Ortodontik Tedavilerin Temporamandibular Eklem Üzerine Etkilerinin Değerlendirilmesi
Özet
Ortodontik tedavilerin temporamandibular eklem (TME) üzerindeki etkileri literatürde uzun süredir tartışılmakta olup, tedavilerin TME rahatsızlıklarına yol açtığını, koruyucu olduğunu ya da hiçbir etkisi bulunmadığını savunan farklı görüşler mevcuttur. TME rahatsızlıkları; eklemi, çiğneme kaslarını ve ilişkili dokuları etkileyen, travma, anatomik, patofizyolojik ve psikososyal faktörlere bağlı multifaktöriyel durumlardır. Sınıf II maloklüzyonların tedavisinde kullanılan fonksiyonel apareylerin, mandibular büyümeyi uyarırken ve kondili yeniden konumlandırırken TME üzerinde kalıcı bir disfonksiyona neden olmadığı, oluşan geçici semptomların ise eklemin adaptasyonuyla ortadan kalktığı rapor edilmiştir. Sınıf III maloklüzyon tedavisinde uygulanan çenelik ve protraksiyon yüz maskesi gibi ağız dışı aygıtlar eklem yapılarında morfolojik değişiklikler ve adaptasyon yaratsa da, TME rahatsızlıkları açısından doğrudan bir risk faktörü oluşturmamaktadır. Hızlı üst çene genişletmesi sırasında mandibular kondilde transversal ve rotasyonel geçici adaptif değişiklikler meydana gelmekte, ancak midpalatal açılmadan kısa bir süre sonra kondiller eski normal durumuna dönmektedir. Sabit ortodontik tedaviler, çekimli veya çekimsiz protokoller ve kullanılan farklı mekanikler incelendiğinde de TME rahatsızlığı riskini artırdığına dair kanıt bulunmamaktadır. Sonuç olarak, ergenlik döneminde yapılan ortodontik tedaviler veya diş çekimleri TME rahatsızlığı riskini artırmamakta, oklüzal ilişkiler ve eklem sağlığı bireysel adaptasyon kapasitesine bağlı olarak şekillenmektedir.
The effects of orthodontic treatments on the temporomandibular joint (TMJ) have long been debated in the literature, with conflicting views suggesting that treatments may cause, prevent, or have no effect on TMJ disorders. TMJ disorders are multifactorial conditions affecting the joint, masticatory muscles, and associated tissues, linked to trauma, anatomical, pathophysiological, and psychosocial factors. Functional appliances used in the treatment of Class II malocclusions stimulate mandibular growth and reposition the condyle without causing permanent TMJ dysfunction, as temporary symptoms disappear after joint adaptation. Extraoral appliances like chin cups and protraction face masks used in Class III malocclusion treatment induce morphological changes and adaptation in joint structures but do not constitute a direct risk factor for TMJ disorders. Rapid maxillary expansion causes temporary transverse and rotational adaptive changes in the mandibular condyle, which return to their normal state shortly after midpalatal expansion. Evaluation of fixed orthodontic treatments, extraction or non-extraction protocols, and different biomechanics also reveals no evidence that they increase the risk of TMJ disorders. Consequently, orthodontic treatments or tooth extractions performed during adolescence do not increase the risk of TMJ disorders, and occlusal relationships and joint health are shaped by individual adaptive capacity.
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