Hızlı Üst Çene Genişletme Aygıtları ve Etkileri
Özet
Hızlı üst çene genişletme (HÜÇG), transversal yöndeki iskeletsel darlıkları gidermek amacıyla midpalatal sutur ve çevre kemik yapıları etkileyen ortopedik bir tedavi yöntemidir. Pubertal büyüme atılımı öncesinde uygulandığında daha stabil ve kalıcı iskeletsel sonuçlar sağlarken, ileri yaşlarda etki daha çok dentoalveolar seviyede kalmaktadır. Tedavi aktif genişletme ve yeni kemik oluşumu için 3-6 aylık retansiyon olmak üzere iki safhada tamamlanır. HÜÇG uygulamalarında vakaya göre farklı mekanik özelliklere sahip aygıtlar tercih edilir. Akrilik ve diş destekli Haas apareyi kuvveti palatal duvarlara yayarken, tamamen diş destekli olan Hyrax apareyi daha hijyenik bir alternatif sunar. Vertikal boyut kontrolü gerektiren uzun yüzlü hastalarda oklüzal akrilik kaplı bonded apareyler avantajlıdır. Anterior bölgede daha fazla genişleme istendiğinde yelpaze şeklinde açılan "Fan Type" vidalar, sürekli ve hafif kuvvet için Ni-Ti hafızalı vidalar kullanılır. Dişsel yan etkileri, tipping hareketini ve kök rezorbsiyonunu minimumda tutarak maksimum iskeletsel genişleme elde etmek amacıyla transpalatal distraksiyon ve minivida destekli (kemik/hibrit destekli) HÜÇG apareyleri geliştirilmiştir. Tedavi sonrasında üst kesicilerde geçici diastema oluşumu, nazal hava yolu direncinde azalma ve mandibulanın aşağı-geri rotasyonu gibi etkiler gözlenir. Nüksü önlemek için overcorrection yapılması ve rijit apareylerle yeterli süre pekiştirme sağlanması kritik önem taşır.
Rapid maxillary expansion (RME) is an orthopedic treatment method that affects the midpalatal suture and surrounding skeletal structures to resolve transverse deficiencies, providing more stable and permanent skeletal results when applied before the pubertal growth spurt, whereas its effects are mostly dentoalveolar in older ages. The treatment is completed in two phases: active expansion and a 3-to-6-month retention period for bone reorganization. Various appliances with different mechanical properties are selected based on the case; the acrylic and tooth-borne Haas appliance distributes forces to the palatal walls, while the tooth-borne Hyrax appliance offers a more hygienic alternative, and bonded appliances with occlusal acrylic coverage are advantageous for controlling vertical dimensions in long-faced patients. Additionally, fan-type screws are indicated for greater anterior expansion, memory screws utilize Ni-Ti properties for continuous light forces, and bone-borne transpalatal distraction or miniscrew-supported (hybrid) appliances are developed to maximize skeletal expansion while minimizing dental side effects like tipping and root resorption. Following expansion, temporary interincisor diastema, reduced nasal airway resistance, and downward-backward mandibular rotation are observed, making overcorrection and a sufficient retention period with rigid appliances critical to prevent relapse.
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