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Türk Ortodonti Dergisi 2009;22:110-123110

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YYaazz››flflmmaa aaddrreessii::CCoorrrreessppoonnddiinngg AAuutthhoorr::Dr Belma IfiIK ASLANGazi University Faculty ofDentistry Department ofOrthodontics06510 Emek, Ankara, TürkiyeTel: +903122034273Faks: +903122239226Email:[email protected]

*Gazi Üniv. Diflhek. Fak.Ortodonti A.D. Ankara,Türkiye **SerbestOrtodontist, Lefkofle, KuzeyK›br›s Türk Cumhuryeti /*Gazi Univ. Faculty ofDentistry Dept. ofOrthodontics, Ankara,Turkey, **Private Practitioner,Lefkosia, Turkish Republic ofNorthern Cyprus

ÖÖZZEETT

Bu çal›flman›n amac›, pekifltirme teda-visi döneminde iskeletsel ve diflsel stabi-liteyi, dil ve perioral yumuflak dokular›nadaptasyonunu incelemektir.

Angle s›n›f I ve/veya s›n›f II kapan›fliliflkisi gösteren, iskeletsel s›n›f 1, dörtadet birinci küçük az› difl çekimlerininyap›ld›¤› toplam 22 birey (15 k›z 7 erkek,kronolojik yafl ortalamas› 17.56±1.2)araflt›rma kapsam›na al›nd›. Aktif orto-dontik tedavi sonunda (T0), pekifltirme te-davisinin 6.(T1) ve 9.(T2) aylar›nda al›-nan lateral sefalometrik ve anteroposteri-or radyografiler üzerinde 18, ortodontikmodeller üzerinde 4 ölçüm ve yumuflakdokular›n difller üzerindeki bask›lar›n›veren 16 adet ölçüm yap›ld›; ölçümler‘Wilcoxon testi’ ile istatistiksel olarak de-¤erlendirildi.

U6s(V) ölçümü T0-T1 (p<0.05) süre-cinde, L1s(V) ölçümü T1-T2 ve T0-T2(p<0.05) sürecinde istatistiksel olarakönemli art›fl gösterdi. Tüm pekifltirme te-davisi zamanlar›nda (T0,T1,T2) istirahatve yutkunma halinde iken lingual bas›nç-lar›n istatistiksel olarak anlaml› düzeydevestibul bas›nçlardan daha fazla oldu¤ubulundu.

Pekifltirme tedavisi süresince, dil ba-s›nc›n›n dudak ve yanak bas›nc›na görefazla bulunmas›na ra¤men, difl pozisyon-lar›n›n stabil kald›¤› saptand›. Retansiyonsonunda, iskeletsel ve diflsel iliflkilerinkorundu¤u; istirahat halinde yumuflakdoku adaptasyonunun sa¤land›¤› sonuç-lar›na var›ld›. (Türk Ortodonti Dergisi2009;22:110-123)

AAnnaahhttaarr KKeelliimmeelleerr:: Yumuflak dokuadaptasyonu, retansiyon, stabilite.

SSUUMMMMAARRYY

The aim of this study was to evaluateskeletal and dental stability and theadaptation of tongue and perioral soft tis-sue during retention treatment period.

The sample included 22 Angle class Iand/or class II, skeletal class I (15 fema-les, 7 males, mean chronologic age17.56±1.2) cases who had 4 premolarextracted. 18 measurements on lateralcephalometric and anteroposterior films,4 measurements on dental casts, 16 me-asurements of the soft tissue were carriedout at the end of active orthodontic treat-ment (T0), at the sixth (T1) and the ninthmonths (T2) of retention treatment peri-od and evaluated statistically using ‘Wil-coxon test’.

U6s(V) measurement showed a signi-ficant increase during T0-T1 (p<0.05)and L1s(V) measurement increased signi-ficantly during T1-T2 and T0-T2(p<0.05). The total lingual pressures atrest and during swallowing were foundsignificantly more than the total vestibu-le pressures in all retention treatment pe-riods (T0,T1,T2) (p<0.01).

Teeth positions were stable during re-tention although lingual pressure wasmore than lip and cheek pressures. Ske-letal, dental measurements and soft tissu-e adaptation at rest were stable at theend of retention. (Turkish J Orthod2009;22:110-123)

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GG‹‹RR‹‹fifiAktif ortodontik ve pekifltirme tedavisi dö-

nemlerinde fonksiyon, görüntü ve difl pozis-yonlar›n›n dengesi üzerinde yumuflak doku-lar›n etkinli¤i, tedavi baflar›s›nda göz önüneal›nmas› gereken konudur (1). Tedavi öncesivar olan anormal kas aktivitesinin devam› te-davi sonras› relaps nedenlerinden olabildi¤igibi (2,3), ortodontik tedavi ile elde edilenyeni olufluma yumuflak dokular›n adaptasyo-nu da tedavi stabilitesi için önemlidir (4).

Proffit ve Fields (5), yumuflak dokular›n te-davi sonunda elde edilen duruma adaptas-yonlar› s›ras›nda, diflleri tekrar tedavi bafl›nda-ki pozisyonlar›na getirecek kadar fazla kuvve-tin ortaya ç›kt›¤›n› ve retansiyon ayg›tlar›n›nyumuflak dokular›n remodelasyonunun ta-mamlanmas›na kadar diflleri bu konumda tu-tabilmesi gerekti¤ini bildirmektedirler.

Dentisyon, dinamik denge durumu diye ad-land›r›lan stabil bir ortamda yer almaktad›r.Dinamik dengeyi etkileyen bafll›ca faktörlerdil, dudak ve yanaklar›n istirahat halinde uy-gulad›klar› bas›nç, periodontal membran tara-f›ndan oluflturulan kuvvetlerdir (6,7); bu ne-denle elde edilen difl pozisyonlar›n›n korun-mas› için, difllere z›t yönlü bas›nç uygulayanorofasiyal kas bas›nçlar›n›n uyum içinde ol-mas› (dudak ve yanak kuvvetlerinin dil kuvvet-leri ile dengede olmas›), kas fonksiyonu iledenge içinde bulunan iyi bir fonksiyonel ok-lüzyonun oluflturulmas› gerekmektedir (6,8,9).

Literatürde, pekifltirme tedavisi dönemin-de yumuflak doku adaptasyonunu inceleyenherhangi bir çal›flma bulunmamaktad›r. Busebeple bu çal›flmada pekifltirme tedavisi sü-recinde, dental, iskeletsel stabilite ile yumu-flak doku adaptasyonunun incelenmesiamaçland›.

