Publication: Sınıf II Bölüm 1 Maloklüzyonlarda Jasper Jumper apareyi ile üst küçük azı ve alt-üst küçük azı çekim protokollerinin sefalometrik karşılaştırması
Abstract
Büyümekte olan Sınıf II Bölüm 1 olguların tedavisinde diş çekimi kararının alınması, ortodontide en sık karşılaşılan sorunların başında gelmektedir. Fonksiyonel tedavi endikasyonlarının da geçerli olduğu durumlarda ise tedavi yönteminin belirlenmesi daha da zorlaşmaktadır. Literatürde, sabit fonksiyonel tedavinin iskeletsel etkinliğine ilişkin çalışmalarda çelişkili sonuçlara varıldığından, diş çekimli tedavi-sabit fonksiyonel tedavi sonuçlarının karşılaştırılması ayrı bir önem kazanmaktadır. Bu retrospektif çalışmanın amacı, sabit fonksiyonel tedavide kullanılan Jasper Jumper aygıtının iskeletsel, dişsel ve yumuşak dokulara etkilerini, üst küçük azı ve alt-üst iki küçük azı çekim protokolleri sonuçlarıyla karşılaştırmaktır. Marmara üniversitesi Ortodonti nden elde edilen, yukarıda belirtilen şekillerde tedavi görmüş, 12-17 yaş arası Sınıf II Bölüm 1 maloklüzyona sahip 91 adet olgunun başlangıç ve bitim yan sefalometrik röntgenlerinin analiz edildiği çalışmada üç ayrı grup oluşturulmuştur: Jumper grubunda (J) 14,25 yaş ortalamasına sahip 33 olgudan; üst küçük azı çekimli grupta (2K) 15,1 yaş ortalamasına sahip 28 olgudan, alt-üst küçük azı çekimli grupta ise (4K) 14,4 yaş ortalamasına sahip 30 olgudan alınmış kayıtlar analiz edilmiştir. Bulgularımız, maksiller büyümenin en fazla J grubunda, en az 2K grubunda sınırlandığını göstermektedir. Mandibüler iskeletsel etki ise en fazla J grubunda meydana gelirken, 2K grubunda mandibüler gelişimin sınırlandığı görülmektedir. Vertikal boyut üç grupta da artarken; en fazla mandibüler rotasyon J grubunda gerçekleşmiş, alt ön yüz yüksekliği ise en fazla J ve 4K gruplarında artış göstermiştir. Dişsel olarak, Oklüzal Düzlem üç grupta da saat yönünde rotasyon yapmış; bu hareket en fazla J, en az 2K grubunda gerçekleşmiştir. Dentoalveoler değişim bulgularına göre, çekimli gruplarda literatürdeki benzer çalışmalarla uyumlu hareketler gözlenirken, çekimsiz grupta Jasper Jumper aygıt etkilerinin aygıt sökümünü takiben kısmen nüks ettiği sonucuna ulaşılmıştır. Muhtemel nüks hareketleri en fazla üst azı dişlerinde gerçekleşirken, üst ve alt keser anteroposterior konumları ile açı değişimlerinde en az nüks gözlemlenmiştir. Azı dişlerinin tüm gruplarda uzaması sonucu dikey boyut tüm gruplarda artış göstermiştir. Yumuşak doku bulgularına göre çekimli gruplarda dudaklarda gerileme gözlenmiş, bu değişimler Nasolabial Açı değişimleri ile uyumlu bulunmuştur. Çene ucu, iskletsel değişimler ile uyumlu olarak, en fazla J grubunda öne gelmiş; 2K grubunda ise hafif gerileme gözlemlenmiştir. Yumuşak doku profilinde ise en fazla düzleşme 4K grubunda, en az 2K grubunda gerçekleşmiştir. Sonuç olarak, sabit fonksiyonel ve çekimli tedavi protokolleri ile, 12-17 yaş aralığındaki Sınıf II bireylerde farklı mekanizmalar ile benzer sonuçlar elde edildiği saptanmıştır. Bu çalışmada; Jasper Jumper aygıtının iskeletsel etkilerinin sınırlı olması, dentoalveoler etkilerinin ise keser bölgesi dışında korunamaması nedeniyle, çekimli ve çekimsiz tedavi protokollerinin yumuşak ve sert dokular üzerinde benzer etkiler gösterdiği sonucuna varılmıştır. Bununla birlikte, çekimli-çekimsiz tedavi etkinliklerinin en etkili analizi, bu tedavi yöntemlerinin uzun dönem sonuçlarının karşılaştırıldığı çalışmalar ile mümkün olacaktır. Sınıf II maloklüzyon, Jasper Jumper, Küçük azı çekimi, Sefalometrik analiz, sert ve yumuşak doku değişimleri 1.1.
