Cerrahi-Önce ve Konvansiyonel Ortodonti-Önce Yaklaşımlarının Karşılaştırılması: Sistematik Derleme (2009-2025)

Öz

Amaç Ortognatik cerrahide “cerrahi-önce” (SFA) yaklaşımının, klasik “ortodonti-önce” (OFA) protokolüne göre klinik sonuçlarını karşılaştırmak. Gereç ve Yöntemler Web of Science’da 2009-2025 arası İngilizce özgün araştırmalar tarandı. SFA ve OFA’yı doğrudan kıyaslayan, klinik nihai sonlanım bildiren karşılaştırmalı kohortlar dâhil edildi; yalnızca splint/oklüzyon set-up metriklerine odaklanan ve özel fenotipli (genellenebilirliği sınırlı) seriler dışlandı. PRISMA 2020’ye göre akış: 43 kayıt tanımlandı; 33 tam-metin adayı ayrıldı; erişilebilen 11 rapor uygunluk açısından incelendi; 10 çalışma dâhil edildi. Nicel havuzlanma planlanmadı; heterojenlik nedeniyle anlatı sentez yapıldı. Bulgular Tedavi süresini raporlayan serilerde SFA toplam süreyi anlamlı kısalttı (örn. 21.1 ± 10.3 ay vs 34.4 ± 11.9 ay; P < 0.001). Maliyet-etkililik çalışması SFA’da ameliyat süresinin daha uzun olabildiğini, ancak hastanede kalış ve doğrudan maliyetlerin benzer kaldığını; zaman-etkinlik üstünlüğünün SFA lehine olduğunu gösterdi. Üç boyutlu analizler, kısa-orta vadede (≈6-12 ay) iskeletsel stabilite/relapsın iki yaklaşım arasında benzer olduğunu destekledi; izole maksiller ilerletmede 6. ay yatay relaps farkı klinik açıdan küçük ve anlamsızdı. Kondiler yer değiştirme ve yüzey remodeling paternleri (inferolateral deplasman, lateral rezorpsiyon–anteromedial appozisyon) yaklaşımlar arasında benzedi. TME tıklaması her iki grupta da azaldı; postoperatif ağrı açısından anlamlı fark yoktu ve en güçlü öngördürücü preoperatif semptomdu. Yaşam kalitesi (OQLQ) her iki grupta ameliyat sonrası belirgin iyileşti; OFA’da preoperatif dekompanzasyon dönemine bağlı geçici kötüleşme görüldü; SFA bu evreyi atladı. Sonuç Uygun endikasyon ve titiz planlamayla SFA, OFA’ya kıyasla benzer iskeletsel/TME güvenliğiyle daha kısa toplam tedavi süresi ve daha hızlı hasta-merkezli kazanımlar sunar. Çok merkezli, ileriye dönük ve standartlaştırılmış 3B ölçütler içeren çalışmalar kanıt kalitesini artıracaktır.

Anahtar Kelimeler

• ortognatik cerrahi
• cerrahi önce yaklaşım
• ortodonti önce yaklaşım
• Cerrahi-Önce vs Ortodonti-Önce: Sistematik Derleme

Comparison of Surgery-First and Orthodontics-First Approaches in Orthognathic Surgery: A Systematic Review (2009-2025)

Öz

Objective To compare clinical outcomes of the surgery-first approach (SFA) versus the conventional orthodontics-first approach (OFA) in orthognathic surgery. Material and Methods A Web of Science search (2009–2025; English, original research) identified comparative cohort studies directly contrasting SFA and OFA and reporting clinical endpoints. Studies limited to splint/occlusion set-up metrics or restricted phenotypes were excluded. Following PRISMA 2020, 43 records were identified; 33 full-text candidates were screened; 11 full texts were assessed; 10 studies were included. Because of heterogeneity in imaging methods, follow-up intervals, and outcome definitions, the findings were synthesized narratively. Results Across studies reporting duration, SFA consistently shortened total treatment time (e.g., 21.1 ± 10.3 vs 34.4 ± 11.9 months; p<0.001). A cost-effectiveness analysis showed longer operating time but similar hospital stay and direct costs with SFA, and superior time-effectiveness (similar OQLQ gains achieved in fewer months). Three-dimensional assessments supported comparable short- to mid-term skeletal stability/relapse (≈6–12 months) between strategies; in isolated maxillary advancement, horizontal relapse at 6 months was small and not different between groups. Condylar displacement and surface remodeling patterns (inferolateral shift; lateral resorption with anteromedial apposition) were similar. Temporomandibular joint (TMJ) clicking decreased in both groups; postoperative TMJ pain did not differ and was mainly predicted by baseline symptoms rather than treatment sequence. Patient-reported outcomes improved substantially after surgery in both groups; OFA exhibited transient pre-operative deterioration due to decompensation, whereas SFA avoided this phase. Conclusion With appropriate case selection and meticulous planning, SFA appears to shorten overall treatment time and accelerate patient-centred benefits while maintaining skeletal and TMJ outcomes comparable to those of OFA.

Anahtar Kelimeler

• surgery first approach
• orthodontics first approach
• orthognathic surgery

Kaynakça

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