BB‹‹RREEYYLLEERR vvee YYÖÖNNTTEEMMYafl aral›¤› 16 ile 20 aras›nda de¤iflen, kro-

nolojik yafl ortalamas› 17.56 olan (15 k›z, 7erkek) 22 birey çal›flmaya dahil edildi. Birey-ler iskeletsel S›n›f 1, diflsel Angle S›n›f I ve/ve-ya S›n›f II kapan›fl iliflkisi göstermekte olup,optimal veya artm›fl dik yön yüz oranlar›nasahipti. Bireyler flu k›staslara göre araflt›rmayadahil edildi: 1) Dört adet birinci küçük az› diflçekimi ile birlikte sabit edgewise ortodontitekni¤inin uygulanmas›, 2) anormal yutkun-ma al›flkanl›¤›n›n olmamas›, 3) aktif büyümeve geliflim at›l›mlar›n›n tamamlanm›fl olmas›,

IINNTTRROODDUUCCTTIIOONNThe influence of soft tissues on equilibri-

um of the positions of teeth, function and fa-cial harmony during active orthodontic treat-ment and retention have to be considered(1). The presence of abnormal muscle acti-vity before orthodontic treatment is one ofthe relapse reasons (2,3); adaptation of softtissues after orthodontic treatment is also im-portant for the stability of treatment (4).

Proffit and Fields (5) stated that strong for-ces occur during the adaptation of soft tissu-es at the end of active orthodontic treatmentthat may return the teeth to the original posi-tions. Therefore retention appliances shouldpreserve the teeth until remodeling of soft tis-sues is completed.

Dentition is located in a stable positioncalled dynamic equilibrium. The primaryfactors for the equilibrium are the restingpressures of the tongue, lips and cheek, andpossibly the forces created within the peri-odontal membrane (6,7); for this reason anequilibrium of soft tissue forces (forces fromthe lips and cheek counterbalanced by for-ces from the tongue) and functional occlusi-on should be constructed in order to providestability (6,8,9).

In literature there are no studies evalua-ting soft tissue adaptation in retention. The-refore the aim of this study was to investiga-te skeletal and dental stability and soft tissu-e pressure adaptation during retention treat-ment period.

SSUUBBJJEECCTTSS aanndd MMEETTHHOODDSS The study group consisted of 22 subjects

(15 females, 7 males) whose ages rangedbetween 16 and 20, with a mean chronolo-gic age of 17.56. Cases had skeletal Class I,Angle class I and/or Class II malocclusionwith optimal or increased vertical facial di-mensions. Inclusion criteria were (1) full fi-xed edgewise orthodontic treatment with ex-traction of four first premolars, (2) no abnor-mal infantile swallowing, (3) completion ofactive growth and development potential, (4)retraction of upper incisors and (5) none ofthe extraoral appliance usage during activeorthodontic treatment (6) no maxillary ex-pansion treatment.

Turkish Journal of Orthodontics 2009;22:110-123

111

Pekifltirme Döneminde Yumuflak Doku AdaptasyonuSoft Tissue Adaptation During Retention

fifieekkiill 11:: AA)) Lateral

sefalogramlar üzerinde

yap›lan iskeletsel ve diflsel

ölçümler, BB)) Posteroanterior

radyografiler üzerindeki

referans düzlemler ve

ölçümler

FFiigguurree 11:: AA)) Skeletal and

dentoalvelar measurements

on lateral cephalograms,

BB)) Reference planes and

measurements on

posteroanterior radiograms.


Dinçer, Ifl›k-Aslan, Darendeliler, Ünsal-Raflit

4) üst kesici difllerde retraksiyon iflleminin ya-p›lm›fl olmas›, 5) aktif ortodontik tedavi s›ra-s›nda herhangi bir a¤›zd›fl› ayg›t›n kullan›l-mam›fl olmas›, 6) üst çenede ekspansiyon ya-p›lmam›fl olmas›

Araflt›rmaya al›nan tüm bireylere pekifltir-me döneminin ilk alt› ay› Hawley apareyi ye-mekler hariç gece gündüz, sonraki üç ay bo-yunca sadece geceleri kulland›r›ld›.

Aktif ortodontik tedavi sonunda (T0), pe-kifltirme döneminin alt›nc› (T1) ve dokuzun-cu aylar›nda (T2) tüm bireylerden lateral sefa-lometrik ve anteroposterior radyografiler, mo-deller ve yumuflak dokular›n difller üzerinde-ki bask›lar›n› veren ölçümler elde edildi. Tümsefalometrik, model ve yumuflak doku bas›nçölçümleri tek bir araflt›rmac› taraf›ndan ger-çeklefltirildi (BÜ). Bireyler yap›lacak ölçümlerhakk›nda bilgilendirildi ve ayd›nlat›lm›flonam formlar› imzalatt›r›ld›.

Lateral sefalometrik filmler üzerinde yap›-lan iskeletsel ve dentoalveoler ölçümler (10)(fiekil 1A):1) SNA (º): Üst çene ile ön kafa kaidesi aras›n-

daki sagital yöndeki iliflkiyi tan›mlayan aç›2) SNB (º): Alt çene ile ön kafa kaidesi ara-

s›ndaki sagital yöndeki iliflkiyi tan›mlayanaç›

3) ANB (º): Üst çene ile alt çene aras›ndakisagital yöndeki iliflkiyi tan›mlayan aç›

4) SN/GoGn (º): Ön kafa kaidesine göre altçene konumunu tan›mlayan aç›

5) Pg-NB (mm): Pogonion noktas›n›n NBdüzlemine olan uzakl›¤›

6) U1/NA (º): Üst çene en ileri kesici diflinuzun ekseninin ile NA düzlemi ile yapt›¤›aç›

All patients received upper and lowerHawley retention appliances with instructi-ons to wear them all the time except duringmeals for six months and only at night for thenext three months.

Lateral and anteroposterior radiographs,dental casts and soft tissue pressure measure-ments on teeth were obtained from all sub-jects at the end of active orthodontic treat-ment (T0), at the end of sixth (T1) and ninthmonths (T2) of retention. All the cephalomet-ric, model and soft tissue pressure measure-ments were performed by a single investiga-tor (BÜ). Patients were informed about themeasurements and asked to sign an informedconsent. Skeletal and dentoalveolar measurements on

lateral cephalograms (10): (Figure 1A)1) SNA (º): The angle defining the sagital in-

terrelationship between maxilla and an-terior cranial base.

2) SNB (º): The angle defining the sagital in-terrelationship between mandibula andanterior cranial base.

3) ANB (º): The angle defining the sagitalinterrelationship between maxilla andmandibula.

