Diş ve diş-kemik destekli hızlı üst çene genişletmesi hastalarının muskuloskeletal yapılarının kıbt ve elastografik değerlerinin karşılaştırılması
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Tarih
2024
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu tez çalışması, diş ve diş-kemik destekli hızlı üst çene genişletme tedavilerinin muskuloskeletal yapılarda meydana getirdiği etkilerin konik ışınlı bilgisayarlı tomografi ve ultrasonografik elastografi kullanılarak karşılaştırılması amacıyla yapılmıştır. Hedefimiz, güncel ortodontik tedavilerde rutin olarak kullanılan diş destekli hızlı üst çene genişletmesi ile son dönemlerde kullanımı oldukça artan mini-vida destekli hızlı üst çene genişletmesinin maksiller kompleks ve masseter, temporal, digastrik venter anterior ve geniohyoid kasları üzerindeki tedavi etkilerini incelemek ve bu değişimleri değerlendirmektir. Çalışmamıza, Kırıkkale Üniversitesi Diş Hekimliği Fakültesi Ortodonti Anabilim Dalı'na tedavi amacıyla başvuran 24 hasta dahil edilmiştir. Bu kapsamda, diş ve diş-kemik destekli hızlı üst çene genişletme tedavisi uygulanan iki grup oluşturulmuştur. Genişletme tedavisinin başlangıcında (T0) ve bitiminde (T1) elde edilen konik ışınlı bilgisayarlı tomografi görüntüleri kullanılarak, ANS ve PNS hizasında midpalatal sütur açılma miktarı, PNS/ANS yüzdesi, pterigopalatin sütur açılma miktarı, nazal ve maksiller genişlik artışı değerlendirilmiştir. Bunun yanı sıra, T0 ve T1 zaman dilimlerinde yapılan ultrasonografik elastografi muayenesi ile temporal, masseter, digastrik venter anterior ve geniohyoid kaslarındaki sertlik değişimleri de analiz edilmiştir. Sürekli verilerin normal dağılıma uygunluğunun incelenmesinde Shapiro-Wilk testinden yararlanıldı. Sürekli verilerin T0 ve T1 ölçümlerinin karşılaştırılmasında normal dağılıma uyan verilerde bağımlı gruplarda t test, normal dağılıma uymayan verilerde Wilcoxon test kullanıldı. Sürekli değişkenlerin diş ve diş-kemik destekli hızlı üst çene genişletme grubundaki hastalar arasındaki karşılaştırmalarında normal dağılıma uyan verilerde bağımsız gruplarda t test, normal dağılıma uymayan verilerin karşılaştırmalarında Mann Whitney U testi kullanıldı. Diş ve diş-kemik destekli hızlı üst çene genişletme gruplarının konik ışınlı bilgisayarlı tomografi ölçümleri sırasında, her iki grupta da T0-T1 zaman dilimleri arasında maksiller ve nazal genişlikte artış gözlenmiştir. Midpalatal sütur açılma oranının değerlendirilmesinde, her iki grupta da ANS hizasında açılma, PNS hizasındakine kıyasla daha fazla olmuş, ancak gruplar arasında anlamlı bir fark bulunmamıştır. Ayrıca, her iki grupta sağ ve sol pterigopalatin süturda açılma meydana gelmiş, fakat bu artışlar gruplar arasında istatistiksel olarak anlamlı olmamıştır. Kas kalınlığı incelemesinde, grup içi ve gruplar arası karşılaştırmalarda istatistiksel olarak anlamlı bir fark bulunmamıştır. Her iki gruptaki hastaların T0 ve T1 zaman dilimleri arasında strain elastografi değerlerinde anlamlı artış gözlenmiş, ancak bu artışlar gruplar arasında istatistiksel olarak anlamlı bir fark yaratmamıştır. Shear-wave elastografi verilerinin analizinde, T0-T1 zaman dilimleri arasında gruplar arasında anlamlı bir fark saptanmamıştır. Ancak, diş destekli hızlı üst çene genişletme grubunda geniohyoid kasının kasılmış durumda ve sol digastrik venter anterior kasının gevşek durumda anlamlı bir düşüş gözlenmiştir. Diş ve diş-kemik destekli hızlı üst çene genişletme tedavilerinin iskeletsel yapılar üzerindeki etkileri benzer bulunmuştur. Her iki grupta strain elastografi muayene sonuçlarına göre kas sertliğinde artış gözlenirken, shear-wave elastografi değerlerine göre ise sertlik artışı saptanmamıştır. Ayrıca, her iki grupta da kas kalınlığında herhangi bir değişiklik gözlenmemiştir.
