Alt Çenede Genişletme (Simfizial Distraksiyon)
Özet
Mandibular genişletme (simfizial distraksiyon), kademeli kuvvetler uygulanarak ayrılan kemik segmentleri arasında yeni kemik oluşumunu sağlayan biyolojik bir yöntemdir. Klinik olarak osteotomi, latent, distraksiyon, konsolidasyon ve remodelling olmak üzere beş dönemden oluşur. Bu yöntem ilk olarak 1990 yılında Guerrero tarafından dental çapraşıklık gösteren transversal alt çene yetersizliklerinin tedavisi için tanıtılmıştır. Operasyon sürecinde lokal veya genel anestezi tercih edilebilir ve radyolojik muayenelerle desteklenen cerrahi planlama, komplikasyonları önlemede kritik rol oynar. Tedavide diş destekli, hibrit (diş-kemik) ve kemik destekli olmak üzere üç temel aparey tipi kullanılır. Diş destekli apareyler ekonomik, hasta uyumu yüksek ve minimal invaziv oldukları için ilk seçenek olarak önerilirken; kemik destekli distraktörler uzun uygulama süresi ve ikincil cerrahi gereksinimi gibi dezavantajlara sahiptir. Cerrahi sonrası genellikle 5-7 günlük bir latent dönemi takiben, günlük 1 mm distraksiyon oranı ideal kabul edilir. Bu tedavi yöntemi şiddetli çapraşıklık, transversal darlık ve V şekilli dental ark gibi durumlarda endike iken; mental sinir parestezisi, kök hasarları, enfeksiyon ve TME problemleri gibi çeşitli komplikasyon risklerini de barındırır.
Mandibular widening (symphyseal distraction) is a biological process where new bone formation is stimulated between bone segments separated by gradual forces, clinically consisting of five stages: osteotomy, latent, distraction, consolidation, and remodelling. First introduced by Guerrero in 1990 as an alternative treatment for transverse mandibular deficiency characterized by anterior dental crowding, the procedure can be performed under local or general anesthesia, where comprehensive radiological planning is essential to prevent complications. The treatment utilizes three main types of appliances: tooth-borne, hybrid (tooth-bone-borne), and bone-borne, with tooth-borne devices preferred as the primary option due to their low cost, high patient tolerance, and minimal invasiveness, whereas bone-borne distractors carry disadvantages such as longer application times and the necessity of a secondary surgery for removal. Following a post-surgical latent period of 5-7 days, a daily distraction rate of 1 mm is generally recommended to ensure optimal bone regeneration. While indicated for severe anterior crowding, maxillomandibular transverse discrepancies, and V-shaped dental arches, the technique also entails potential complication risks, including mental nerve paresthesia, root injuries, secondary infections, and mild temporomandibular joint disorders.
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