Effects of combined rapid palatal expansion and face mask therapy on mandibular dentition

Yıl 2019, , 81 - 86, 01.09.2019

Fatma Deniz Uzuner , Şenol Gülşen Selin Kale Varlık , Tuba Tortop

https://doi.org/10.17214/gaziaot.551225

Öz

Objective: The study aimed to evaluate the effects of combined rapid maxillary expansion
(RPE) and face mask (FM) application on the mandibular dentition.

Materials and Method: In this retrospective study pre- and post-treatment cephalometric
radiographs and orthodontic models of 25 patients (10 female, 15 male) with a
mean skeletal age of 12 years and 1 month, being in permanent dentition, having
skeletal Class 3 anomaly (ANB<0) accompanying with maxillary retrognathism
and posterior crossbite who had been treated with a combined application of
bonded Hyrax RPE and FM were evaluated. The mean duration for the RPE-FM
application was 8.7 months. The lower arch intermolar and intercanine widths,
arch depth and the amount of crowding between canines were evaluated using Littles’
Irregularity Index (LII) on the 3D images of the models utilizing the 3Shape
OrthoAnalyzer 2013-1 program. Mandibular incisors’ inclination (IMPA degree)
were determined on cephalometric radiographs. The statistical evaluation was
done with paired t-test, and the statistical significance was set at p<0.01.

Results: In the lower
dental arch, a significant increase of 1.38 mm was found in the intermolar
width (p<0.001). While no significant difference was observed in the intercanine
width, there was a significant decrease in the arch depth (1.45 mm; p<0.001)
and a significant increase in the LII value (1.46 mm; p<0.01). Besides, there
was no significant difference in the IMPA degree.

Conclusion: Combined
RPE-FM application in the treatment of skeletal Class 3 malocclusion provides
an increase in mandibular intermolar width that may increase the arch length. On
the contrary, a decrease in the arch depth results in shortening of the arch
length. Clinicians should be conscious of a mandibular anterior crowding during
this type of combined therapy.

Anahtar Kelimeler

Angle Class III, crowding, dental arch, extraoral traction appliances, palatal expansion technique

Hızlı üst çene genişletmesi ve yüz maskesi kombine uygulamasının mandibular dentisyona etkisi

Öz

Amaç: Bu
çalışmanın amacı, Hızlı
Üst Çene Genişletmesi (HÜÇG) ve Yüz maskesi (YM) kombine uygulamasının mandibular
dentisyona etkisini değerlendirmektir.

Gereç ve Yöntem: Bu retrospektif
çalışmada daimi dişlenme döneminde olan, ortalama iskelet yaşı 12 yıl 1 ay
olan, posterior çapraz kapanış ve maksiller retrognatinin eşlik ettiği
iskeletsel Sınıf 3 anomaliye (ANB<0) sahip olup tedavi protokolü gereği
yapıştırmalı tip Hyrax vidalı HÜÇG aygıtı ile Petit tip YM’nin kombine uygulandığı
25 bireye (10 kız, 15 erkek) ait tedavi başı ve sonu sefalometrik film ve
ortodontik modeller değerlendirildi. HÜÇG-YM kullanımı ortalama 8.7 aydı.
Ortodontik modellerin 3D görünümünde 3Shape Ortho Analyzer 2013-1 programıyla
alt çenede intermolar, interkanin genişlik, ark derinliği ve alt anterior bölge
kanin-kanin arası çapraşıklık miktarı Little düzensizlik indeksi (LDİ) metodu
kullanılarak ölçüldü. Lateral sefalometrik filmlerde alt keser eğimi (IMPA
açısı) ölçüldü. Verilerin istatistiksel olarak değerlendirilmesinde
eşleştirilmiş t-testi kullanıldı. İstatistiksel anlamlılık değeri p<0.01 olarak
kabul edildi.

Bulgular: Kombine uygulama
sonunda alt dental arkta intermolar genişlikte ortalama 1.38 mm anlamlı artış
bulundu (p<0.001). Buna karşılık, interkanin genişliğinde değişim saptanmadı.
Ark derinliğinde ise 1.45 mm anlamlı azalma (p<0.001) ve LDİ değerinde 1.46
mm anlamlı artış görüldü (p<0.01). Alt keser eğiminde (IMPA açısı)
istatistiksel olarak anlamlı değişim saptanmadı.

Sonuç: HÜÇG-YM kombine uygulaması sonunda
alt çenede oluşan intermolar genişlikteki artış ark boyunu arttırırken, buna
karşılık ark derinliğindeki azalma ark boyunu azaltmaktadır. Klinisyenler bu
kombine uygulamayla alt çenede kesici dişlerde çapraşıklık miktarının artabileceğini
göz önünde bulundurmalıdır.

