Akrilik Bloklu ve Bloksuz Hızlı Üst Çene Genişletme Protokollerinde Molar Devrilmesinin Posteroanterior Filmler Üzerinde Karşılaştırılması

Year 2026, Volume: 12 Issue: 1 , 25 - 35 , 30.04.2026

Sinem Dedeoğlu Öztürk , Banu Mert , A. Nejat Erverdi

https://izlik.org/JA66WR44AN

Abstract

ÖZET
Amaç: Bu retrospektif çalışmanın amacı, bloklu (akrilik blok) ve bloksuz hızlı üst çene genişletme (HÜÇG) uygulamalarının üst molar dişlerin bukkale devrilmesi üzerindeki etkilerini değerlendirmektir.
Gereç ve Yöntemler: Bloklu ve bloksuz HÜÇG uygulanmış olan vakalar taranarak yaşları 12-15 arası değişen 15 erkek 15 kadın olmak üzere toplam 30 birey çalışmaya dahil edilmiştir. Genişletme öncesi ve sonrası rutin olarak alınmış PA filmler, araştırmanın gerecini oluşturmaktadır. Belirlenen doğru, düzlem, noktalar yardımıyla tedavi öncesi ve sonrası 10’ar adet ölçüm PA filmler üzerinde gerçekleştirilmiştir.
Bulgular: Bloklu HÜÇG yapılan bireylerde üst molar dişlerin uzun aksları arasındaki açı ortalama (ort.) 6,4˚ artarken, bloksuz HÜÇG yapılmış bireylerde 10˚ artmıştır (p<0,05). Üst sağ ve sol 1. molar dişlerin uzun akslarının, yatay referans düzlemiyle yaptığı açıların ortalaması bloklu HÜÇG yapılmış bireylerde ort. 3,2˚ artarken bloksuz HÜÇG yapılmış bireylerde 6,2˚ artmıştır (p<0,05).
Sonuç: Hem bloklu hem de bloksuz grupta HÜÇG sonrası molar devrilmesi görülmüştür. Bloklu grupta molar devrilmesinin bloksuz gruba göre daha az gerçekleşmiş olması istatistiksel olarak anlamlıdır. Çalışma, akrilik bloklu apareylerin üst molar dişlerdeki devrilme miktarını azaltsa da tamamen ortadan kaldırmadığını göstermektedir. Vertikal büyüme yönü olan bireylerde her iki aparey kullanımının da molar devrilmesiyle sonuçlanarak dik yön boyutlarında artışa neden olabileceği göz önünde bulundurulmalıdır.

Keywords

Diş Hareketi , Ortodontik Apareyler , Üst çene genişletmesi

Comparison of Molar Tipping in RPE Protocols With and Without Acrylic Block on Posteroanterior Films

https://izlik.org/JA66WR44AN

Abstract

ABSTRACT
Objectives: This study aimed to evaluate and compare the effects of rapid maxillary expansion (RME) with and without blocks (acrylic) on buccal tipping of maxillary molars using posteroanterior (PA) films.
Materials and methods: This retrospective study included 30 individuals (15 males and 15 females; aged 12–15 years) who underwent RME with either block or non-block appliances. PA films obtained before (t0) and immediately after expansion (t1) were analyzed. Ten linear and angular measurements were performed using predefined landmarks, reference lines, and planes. The U6MZ angle was considered the primary outcome variable. Statistical analyses were conducted using appropriate parametric and non-parametric tests, and effect sizes were calculated, p<0,05 was considered statistically significant.
Results: Molar tipping was observed in both groups following RME. The increase in the angle between the long axes of the maxillary molars was greater in the non-block group (10°) compared to the block group (6,4°) (p<0,05). Similarly, the increase in molar inclination relative to the reference plane was higher in the non-block group (6,2°) than in the block group (3,2°) (p<0,05). A statistically significant difference was found between the groups for the primary outcome variable (U6MZ), with a large effect size (Cohen’s d = 1,53), indicating a clinically significant difference.
Conclusion: Both block and non-block RME protocols result in molar tipping; however, block appliances significantly reduce the magnitude of this effect. Despite this reduction, molar tipping is not completely eliminated. These findings suggest that appliance selection should be carefully considered, particularly in patients with vertical growth patterns, where increased molar tipping may contribute to unfavorable vertical changes.

