Gamze YILDIRIM, Elvan ONEM OZBİLEN, Fulya ÖZDEMİR

Dikey Büyüme Paterni Olan Sınıf III Hastalarda Sınıf III Elastiklerle Hibrit Hyrax-Mentonplate Tedavisi Sonrası İskeletsel ve Dental Yapıların Retrospektif Olarak 3 Boyutlu Değerlendirilmesi: Bir Pilot Çalışma

Amaç: Bu çalışmanın amacı, hibrit hyrax-mentonplak ve Sınıf III elastik kombinasyonu ile tedavi edilen iskeletsel Sınıf III maloklüzyonlu ve vertikal yönde artmış büyüme paterni olan hastalarda meydana gelen iskeletsel ve dental değişiklikleri üç boyutlu olarak değerlendirmektir. Gereç ve Yöntem: Bu retrospektif çalışmada hibrit hyrax-mentonplak ve Sınıf III elastik kombinasyonu ile ortopedik tedavi görmüş 6 hastanın (5 kadın ve 1 erkek, Ortalama yaş: 11,9±0,9 yıl) Konik Işınlı Bilgisayarlı Tomografi görüntüleri, …….. Üniversitesi Ortodonti Anabilim Dalı arşivinden alınmıştır. Başlangıç ve protraksiyon sonrası iskeletsel ve dental parametreler 3D SLICER versiyon 5.0.2 yazılımı (www.slicer.org) kullanılarak incelenmiştir. Başlangıç ve protraksiyon sonrası değişiklikleri analiz etmek için Wilcoxon eşleştirilmiş iki örnek testi kullanılmıştır. İstatistiksel anlamlılık p<0,05 olarak belirlenmiştir. Bulgular: Sagital iskeletsel değerlendirmede SNA açısında 2,31° ve ANB açısında 2,8° istatistiksel olarak anlamlı artış bulunurken (p<0,05), SNB açısında anlamlı değişiklik bulunamamıştır (p0,05). Vertikal iskeletsel değerlendirmede FH-OP ve SN-OP açılarında sırasıyla 5,28° ve 5,18° anlamlı azalma gözlenirken (p<0,05), diğer vertikal iskeletsel ölçümlerde anlamlı bir değişiklik bulunmamıştır (p0,05). Dental değerlendirme parametrelerinden, LI-OP açısında 8,82° anlamlı azalma, LI-MP açısında 5,27° artış ve overjet değişiminde 3,75 mm anlamlı artış gözlenmiştir (p<0,05). Üst keser açıları, UI-LI açısı ve overbite ölçümlerinde anlamlı bir değişiklik bulunamamıştır (p0,05). Sonuç: Hibrit hyrax-mentonplak ve Sınıf III elastik kombinasyonu uygulaması ile iskeletsel Sınıf III maloklüzyonlu ve artmış vertikal büyüme paternli hastalarda, yüz yüksekliğinde değişiklik olmaksızın ve mandibular ve palatal düzlemde rotasyon gözlenmeksizin sagittal yönde ortopedik düzeltme sağlanabilmektedir.

Anahtar Kelimeler:

Ortodontik Tespit İşlemleri, Ortodonti-Düzeltici, Ortodontik Alet Dizaynı

Retrospective 3-dimensional Evaluation of Skeletal and Dental Structures Following Treatment with Hybrid Hyrax-Mentonplate with Class III Elastics in Class III Patients with Vertical Growth Pattern: A Pilot Study

Objective: The aim of the present study is to evaluate the skeletal and dental changes three-dimensionally in patients with skeletal Class III malocclusion and vertical growth pattern treated with hybrid hyrax-mentonplate and Class III elastic combination. Materials and Methods: In this retrospective study, cone-beam computed tomography images of 6 patients (5 females and 1 male; Mean age: 11.9±0.9 years) who had undergone an orthopedic treatment with hybrid hyrax-mentonplate and Class III elastic combination were retrieved from the archive of … University, Department of Orthodontics. Initial and post-protraction skeletal and dental parameters were investigated by using 3D SLICER version 5.0.2 software (www.slicer.org). The Wilcoxon paired-sample test was used for comparing initial and post-protractional changes. Statistical significance was set at p<0.05. Results: Sagittal skeletal evaluation showed statistically significant increases of 2.31° in SNA, and 2.8° in ANB (p<0.05) with no significant change in SNB (p0.05). There were no significant changes in vertical skeletal parameters except significant decreases in FH-OP and SN-OP angles of 5.28° and 5.18°, respectively. In terms of dental changes, while a significant decrease was found in LI-OP angle (8.82°), significant increases in LI-MP angle and in overjet change were found (5.27°, 3.75 mm, respectively) (p<0.05). There were no significant changes in upper incisor parameters, UI-LI angle, and overbite (p0.05). Conclusion: With the use of hybrid hyrax-mentoplate and Class III elastic combination, orthopedic sagittal correction can be achieved in patients presenting high angle skeletal Class III without causing any changes in facial height, and the slope of mandibular and palatal planes.