4) SN/Go-Gn (º): Position of mandibularplane according to anterior cranial plane.

5) Pg-NB (mm): The perpendicular distancefrom pogonion to NB.

6) U1/NA (º): The angle between the longaxis of the most protrusive maxillary cen-tral incisor and NA plane.

7) U1-NA (mm): The perpendicular distancefrom the incisive edge of the most protrusi-ve maxillary central incisor to NA plane.

7) U1-NA (mm): Üst çene kesici difl kronu-nun en ileri noktas›n›n NA düzlemineolan uzakl›¤›

8) L1/NB (º): Alt çene en ileri kesici diflin uzunekseninin ile NB düzlemi ile yapt›¤› aç›

9) L1-NB (mm): Alt çene kesici difl kronununen ileri noktas›n›n NB düzlemine olanuzakl›¤›

10) U1/L1 (º): Üst ve alt en ileri orta kesici di-flin uzun eksenleri aras›ndaki aç›

11) Holdaway fark›: 1-NB uzakl›¤› ile Pg-NBuzakl›¤› aras›ndaki farkt›r

12)Overjet (mm): Üst en ileri kesici diflin ke-sici kenar› ile alt en ileri kesici diflin vesti-bul yüzeyi aras›nda kalan ön-arka yönde-ki mesafe

13)Overbite (mm): Üst ve alt en ileri kesicidifllerin kesici kenarlar› aras›ndaki dikyön kapan›fl fazlal›¤›

Posteroanterior radyografiler üzerinde kul-lan›lan düzlemler ve yap›lan ölçümler (10)(fiekil 1B):1) ZR-AGR ve ZL-AGL: Sa¤ ve sol zigomatik

noktalar ile sa¤ ve sol antigonial noktalararas›ndaki düzlemlerdir. Frontal yüz düz-lemi

2) ZR-ZL: Sa¤ ve sol zigomatik noktalar› bir-lefltiren düzlemdir. Z düzlemi

3) U6R-ZRAGR (mm): Üst sa¤ birinci büyükaz› diflinin bukkal yüzünün transversalyöndeki en ileri noktas›n›n frontal yüzdüzlemine uzakl›¤›

4) U6L-ZLAGL (mm): Üst sol birinci büyükaz› diflinin bukkal yüzünün transversalyöndeki en ileri noktas›n›n frontal yüzdüzlemine olan uzakl›¤›

5) L6R-ZRAGR (mm): Alt sa¤ birinci büyükaz› diflinin bukkal yüzünün transversalyöndeki en ileri noktas›n›n frontal yüzdüzlemine uzakl›¤›

8) L1-NB (º): The angle between the longaxis of the most protrusive mandibularcentral incisor and NB plane.

9) L1-NB (mm): The perpendicular distancefrom the incisive edge of the most protrusi-ve mandibular central incisor to NB plane.

10)U1/L1 (º): The angle between the long axisof the most protrusive maxillary central in-cisor and mandibular central incisor.

11) Holdaway difference: The difference bet-ween L1-NB and Pg-NB.

12) Overjet: The sagital distance betweenthe incisive edge of the most protrusiveupper incisor and the vestibule surface ofthe most protrusive lower incisor.

13) Overbite: The vertical distance betweenthe incisive edge of the most protrusiveupper and lower incisors.

Reference planes and measurements onposteroanterior radiograms (10) (Figure 1B):1) ZR-AGR and ZL-AGL: The planes betwe-

en right and left zygomatic points andright and left antigonial points. Frontal fa-cial plane

2) ZR-ZL: The plane passing through rightand left zygomatic points. Z plane

3) U6R-ZRAGR (mm): The perpendiculardistance from the most vestibule point ofupper right first molar to frontal facialplane.

4) U6L-ZLAGL (mm): The perpendicular dis-tance from the most vestibule point ofupper left first molar to frontal facial pla-ne.

5) L6R-ZRAGR (mm): The perpendiculardistance from the most vestibule point oflower right first molar to frontal facialplane.

fifieekkiill 22:: AA)) Üst dental modeler

üzerinde yap›lan ölçümler,

BB)) Alt dental modeler

üzerinde yap›lan ölçümler

FFiigguurree 22:: AA)) Measurements on

upper dental casts,

BB)) Measurements on lower

dental casts.


113




6) L6L-ZLAGL (mm): Alt sol birinci büyük az›diflinin bukkal yüzünün transversal yön-deki en ileri noktas›n›n frontal yüz düzle-mine uzakl›¤›

Ortodontik modeller üzerinde yap›lan öl-çümler (fiekil 2):1) Üst interkanin genifllik (U3R+U3L)2) Alt interkanin genifllik (L3R+L3L)3) Üst intermolar genifllik (U6R+U6L)4) Alt intermolar genifllik (L6R+L6L)

Yumuflak dokular›n (dudak, yanak, dil),difller üzerine uygulad›klar› bask›y› ölçmekamac›yla strain-gauge’ ler kullan›ld› (11) (fie-kil 3A). 0,6/120LY11 tipindeki strain-gaugele-ri (Hottinger Baldwin Messtechnik GMBH,D-64293 Darmstadt, Almanya) difllerin üzeri-ne yerlefltirmek amac› ile her difl yüzeyineuygun olarak 1 mm kal›nl›¤›nda so¤uk akril-den mini plaklar haz›rland›. Yumuflak dokubask› de¤erlerini mümkün oldu¤unca gerçe-¤e yak›n elde etmek amac› ile strain-gau-ge’lerin yap›flt›r›ld›¤› mini plak kal›nl›¤›n›nçok fazla olmamas›na dikkat edildi (12). Stra-in-gauge’ ler Bond-200 (MicromeasurmentComp., Measurement Group, Inc. Raleign,N.C, ABD) tipindeki adeziv ile akrilik miniplaklar üzerine yap›flt›r›larak, polycarboxyla-te siman (Adhesor, Türkiye) arac›l›¤› ile kuru-tulmufl difllerin vestibul veya lingual yüzeyle-rine yerlefltirildi (fiekil 3B ve 4).

Ölçümler alt ve üst çenenin sa¤ taraf›nda-ki difller üzerinde gerçeklefltirildi. Burada Go-uld ve Picton’ (13) in sa¤ taraftaki kuvvetlerinsol tarafa göre daha fazla olabilece¤i ile ilgilibulgular› göz önünde bulunduruldu. Strain-

6) L6L-ZLAGL (mm): The perpendicular dis-tance from the most vestibule point of lo-wer left first molar to frontal facial plane.

