the mandibular sagittal split ramus osteotomy associated with the presence or absence of third molars.
        J Oral Maxillofac Surg. 2001; 59: 854-858
        • Precious DS.
        Removal of third molars with sagittal split osteotomies: the case for.
        J Oral Maxillofac Surg. 2004; 62: 1144-1146
        • Kawamura H
        • Nagasaka H
        • Sato S
        • et al.
        Sagittal split ramus osteotomy combined with titanium mini-plate internal fixation.
        Jpn J Jaw Deform. 1991; 1: 105-112
        • Nagasaka H.
        Radiographic study of condylar position before and after orthognathic surgery in mandibular prognathism.
        Jpn J Oral Maxillofac Surg. 1993; 39: 623-638
        • Aymach Z
        • Nei H
        • Kawamura H
        • et al.
        Biomechanical evaluation of a T-shaped miniplate fixation of a modified sagittal split ramus osteotomy with buccal step, a new technique for mandibular orthognathic surgery.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology. 2011; 111: 58-63
        • Wolford LM
        • Bennett MA
        • Rafferty CG.
        Modification of the mandibular ramus sagittal split osteotomy.
        Oral Surg Oral Med Oral Pathol. 1987; 64: 146-155
        • Wolford LM.
        The sagittal split ramus osteotomy as the preferred treatment for mandibular prognathism.
        J Oral Maxillofac Surg. 2000; 58: 310-312
        • Wolford LM.
        Influence of osteotomy design on bilateral mandibular ramus sagittal split osteotomy.
        J Oral Maxillofac Surg. 2015; 73: 1994-2004
        • Wolford LM
        • Rodrigues DB
        • Limoeiro E.
        Orthognathic and TMJ surgery: postsurgical patient management.
        J Oral Maxillofac Surg. 2011; 69: 2893-2903
        • Nagasaka H.
        The present and future of the skeletal anchorage system (SAS) using miniplates for the treatment and management of jaw deformities.
        Jpn J Jaw Deform. 2012; 22 (Suppl): 35-44
        • Kwon TG
        • Han MD.
        Current status of surgery first approach (part II): precautions and complications.
        Maxillofac Plast Reconstr Surg. 2019; 41: 23
        • Godoy F
        • Laureano Filho JR
        • Rosenblatt A
        • et al.
        Prevalence of banding and bonding molar brackets in orthognathic surgery cases.
        J Oral Maxillofac Surg. 2011; 69: 911-916
        • Attishia R
        • Van Sickels JE
        • Cunningham LL.
        Incidence of bracket failure during orthognathic surgery: a comparison of two techniques to establish interim maxillomandibular fixation.
        Oral Maxillofac Surg. 2015; 19: 143-147
      2. Huang CS, Hsu, SS-P,Chen YR. Systematic review of the surgery-first approach in orthognathic surgery. Biomed J 37: 184–90.

        • Peiró-Guijarro MA
        • Guijarro-Martínez R
        • Hernández-Alfaro F.
        Surgery first in orthognathic surgery: a systematic review of the literature.
        Am J Orthod Dentofac Orthop. 2016; 149: 448-462
        • Yamauchi K
        • Takahashi T
        • Yamaguchi Y
        • et al.
        Effect of “surgery first” orthognathic approach on temporomandibular symptoms and function: a comparison with “orthodontic first” approach.
        Oral Surg Oral Med Oral Pathol Oral Radiol. 2019; 127: 387-392
        • Frost HM.
        The biology of fracture healing. An overview for clinicians. Part I.
        Clin Orthop Relat Res. 1989; 248: 283-293
        • Frost HM.
        The regional acceleratory phenomenon: a review.
        Henry Ford Hosp Med J. 1983; 31: 3-9
        • Chung KR
        • Oh MY
        • Ko SJ.
        Corticotomy-assisted orthodontics.
        J Clin Orthod. 2001; 35: 331-339
        • Iino S
        • Sakoda S
        • Ito G
        • et al.
        Acceleration of orthodontic tooth movement by alveolar corticotomy in the dog.
        Am J Orthod Dentofacial Orthop. 2007; 131 (e1–8): 448
        • Yuan H
        • Zhu X
        • Lu J
        • et al.
        Accelerated orthodontic tooth movement following le Fort i osteotomy in a rodent model.
        J Oral Maxillofac Surg. 2014; 72: 764-772
        • Mueller M
        • Schilling T
        • Minne HW
        • et al.
        A systemic acceleratory phenomenon (SAP) accompanies the regional acceleratory phenomenon (RAP) during healing of a bone defect in the rat.
        J Bone Miner Res. 1991; 6: 401-410
        • Eghbali-Fatourechi GZ
        • Lamsam J
        • Fraser D
        • et al.
        Circulating osteoblast-lineage cells in humans.
        N Engl J Med. 2005; 352: 1959-1966
        • Kassem M
        • Risteli L
        • Mosekilde L
        • et al.
        Formation of osteoblast-like cells from human mononuclear bone marrow cultures.
        APMIS. 1991; 99: 269-274
        • Long MW
        • Williams JL
        • Mann KG.
        Expression of human bone-related proteins in the hematopoietic microenvironment.
        J Clin Invest. 1990; 86: 1387-1395
        • Pignolo RJ
        • Kassem M.
        Circulating osteogenic cells: Implications for injury, repair, and regeneration.
        J Bone Miner Res. 2011; 26: 1685-1693
        • Abe Y
        • Chiba M
        • Yaklai S
        • et al.
        Increase in bone metabolic markers and circulating osteoblast-lineage cells after orthognathic surgery.
        Sci Rep. 2019; : 1-10https://doi.org/10.1038/s41598-019-56484-x