**4. Time for orthodontic bonding and force application**

On the basis of simulated model surgery setup, surgical guidance splint is prepared. Before the surgery, orthodontic bracket bonding/banding is placed but no arch wire is used. Bonding orthodontic bracket was reported as immediately before surgery [26, 47, 48], 1 week before surgery [16, 26, 38], and 1–2 months before surgery [50]. Some studies reported the usage of passive archwire before the surgery [49, 50, 52, 53, 55]. Passive arch can be used 1–3 days before the surgery [17, 35]. In some cases, the orthodontist can prefer minimal orthodontic preparation during 6 months [49] before the surgery, and then, they are continuing the orthodontic treatment after the surgery. Intermaxillary fixation of jaws during the surgery can be done by bony screws following the surgical guidance splints placements in cases without arch wires [47, 50, 51]. Kim et al. maintained intermaxillary fixation without surgical splint for 2 weeks but used intermaxillary elastic [50]. The osteotomized bones are fixed by rigid fixation.

Although there are benefits of the SFA, there are some difficulties like the prediction of final occlusion, instability of postsurgical transient occlusion [10, 65], the requirement of presurgical orthodontic setup before surgery in some complex cases, and requirement of frequent orthodontic appointment due to RAP. The treatment plan requires detailed and meticulous planning.

Surgery First Approach

151

http://dx.doi.org/10.5772/intechopen.80951

The surgery first approach is an alternative method that may be more satisfying for orthodontists and patients by minimizing the treatment time required for orthodontic treatment

Department of Plastic Reconstructive and Esthetic Surgery, University of Gazi, Ankara,

[1] Obwegeser HL. Surgical correction of small or retrodisplaced maxillae. The "dish-face"

[2] Poulton DR, Taylor RC, Ware WH. Cephalometric x-ray evaluation of the vertical osteotomy correction of mandibular prognathism. Oral Surgery, Oral Medicine, and Oral

[3] Poulton DR, Ware WH. Surgical-orthodontic treatment of severe mandibular retrusion.

[4] Bell WH, Creekmore TD. Surgical-orthodontic correction of mandibular prognathism.

[5] Bell WH, Proffit WR, White RP. Surgical Correction of Dentofacial Deformities.

[6] Worms FW, Isaacson RJ, Speidel TM. Surgical orthodontic treatment planning: Profile

[7] Profit WR, White RP Jr. Who needs surgical-orthodontic treatment? The International

analysis and mandibular surgery. The Angle Orthodontist. 1976;**46**:1-25

Journal of Adult Orthodontics and Orthognathic Surgery. 1990;**5**:81-89

deformity. Plastic and Reconstructive Surgery. 1969;**43**:351-365

II. American Journal of Orthodontics. 1973;**3**:237-255

American Journal of Orthodontics. 1973;**63**:256-270

Philadelphia: Saunders; 1980. pp. 1-3

**6. Conclusion**

**Author details**

Ayşe Gülşen

**References**

Turkey

compared to conventional approach.

Pathology. 1963;**16**:807-820

Address all correspondence to: aysegulsen1968@gmail.com

Postoperatively, surgical splint is left for 2–4 weeks [34, 50, 53], and intermaxillary elastics usage may begin after orthodontic wire was placed.

There is no definitive consensus about postsurgical orthodontic force application time. But generally, the orthodontic treatment in SFA begins in 1 or 2 weeks after surgery. The surgical splint and inter-maxillary fixation were removed for the tooth movement. Liao et al. reported that postsurgical orthodontics begun immediately after surgery [17]. This is beneficial to shorten the orthodontic treatment time due to the regional accelerated phenomena. The studies showed that the orthognathic surgery triggers a 3- to 4-month period of higher osteoclastic activity, serum findings, and metabolic changes and that in the dentoalveolar bone postoperatively [15, 56]. Archwire changes took place every 2–3 weeks. Arch coordination may be managed with transpalatal elastics or active transpalatal arch. In segmental surgery patients, passive continuous arches which were placed before surgery are changed with sectional arches at first orthodontic appointment after surgery.