Measurements on dental casts (Figure 2):1) Upper intercanine dimension (U3R+ U3L)2) Lower intercanine dimension (L3R+ L3L)3) Upper intermolar dimension (U6R+ U6L)4) Lower intermolar dimension (L6R+L6L)

Strain gauges were used to measure thesoft tissue pressures (lips, cheek and tongue)on teeth (11) (Figure 3A). Cold-curing ortho-dontic acyrlic resin mini plates 1mm inthickness were prepared to attach the 0.6/120LY11 type strain gauges (Hottinger Bald-win Messtechnik GMBH, D-64293 Darm-stadt, Germany) on teeth. Acrylic mini plateswere prepared as thin as possible to achievethe reliable soft tissue pressures (12). Strain-gauges were glued onto the acrylic mini pla-tes with Bond-200 type adhesive (Microme-asurment Comp., Measurement Group, Inc.Raleign, N.C, USA) and acrylic mini plateswere attached onto the labial or lingual sur-faces of the teeth with polycarboxylate ce-ment (Adhesor, Turkey) (Figure 3B and 4).

Gould and Picton (13) stated that pressu-res on the right side could be more thanpressures on the left side therefore in thisstudy measurements were made on the rightside of the jaws. Patients were instructed toswash their mouth with water at room tem-perature in order to avoid incorrect resultsthat can occur due to temperature changes.

fifieekkiill 33:: AA)) Yumuflak doku

bas›nç ölçümünde kullan›lan

strain gauge’ ler, BB)) Akrilik

mini-pla€a yap›flt›r›lan strain

gauge’ ler

FFiigguurree 33:: AA)) Strain gauges

used in soft tissue pressure

measurements, BB)) Strain

gauges glued to acyrlic mini-

plates.

gauge ile mini plaklar difllerin üzerine yap›fl-t›r›lmadan önce, ›s› de¤iflimine ba¤l› meyda-na gelebilecek hatal› sonuçlar› önlemek aç›-s›ndan hastalar›n a¤z›, oda ›s›s›nda bekletil-mifl su ile çalkaland›.

Strain-gauge’ den ç›kan iki telin birbirinetemas edip k›sa devre oluflturmas›n› önlemekamac› ile kablo üzeri kapland› ve daha sonragauge’ ler ‘E10MK11 Digital Strain Indicator’e (Tecquipment Comp., ABD) yar›m köprü(half bridge) Wheatstone tekni¤i ile ba¤land›(14) (fiekil 5). Ölçümler, hasta do¤al bafl po-zisyonunda, istirahat halinde ve yutkunma s›-ras›nda olmak üzere iki ayr› konumda yap›l-d› (15). Ölçümler, strain-gauge ile mini-plak-lar difller üzerine yap›flt›r›l›p, ön bölgede du-dak, yan bölgede de yanaklar ekarte edilip,strain indicator’ de de¤iflmeyen s›f›r de¤eri el-de edildikten sonra gerçeklefltirildi. Istirahatpozisyonunda dudak ve yanak serbest b›rak›-l›p hastaya rahat durmas›, yutkunmada isetükrü¤ünü yutmas› söylendi. Bu hareketlerölçüm yap›lmadan önce hastaya birkac defatekrarlat›ld› (14). Ölçüm yaparken kablolar›n,anteriorda dudaklar›n aras›ndan, bukkaldeise dudak köflesinden d›flar›ya uzat›lmas›nadikkat edildi. Her ölçüm üç defa arka arkayatekrarlanarak, üç de¤erin ortalamas› kullan›l-d›. E10MK11 Digital Strain Indicator ile eldeedilen de¤erler Mmm/mm (x10-6) birimindeolup, bu de¤erlerin gram’ a dönüfltürülmesiamac› ile, do¤al difllerden yararlan›larak ha-z›rlanan bir model üzerinde strain-gauge’ le-rin yer ald›¤› mini-plaklar yap›flt›r›l›p grama¤›rl›klar› yüklendi (fiekil 6). Bu kalibrasyon

The two wires existing from strain-gaugeswere coated in order to prevent short circuitand then strain gauges were connected tothe ‘E10MK11 Digital Strain Indicator’ (Tec-quipment Comp., USA) with half bridgeWheatstone technique (14) (Figure 5). Recor-dings were made at rest and during swallo-wing. The patients were seated in a dentalchair with their heads in natural head positi-on (15). Having strain gauges attached to thesurface of teeth with mini-plates, measure-ments were made after lips and cheek wereremoved from the surface of teeth and zerovalue on strain indicator was achieved. Sub-jects were asked to relax their lips and cheekat rest position and swallow their saliva du-ring swallowing. Patients repeated these po-sitions before measurements were establis-hed (14). Cables were extended to the outsi-de of the mouth between lips in the labialand from the corner of the lips in the buccal.Each measurement was repeated three timesand average of the three measurements wasused. The values achieved by E10MK11 Di-


115


fifieekkiill 44:: Akrilik mini-plakla

birlikte difle yap›flt›r›lan strain

gauge’ ler

FFiigguurree 44:: Acyrlic mini-plates

with strain gauges attached to

teeth.

fifieekkiill 55:: Difl üzerindeki bas›nç

de€erlerini ölçen ‘digital

strain indicator’ cihaz›

FFiigguurree 55:: Digital strain

indicator device used to

measure pressure values on

teeth.



iflleminde, 2 gram’ ›n 140 Mmm/mm (140x10(üzeri -6) mm/mm) de¤erine eflde¤er oldu¤u bu-lundu. Tüm ortalama de¤erler gram cinsindenhesapland› ve bas›nç olarak de¤erlendirildi.

Yumuflak dokular›n difller üzerine uygula-d›¤› bas›nc› ölçmek amac› ile üst ve alt kesicidifller ile sa¤ üst ve alt birinci büyük az› diflle-ri kullan›larak afla¤›daki ölçümler yap›ld›:

1) U1r(V) : Üst orta kesici difllerin vestibulyüzeylerine istirahat halinde duda¤›n uy-gulad›¤› bas›nçt›r.

2) U1r(P) : Üst orta kesici difllerin palatinalyüzeylerine istirahat halinde dilin uygula-d›¤› bas›nçt›r.

3) L1r(V) : Alt orta kesici difllerin vestibulyüzeylerine istirahat halinde duda¤›n uy-gulad›¤› bas›nçt›r.

4) L1r(L) : Alt orta kesici difllerin lingual yü-zeylerine istirahat halinde dilin uygulad›-¤› bas›nçt›r.

5) U6r(V) : Üst sa¤ birinci molar diflin vesti-bul yüzeyine istirahat halinde yana¤›n uy-gulad›¤› bas›nçt›r.