Keywords

Orthodontic Appliances , Maxillary Expansion , Tooth Movement

References

• Proffit WR, Larson BE, Sarver DM. Güncel Ortodonti. Çeviren: Darendeliler N. 6. Baskı. Ankara: Elsevier Inc.; 2020. s. 430-6.
• McNamara JA. Maxillary transverse deficiency. Am J Orthod Dentofacial Orthop. 2000;117(5):567-70.
• Cisneros TVC, Zapata MEV, Balseca MA, Freitas KMS, Miranda E. Relationship between maxillary atresia and mandibular deviation in young adults: A retrospective CBCT study. Int Orthod. 2026;24(2):101085.
• McNamara JA, Lione R, Franchi L, ve ark. The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod. 2015;16:1-7.
• Haas AJ. Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod. 1970;57(3):219-55.
• Garrett BJ, Caruso JM, Rungcharassaeng K, Farrage JR, Kim JS, Taylor GD. Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2008;134(1):8.e1-8.e11.
• Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthod. 1961;31(2):73-90.
• Asanza S, Cisneros GJ, Nieberg LG. Comparison of Hyrax and bonded expansion appliances. Angle Orthod. 1997;67(1):15-22.
• Wendling LK, McNamara JA, Franchi L, Baccetti T. A prospective study of the short-term treatment effects of the acrylic-splint rapid maxillary expander combined with the lower Schwarz appliance. Angle Orthod. 2005;75(1):7-14.
• Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod. 1970;58(1):41-66.
• Melsen B. Palatal growth studied on human autopsy material: a histologic microradiographic study. Am J Orthod. 1975;68(1):42-54.
• Chung CH, Font B. Skeletal and dental changes in the sagittal, vertical, and transverse dimensions after rapid palatal expansion. Am J Orthod Dentofacial Orthop. 2004;126(5):569-75.
• Gökçe G, Akan B, Veli İ. A posteroanterior cephalometric evaluation of different rapid maxillary expansion appliances. J World Fed Orthod. 2021;10(3):112-8.
• Akyalcin S, Cozad BE, English JD, Colville CD, Laman S. Diagnostic accuracy of impression- free digital models. Am J Orthod Dentofacial Orthop. 2013;144(6):916-22.
• Cortella S, Shofer FS, Ghafari J. Transverse development of the jaws: norms for the posteroanterior cephalometric analysis. Am J Orthod Dentofacial Orthop. 1997;112(5):519-22.
• Grummons D. Nonextraction emphasis: space gaining efficiencies, part II. World J Orthod. 2001;2(2):177.
• Ricketts RM. Perspectives in the clinical application of cephalometrics: the first fifty years. Angle Orthod. 1981;51(2):115-50.
• Sari Z, Uysal T, Usumez S, Basciftci FA. Rapid maxillary expansion: is it better in the mixed or in the permanent dentition? Angle Orthod. 2003;73(6):654-61.
• Orhan M, Üşümez S. A new method for the assessment of changes in molar inclination during RME. Virtual J Orthod. 2001;4.
• Alpern MC, Yurosko JJ. Rapid palatal expansion in adults: with and without surgery. Angle Orthod. 1987;57(3):245-63.
• Memikoğlu TU, İşeri H, Uysal ME. Comparison of dentofacial changes with rigid acrylic bonded and Haas type banded rapid maxillary expansion devices. Türk Ortodonti Derg. 1997;10(3):255-64.
• Sarver DM, Johnston MW. Skeletal changes in vertical and anterior displacement of the maxilla with bonded rapid palatal expansion appliances. Am J Orthod. 1989;95(6):462-6.
