Derin örtülü kapanışa sahip karışık dişlenme dönemindeki olgularda preortodontik trainer apareyinin etkisinin incelenmesi
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Tarih
2016
Yazarlar
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Derin örtülü kapanış, bir grup dişi veya tüm dişleri, alveol kemiği, mandibula ve maksillayı ve/veya yumuşak dokuları ilgilendiren karmaşık bir ortodontik sorundur. Erken ortodontik yaklaşımlarda amaç kalıcı dişlenme tamamlanmadan uygun dişsel ve iskeletsel ilişkiyi sağlamak ve malokluzyonun şiddetlenmesinin önüne geçmektir. Çalışmamızın amacı, derin örtülü kapanışa sahip 8-10 yaş aralığındaki çocuklarda myofonksiyonel bir aparey olan preortodontik trainer apareyinin dişsel ve iskeletsel etkilerini değerlendirmek ve aynı yaş grubundaki çocuklarla karşılaştırmaktır. Bu amaçla preortodontik trainer apareyi ile tedavi grubuna en az 4 mm veya daha fazla overbite'a sahip, mandibuler retruzyon ve hipodiverjan büyüme gösteren 18 hasta (10 kız, 8 erkek) dahil edildi. Kontrol grubunu ise aynı anomaliye sahip ve herhangi bir ortodontik tedavi görmeyen 18 hasta (11 kız, 7 erkek) oluşturdu. Hastaların ortalama yaşları tedavi grubunda 8 yıl 4 ay, kontrol grubunda 8 yıl 7 aydı. Preortodontik trainer apareyi gündüz bir saat ve gece uyku süresince kullandırıldı. Her hastadan tedavi başında (T0) ve tedavi sonunda (T1) olmak üzere ağız dışı ve ağız içi fotoğraflar, lateral sefalometrik röntgenler ve alçı modeller elde edildi. Tedavi sonu kayıtları (T1) tedavi grubunda 13,7±1,8 ay, kontrol grubunda ise 12,4±1,4 ay sonra alındı. Çalışma sonunda preortodontik trainer apareyi ile overbite miktarında ortalama 0,99 mm azalma görüldü ve kontrol grubundaki fark ile kıyaslandığında anlamlı bulundu (p < 0,001). SNB açısında 1,17º artış ve ANB açısında 0,9º azalma görüldü (p ˂ 0,001). SNGoGn, FH-MD, PD-MD ve OD-SN dik yön değerlerinde istatistiksel olarak anlamlı artış gerçekleşti. Preortodontik trainer apareyi alt ön yüz yüksekliğinde (ANS-Me) anlamlı artışa neden oldu (p ˂ 0,001). Tedavi grubunda aktif mandibuler büyüme gösterilemedi. Diğer iskeletsel ölçümlerde kontrol grubu ile kıyaslandığında anlamlı fark bulunmadı. Tedavi grubunda kontrol grubu ile kıyaslandığında maksiller kesici dişlerde labiale eğilme (p = 0,006) ve mandibuler kesici dişlerde labiale eğilme (p ˂ 0,001) gerçekleşti. Keserler arası açıda anlamlı azalma görüldü (p ˂ 0,001). Üst ve alt 1. kalıcı molarlar arası genişlikte tedavi grubundaki değişim kontrol grubu ile kıyaslandığında anlamlı bulunmadı ve normal büyüme değerleriyle ilişkilendirildi. Üst süt kaninler arası genişlikte 1,04 mm (p = 0,001) ve alt süt kaninler arası genişlikte 1,11 mm (p = 0,019) anlamlı artış görüldü. Çalışmamızın sonuçlarına göre preortodontik trainer apareyinin mandibuda saat yönünde rotasyon ve sagittal büyümeye neden olduğu, kesici dişlerde labiale eğilme ve arklarda genişleme sağladığı görüldü. Apareyin etkilerinin daha çok dento-alveoler olduğu, iskeletsel etkilerinin sınırlı olduğu gözlendi. Bu sonuçlara göre preortodontik trainer apareyinin derin örtülü kapanışlı çocuklarda Sınıf II ilişki ve overbite'ın düzeltilmesinde etki gösterdiği, erken dönemde myofonksiyonel tedavi yaklaşımının fasiyal estetikte iyileşmeye neden olduğu söylenebilir.