6) U6r(P) : Üst sa¤ birinci molar diflin pala-tinal yüzeyine istirahat halinde dilin uy-gulad›¤› bas›nçt›r.

7) L6r(V) : Alt sa¤ birinci molar diflin vesti-bul yüzeyine istirahat halinde yana¤›n uy-gulad›¤› bas›nçt›r.

8) L6r(L) : Alt sa¤ birinci molar diflin lingu-al yüzeyine istirahat halinde dilin uygula-d›¤› bas›nçt›r.

9) U1s(V) : Üst orta kesici difllerin vestibulyüzeylerine yutkunma halinde duda¤›nuygulad›¤› bas›nçt›r.

gital Strain Indicator were as Mmm/mm (x10-

6 mm/mm) unit and to translate these valuesto gram values, a model containing naturalteeth was prepared, strain gauges with mini-plates were attached and gram values wereloaded (Figure 6). It was found that 2 gm we-re equal to 140 Ìmm/mm( 140?10 ( -6)mm/mm) in this calibration procedure. Allthe average values were calculated as gramand evaluated as pressure. To measure thesoft tissue pressures on teeth, following me-asurements were made using upper and lo-wer incisors and right first molars.

1) U1r(V) : The pressure of lips on the labi-al side of upper central teeth at rest.

2) U1r(P) : The pressure of tongue on thepalatal side of upper central teeth at rest.

3) L1r(V) : The pressure of lips on the labi-al side of lower central teeth at rest.

4) L1r(L) : The pressure of tongue on thelingual side of lower central teeth at rest.

5) U6r(V) : The pressure of cheek on thebuccal side of upper first molar teeth atrest.

6) U6r(P) : The pressure of tongue on thepalatal side of upper first molar teeth atrest.

7) L6r(V) : The pressure of cheek on thebuccal side of lower first molar teeth atrest.

8) L6r(L) : The pressure of tongue on the lin-gual side of lower first molar teeth atrest.

9) U1s(V): The pressure of lips on the labial

fifieekkiill 66:: Kalibrasyon iflleminde

kullan›lan gram de€erleri

FFiigguurree 66:: Gram values used in

calibration.


117


10)U1s(P) : Üst orta kesici difllerin palatinalyüzeylerine yutkunma halinde dilin uygu-lad›¤› bas›nçt›r.

11) L1s(V) : Alt orta kesici difllerin vestibulyüzeylerine yutkunma halinde duda¤›nuygulad›¤› bas›nçt›r.

12) L1s(L) : Alt orta kesici difllerin lingual yü-zeylerine yutkunma halinde dilin uygula-d›¤› bas›nçt›r.

13) U6s(V) : Üst sa¤ birinci molar diflin vesti-bul yüzeyine yutkunma halinde yana¤›nuygulad›¤› bas›nçt›r.

14) U6s(P) : Üst sa¤ birinci molar diflin pa-latinal yüzeyine yutkunma halinde dilinuygulad›¤› bas›nçt›r.

15) L6s(V) : Alt sa¤ birinci molar diflin ves-tibul yüzeyine yutkunma halinde duda¤›nuygulad›¤› bas›nçt›r.

16) L6s(L) : Alt sa¤ birinci molar diflin lin-gual yüzeyine yutkunma halinde dilin uy-gulad›¤› bas›nçt›r.

Ayr›ca, istirahat ve yutkunma halindekitoplam vestibul ve toplam lingual de¤erleride hesapland›. Çal›flmada elde edilen verilerWilcoxon testi (Windows versiyonu 13.00SPSS Inc., Chicago, Illinois, USA) ile istatis-tiksel olarak de¤erlendirildi.

side of upper central teeth during swallo-wing.

10) U1s(P): The pressure of tongue on the pa-latal side of upper central teeth duringswallowing.

11) L1s(V): The pressure of lips on the labialside of lower central teeth during swallo-wing.

12) L1s(L): The pressure of tongue on the lin-gual side of lower central teeth duringswallowing.

13) U6s(V) :The pressure of cheek on thebuccal side of upper first molar teeth du-ring swallowing.

14) U6s(P) : The pressure of tongue on thepalatal side of upper first molar teeth du-ring swallowing.

15) L6s(V) : The pressure of cheek on thebuccal side of lower first molar teeth du-ring swallowing.

16) L6s(L) : The pressure of tongue on the lin-gual side of lower first molar teeth duringswallowing.

Also the total (incisor+molar) buccal andlingual pressure values were calculated atrest and during swallowing. The results ofthe study were analyzed by Wilcoxon testusing the Statistical Package for Social Scien-ces (Windows version 13.00 SPSS Inc., Chi-cago, Illinois, USA)

TTaabblloo II:: Ölçüm tekrarlama

katsay›lar› (r)

TTaabbllee II:: Intraclass correlation

coefficients (r) for repeated

measurements



BBUULLGGUULLAARRBireysel çizim ve hata düzeyinin kontrolü

amac› ile rastgele seçilen 10 bireye ait lateralsefalometrik ve anteroposterior film, ortodon-tik model ve yumuflak doku ölçümlerine ilifl-kin ‘ölçüm tekrarlama katsay›lar›n›n (r) 1.00tam de¤erine oldukça yak›n oldu¤u saptand›(16) (Tablo I).

Bireylerin pekifltirme dönemi 6. ve 9. ay-lar›nda iskeletsel ve dentoalveoler sefalomet-rik ve model ölçüm de¤erlerinde istatistikselolarak önemli bir de¤iflim kaydedilmedi (Tab-lo II,III).

RREESSUULLTTSSLateral and anteroposterior cephalomet-

ric, dental cast and soft tissue pressure me-asurements of randomly selected 10 subjectswere repeated by the same examiner and in-traclass correlation coefficients were nearly1.00 for all variables, confirming the reliabi-lity of the measurements (16). (Table I)

No significant change was found in ske-letal, dental and also dental cast measure-ments at the sixth (T1) and ninth months (T2)of retention treatment period. (Table II,III)