• Howe RP. Palatal expansion using a bonded appliance: report of a case. Am J Orthod. 1982;82(6):464-8.
• Timms DJ. A study of basal movement with rapid maxillary expansion. Am J Orthod. 1980;77(5):500-7.
• Spolyar JL. The design, fabrication, and use of a full-coverage bonded rapid maxillary expansion appliance. Am J Orthod. 1984;86(2):136-45.
• Horne S, Sung D, Campos HC, ve ark. Effects of bonded rapid palatal expander on vertical dimension: a systematic review and meta-analysis. J Clin Med. 2025;14(19):7035.
• Viarani V, Festa P, Galasso G, ve ark. Randomized controlled clinical trial to evaluate skeletal and dental treatment effects of rapid maxillary expansion in children. Appl Sci. 2025;15(13):7187.
• Alqahtani SFM, Anab NAH, Alzaid SA, ve ark. Comparative CBCT and cephalometric analysis of vertical maxillary changes with bonded and banded expanders. J Pioneering Med Sci. 2025;14:47-55.
• Basciftci FA, Karaman AI. Effects of a modified acrylic bonded rapid maxillary expansion appliance and vertical chin cap on dentofacial structures. Angle Orthod. 2002;72(1):61-71.
• Kılıç N, Kiki A, Oktay H. A comparison of dentoalveolar inclination treated by two palatal expanders. Eur J Orthod. 2008;30(1):67-72.
• Kanomi R, Deguchi T, Kakuno E, Takano-Yamamoto T, Roberts WE. CBCT of skeletal changes following rapid maxillary expansion. Angle Orthod. 2013;83(5):851-7.
• Ulkur F, Ozdemir F, Germec-Cakan D, Kaspar EC. Landmark errors on posteroanterior cephalograms. Am J Orthod Dentofacial Orthop. 2016;150(2):324-31.
• Garib DG, Henriques JF, Janson G, de Freitas MR, Fernandes AY. Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders. Am J Orthod Dentofacial Orthop. 2006;129(6):749-58.
• Brunetto M, Andriani JSP, Ribeiro GL, Locks A, Correa M, Correa LR. Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion. Am J Orthod Dentofacial Orthop. 2013;143(5):633-44.
• Signorelli L, Patcas R, Peltomäki T, Schätzle M. Radiation dose of cone-beam computed tomography compared to conventional radiographs in orthodontics. J Orofac Orthop. 2016;77:9-15.
• Smith BR, Park JH, Cederberg RA. An evaluation of cone-beam computed tomography use in postgraduate orthodontic programs. J Dent Educ. 2011;75(1):98-106.
• Ramoglu SI, Sari Z. Maxillary expansion in the mixed dentition: rapid or semi-rapid? Eur J Orthod. 2010;32(1):11-8.
• Phatouros A, Goonewardene MS. Morphologic changes of the palate after rapid maxillary expansion: a 3-dimensional computed tomography evaluation. Am J Orthod Dentofacial Orthop. 2008;134(1):117-24.
• Ciambotti C, Ngan P, Durkee M, Kohli K, Kim H. A comparison of dental and dentoalveolar changes between rapid palatal expansion and nickel- titanium palatal expansion appliances. Am J Orthod Dentofacial Orthop. 2001;119(1):11-20.
• Grünheid T, Larson CE, Larson BE. Midpalatal suture density ratio: a predictor of skeletal response to rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2017;151(2):267-76.
• Holberg C, Rudzki-Janson I. Stresses at the cranial base induced by rapid maxillary expansion. Angle Orthod. 2006;76(4):543-50.
• Gautam P, Valiathan A, Adhikari R. Stress and displacement patterns in the craniofacial skeleton with rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2007;132(1):5.e1-5.e11.