Deep bite is a complex orthodontic problem involved in a teeth or whole dentition, alveoler bone, mandible and maxilla and /or soft tissues. The goal of early orthodontic treatment is to achieve dental and skeletal harmony prior to the complete eruption of the permanent dentition. The aim of the present study was to evaluate the dental and skeletal effects of a myfunctional appliance: the preorthodontic trainer in patients with deep bite in the age group 8-10 years and comparison with the normative growth data of children in the same aged group. 18 patients (10 girls, 8 boys) showed 4 mm or more overbite, mandibular retrusion and hypodiverjant growth pattern were included in the treatment group with preorthodontic trainer. 18 patients (11 girls, 7 boys) showed the same malocclusion and had no orthodontic treatment history included in the control group. The mean age in the treatment group was 8 years 4 months and in the control group 8 years 7 months. The patients were instructed to use the trainer every day for one hour and overnight while they sleep. The extraoral and intraoral photographs, lateral cephalograms and cast models of both groups were taken before (T0) and after (T1) the treatment / observation period. Final photographs, lateral cephalograms and cast models (T1) were obtained 13,7±1,8 months after trainer application, compared with a mean of 12,4±1,4 months later for the control group. Significant reduction in the overbite (-0,99mm, p˂0,001) were noted in the treatment group when compared with the control group at the end of the study period. Significant increase in SNB angle (1,17º , p ˂ 0,001) and decrease in ANB angle (-0,9º, p ˂ 0,001) was observed. SNGoGn, FH-MD, PD-MD ve OD-SN values showed a significant increase in the treatment group. Lower anterior facial height (ANS-Me) increased significantly in the treatment group ( p ˂ 0,001). The mandibular growth in the treated group when compared with the control group were insignificant. Differences of other skeletal parameters between treatment and control group were insignificant. Increase of the proclination of maxillary (p = 0,006) and mandibular incisors (p ˂ 0,001) were noted significantly different in the treatment group when compared with the control group. A significant reduction of interincisal angle was observed (p ˂ 0,001). The difference in intermolar width of maxillary and mandibular arch was insignificant and involded in normal growth period. There was a significant increase in the maxillary primary intercanine width (1,04 mm, p = 0,001) and in the mandibular primary intercanine width (1,11 mm, p = 0,019) in the treatment group compared with the control group. At the end of the study period, preorthodontic trainer group subjects showed anterior rotation and sagittal growth of mandible, provided inclination of incisors and passive arch expansion. The preorthodontic trainer appliance produced more dentoalveolar changes and limited skeletal effects. According to the findings of the present study, it may be suggested that preorthodontic trainer appliance is effective on correction of Class II relationship and overbite on deep bite patients in mixed dentition period and improves the patient's facial profile.
Deep bite is a complex orthodontic problem involved in a teeth or whole dentition, alveoler bone, mandible and maxilla and /or soft tissues. The goal of early orthodontic treatment is to achieve dental and skeletal harmony prior to the complete eruption of the permanent dentition. The aim of the present study was to evaluate the dental and skeletal effects of a myfunctional appliance: the preorthodontic trainer in patients with deep bite in the age group 8-10 years and comparison with the normative growth data of children in the same aged group. 18 patients (10 girls, 8 boys) showed 4 mm or more overbite, mandibular retrusion and hypodiverjant growth pattern were included in the treatment group with preorthodontic trainer. 18 patients (11 girls, 7 boys) showed the same malocclusion and had no orthodontic treatment history included in the control group. The mean age in the treatment group was 8 years 4 months and in the control group 8 years 7 months. The patients were instructed to use the trainer every day for one hour and overnight while they sleep. The extraoral and intraoral photographs, lateral cephalograms and cast models of both groups were taken before (T0) and after (T1) the treatment / observation period. Final photographs, lateral cephalograms and cast models (T1) were obtained 13,7±1,8 months after trainer application, compared with a mean of 12,4±1,4 months later for the control group. Significant reduction in the overbite (-0,99mm, p˂0,001) were noted in the treatment group when compared with the control group at the end of the study period. Significant increase in SNB angle (1,17º , p ˂ 0,001) and decrease in ANB angle (-0,9º, p ˂ 0,001) was observed. SNGoGn, FH-MD, PD-MD ve OD-SN values showed a significant increase in the treatment group. Lower anterior facial height (ANS-Me) increased significantly in the treatment group ( p ˂ 0,001). The mandibular growth in the treated group when compared with the control group were insignificant. Differences of other skeletal parameters between treatment and control group were insignificant. Increase of the proclination of maxillary (p = 0,006) and mandibular incisors (p ˂ 0,001) were noted significantly different in the treatment group when compared with the control group. A significant reduction of interincisal angle was observed (p ˂ 0,001). The difference in intermolar width of maxillary and mandibular arch was insignificant and involded in normal growth period. There was a significant increase in the maxillary primary intercanine width (1,04 mm, p = 0,001) and in the mandibular primary intercanine width (1,11 mm, p = 0,019) in the treatment group compared with the control group. At the end of the study period, preorthodontic trainer group subjects showed anterior rotation and sagittal growth of mandible, provided inclination of incisors and passive arch expansion. The preorthodontic trainer appliance produced more dentoalveolar changes and limited skeletal effects. According to the findings of the present study, it may be suggested that preorthodontic trainer appliance is effective on correction of Class II relationship and overbite on deep bite patients in mixed dentition period and improves the patient's facial profile.
Açıklama
Anahtar Kelimeler
Derin Örtülü Kapanış, Erken Ortodontik Yaklaşım, Myofonksiyonel Tedavi, Preortodontik Trainer Apareyi, Deep Bite, Early Orthodontic Treatment, Myofunctional Therapy, Preorthodontic Trainer Appliance
