Üst Çene Genişletme Tedavililerinde Vida Açma Protokolleri
Özet
Bu çalışma, sabit ortodontik tedavilerde Damon ve Insignia gibi kapaklı braket sistemlerinin çene genişletme ve tedavi etkinliklerini karşılaştırmalı olarak incelemektedir. Günümüz ortodontisinde hasta konforunu artırmak ve tedavi süresini kısaltmak amacıyla kişiye özel aparey tasarımları önem kazanmıştır. Üst çenenin transversal darlığı posterior bölgede karanlık üçgenlere yol açarak estetik ve fonksiyonel sorunlar yaratmaktadır. Geleneksel yöntemler orijinal ark formunu korumaya çalışırken, pasif kendinden bağlamalı bir mekanizmaya sahip olan Damon sistemi, biyolojik sınırlardaki hafif kuvvetler ve ark telleriyle kütlesel bir transversal genişletme sağlamaktadır. Bu sistemde kesici dişlerin öne doğru eğilmesi dudak kaslarının tampon etkisiyle engellenmektedir. Diğer taraftan, tersine mühendislik prensibiyle çalışan dijital tabanlı kişiye özel Insignia sistemi, tedavi sonu oklüzyonu önceden simüle ederek klinisyene tip ve tork değerlerini özelleştirme imkanı sunmaktadır. Ondokuz Mayıs Üniversitesi'nde yapılan doktora tez çalışmalarında, Damon sisteminin MBT ve Insignia sistemlerine kıyasla alt çene molarlar arası mesafede ve alt keser eğimlerinde (protrüzyon) istatistiksel olarak daha fazla artış ve genişleme eğilimi gösterdiği belirlenmiştir. Buna karşın, kişiye özgü tasarımı sayesinde Insignia sisteminin interkanin ve intermolar mesafeleri biyolojik sınırlar içinde koruduğu, tedavi sonuçlarını daha öngörülebilir kıldığı ve bitim aşamasını kolaylaştırdığı saptanmıştır. Sonuç olarak, üç boyutlu dijital planlama sunan kişiye özel sistemlerin gelecekte hem hekim hem hasta için daha konforlu, estetik ve güvenilir sonuçlar sağlayacağı vurgulanmaktadır.
This study comparatively examines the jaw expansion and treatment efficiencies of self-ligating bracket systems, such as Damon and Insignia, in fixed orthodontic treatments. In contemporary orthodontics, customized appliance designs have gained importance to enhance patient comfort and shorten treatment duration. Transversal narrowness of the maxilla creates aesthetic and functional problems by causing dark buccal corridors in the posterior region. While conventional methods attempt to preserve the original arch form, the Damon system, featuring a passive self-ligating mechanism, achieves bulk transversal expansion utilizing light forces within biological limits and archwires, where the protrusion of incisors is prevented by the bumper effect of the lip muscles. On the other hand, the digitally-driven, customized Insignia system, operating on reverse-engineering principles, simulates the final occlusion prior to treatment, allowing the clinician to customize tip and torque values. Doctoral thesis studies conducted at Ondokuz Mayıs University revealed that the Damon system exhibited a greater tendency for expansion and a statistically significant increase in mandibular intermolar distance and lower incisor inclination (protrusion) compared to MBT and Insignia systems. Conversely, due to its patient-specific design, the Insignia system maintained intercanine and intermolar distances within biological boundaries, rendered treatment outcomes predictable, and facilitated the finishing phase. In conclusion, it is emphasized that customized systems offering three-dimensional digital planning will provide more comfortable, aesthetic, and reliable results for both clinicians and patients in the future.
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