Ortognatik Cerrahi Sonrası İlaç Kullanımına Bağlı İnflamatuvar Biyobelirteçler ve Kök Rezorpsiyonundaki Değişiklikler

Abstract

Amaç: Ortognatik cerrahi sırasında ve sonrasında uygulanan ilaçların dişeti oluğu sıvısındaki inflamatuar biyobelirteçler üzerindeki etkisini araştırmak ve bu biyobelirteçlerle maksiller ve mandibular kesici diş kök rezorpsiyonu arasındaki olası ilişkiyi değerlendirmek. Gereç ve Yöntem: Bu prospektif uzunlamasına çalışmaya ortognatik cerrahi geçiren 25 hasta dahil edildi. Dört hafta içinde enfeksiyon gelişen 12 hasta dışlandıktan sonra, 13 hasta (ortalama yaş 24.8 ± 12.7 yıl) nihai analize alındı. Tüm katılımcılara standart bir opioid, NSAID ve parasetamol protokolü uygulandı. Dişeti oluğu sıvısı örnekleri cerrahi öncesi (T0), cerrahiden bir hafta sonra (T1) ve dört hafta sonra (T2) toplandı. OPG, RANKL, IL-1β ve IL-6 düzeyleri ELISA yöntemiyle ölçüldü. Dış apikal kök rezorpsiyonu radyografik olarak T0 (ortodontik tedavi başlangıcı), T1 (cerrahi öncesi) ve T2 (tedavi sonrası) dönemlerinde değerlendirildi. İstatistiksel analizde parametrik olmayan testler ve tekrarlayan ölçümlerde ANOVA kullanıldı. Bulgular: IL-1β ve OPG düzeylerinde zaman içinde anlamlı bir değişiklik saptanmadı. Mandibulada RANKL düzeyleri T0’dan T1’e anlamlı olarak arttı (p<0.05) ve IL-6 düzeyleri T0’a kıyasla T1 ve T2’de anlamlı artış gösterdi (p<0.05). Maksillada bu biyobelirteçlerde anlamlı değişim gözlenmedi. Kök rezorpsiyonu analizinde maksiller lateral kesici dişlerde cerrahi sonrası değerlere göre anlamlı azalma bulundu (p=0.003), mandibular kesici dişlerde ise dönemler arasında fark saptanmadı. Sonuç: Ortognatik cerrahi sırasında ve sonrasında uygulanan ilaçlar, maksillada inflamatuar biyobelirteçlerin yükselmesini baskılarken mandibulada RANKL ve IL-6 artışına izin vermektedir. Bu biyobelirteç farklılıkları, maksiller ve mandibular kesici dişler arasındaki kök rezorpsiyonu desenlerini açıklayabilir. Cerrahi sonrası hızlanmış ortodontik diş hareketinin biyolojik mekanizmaları değerlendirilirken ilaçların inflamatuar yanıt üzerindeki düzenleyici etkisi dikkate alınmalıdır.

Keywords

• Biyobelirteçler
• İnterlökin-6
• Kök rezorpsiyonu
• Ortognatik cerrahi
• RANKL

Medication-Related Changes in Inflammatory Biomarkers and Root Resorption After Orthognathic Surgery

Abstract

Purpose: To investigate the effects of medications administered during and after orthognathic surgery on inflammatory biomarkers in gingival crevicular fluid and to evaluate their association with maxillary and mandibular incisor root resorption. Materials and Methods: This prospective longitudinal study included 25 patients undergoing orthognathic surgery. Twelve patients with postoperative infection within four weeks were excluded, leaving 13 (mean age 24.8 ± 12.7 years) for analysis. All received a standardized medication protocol of an opioid, a nonsteroidal anti-inflammatory drug (NSAID), and paracetamol. Gingival crevicular fluid samples were collected before surgery (T0), one week (T1), and four weeks (T2) postoperatively. Osteoprotegerin (OPG), receptor activator of nuclear factor kappa B ligand (RANKL), interleukin-1β (IL-1β), and interleukin-6 (IL-6) levels were quantified by ELISA. External apical root resorption was assessed radiographically at T0 (start of orthodontic treatment), T1 (before surgery), and T2 (after treatment). Statistical analysis used nonparametric tests and repeated-measures ANOVA. Results: IL-1β and OPG levels showed no significant changes over time. In the mandible, RANKL increased from T0 to T1 (p < 0.05) and IL-6 rose from T0 to T1 and T2 (p < 0.05). No significant biomarker changes occurred in the maxilla. Root resorption decreased significantly in maxillary lateral incisors after surgery compared with presurgical values (p = 0.003), whereas mandibular incisors showed no differences. Conclusion: Perioperative medications may suppress inflammatory biomarker elevation in the maxilla but permit RANKL and IL-6 increases in the mandible. These variations may underlie distinct root-resorption patterns and should be considered when interpreting biologic mechanisms of accelerated tooth movement after orthognathic surgery.

Keywords

• Orthognathic surgery
• Root resorption
• Interleukin-6
• RANKL
• Inflammatory biomarkers

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