Anahtar Kelimeler

Ağız dışı çekme aletleri, Angle sınıf 3, arkus dentalis, çapraşıklık, damak genişletme tekniği

Kaynakça

• Guyer EC, Ellis E 3rd, McNamara JA Jr, Behrents RG. Components of Class III Malocclusion in Juveniles and Adolescents. Angle Orthod 1986;56:7-30.
• Ellis E 3rd, McNamara JA Jr. Components of adult Class III malocclusion. J Oral Maxillofac Surg 1984;42:295-305.
• Kapust AJ, Sinclair PM, Turley PK. Cephalometric effects of face mask/expansion therapy in Class III children: A comparison of three age groups. Am J Orthod Dentofacial Orthop 1998;113:204-12.
• Nartallo-Turley PE, Turley PK. Cephalometric effects of combined palatal expansion and facemask therapy on Class III malocclusion. Angle Orthod 1998;68:217-24.
• Ngan P, Hagg U, Yiu C, Merwin D, Wei SH. Treatment response to maxillary expansion and protraction. Eur J Orthod 1996;18:151-68.
• Vaughn GA, Mason B, Moon HB, Turley PK. The effects of maxillary protraction therapy with or without rapid palatal expansion: A prospective, randomized clinical trial. Am J Orthod Dentofacial Orthop 2005;128:299-309.
• Kanomi R, Deguchi T, Kakuno E, Takano-Yamamoto T, Roberts WE. CBCT of skeletal changes following rapid maxillary expansion to increase arch-length with a development-dependent bonded or banded appliance. Angle Orthod 2013;83:851-57.
• Çörekçi B, Göyenç YB. Dentofacial changes from fan-type rapid maxillary expansion vs traditional rapid maxillary expansion in early mixedd entition. Angle Orthod 2013;83:842-50.
• Kim JH, Viana MAG, Graber TM, Omerza FF, BeGole EA. The effectiveness of protraction face mask therapy: A meta-analysis. Am J Orthod Dentofacial Orthop 1998;113:204-12.
• Akkaya S, Lorenzon S, Üçem TT. A comparison of sagittal and vertical effects between bonded rapid and slow maxillary expansion procedures. Eur J Orthod 1999;21:175-80.
• Farronato G, Giannini L, Galbiati G, Maspero C. Sagittal and vertical effects of rapid maxillary expansion in Class I, II, and III occlusions. Angle Orthod 2011;81:298-303.
• McNamara JA Jr, Franchi L, McClatchey LMN. Orthodontic and orthopedic expansion of the transverse dimension: A four decade perspective. Semin Orthod 2019;25:3-15.
• Akkaya S, Gülsen A, Taner-Sarisoy L, Balos B, Evaluation of the Effects of Maxillary Expansion on the Nasopharyngeal Area. World J Orthod 2002;3:211-16.
• da SilvaFilho OG, Magro AC, Capelozza Filho L. Early treatment of the Class III malocclusion with rapid maxillary expansion and maxillary protraction. Am J Orthod Dentofacial Orthop 1998;113:196-203.
• Uzuner FD, Öztürk D, Kale Varlık S. Effects of combined bonded maxillary expansion and face mask on dental arch length in patients with skeletal Class III malocclusions. J Clin Pediatr Dent 2017;41:75-81.
• Lione R, Huanca Ghislanzoni LT, Defraia E, Franchi L, Cozza P. Bonded versus banded rapid palatal expander followed by facial mask therapy: analysis on digital dental casts. Eur J Orthod 2016;38:217-22.
• Ngan P, Yiu C, Hu A, Hägg U, Wei SH, Gunel E. Cephalometric and occlusal changes following maxillary expansion and protraction. Eur J Orthod 1998;20:237-54.
• Halicioglu K, Yavuz İ, Ceylan İ, Erdem A. Effects of face mask treatment with and without rapid maxillary expansion in young adult subjects. Angle Orthod 2014;84:853-61.
• Williams MD, Sarver DM, Sadowsky PL, Bradley E. Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study. Semin Orthod 1997;3:265-74.
• Tibana RH, Palagi LM, Miguel JA. Changes in Dental Arch Measurements of Young Adults with Normal Occlusion--A Longitudinal Study. Angle Orthod 2004;74:618–23.
• Little RM. The irregularity index: a quantitative score of mandibular anterior alignment. Am J Orthod 1975;68:554-63.
• Dinçel M, Gümüş HÖ, Büyük SK, Kılınç Hİ, Bilgin MS. 3 boyutlu dijital modeller üzerinde yapılan ölçümlerin doğruluğunun değerlendirilmesi. J Dent Fac Atatürk Uni 2013;21:366-70.
• Fleming PS, Marinho V, Johal A. Orthodontic measurements on digital study models compared with plaster models: a systematic review. Orthod Craniofac Res 2011;14:1-16.
• Tran AM, Rugh JD, Chacon JA, Hatch JP. Reliability and validity of a computer-based Little irregularity index. Am J Orthod Dentofacial Orthop 2003;123:349-51.
• Akkaya S, Lorenzon S, Üçem TT. Comparison of dental arch and arch perimeter changes between bonded rapid and slow maxillary expansion procedures. Eur J Orthod 1998;20:255-61.
• Pacheco AA, Franco A, Antelo OM, Pithon MM, Tanaka OM. Changes in the mandibular arch after rapid maxillary expansion in children: A three-dimensional analysis using digital models. Eur J Gen Dent 2018;7:47-50.
• Baldini A, Nota A, Santariello C, Assi V, Ballanti F, Cozza P. A comparative assessment of changes in dental arches associated with different activation protocols of rapid maxillary expansion Eur J Paediatr Dent 2018;19:35-9.
• MacDonald KE, Kapust AJ, Turley PK. Cephalometric after the correction of Class III malocclusion with maxillary expansion / facemask therapy. Am J Orthod Dentofacial Orthop 1999;116:13-24.
• Isci D, Turk T, Elekdag-Turk S. Activation-deactivation rapid palatal expansion and reverse headgear in Class III cases. Eur J Orthod 2010;32:706-15.