Hızlı Üst Çene Genişletme Sonrası Stabiliteyi Artırma Yöntemleri
Özet
Hızlı üst çene genişletme (HÜÇG), midpalatal suturun açılmasıyla üst çene darlığını düzelten ancak sonrasında nüks eğilimi yüksek olan bir ortodontik yöntemdir. Nüksü önlemek için uygulanan 3-6 aylık geleneksel pekiştirme dönemi tedavi süresini uzatarak hasta uyumunu azaltmaktadır. Bu süreyi kısaltmak ve suturdaki yeni kemik yapımı ile kalitesini artırmak amacıyla kimyasal ajanlar, biyostimülasyon ve gen tedavisi gibi çeşitli yöntemler araştırılmaktadır. Teriparatid, D ve C vitaminleri gibi hormonal ve vitamin desteklerinin yanı sıra TGF-β, VEGF ve EGF gibi anjiyojenik büyüme faktörlerinin lokal veya sistemik uygulamalarının kemik rejenerasyonunu hızlandırdığı saptanmıştır. Ayrıca çörek otu, propolis, resveratrol, tıbbi adaçayı ve kapari gibi yüksek antioksidan içerikli bitkisel ekstrelerin osteoblastik aktiviteyi artırdığı; zoledronik asit gibi bifosfonatların ve kalsitoninin ise osteoklastları baskılayarak kemik yıkımını önlediği belirtilmektedir. Bor ve stronsiyum gibi elementler ile trombositten zengin plazma (PRP) ve hyalüronik asit uygulamaları da kemik mineral yoğunluğuna olumlu katkılar sağlamaktadır. Gen tedavisinde rhBMP-2 kullanımı yönlendirilmiş osteogenezisi desteklerken, düşük seviyeli lazer tedavisi (DSLT) invaziv olmaması ve insan çalışmalarında kemik densitesini artırarak retansiyon süresini kısalttığının kanıtlanmasıyla öne çıkmaktadır.
Rapid maxillary expansion (RME) is an orthodontic method that corrects maxillary deficiency by opening the midpalatal suture, yet it carries a high risk of relapse. The traditional 3 to 6-month retention period used to prevent relapse prolongs the total treatment time, thereby reducing patient compliance. To shorten this period and improve the speed and quality of new bone formation in the suture, various methods such as chemical agents, biostimulation, and gene therapy are being investigated. Hormonal and vitamin supplements, including teriparatide, vitamin D, and vitamin C, alongside local or systemic applications of angiogenic growth factors like TGF-β, VEGF, and EGF, have been shown to accelerate bone regeneration. Additionally, herbal extracts with high antioxidant content, such as nigella sativa, propolis, resveratrol, salvia officinalis, and capparis spinosa, enhance osteoblastic activity, while calcitonin and bisphosphonates like zoledronic acid prevent bone resorption by inhibiting osteoclasts. Elements like boron and strontium, as well as platelet-rich plasma (PRP) and hyaluronic acid applications, also contribute positively to bone mineral density. In gene therapy, the use of rhBMP-2 supports directed osteogenesis, whereas low-level laser therapy (LLLT) stands out because it is non-invasive and has been proven in human studies to accelerate bone regeneration, thereby shortening the required retention time.
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