Keywords:

Orthodontic Anchorage Procedures, Orthodontics-Corrective, Orthodontic Appliance Design,

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Arman, A, TU Toygar and E Abuhijleh. Evaluation of maxillary protraction and fixed appliance therapy in Class III patients. Eur J Orthod. 2006;28(4):383-392.
Baccetti, T, L Franchi and JA McNamara Jr. Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop. 2000;118(4):404-413.
Cevidanes, L, T Baccetti, L Franchi, JA McNamara Jr and H De Clerck. Comparison of two protocols for maxillary protraction: bone anchors versus face mask with rapid maxillary expansion. Angle Orthod. 2010;80(5):799-806.
Çetinsahin, A and A Arman. Application of implants for orthodontic anchorage. Turk J Orthod. 2005;18(1):77-89.
De Clerck, H, L Cevidanes and T Baccetti. Dentofacial effects of bone-anchored maxillary protraction: a controlled study of consecutively treated Class III patients. Am J Orthod Dentofacial Orthop. 2010;138(5):577-581.
De Clerck, HJ, MA Cornelis, LH Cevidanes, GC Heymann and CJ Tulloch. Orthopedic traction of the maxilla with miniplates: a new perspective for treatment of midface deficiency. J Oral Maxillofac Surg. 2009;67(10):2123-2129.
de Oliveira Ruellas, AC, C Tonello, LR Gomes, MS Yatabe, L Macron, J Lopinto, ve ark. Common 3-dimensional coordinate system for assessment of directional changes. Am J Orthod Dentofacial Orthop. 2016;149(5):645-656.
Eid, OM, AA-F Ramadan, MA Nadim and TA-B Hamed. Maxillary protraction using orthodontic miniplates in correction of Class III malocclusion during growth. J World Fed Orthod. 2016;5(3):100-106.
Ellis III, E and JA McNamara Jr. Components of adult Class III malocclusion. J Oral Maxillofac Surg. 1984;42(5):295-305.
Elnagar, MH, E Elshourbagy, S Ghobashy, M Khedr and CA Evans. Comparative evaluation of 2 skeletally anchored maxillary protraction protocols. Am J Orthod Dentofacial Orthop. 2016;150(5):751-762.
Facio-Umaña, JA, J Chaurand and PI Gonzalez-Luna. Early class III treatment with maxillary protraction-miniscrew-assisted rapid palatal expansion (MARPE) and mandibular miniplates. Ann Oral Maxillofac Surg. 2021;4(1):100-151.
Fedorov, A, R Beichel, J Kalpathy-Cramer, J Finet, J-C Fillion-Robin, S Pujol, ve ark. 3D Slicer as an image computing platform for the Quantitative Imaging Network. Magn Reson Imaging. 2012;30(9):1323-1341.
Heymann, GC, L Cevidanes, M Cornelis, HJ De Clerck and JC Tulloch. Three-dimensional analysis of maxillary protraction with intermaxillary elastics to miniplates. Am J Orthod Dentofacial Orthop. 2010;137(2):274-284.
Kapust, AJ, PM Sinclair and PK Turley. Cephalometric effects of face mask/expansion therapy in Class III children: a comparison of three age groups. Am J Orthod Dentofacial Orthop. 1998;113(2):204-212.
Katyal, V, B Wilmes, M Nienkemper, M Darendeliler, W Sampson and D Drescher. The efficacy of Hybrid Hyrax-Mentoplate combination in early Class III treatment: a novel approach and pilot study. Aust Orthod J. 2016;32(1):88-96.
Kaya, D, I Kocadereli, B Kan and F Tasar. Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions; a pilot study. Angle Orthod. 2011;81(4):639-646.
Kircelli, BH and ZÖ Pektas. Midfacial protraction with skeletally anchored face mask therapy: a novel approach and preliminary results. Am J Orthod Dentofacial Orthop. 2008;133(3):440-449.
Leung, CC, L Palomo, R Griffith and MG Hans. Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations. Am J Orthod Dentofacial Orthop. 2010;137(4):109-119.
Liang, S, F Wang, Q Chang and Y Bai. Three-dimensional comparative evaluation of customized bone-anchored vs tooth-borne maxillary protraction in patients with skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop. 2021;160(3):374-384.