TTaabblloo IIII.. Lateral sefalometrik

ve anteroposterior ölçümlerin

retansiyonun bafllang›c› (T0),

alt›nc› (T1) ve dokuzuncu (T2)

aylar›ndaki ortalama

de€erleri (x) ve T0-T1, T1-T2

ve T0-T2 dönemleri

aras›ndaki farklar›n

önemlili€i

TTaabbllee IIII.. Mean values (x) of

lateral and anteroposterior

cephalogram measurements

at the beginning (T0), the

sixth (T1) and the ninth

months (T2) of retention and

significance values of

differences between T0-T1,

T1-T2 and T0-T2

TTaabblloo IIIIII.. Retansiyonun

bafllang›c› (T0), alt›nc› (T1) ve

dokuzuncu (T2) aylar›ndaki

dental model ölçümlerinin

ortalama de€erleri (x) ve T0-

T1, T1-T2 ve T0-T2 dönemleri


önemlili€i

TTaabbllee IIIIII.. Mean values (x) of

dental cast measurements at

the beginning (T0), the sixth

(T1) and the ninth months

(T2) of retention and

significance values of

differences between T0-T1,

T1-T2 and T0-T2

TTaabblloo IIVV.. Retansiyonun



yumuflak doku bas›nç

ölçümlerinin (gm) ortalama

de€erleri (x) ve T0-T1, T1-T2

ve T0-T2 dönemleri


önemlili€i

TTaabbllee IIVV.. Mean values (x) of

soft tissue pressure

measurements (gm) at the

beginning (T0), the sixth (T1)

and the ninth months (T2) of

retention and significance

values of differences between

T0-T1, T1-T2 and T0-T2


119


U6s(V) ölçümünde T0-T1 dönemlerinde;L1s(V) ölçümünde ise T1-T2 ve T0-T2 dönem-lerinde istatistiksel olarak önemli art›fl (p<0.05)saptand›. Di¤er yumuflak doku ölçüm de¤erle-rinde pekifltirme tedavisi süresince önemli birde¤iflim tespit edilmedi (Tablo IV).

Tüm retansiyon tedavisi zamanlar›nda(T0,T1,T2), istirahat ve yutkunma halindeiken lingual bas›nçlar›n 0.01 düzeyinde ves-tibul bas›nçlardan daha fazla oldu¤u bulun-du (Tablo V).

TTAARRTTIIfifiMMAAÇekimli veya çekimsiz olarak tedavi edil-

mifl ço¤u vakada relaps›n meydana geldi¤ibirçok çal›flmada bildirilmektedir (9,17-20).Bir k›s›m araflt›r›c›, intraoral ve ekstraoral yu-muflak dokular›n difller üzerine uygulad›klar›bas›nc›n retansiyon döneminde relapsa se-bep olabilece¤ini ve elde edilen difl pozis-yonlar›n›n korunmas› veya stabilizasyonuiçin difllere z›t yönlü bas›nç uygulayan yumu-flak dokular›n birbirini dengelemesi gerekti¤i-ni bildirmektedir (6,8,9,21,22). Bu çal›flmadaorofasiyal yumuflak dokular›n relaps üzerin-deki önemli etkisi göz önünde bulundurula-rak dudak, yanak ve dilin difllerin vestibul vepalatal/lingual yüzeylerine uygulad›klar› ba-s›nç ölçüldü. Difl ve alveolar yap› üzerindekibas›nç ölçümlerinde bafl pozisyonu da çokönemlidir. Ingervall ve Thüer (15) bafl ekstan-siyon durumundayken, do¤al bafl konumunagöre bas›nçlar›n daha fazla oldu¤unu bildir-mektedirler. Bu sebeple, bu çal›flmada yumu-flak doku ölçümlerinin bafl pozisyonundanetkilenmemesi için ölçümler do¤al bafl pozis-yonunda al›nd›. Yumuflak doku ölçüm sonuç-lar›n›n mümkün oldu¤unca gerçe¤i yans›tabil-mesi amac› ile daha önce yap›lan çal›flmalar-da da (11,23) güvenle kullan›lan 0.6/120LY11boyutunda strain gauge’ ler ve 1 mm inceli¤in-de mini akrilik plaklar kullan›ld› (12). Baz›araflt›rmalarda, istirahat halinde bas›nç ölçüm-lerinin, difl yüzeyinden 0-2 mm mesafede ya-p›lmas› gerekti¤i bildirilmektedir (23,24).

Bu çal›flmada, pekifltirme süresince inter-kanin ve intermolar geniflliklerinin ve ark bo-

The value of U6s (V) showed a significantincrease during T0-T1 (p<0.05) and L1s(V)measurement increased significantly duringT1-T2 and T0-T2 (p<0.05). There was no sig-nificant change in the other soft tissue pressu-re measurements during retention (Table IV).

The total lingual pressures at rest and du-ring swallowing were found significantly mo-re than the total vestibule pressures in all re-tention treatment periods (p<0.01) (Table V).

DDIISSCCUUSSSSIIOONNIn many studies it is reported that ortho-

dontic relapse occurs in most of the extracti-on or non-extraction cases (9,17-20). Forcesgenerated by extraoral and intraoral soft tis-sues are known to be a potent factor that canaffect the teeth position and malocclusion soan equilibrium between these opposite sidedsoft tissue pressures should be constructed toprovide stability (6,8,9,21,22). In this presentstudy lip, cheek and tongue pressures on thevestibule and palatal/lingual surfaces of theteeth were measured considering the effectof orofacial soft tissues in relapse. The headposition is also very important in pressuremeasurements of the teeth and alveolar pro-cess. Ingervall and Thüer (15) stated that thepressures are slightly greater with the head inextended than in the natural position. There-fore we have recorded the pressure values innatural head position. We have used strain-gauges 0.6/120LY11 in size that have beenused safely in previous studies (11, 23) andprepared acrylic mini-plates 1 mm in thick-ness to achieve the most reliable soft tissuepressures on the teeth as possible (12). In so-me researches it was pointed out that themeasurements of the resting pressures haveto be made within an area of 0 mm to 2 mmfrom the tooth surface (23,24).

In this study intercanine and intermolardimensions and arch alignment were foundstable during retention period. Some authors(25,26) claimed that there is no relationshipbetween mandibular crowding and interca-nine distance whereas others (27,28) stated

TTaabblloo VV.. Retansiyonun



total vestibul ve lingual

yumuflak doku bas›nç

ölçümlerinin (gm) istirahat ve

yutkunma halindeki ortalama

de€erleri (x) ve vestibul ile

lingual bas›nçlar aras›ndaki

farklar›n önemlili€i

TTaabbllee VV.. Mean values (x) of

total vestibule and lingual soft

tissue pressure measurements

(gm) at rest and during

swallowing at the beginning

(T0), the sixth (T1) and the

ninth months (T2) of retention

and significance values of

differences between vestibule

and lingual pressures



yu sapmalar›n›n korundu¤u bulundu. Birgrup araflt›rmac›, mandibular arkta görülençaprafl›kl›k ile interkanin geniflli¤indeki de¤i-flim aras›nda iliflki olmad›¤›n› ileri sürerken(25,26), bir baflka grup ise ortodontik tedavisonras› görülen çaprafl›kl›ktan tedavi esnas›n-da orijinal ark formuna sad›k kal›nmamas›n›sorumlu tutmaktad›r (27,28).

