Hatice GÖKALP, Çiğdem SOYDAL, Ruhangiz SAMUROĞLU, Funda Aydın MUSTAFA

Alternatif hızlı maksiller genişletme ve daraltmanın sirkummaksiller süturalar üzerine etkisinin 99mTc-MDP spect kemik sintigrafisi ile değerlendirilmesi

Bu çalışmanın amacı, alternatif hızlı maksiller genişletme ve daraltma Alt-RAMEC yönteminin sirkummaksiller süturalar üzerindeki etkisinin ‘’99mTechnetium-Methylene Diphosphonate 99mTc-MDP Single Photone Emission Computed Tomography SPECT Kemik Sintigrafisi’’ ile değerlendirilmesidir. Bu retrospektif çalışmanın materyali Ankara Üniversitesi Diş Hekimliği Fakültesi Ortodonti Anabilim Dalında Alt - RAMEC yöntemi ile tedavi gören 7 adölesan bireyin 99mTc-MDP SPECT Kemik Sintigrafi kayıtlarından oluşmaktadır. Tüm bireyler maksiller darlığı olan veya olmayan iskeletsel Sınıf III maloklüzyona sahiptir. Bireylerin ortalama kronolojik yaşı 11,3±0,86’ tür. Çalışmada, McNamara tipi maksiller ekspansiyon apareyi kullanılarak midpalatal ve sirkummaksiller süturaların elevasyonu için AltRAMEC protokolü uygulanmıştır. Alt-RAMEC protokolüne göre, ilk hafta ekspansiyon, ikinci hafta konstriksiyon şeklinde devam edilmiş ve 7. hafta ekspansiyon ile bitirilecek şekilde 7 haftalık bir maksiller genişletme yapılmıştır. Günlük ekspansiyon/konstriksiyon miktarı 0,5 mm’dir. Maksilla ve sirkummaksiller süturaların kemik aktivitesi 99mTechnetium-Methylene Diphosphonate 99mTc-MDP enjeksiyonu ile kemik SPECT uygulanarak değerlendirilmiştir. SPECT görüntüleri transaksial-koronal-sagittal düzlemlerde alınmıştır. SPECT kemik sintigrafisi kayıtları Alt-RAMEC öncesi T1 , kesici dişler başabaş ilişkideyken T2 ve T2 periyodundan 6 ay sonra T3 periyodlarında olacak şekilde alınmıştır. Dönemler arasındaki değişiklikleri göstermek için varyansların tekrarlanan ölçüm analizleri ANOVA kullanılmıştır. T1, T2 ve T3 periyodlar arasında hesaplanan kemik aktivite indeksi KAI değerlerindeki değişim değerlendirildiğinde sütura palatine medianın sağ arka kesiminde p=0.05 , sağ sütura zigomatikomaksillariste p=0.004 , sol sütura zigomatikomaksilleriste p=0.04 ve sol sütura temporomaksillariste p=0.007 izlenen değişiklikler istatistik olarak anlamlı bulunmuştur. Bu çalışmanın sonucunda, Alt-RAMEC yönteminin midpalatal süturu genişletme etkisine ek olarak sirkummaksiller süturaların bazıları üzerinde de etkili bir maksiller ekspansiyon yöntemi olduğu bulunmuştur.

Anahtar Kelimeler:

Alt-RAMEC, Maksiller Ekspansiyon, Sintigrafi, Sirkummaksiller Süturalar

Evaluation Of Alternate Rapid Maxillary Expansion And Construction Effects On Circum- maxillary Sutures By 99mTc-MDP SPECT Bone Scintigraphy