Maino, G, Y Turci, A Arreghini, E Paoletto, G Siciliani and L Lombardo. Skeletal and dentoalveolar effects of hybrid rapid palatal expansion and facemask treatment in growing skeletal Class III patients. Am J Orthod Dentofacial Orthop. 2018;153(2):262-268.
Merwin, D, P Ngan, U Hagg, C Yiu and SH Wei. Timing for effective application of anteriorly directed orthopedic force to the maxilla. Am J Orthod Dentofacial Orthop. 1997;112(3):292-299.
Miranda, F, JC da Cunha Bastos, AM Dos Santos, G Janson, JRP Lauris and D Garib. Dentoskeletal comparison of miniscrew-anchored maxillary protraction with hybrid and conventional hyrax expanders: A randomized clinical trial. Am J Orthod Dentofacial Orthop. 2021;160(6):774-783.
Nevzatoglu, S and N Kucukkeles. Long-Term Results of Rapid Maxillary Expansion and Facemask: Long-Term of Regular Protraction. Turk J Orthod. 2014;27(2):51-62.
Ngan, P, B Wilmes, D Drescher, C Martin, B Weaver and E Gunel. Comparison of two maxillary protraction protocols: tooth-borne versus bone-anchored protraction facemask treatment. Prog Orthod. 2015;16(1):26.
Nienkemper, M, B Wilmes, L Franchi and D Drescher. Effectiveness of maxillary protraction using a hybrid hyrax-facemask combination: a controlled clinical study. Angle Orthod. 2015;85(5):764-770.
Nienkemper, M, B Wilmes, A Pauls and D Drescher. Maxillary protraction using a hybrid hyrax-facemask combination. Prog Orthod. 2013;14(1):5.
Özbilen, EÖ, HN Yılmaz and YB Acar. Does Alt-RAMEC protocol and facemask treatment affect dentoalveolar structures? A 3-dimensional study. Angle Orthod. 2021;91(5):626-633.
Rossini, G, C Cavallini, M Cassetta and E Barbato. 3D cephalometric analysis obtained from computed tomography. Review of the literature. Ann Stomatol (Roma). 2011;2(3-4):31-39.
Saadia, M and E Torres. Sagittal changes after maxillary protraction with expansion in class III patients in the primary, mixed, and late mixed dentitions: a longitudinal retrospective study. Am J Orthod Dentofacial Orthop. 2000;117(6):669-680.
Singer, SL, PJ Henry and I Rosenberg. Osseointegrated implants as an adjunct to facemask therapy: a case report. Angle Orthod. 2000;70(3):253-262.
Sung, SJ and HS Baik. Assessment of skeletal and dental changes by maxillary protraction. Am J Orthod Dentofacial Orthop. 1998;114(5):492-502.
Şar, Ç, A Arman-Özçırpıcı, S Uçkan and AC Yazıcı. Comparative evaluation of maxillary protraction with or without skeletal anchorage. Am J Orthod Dentofacial Orthop. 2011;139(5):636-649.
Şar, Ç, Z Şahinoğlu, AA Özçırpıcı and S Uçkan. Dentofacial effects of skeletal anchored treatment modalities for the correction of maxillary retrognathia. Am J Orthod Dentofacial Orthop. 2014;145(1):41-54.
Tarraf, NE, O Dalci, K Dalci, AT Altug and MA Darendeliler. A retrospective comparison of two protocols for correction of skeletal Class III malocclusion in prepubertal children: hybrid hyrax expander with mandibular miniplates and rapid maxillary expansion with face mask. Prog Orthod. 2023;24(1):3.
Tortop, T, A Keykubat and S Yuksel. Facemask therapy with and without expansion. Am J Orthod Dentofacial Orthop. 2007;132(4):467-474.
Westwood, PV, JA McNamara Jr, T Baccetti, L Franchi and DM Sarver. Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop. 2003;123(3):306-320.
Willmann, JH, M Nienkemper, NE Tarraf, B Wilmes and D Drescher. Early Class III treatment with Hybrid-Hyrax-Facemask in comparison to Hybrid-Hyrax-Mentoplate–skeletal and dental outcomes. Prog Orthod. 2018;19(1):42.
Wilmes, B, M Nienkemper, B Ludwig, CH Kau and D Drescher. Early Class III treatment with a hybrid hyrax-mentoplate combination. J Clin Orthod. 2011;45(1):15-21.
Yüksel, S, TT Üçem and A Keykubat. Early and late facemask therapy. Eur J Orthod. 2001;23(5):559-568.