Üst Çene Genişletmesinin Hava Yolu ve Periodontal Dokulara Etkisi
Özet
Maksiller darlık tedavisinde sıkça tercih edilen Hızlı Üst Çene Genişletmesi (HÜÇG) uygulamasının hava yolu ve periodontal dokular üzerindeki çok yönlü etkileri literatür verileri doğrultusunda incelenmiştir. HÜÇG sonrasında bölgesel yakınlık nedeniyle nazal kavite genişliğinde ve hacminde belirgin, uzun dönemde de korunan artışlar gözlenirken, nazal havayolu direncinde azalma meydana gelmektedir. Buna karşın, zigomatik ark ve pterigomaksiller bölgedeki anatomik direnç nedeniyle faringeal hava yolu hacmi ile minimal kesitsel alanda meydana gelen değişimler sınırlı kalmakta ve literatürde çelişkili sonuçlar barındırmaktadır. Aparey uygulamalarının maksiller sinüs hacmini artırabildiği, dil postürünü iyileştirebildiği ve hyoid kemiği ile baş pozisyonunda normalleşme eğilimine katkı sağladığı bildirilmiştir. Ayrıca üst solunum yolu obstrüksiyonu ile ilişkili dirençli enürezis noktürna (gece altını ıslatma) vakalarında, HÜÇG sonrasında nazal hacim artışına paralel olarak gece ıslatma sayısında fonksiyonel bir azalma kaydedilmiştir. Periodontal dokular açısından bakıldığında ise hem hızlı hem de yavaş genişletme protokollerinin plak birikimi, dişeti çekilmesi, bukkal kemik ve ataşman kayıpları ile kortikal fenestrasyon gibi irritasyonlara yol açtığı bilgisayarlı tomografi çalışmalarında gösterilmiştir. Hızlı genişletmede daha fazla diş devrilmesi ve dehisens görülürken, yavaş genişletmede daha paralel bir diş hareketi ancak zaman zaman daha yoğun kemik kayıpları izlenmektedir. Sonuç olarak, sadece solunum veya enürezis problemlerini çözmek amacıyla ortodontik endikasyon olmaksızın genişletme yapılmamalı, periodontal yan etkileri en aza indirmek için tedavi boyunca kontrollü hareket ve sıkı bir periodontal takip sağlanmalıdır.
The multifaceted effects of Rapid Maxillary Expansion (RME), a common treatment for maxillary deficiency, on the airway and periodontal tissues have been evaluated based on literature data. Due to regional proximity, RME leads to significant, long-term stable increases in nasal cavity width and volume, alongside decreased nasal airway resistance, whereas changes in pharyngeal airway volume and minimal cross-sectional area remain limited and controversial due to anatomical resistance in the zygomatic arch and pterygomaxillary junction. RME applications can increase maxillary sinus volume, improve low tongue posture, and contribute to a normalization trend in hyoid bone and head position. Furthermore, in therapy-resistant nocturnal enuresis cases associated with upper airway obstruction, a functional reduction in bedwetting frequency has been reported following RME, correlating with increased nasal volume. Regarding periodontal health, computed tomography studies demonstrate that both rapid and slow expansion protocols cause irritation, including plaque accumulation, gingival recession, buccal bone and attachment losses, and cortical fenestrations. Rapid expansion is associated with higher tooth tipping and dehiscence, while slow expansion exhibits more parallel tooth movement but potentially more intense bone loss. Consequently, expansion should not be performed purely for respiratory or enuresis issues without orthodontic indications, and controlled movement paired with strict periodontal monitoring is essential to minimize adverse periodontal effects.
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