Bu çal›flmada, aktif tedavi sonunda eldeedilen kesici difllerin eksen e¤imleri ve ko-numlar›n›n pekifltirme süresince korundu¤utespit edildi. Üner ve Dinçer’ in (29), Hawleyapareyi ile yap›lan retansiyonun, üst ve alt diflkonumlar›na etkisini inceledikleri çal›flmada,alt kesici difllerin lingoversiyonuna ba¤l› ola-rak interinsizal aç›n›n artt›¤› bildirilmektedir.

Bu araflt›rmada yutkunma s›ras›nda üstmolar diflte alt›nc› ay sonunda; alt kesici difl-te alt›nc› ve dokuzuncu ay sonunda vestibultaraftaki yanak ve dudak bas›nçlar›nda istatis-tiksel olarak önemli art›fllar saptanmas›nara¤men, istirahat halinde yumuflak doku ba-s›nçlar›nda önemli bir de¤iflim gözlenmedi.Çi¤neme ve yutkunma s›ras›nda kesicilerüzerine etkiyen kuvvetler k›sa süreliyken;gün boyu 4-6 saatten daha uzun etkiyen kuv-vetlerin k›sa sürede difl hareketi oluflturabile-ce¤i öne sürülmektedir (30). Di¤er taraftandifl pozisyonlar›n›n stabilizasyonunda, ‹stira-hat halindeki kuvvetlerin en fazla öneme sa-hip oldu¤u; bu nedenle de yumuflak dokula-r›n istirahat halinde uygulad›klar› bas›nc›ndaha çok dikkate al›nmas› gerekti¤i vurgulan-maktad›r (6,31,32). Bu sebeple araflt›rmadayumuflak doku bas›nçlar›, istirahat ve ikinciolarak da en fazla yap›lan fonksiyon olan yut-kunma halinde ölçüldü.

Bu araflt›rmada, istirahat ve yutkunma po-zisyonlar›nda total dil bas›nç de¤erlerinin,dudak ve yanak bas›nç de¤erlerine oranla da-ha fazla oldu¤u bulundu. Bu z›t yönlü kuv-vetlerin dengeli olmamas›na ra¤men, difl po-zisyonlar›nda relapsa rastlanmad›. Dentisyonüzerinde, kesik kesik etkiyen dil kuvvetleri-nin ve sürekli etkiyen yanak kuvvetlerinin d›-fl›nda, oklüzyon kuvvetleri gibi birçok kuvvetetkili olmaktad›r (6). Gould ve Picton (23) ileKato ve ark.’ n›n (33) belirtti¤i gibi difllerinkök formlar›, kron boyutlar›, eksen e¤imleri,periodontal membrane, alveolar kemi¤in yo-¤unlu¤u ve okluzal kuvvetler gibi faktörlerlingual kuvvetleri dengelemifl olabilir.

that changes in intercanine distance is res-ponsible for mandibular arch crowding.

In this study the achieved positions andinclinations of incisors at the end of activeorthodontic treatment were found stable du-ring retention. Üner ve Dinçer (29) reportedthat interincisal angle increased significantlydue to the lingoversion of lower incisors in astudy that evaluated the effects of Hawley re-tention appliance in upper and lower teethpositions.

In this study significant increase was ob-served in soft tissue pressures on the vestibu-le side of upper molar teeth at the end ofsixth month and also lower incisors both atthe sixth (T1) and ninth months (T2) of reten-tion treatment period during swallowingwhile there was no significant change at restposition in non of the soft tissue pressure me-asurements. Forces that act on incisors du-ring chewing and swallowing are of shortduration, but it has been postulated that for-ces operating longer than 4 to 6 hours perday can produce tooth movements in a rela-tively short time (30). On the other hand res-ting forces have the greatest importance onthe position of teeth so it has been emphasi-zed that soft tissue pressures at rest positionshould be taken into consideration (6,31,32).Therefore in this study we have measuredsoft tissue pressures at rest position and thenduring swallowing which is the most repea-ted function.

In this present investigation total lingualpressures both at rest position and duringswallowing were found more than total ves-tibule pressures. Although these opposite si-ded forces were not in equilibrium there wasno relapse in the position of teeth. Many for-ces operate on the dentitions not only the in-termittent tongue force or the more constantcheek forces but also the forces of occlusion(6). Root forms of the teeth, dimensions ofthe teeth crowns, inclination of the teeth, pe-riodontal membrane, density of alveolar bo-ne and occlusal forces could equilibrate lin-gual pressures as Gould and Picton (23) andKato et al. (33) stated.

The stability of the difference betweenlingual and vestibule pressures in the favor oflingual pressures during retention treatmentperiod could demonstrate soft tissue adapta-


121


Difllerin vestibul ve lingual bölgelerinde-ki yumuflak doku bas›nçlar› aras›nda lingualbas›nçlar›n lehine olacak flekilde bulunanfark›n pekifltirme süresince de¤iflmemesi, yu-muflak doku adaptasyonunun sa¤land›¤›n›gösterebilir. Son y›llarda yay›nlanm›fl olanWinocur ve ark.’ n›n (34) çal›flmas›nda, nö-romusküler adaptasyonun braket sökümün-den birkaç dakika sonra bafllad›¤›; ikinci afla-ma olarak musküler adaptasyonun retansiyo-nun ilk üç ay›nda gerçekleflti¤i bildirilmekte-dir. Küçükkelefl ve ark. (35) h›zl› çene genifl-letmesi uygulad›klar› çal›flmada, yanak vedudaklar›n dental arklar›n yeni pozisyonunaretansiyonun ilk üç ay›nda uyum sa¤lad›¤›n›;dil adaptasyonunun ise daha uzun sürdü¤ü-nü bildirmektedirler.

Bu araflt›rmada, retansiyon süresince in-traoral ve ekstraoral yumuflak doku bas›nçla-r› aras›ndaki dengenin korunmufl olmas› veyaadaptasyonunun gerçekleflmesi, üst ve altmolar difllerin bukkolingual e¤imleri ile inter-molar ve interkanin geniflliklerin de¤iflmeme-si aras›nda iliflki kurulabilinir.