This thesis aims to compare the effects of tooth-borne rapid maxillary expansion and tooth-bone-borne rapid maxillary expansion treatments on musculoskeletal structures using cone-beam computed tomography (CBCT) and ultrasonographic elastography. Our objective is to examine the treatment effects of tooth-borne rapid maxillary expansion, routinely used in current orthodontic treatments, and the increasingly popular tooth-bone-borne rapid maxillary expansion on the maxillary complex and the masseter, temporal, anterior digastric, and geniohyoid muscles, and to evaluate these changes. Our study included 24 patients who applied for treatment at the Department of Orthodontics, Faculty of Dentistry, Kırıkkale University. Two groups were formed, one receiving tooth-borne rapid maxillary expansion and the other tooth-bone-borne rapid maxillary expansion. Using CBCT images obtained at the beginning (T0) and the end (T1) of the expansion treatment, the amount of midpalatal suture opening at the ANS and PNS levels, PNS/ANS percentage, pterygopalatine suture opening, and nasal and maxillary width increase were evaluated. Additionally, changes in the stiffness of the temporal, masseter, anterior digastric, and geniohyoid muscles were analyzed using ultrasonographic elastography examinations at T0 and T1. The Shapiro-Wilk test was used to examine the normality of the distribution of continuous data. For the comparison of T0 and T1 measurements of continuous data, the paired t-test was used for normally distributed data, and the Wilcoxon test was used for non-normally distributed data. For comparisons between patients in the tooth-borne and tooth-bone-borne rapid maxillary expansion groups, the independent t-test was used for normally distributed data, and the Mann-Whitney U test was used for non-normally distributed data. During the CBCT measurements of the tooth-borne and tooth-bone-borne rapid maxillary expansion groups, both groups showed an increase in maxillary and nasal width between the T0 and T1 time periods. In the evaluation of the midpalatal suture opening rate, both groups exhibited more opening at the ANS level compared to the PNS level, but no significant difference was found between the groups. Additionally, both groups showed opening in the right and left pterygopalatine sutures, but these increases were not statistically significant between the groups. In muscle thickness examination, no statistically significant difference was found in intra-group and inter-group comparisons. A significant increase was observed in strain elastography values between the T0 and T1 time periods in both groups, but this increase did not create a statistically significant difference between the groups. In the analysis of shear-wave elastography data, no significant difference was found between the groups for the T0-T1 time periods. However, in the tooth-borne rapid maxillary expansion group, a significant decrease was observed in the contracted state of the geniohyoid muscle and the relaxed state of the left anterior digastric muscle. The effects of tooth-borne and tooth-bone-borne rapid maxillary expansion treatments on the skeletal structures were found to be similar. While an increase in muscle stiffness was observed in both groups according to strain elastography examination results, no increase in stiffness was found according to shear wave elastography values. There was also no change in muscle thickness in either group.
This thesis aims to compare the effects of tooth-borne rapid maxillary expansion and tooth-bone-borne rapid maxillary expansion treatments on musculoskeletal structures using cone-beam computed tomography (CBCT) and ultrasonographic elastography. Our objective is to examine the treatment effects of tooth-borne rapid maxillary expansion, routinely used in current orthodontic treatments, and the increasingly popular tooth-bone-borne rapid maxillary expansion on the maxillary complex and the masseter, temporal, anterior digastric, and geniohyoid muscles, and to evaluate these changes. Our study included 24 patients who applied for treatment at the Department of Orthodontics, Faculty of Dentistry, Kırıkkale University. Two groups were formed, one receiving tooth-borne rapid maxillary expansion and the other tooth-bone-borne rapid maxillary expansion. Using CBCT images obtained at the beginning (T0) and the end (T1) of the expansion treatment, the amount of midpalatal suture opening at the ANS and PNS levels, PNS/ANS percentage, pterygopalatine suture opening, and nasal and maxillary width increase were evaluated. Additionally, changes in the stiffness of the temporal, masseter, anterior digastric, and geniohyoid muscles were analyzed using ultrasonographic elastography examinations at T0 and T1. The Shapiro-Wilk test was used to examine the normality of the distribution of continuous data. For the comparison of T0 and T1 measurements of continuous data, the paired t-test was used for normally distributed data, and the Wilcoxon test was used for non-normally distributed data. For comparisons between patients in the tooth-borne and tooth-bone-borne rapid maxillary expansion groups, the independent t-test was used for normally distributed data, and the Mann-Whitney U test was used for non-normally distributed data. During the CBCT measurements of the tooth-borne and tooth-bone-borne rapid maxillary expansion groups, both groups showed an increase in maxillary and nasal width between the T0 and T1 time periods. In the evaluation of the midpalatal suture opening rate, both groups exhibited more opening at the ANS level compared to the PNS level, but no significant difference was found between the groups. Additionally, both groups showed opening in the right and left pterygopalatine sutures, but these increases were not statistically significant between the groups. In muscle thickness examination, no statistically significant difference was found in intra-group and inter-group comparisons. A significant increase was observed in strain elastography values between the T0 and T1 time periods in both groups, but this increase did not create a statistically significant difference between the groups. In the analysis of shear-wave elastography data, no significant difference was found between the groups for the T0-T1 time periods. However, in the tooth-borne rapid maxillary expansion group, a significant decrease was observed in the contracted state of the geniohyoid muscle and the relaxed state of the left anterior digastric muscle. The effects of tooth-borne and tooth-bone-borne rapid maxillary expansion treatments on the skeletal structures were found to be similar. While an increase in muscle stiffness was observed in both groups according to strain elastography examination results, no increase in stiffness was found according to shear wave elastography values. There was also no change in muscle thickness in either group.
Açıklama
Diş Hekimliği Fakültesi, Ortodonti Ana Bilim Dalı
Anahtar Kelimeler
Diş Hekimliği, Dentistry