CEPHALOMETRIC COMPARISON OF CLASS II DIVISION 1 PATIENTS TREATED WITH JASPER JUMPER, 2 PREMOLAR EXTRACTION, AND 4 PREMOLAR EXTRACTION PROTOCOLS During the correction of Class II Division 1 malocclusion in growing patients, one of the most difficult decisions is to incorporate extraction into the treatment plan. In cases where functional treatment is also indicated, the decision to remove teeth becomes much more difficult. In literature, there are controversial decisions as to the skeletal effects of functional appliances, which add to the importance of the studies comparing extraction and non-extraction treatments. The aim of this retrospective study was to compare skeletal, dental, and soft tissue effects of a fixed functional appliance called Jasper Jumper, to those of upper first premolar and to four premolar extraction cases. The initial and finishing lateral cephalograms of 91 Class II Division 1 cases, between 12 to 17 years of age, were obtained from the archives of Marmara University-Department of Orthodontics, and sorted into three groups according to the treatment plan: The Jumper group (J) consisted of 33 cases, with an average age of 14,25; the upper premolar extraction group (2K) consisted of 28 cases with an average age of 15,1; and the 4 premolar extraction group (4K) included 30 patients with an average age of 14,4. The results showed that the maxillary restriction was highest in J group, and lowest in the 2K group. The mandibular skeletal effect was evident in J group; while the mandibular growth was inhibited in the 2K group. The vertical dimension increased in all three groups; where the highest mandibular rotation was seen in the J group and the greatest increase in Lower Anterior Facial Height was recorded in J and 4K groups. Dentally, all three groups showed clockwise rotation of the Occlusal Plane, which was highest in the J group, and lowest in 2K group. The dentoalveolar changes were consistent with the findings of similar extraction studies in literature; while in J group, the dentoalveolar effects of the Jasper Jumper seem to have partially relapsed following the removal of the appliance. Most of the appliance effects were maintained in the upper and lower incisor region, while the upper molars moved contrary to Jumper effects at the end of the treatment. The molar extrusion in all three groups resulted in an increase of the vertical dimension. Soft tissue findings showed retrusion of the lips in extraction groups, which were consistent with the Nasolabial Angle changes. The chin projection increased mainly in the J group, while in the 2K group a slight retrusion was found. The 4K group showed the greatest amount of straightening in soft tissue profile, while 2K group showed the least changes. As a result, current study found similar results between fixed functional and premolar extraction protocols in the correction of Class II Division 1 malocclusions between 12 and 17 years of age, despite of the different treatment mechanisms. It can be hypothesized that due to the insufficient skeletal effect of the Jasper Jumper appliance, and that the dentoalveolar changes cannot be maintained fully after the removal of the appliance; the fixed functional and premolar extraction treatment protocols have similar effects upon the hard and soft tissues on the face. However, further studies about the long-term effects of the two protocols are recommended for a more detailed comparison of the efficiency between fixed functional and extraction treatment approaches. KEY WORDS: Class II malocclusion, Jasper Jumper, Premolar extraction, Cephalometric analysis, Hard and soft tissue changes
CEPHALOMETRIC COMPARISON OF CLASS II DIVISION 1 PATIENTS TREATED WITH JASPER JUMPER, 2 PREMOLAR EXTRACTION, AND 4 PREMOLAR EXTRACTION PROTOCOLS During the correction of Class II Division 1 malocclusion in growing patients, one of the most difficult decisions is to incorporate extraction into the treatment plan. In cases where functional treatment is also indicated, the decision to remove teeth becomes much more difficult. In literature, there are controversial decisions as to the skeletal effects of functional appliances, which add to the importance of the studies comparing extraction and non-extraction treatments. The aim of this retrospective study was to compare skeletal, dental, and soft tissue effects of a fixed functional appliance called Jasper Jumper, to those of upper first premolar and to four premolar extraction cases. The initial and finishing lateral cephalograms of 91 Class II Division 1 cases, between 12 to 17 years of age, were obtained from the archives of Marmara University-Department of Orthodontics, and sorted into three groups according to the treatment plan: The Jumper group (J) consisted of 33 cases, with an average age of 14,25; the upper premolar extraction group (2K) consisted of 28 cases with an average age of 15,1; and the 4 premolar extraction group (4K) included 30 patients with an average age of 14,4. The results showed that the maxillary restriction was highest in J group, and lowest in the 2K group. The mandibular skeletal effect was evident in J group; while the mandibular growth was inhibited in the 2K group. The vertical dimension increased in all three groups; where the highest mandibular rotation was seen in the J group and the greatest increase in Lower Anterior Facial Height was recorded in J and 4K groups. Dentally, all three groups showed clockwise rotation of the Occlusal Plane, which was highest in the J group, and lowest in 2K group. The dentoalveolar changes were consistent with the findings of similar extraction studies in literature; while in J group, the dentoalveolar effects of the Jasper Jumper seem to have partially relapsed following the removal of the appliance. Most of the appliance effects were maintained in the upper and lower incisor region, while the upper molars moved contrary to Jumper effects at the end of the treatment. The molar extrusion in all three groups resulted in an increase of the vertical dimension. Soft tissue findings showed retrusion of the lips in extraction groups, which were consistent with the Nasolabial Angle changes. The chin projection increased mainly in the J group, while in the 2K group a slight retrusion was found. The 4K group showed the greatest amount of straightening in soft tissue profile, while 2K group showed the least changes. As a result, current study found similar results between fixed functional and premolar extraction protocols in the correction of Class II Division 1 malocclusions between 12 and 17 years of age, despite of the different treatment mechanisms. It can be hypothesized that due to the insufficient skeletal effect of the Jasper Jumper appliance, and that the dentoalveolar changes cannot be maintained fully after the removal of the appliance; the fixed functional and premolar extraction treatment protocols have similar effects upon the hard and soft tissues on the face. However, further studies about the long-term effects of the two protocols are recommended for a more detailed comparison of the efficiency between fixed functional and extraction treatment approaches. KEY WORDS: Class II malocclusion, Jasper Jumper, Premolar extraction, Cephalometric analysis, Hard and soft tissue changes