Obezite ve Ortodonti
Özet
Obezite, günümüzde kronik enerji metabolizması bozukluğu olarak tanımlanan ve kronik hastalıklarla ilişkisi bulunan küresel bir sağlık sorunudur. Ortodonti hastalarının çoğunluğunu oluşturan büyüme çağındaki çocuklarda obezite; kraniofasiyal morfolojiyi, kemik metabolizmasını, puberte dönemini ve diş sürme zamanlamasını doğrudan etkilemektedir. Yapılan araştırmalar, yüksek vücut kitle indeksine (VKİ) sahip obez adölesanlarda büyüme hormonu sekresyonunun azaldığını, buna karşın IGF-I artışına bağlı olarak alt çene uzunluğu (Co-Pg) ve korpus uzunluğunun (Go-Pg) kontrol gruplarına kıyasla anlamlı derecede fazla olduğunu ve her iki çenede prognatizm görüldüğünü ortaya koymaktadır. Yumuşak doku profili incelendiğinde ise obez bireylerin transvers yönde daha geniş, sagittal yönde derin ve vertikal yönde daha kısa bir yüz yapısına sahip oldukları; alt anterior yüz yüksekliğinin arttığı ve mandibuler düzlem açısının azaldığı saptanmıştır. Dental gelişimin obez çocuklarda daha hızlı seyretmesi ve leptin hormonunun osteoklastogenezi inhibe ederek ortodontik diş hareketini yavaşlatabilmesi gibi faktörler, ortodontik tedavi zamanlaması, mekanik kuvvet yönetimi ve seri çekim planlamalarında VKİ'nin de dikkate alınmasını zorunlu kılmaktadır. Sonuç olarak, obez bireylerde hızlanmış dental ve kraniofasiyal büyüme döngüsü, ortodontistlerin tedavi hedeflerini ve zamanlamasını kişiselleştirmesini gerektirmektedir.
Obesity has become a global health problem defined as a chronic energy metabolism disorder and is associated with chronic diseases. In growing children, who constitute the majority of orthodontic patients, obesity directly affects craniofacial morphology, bone metabolism, the pubertal period, and the timing of tooth eruption. Research reveals that in obese adolescents with a high body mass index (BMI), growth hormone secretion decreases, whereas, due to the increase in IGF-I levels, mandibular length (Co-Pg) and corpus length (Go-Pg) are significantly greater compared to control groups, and increased prognathism is observed in both jaws. When the soft tissue profile is examined, it has been determined that obese individuals have a wider transverse, deeper sagittal, and shorter vertical facial structure, with increased lower anterior facial height and a decreased mandibular plane angle. Factors such as accelerated dental development in obese children and the ability of the hormone leptin to slow orthodontic tooth movement by inhibiting osteoclastogenesis make it mandatory to consider BMI in orthodontic treatment timing, mechanical force management, and serial extraction planning. Consequently, the accelerated dental and craniofacial growth cycle in obese individuals requires orthodontists to individualize treatment goals and timing.
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