Ahmet Emin DEMİRBAŞ, Gökhan ÇOBAN, İbrahim YAVUZ

İskeletsel Sınıf III Bireylerin Çift Çene Ortognatik CerrahiSonrası Yumuşak Doku Değişimlerinin Stereofotogrametriile Değerlendirilmesi

Amaç: İskeletsel Sınıf III malokluzyona sahip hastaların, çift çeneortognatik cerrahi tedavi sonrasında yumuşak dokularındameydana gelen değişikliklerin üç boyutlu (3D) fotografikgörüntüleme yöntemi ile incelenmesidir. Gereç ve Yöntemler: Çalışmamız Erciyes Üniversitesi DişHekimliği Fakültesi Ortodonti Anabilim Dalı’nda üst çenede tekparçalı Le Fort I, alt çenede bilateral sagital split osteotomisi ileçift çene ortognatik cerrahi tedavisi görmüş 11’i kadın 17’si erkektoplam 28 hasta üzerinde yapılmıştır (yaş ortalaması 20,4 ± 3,01,yaş aralığı 17,03 - 31,16). Üst çene ilerletme miktarı ortalama 4,70± 1,20 mm iken; gömme miktarı 2,23 ± 0,97 mm’dir. Alt çenegeri alma miktarı ise ortalama 4,23 ± 1,56 mm’dir. 3Dstereofotogrametrik kayıtlar operasyondan hemen önce ve en az6 ay sonra alınmıştır. Veriler cinsiyetler arasında farklılıkgözlenmediği için tek grup olarak değerlendirilmiştir. İstatistikselanaliz için ‘paired t testi’ kullanılmıştır. Bulgular: Sagital yönde maksiller uzunluklar, mandibularkonveksite açısı, yumuşak doku A ve ANB açıları istatistikselolarak anlamlı şekilde artmıştır. Maksiller konveksite açısı,mandibular uzunluklar ve korpus uzunlukları, yüz konveksiteaçısı, total yüz konveksite açısı ve yumuşak doku B açısıistatistiksel olarak anlamlı şekilde azalmıştır. Transvers yöndeburun genişliği ve burun tabanı genişliği istatistiksel olarakanlamlı şekilde artmıştır. Vertikal yönde ise maksiller yükseklik,üst vermilyon yüksekliği, orta yüz yüksekliğinin alt yüzyüksekliğine oranı istatistiksel olarak anlamlı şekilde artarken; altvermilyon yüksekliği, alt dudak uzunluğu, mandibular yükseklik,orta ve alt yüz uzunlukları, ön yüz yüksekliği, vertikal vementolabial açılar istatistiksel olarak anlamlı şekilde azalmıştır. Sonuç: Ortognatik cerrahi tedavisi sonucunda en belirgindeğişiklikler sagital yönde, en hafif değişiklikler ise transversalyön ölçümlerinde gözlenmiştir. Çalışmamız iskeletsel Sınıf IIIhastalarda, çift çene ameliyatı sonrası yumuşak dokudeğişimlerinin ve hasta beklentilerinin ne ölçüdekarşılanabileceğinin öngörülebilmesi açısından faydalı olabilir.

Evaluation of Soft Tissue Changes in Skeletal Class IIIPatients After Bimaxillary Orthognathic Surgery withStereophotogrammetry

Background: To examine the changes after bimaxillaryorthognathic surgery in soft tissues of patients with skeletal ClassIII malocclusion using three-dimensional (3D) photographicimaging. Methods: This study was conducted on 28 patients, 11 female,17 male, who treated with one-piece Le Fort I in the maxilla alongwith bilateral sagittal split osteotomy in the mandible in ErciyesUniversity Faculty of Dentistry Department of Orthodontics (mean age 20.4 ± 3.01, range 17.03 - 31.16). While the maxillaryadvancement amount was 4.70 ± 1.20 mm; impaction amountwas 2.23 ± 0.97 mm. The amount of mandibular set-back was4.23 ± 1.56 mm. 3D stereophotogrammetric recordings weretaken just before and at least 6 months after the operation. Thedata were evaluated as a single group, as no difference wasobserved between genders. "paired t test" was used for statisticalanalysis. Results: In the sagittal direction, maxillary lengths, mandibularconvexity angle, soft tissue A and ANB angles increasedstatistically significantly. The maxillary convexity angle,mandibular lengths and corpus lengths, facial convexity angle,total facial convexity angle and soft tissue B angle werestatistically significantly decreased. In the transverse direction,nasal and nasal base widths increased statistically significantly.In the vertical direction, maxillary height, upper vermilion height,the ratio of mid-face height to lower face height increasedstatistically significantly, lower vermillion height, lower lip length,mandibular height, mid and lower face heights, anterior faceheight, vertical and mentolabial angles were statisticallysignificantly decreased. Conclusion: As a result of orthognathic surgery treatment, themost prominent changes were observed in sagittal, the slightestchanges in transversal direction measurements. This study maybe useful in predicting postoperative soft tissue changes and towhat extent patient’s expectations can be satisfied in skeletalClass III patients after bimaxillary orthognathic surgery.

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