Kemik Destekli Hızlı Maksiller Genişletme
Özet
Kemik destekli hızlı maksiller genişletme (HMG), üst çene iskeletsel yetmezliklerinin tedavisinde özellikle büyüme gelişimi tamamlanmış yetişkinlerde cerrahiye alternatif olarak popülerlik kazanan etkili bir ortodontik prosedürdür. Geleneksel HMG yöntemlerinin minimal iskeletsel etki, bukkal devrilme, diş eti çekilmesi ve kök rezorpsiyonu gibi dental ve periodontal yan etkilerinden kaçınmak veya karmaşık cerrahi riskleri elimine etmek amacıyla apareylere ortodontik minividalar entegre edilmiştir. Bu derlemede MICRO Expander, TANDEM, C-Expander gibi tamamen kemik destekli tasarımlar ile Hibrid Hyrax ve Maksiller İskelet Genişletici (MSE) gibi diş-kemik destekli aparey seçenekleri incelenmiştir. Teşhis aşamasında dental modeller ve posteroanterior filmler dental kompanzasyonu yansıtamadığı ve süperpozisyon hatası barındırdığı için günümüzde konik ışınlı bilgisayarlı tomografi (KIBT) ve Yonsei Transvers İndeksi gibi üç boyutlu yaklaşımlar tercih edilmektedir. Dijital cerrahi kılavuzlar ile palatal bölgeye (özellikle 3. ve 4. ruga seviyesine) güvenli yerleşim sağlanabilmekte, bikortikal vidalamanın monokortikale kıyasla daha stabil olduğu belirtilmektedir. Tedavi sonrasında midpalatal suturda paralel ayrılma, nazal kavite hacminde artış ve uyku kalitesinde iyileşme gibi olumlu etkiler elde edilirken, minivida mobilitesi, asimetrik genişleme veya hijyen eksikliğine bağlı gingival hiperplazi gibi limitasyonlar da görülebilmektedir.
Bone-borne rapid maxillary expansion (RME) is an effective orthodontic procedure that has gained popularity as an alternative to surgery for treating maxillary skeletal deficiencies, especially in adults who have completed their growth. To avoid the minimal skeletal effects, dental, and periodontal side effects of traditional RME—such as buccal tipping, gingival recession, and root resorption—or to eliminate complex surgical risks, orthodontic miniscrews have been integrated into expansion appliances. This review examines purely bone-borne designs like the MICRO Expander, TANDEM, and C-Expander, alongside tooth-bone-borne appliances like the Hybrid Hyrax and Maxillary Skeletal Expander (MSE). In the diagnostic phase, since dental models and posteroanterior radiographs fail to reflect dental compensation and suffer from magnification or superposition errors, three-dimensional approaches such as cone-beam computed tomography (CBCT) and the Yonsei Transverse Index are preferred. Digital surgical guides facilitate accurate and safe placement in the palatal region, particularly at the 3rd and 4th rugae levels, with bicortical engagement offering superior stability compared to monocortical placement. Following treatment, positive outcomes such as parallel midpalatal suture opening, increased nasal cavity volume, and improved sleep quality are achieved, though limitations like miniscrew mobility, asymmetric expansion, or gingival hyperplasia due to poor hygiene can occur.
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