**6. Conclusion**

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

usage may begin after orthodontic wire was placed.

arches at first orthodontic appointment after surgery.

were reported to affect stability in SFA cases [59].

fixation.

150 Current Approaches in Orthodontics

**5. Relapse in SFA**

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

Postoperatively, surgical splint is left for 2–4 weeks [34, 50, 53], and intermaxillary elastics

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

The short- and long-term relapse rates in SFA have been investigated, and the results are good by comparison with the conventional surgical approach with a maximum follow-up of 3 years [19, 57–59]. Without presurgical orthodontics, the patients may have likely to develop unstable occlusion after surgery leading to relapse. However, some of the comparative studies between conventional and surgery first approach showed no statistical differences in relapse and almost equal for those achieved using the more traditional orthodontics-first approach [17, 19, 51, 53, 59–63]. Advancement of fixation system enabled more stabilized results due to more stable fixation of bony segments. On the other side, based on one research and on the meta-analysis, SFA showed more relapses than in the conventional approach [57, 64]. Larger overbite, a deeper curve of Spee, a greater negative overjet, and a greater mandibular setback 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 compared to conventional approach.
