Ortognatik Cerrahide “Önce Cerrahi” Yaklaşımı
Özet
Ortognatik cerrahide konvansiyonel üç aşamalı yöntemin uzun tedavi süresi ve operasyon öncesi estetik kötüleşme gibi dezavantajlarını gidermek için geliştirilen "önce cerrahi" yaklaşımı, cerrahi öncesi ortodontiyi elimine ederek çeneleri ameliyatla ideal konuma getirir. İlk kez 1991'de Brachvogel ve arkadaşları tarafından tanıtılan bu yöntemin en büyük avantajları, hastanın ana şikayeti olan yüz estetiğinin tedavinin başında düzeltilmesi ve bölgesel hızlanma fenomeni (RAP) sayesinde toplam tedavi süresinin 1-1.5 yıl kadar kısalmasıdır. Ameliyat sonrası dokularda artan metabolik ve osteoklastik aktivite, diş hareketlerini dikkate değer şekilde hızlandırır. Ancak, postoperatif nihai oklüzyonun dental girişimler nedeniyle tahmin edilmesinin güçlüğü, bu yaklaşımın en zorlu yönüdür; bu yüzden hassas bir cerrahi planlama, deneyimli hekimler ve çok doğru vaka seçimi gerektirir. Ciddi çapraşıklık, asimetri, Sınıf II Divizyon 2 vakalar veya akut periodontal problemleri olan hastalar için bu yöntem uygun değildir. Günümüzde üç boyutlu cerrahi planlama yazılımlarıyla daha titizlikle uygulanan bu yaklaşımda, braketlerin yerleştirilmesi, pasif paslanmaz çelik veya nikel-titanyum ark tellerinin hazırlanması ve postoperatif splint kullanımı konularında klinisyenler arasında farklı tedavi protokolleri bulunmaktadır.
The "surgery-first" approach in orthognathic surgery eliminates preoperative orthodontics, positioning the jaws ideally through surgery to overcome the conventional method's long treatment duration and preoperative aesthetic decline. Introduced by Brachvogel et al. in 1991, its key advantages include immediate correction of facial aesthetics and a 1-1.5 year reduction in total treatment time due to the regional acceleratory phenomenon (RAP). Postoperative metabolic and osteoclastic activity significantly accelerates orthodontic tooth movement. However, predicting post-surgical occlusion remains challenging due to dental interferences, requiring meticulous planning, experienced clinicians, and strict patient selection. It is contraindicated for patients with severe crowding, severe asymmetry, Class II Division 2 malocclusions, or acute periodontal problems. Although enhanced by modern three-dimensional planning software, clinical protocols still vary regarding bracket placement, preparation of passive stainless steel or nickel-titanium archwires, and the duration of postoperative splint wear.
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