Baz› araflt›rmac›lar, alt çenenin lingualin-de bukkal bölgeye göre daha fazla bas›nçbulduklar›n› belirtmektedir (6,23). Thüer (22)ise mandibulan›n posterior bölgesinde buk-kal ve lingual bas›nçlar›n ayn› büyüklükte ol-du¤unu bildirmektedir. Proffit (4) de, di¤erçal›flmalardan daha fazla olmakla birlikte,bukkal ve lingualdeki bas›nçlar›n ayn› bü-yüklükte oldu¤unu bildirmektedir. Hensel(36) ise farkl› olarak lingual bölgede bukkalbölgeden daha az bas›nç tespit ettiklerini be-lirtmektedir. Thüer ve ark. (22) ile Lear veMoorrees (37) da maksillada median bukkalbölgede, istirahat halindeki bas›nçlar›n lingu-al bas›nçlardan 2.7 kat daha fazla oldu¤unu;Hensel (36) de bukkal bas›nçlar›n lingual ba-s›nçlardan 7 kat daha fazla oldu¤unu bildir-mektedirler. Çal›flmalardaki bu çeliflkili so-nuçlar farkl› yöntemlerin uygulanmas›ndankaynaklanabilir. Bizim çal›flmam›zda, bukkalbölgeden daha fazla bulunan lingual bas›nç-lar birçok araflt›rmac›n›n sonuçlar›yla uyumiçerisindedir (6,22,38). Bu bas›nçlar›n, günboyu az sürede etkili olduklar› için difl pozis-yonunu etkilemeyece¤ine inan›lmaktad›r (6).Ruan ve ark. (39) istirahat halinde, dudak veyanak kuvvetlerinin, dil kuvvetinden dahafazla oldu¤unu; yutkunma halinde ise dilkuvvetinin, labial kuvvetten daha fazla oldu-

tion. In a recent study Winocur et al.(34) sta-ted that neuromuscular adaptability beginswithin several minutes after bracket removaland a second stage of muscular adaptationoccurs within 3 months of retention. Küçük-kelefl et al (35) reported that the cheeks andlips almost adapt to the new position of den-tal arches at the end of the third months ofretention, whereas tongue adaptation tookcomparatively longer in which rapid maxil-lary expansion treatment was applied.

The stability and adaptation of intraoraland extraoral soft tissues could be related tothe buccolingual inclination of upper and lo-wer molar teeth and also the constancy of in-tercanine and intermolar dimensions.

Some authors have found considerablyhigher pressures on the lingual than on thebuccal side in the mandible (6,23). Howe-ver, Thüer (22) found same magnitude ofpressure on the buccal and lingual side ofthe mandibular posterior teeth. Also pressu-res reported by Proffit (4) were of about thesame magnitude, buccally and lingually, butconsiderably larger than those reported bypractically all other authors. In contrast Hen-sel (36) found smaller lingual than buccalpressures. In the maxilla Thüer et al.(22) andLear and Moorrees (37) found the medianbuccal resting pressure 2.7 times greaterthan the lingual pressure; on the other handHensel (36) reported seven times greaterbuccal than lingual pressures. The inconsis-tent results could largely be due to a metho-dological nature. In our study the greater lin-gual than buccal pressures during swallo-wing are in line with the results of many aut-hors (6,22,38). Because of their short durati-on during the day and night, these pressuresare, however, not believed to influence theposition of the teeth (6). Ruan et al. (39), sho-wed that the forces from the lips and the che-eks at rest are higher than those from the ton-gue, while the lingual force is larger than la-bial force during swallowing. It is stated thatadditional forces add up to the equilibriumof tooth position. Forces emanating from theperiodontal membrane, occlusion, rootforms, inclination of the teeth, alveolar bonedensity, dimension of teeth crown are the ot-her factors influencing the equilibrium(23,33).

KKAAYYNNAAKKLLAARR//RREEFFEERREENNCCEESS

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18. Little RM: Stability and relapse of mandibularanterior alignment: University of Washingtonstudies. Semin Orthod 1999; 5:191-204.

19. Erdinc AE,Nanda RS, Ifliksal E: Relapse of anteri-or crowding in patients treated with extractionand nonextraction of premolars. Am J OrthodDentofacial Orthop 2006; 129: 775-84.

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21. Retain K. Clinical and histologic observations ontooth movement during and after orthodontictreatment. Am J Orthod 1967; 53: 721-45.

22. Thüer U, Sieber R, Ingervall B. Cheek and tongu-e pressures in the molar areas and the atmosphe-ric pressure in the palatal vault in young adults.Eur J Orthod 1999; 21: 299-309.

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¤unu bildirmektedir. Difllerin stabilizasyon-lar›nda baflka faktörler oldu¤u ileri sürülmek-te olup, bu faktörler aras›nda periodontalmembran, oklüzyon, difl köklerinin flekilleri,difllerin eksen e¤imleri, alveolar kemik yo-¤unlu¤u, difl kronlar›n›n uzunlu¤u say›lmak-tad›r (23,33).

SSOONNUUÇÇAktif ortodontik tedavi sonras›nda iskelet-

sel ve dentoalveoler iliflkilerin korundu¤u; is-tirahat halinde intraoral ve ekstraoral yumu-flak doku bas›nçlar›n›n de¤iflmedi¤i saptand›.Retansiyon tedavisi süresince, dil bas›nc›n›ndudak ve yanak bas›nc›na göre fazla bulun-mas›na ra¤men difl pozisyonlar›n›n stabil kal-d›¤› sonuçlar›na var›ld›.

CCOONNCCLLUUSSIIOONNSSAfter active orthodontic extraction treat-

ment skeletal and dental measurements, in-traoral and extraoral soft tissue pressures atrest were stable. Although lingual pressurewas more than lip and cheek pressures, teethpositions were stable during retention treat-ment period.


123


21. Little RM, Wallen TR, Riedel RA. Stability andrelapse of mandibular anterior alignment- firstpremolar extraction cases treated by traditionaledgewise orthodontics. Am J Orthod 1981; 80:349-65.

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32. Kato Y, Kuroda T, Togawa T. Perioral force me-asurement by a radiotelemetry device. Am J Ort-hod Dentofacial Orthop 1989; 95: 410-4.

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34. Küçükkelefl N, Ceylano¤lu C. Maxillary expansi-on using a diaphragm pressure transducer. Ang-le Orthod 2003; 73: 662-8.

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37. Luffingham JK. Lip and cheek pressure exertedupon teeth in three adult groups with differentocclusions. Archs Oral Biol 1969; 14: 337-50.

38. Ruan WH, Chen MD, Gu ZY, Lu Y, Su JM, GuoQ. Muscular forces exerted on the normal deci-duous dentition. Angle Orthod 2005; 75: 785-90.

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