Aim of this study is to analyse alternate rapid maxillary expansion and construction AltRAMEC on circummaxillary sutures by 99mTechnetium-Methylene Diphosphonate 99mTc-MDP Single Photone Emission Computed Tomography SPECT Bone Scintigraphy. Material of the retrospective study consisted of SPECT bone scintigraphic records taken from 7 adolescent treated by Alt-RAMEC at the Department of Orthodontics, Ankara University. All patients had skeletal Class lll malocclusion associated with/without maxillary construction. Mean chronological age of those was 11,3±0,86 years. Growth period was defined from handwrist films. All patients had in pubertal growth period. McNamara type maxillary expansion appliance was used. Alt-RAMEC protocol was used for providing elevation in both midpalatal and circummaxillary sutures. Activations were 7 weeks of Alt-RAMEC, commencing with expansion in the first week, alternating to constriction in the second week, and ending with expansion in the seventh week. The daily expansion/constriction of the Alt-RAMEC was 0,5 mm. Bone activity of maxilla and circummaxillary sutures was evaluated by 99mTechnetiumMethylene Diphosphonate 99mTc-MDP of skull. SPECT images were obtained in transaxialcoronal-sagittal planes. The SPECT bone scintigraphy records were obtained before AltRAMEC T1 , after edge to edge incisor relations T2 and after six months later then T2 period T3 . Repeated measurements analysis of variance ANOVA was used assess the difference between the periods. While bone activity was significant in posterior part of midpalatal and zygomaticomaxillary sutures in right side, it was significant in zygomatico-maxillary and temporo-maxillary sutures in left side. In conclusion Alt-RAMEC is an effective maxillary expansion modality effecting on circummaxillary sutures in addition to midpalatal suture

Keywords:

Alt- RAMEC, Maxillary Expansion, Scintigraphy, Circummaxillary Sutures,

PDF

___

1. Bourdet, 1737. Cited by Hellman ’20. Orthodontia: its origin, evoluation and culmination as speciality. Dent Cosmos, 62: 14
2. Tweed CH: Clinical orthodontics, vol 2, St Louis, 1966 Mosby
3. Moyers R, Handbook of orthodontics, ed 3, Chicago, 1977, Year - Book Medical
4. Haas AJ. Palatal expansion: just beginning of dentofacial orthopedics. Am J Orthod. 1970; 57: 219-255.
5. McNamara JA Jr. An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod. 1987; 21: 598- 608.
6. Turley PK. Orthopedic correction of Class III malocclusion with palatal expansion and custom protractor headgear. J Clin Orthod. 1988; 22: 314-325.
7. Liou EJ, Tsai WC. A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate - Craniofacial Journal, March 2005, Vol. 42 No.2
8. Haas A J. Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthodontist 1961 31: 73–90.
9. Melsen B. Palatal growth studied on human autopsy material. A histologic microradiographic study. American Journal of Orthodontics 1975 68: 42–54.
10. Starnbach HK, Bayne D, Cleall JF, Subteleny JD. Facio - skeletal and dental changes resulting from rapid maxillary expansion. Angle Orthod. 1966;36:152-164.
11. Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod. 1970;58:41-66.
12. Ngan P, Yiu C, Hu A, Hagg U, Wei SH, Gunel E. Cephalometric and occlusal changes following maxillary expansion and protraction. Eur J Orthod. 1998;20:237-254.
13. Williams MD, Sarver DM, Sadowsky PL, Bradley E. Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study. Semin Orthod. 1997;3:265-274.
14. Alcan T, Keles A, Erverdi N. The effects of a modified protraction headgear on maxilla. Am J Orthod Dentofacial Orthop. 2000; 117: 27-38.
15. Liou EJ, Chen KT. New orthodontic and orthopedic managements on the premaxillary deformities in patients with bilateral cleft before alveolar bone grafting. Ann Coll Surg Hong Kong. 2003;7:73-82.
16. Liou EJ. Tooth borne maxillary protraction in Class III patients. J Clin Orthod. 2005;39:68-75.
17. Wang YC, Chang P, Liou EJ. Opening of circummaxillary sutures by alternate rapid maxillary expansions and constrictions. Angle Orthod. 2009;79:230-234.
18. Kaya D, Kocadereli I, Kan B, Tasar F. Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions: a pilot study. Angle Orthod. 2011;81:639-646.
19. Baydaş B, Yavuz İ, Uslu H, Dağsuyu İM, Ceylan İ. Nonsurgical rapid maxillary expansion effects on craniofacial structures in young adult females A bone scintigraphy study. Angle Orthod. 2006;76:759-767.
20. Arat ZM, Gökalp H, Atasever T, Türkkahraman H. 99mTechnetium-Labeled methylene dishosphonate uptake in maxillary bone during and after maxillary expansion. Angle Orthod. 2003;73:545-549.