Treatment of the Mandibular Transversal Skeletal Deficiency with Midline Distraction: Two Case Reports

Year 2020, Volume: 6 Issue: 2, 34 - 41, 26.08.2020

İrem Yolcu , Orhan Çiçek , Uğur Gülşen Nurhat Özkalaycı

Abstract

Distraction osteogenesis (DO) is a biological process that involves the formation of new bone with controlled stretching force between two separated bone fragments. The mandible midline distraction osteogenesis is the distraction osteogenesis procedure which applied in the treatment of transversal mandible deficiency. Although it is an easy and effective procedure, complications such as pressure ulcer, wound opening and nerve damage can be seen. In this report, two patients who have an indication of widening with the procedure of mandible midline distraction osteogenesis because of transverse deficiency were presented. In Case 1; A 17-year-old male patient with complaint of poor anterior aesthetics and crowding teeth was evaluated at department of Orthodontics. Orthodontic evaluation revealed that there was a skeletal class II relationship and dental class I relationship, severe crowding, bilateral non-occlusion in the premolar region and mandibular skeletal transversal deficiency. In Case 2; A 15-year-old male patient with a complaint of crowding in canine teeth was evaluated at department of Orthodontics. Orthodontic evaluation revealed that there was a skeletal class I relationship, a class II molar relationship on the left side and a crossbite molar relationship on the right side, severe crowding and transversal deficiency. For ideal and stable treatment results, it was decided to perform midline distraction osteogenesis and explained to patients and parents. In Case 1; The patient accepted the treatment and the non-occlusion in the premolar region was corrected by completing the distraction and obtaining adequate skeletal expansion in the mandible anterior region. Treatment of the patient is still continuing. In Case 2; Distraction osteogenesis procedure was abandoned due to the patient's concern about complication risks. It was decided to rapid maxillary expansion and fixed orthodontic treatment with premolars extraction. Dental crowding and skeletal transversal deficiency were successfully treated. Dental class 1 molar and canine relationship was achieved. Functionally sound occlusion was achieved. Satisfying esthetic appearance was obtained.

Keywords

crowding, transversal deficiency, Distraction, Orthodontics

Alt Çene Transversal İskeletsel Darlığın Orta Hat Distraksiyonu İle Tedavisi: İki Olgu Sunumu

Abstract

Distraksiyon osteogenezisi (DO), birbirinden ayrılmış iki kemik parçası arasında kontrollü germe kuvvetiyle yeni kemik oluşmasını içeren biyolojik bir süreçtir. Alt çene orta hat distraksiyon osteogenezisi ise, transversal alt çene darlıklarının tedavisinde uygulanan distraksiyon osteogenezis işlemidir. Kolay ve etkili bir uygulama olmakla birlikte basınç ülseri, yara açılması ve sinir hasarı gibi komplikasyonlar görülebilmektedir. Bu sunumda transversal darlığı nedeniyle alt çene orta hat distraksiyon ostogenezisi ile genişletme endikasyonu olan iki hasta sunulmuştur. Olgu 1’de; on yedi yaşında erkek hasta, kötü ön estetik ve dişlerindeki çapraşıklık şikâyetiyle ortodonti kliniğine başvurdu. Yapılan ortodontik değerlendirmede iskeletsel sınıf II ve dişsel sınıf I ilişkisi, şiddetli çapraşıklığı, küçük azılar bölgesinde çift taraflı non-oklüzyon olduğu ve alt çenede transversal iskeletsel darlık olduğu görüldü. Olgu 2’de; on beş yaşında erkek hasta, köpek dişlerindeki çapraşıklık şikâyeti ile ortodonti kliniğine başvurdu. Yapılan ortodontik değerlendirmede iskeletsel sınıf I ilişki, sol tarafta sınıf II molar ilişki ve sağ tarafta çapraz kapanış, şiddetli çapraşıklık ve transversal darlık olduğu görüldü. İdeal ve stabil tedavi sonuçları için alt çene orta hat distraksiyon osteogenezisi yapılmasına karar verilip hastalara ve ebeveynlere anlatıldı. Olgu 1’de; hasta tedaviyi kabul edip distraksiyonun tamamlanması ve alt çene ön bölgede yeterli iskeletsel genişletmeyle küçük azı dişler bölgesindeki non-oklüzyon düzeltildi. Hastanın tedavisi hâlâ devam etmektedir. Olgu 2’de; hastanın komplikasyon riskleri endişesi nedeniyle distraksiyon ostegenezisi işleminden vazgeçildi. Hastada üst çene hızlı genişletilmesi ve küçük azı dişleri çekimli sabit ortodontik tedaviye karar verildi. Dişsel çapraşıklık ve iskeletsel transversal darlık başarılı bir şekilde tedavi edildi. Dişsel sınıf 1 molar ve kanin ilişki sağlandı. Fonksiyonel olarak sağlıklı bir kapanış elde edildi. Memnun edici bir estetik görünüş sağlandı.

Keywords

Çapraşıklık, Transversal darlık, Distraksiyon, Ortodonti

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