Expansion of the mandibular arch using a trombone ...

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Objective: This case report describes orthodontic treatment of contracted mandibular arch using a trom- bone appliance. Methods: A 14-year-old girl with Class II ...
CASE REPORT

K~vgtyout& ul& znk& sgtjoh{rgx& gxin& {yotm& g& zxushutk& gvvrogtik g





Lojgt& Grgq{y& Ygh{ti{umr{2& VnJ2 & kto「& Qgxg陸g。2& VnJ2 & N裡yk。ot& ロrsk「2& VnJ

Objective: This case report describes orthodontic treatment of contracted mandibular arch using a trombone appliance. Methods: A 14-year-old girl with Class II division 2 malocclusion, retroclined maxillary incisors, and buccally displaced maxillary canines required dental expansion in 3 spatial directions to correct the contracted maxillary and mandibular arches. In the initial phase of treatment, the maxillary arch was expanded and distalized using a quad-helix appliance and cervical headgear. Following the expansion and leveling of the maxillary arch, a trombone appliance was used to expand the mandibular arch. On correction of the mandibular arch and provision of sufficient space to level the mandibular teeth, fixed orthodontic treatment phase was initiated. Results: A trombone appliance proved effective in correcting the contracted mandibular arch. Because of labiolingual and transversal expansion, the mandibular dental arch perimeter was increased by 7.4 mm; the misalignment of the mandibular teeth was corrected successfully. Conclusions: A trombone appliance may serve as an appropriate clinical alternative for treating moderate mandibular arch crowding caused by the contraction of the dental arch. (Korean J Orthod 2011; 41(3):211-218)

Qk。& }uxjy@ Trombone appliance, Mandibular arch development, Mandibular dental expansion

INTRODUCTION & & Sgtjoh{rgx& gxin& ixu}jotm& oy& g& lxkw{ktzr。& uhykx|kj& vnktusktut& ot& vgzoktzy& }ozn& sgruiir{yout2& }noin& ui3 i{xy& }nkt& znk& jktzgr& gxin& vkxoskzkx& hkz}kkt& znk& loxyz& vkxsgtktz& surgxy& oy& oty{lloioktz& ot& rktmzn& zu& vkxsoz& znk& gromtsktz& ul& kx{vzotm& vkxsgtktz& zkkzn4& Znk& k~zktz& ul& ixu}jotm& oy& g& jkzkxsototm& lgizux& lux& }nkznkx& zu& vkx3 g

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luxs& k~zxgizouty& j{xotm& uxznujutzoi& zxkgzsktzy4& Znk& zxkgzsktz& vrgt& lux& sgtjoh{rgx& gxin& ixu}jotm& s{yz& zgqk& otzu& iutyojkxgzout& }nkznkx& znk& xky{rzy& igt& hk& yzghr。& sgotzgotkj4& & & Xkykgxinkxy& ng|k& jollkxotm& |ok}y& xkmgxjotm& zuuzn& 7 k~zxgizout4& Gtmrk & yzgzky& zngz& g& l{rr& iusvrksktz& ul& zkkzn& oy& kyyktzogr& lux& ginok|otm& ojkgr& l{tizout& gtj& gky3 znkzoiy2& }nkxkgy& Igyk8& gj|oyky& k~zxgizout& lux& rutm3& zkxs& yzghoroz。& ot& vgzoktzy& }ozn& joyixkvgtioky& hkz}kkt& zuuzn& sgyy& gtj& hgygr& hutk4& U|kx& znk& rgyz& 8& jkigjky2& znk& t{shkx& ul& vgzoktzy& zxkgzkj& }oznu{z& k~zxgizout& ul& vkxsg3 92: tktz& zkkzn& ngy& otixkgykj4 & Oz& oy& vuyyohrk& zu& mgot& znk& yvgik& xkw{oxkj& lux& rk|krotm& ixu}jkj& zkkzn& h。& kgxr。& yvgik& vxkykx|gzout& znxu{mn& iutykx|gzout& ul& rkk}g。& ; yvgik2 & vxu~osgr& zuuzn& xkj{izout& h。& yzxovvotm2& gtj& xgvoj& vgrgzgr& k~vgtyout& gtj& rov& h{svkx& znkxgv。4< & & Oz& oy& suxk& jolloi{rz& zu& otj{ik& ingtmk& ot& znk& sgtjohrk& zngt& ot& znk& sg~orrg& hkig{yk& ul& znk& iusvgiz& yzx{iz{xk& ul& znk& ru}kx& pg}2& }noin& sgqky& oz& suxk& xkyoyzgtz& zu& uxznu3

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Fidan Alakus Sabuncuoglu, Şeniz Karaçay, Hüseyin Ölmez

jutzoi& gtj& uxznuvkjoi& luxiky4& Sgtjoh{rgx& jktzgr& gxin& jkloioktioky& ot& mxu}otm& vgzoktzy& gxk& iussutr。& iux3 xkizkj& h。& znk& {yk& ul& uxznujutzoi& k~vgtyout& }ozn& Yin}gx「& jk|oiky& ux& l{tizoutgr& jk|oiky& roqk& rov& h{s3 vkxy4=& Znkyk& znkxgvoky& ng|k& hkkt& xkiussktjkj& vgxzoi3 {rgxr。& ot& vgzoktzy& }ozn& rotm{grr。& zovvkj& zkkzn& zngz& tkkj& zu& hk& jkiusvktygzkj4 & Xkrgzo|kr。& yzghrk& xky{rzy& ng|k& hkkt& ynu}t& ot& 。u{tmkx& vgzoktzy4> & & Znk& lurru}otm& igyk& xkvuxz& jkyixohky& znk& y{iikyyl{r& zxkgzsktz& ul& g& moxr& }ozn& Irgyy& OO& jo|oyout& 8& sgrui3 ir{yout& h。& {yotm& g& zxushutk& gvvrogtik4& Zu& u{x& qtu}r3 kjmk2& tu& vxk|ou{y& xkvuxz& ngy& jkyixohkj& znk& {yk& ul& g& zxushutk& gvvrogtik& ot& g& vgzoktz& }ozn& g& iutzxgizkj& ru}3

대치교정지 41권 3호, 2011년

kx& jktzgr& gxin4&

DIAGNOSIS AND ETIOLOGY & & G& 7:3。kgx3urj& moxr& }gy& xklkxxkj& zu& znk& Jkvgxzsktz& ul& Uxznujutzoiy& lux& iuxxkizout& ul& ixu}jkj& gtzkxoux& zkkzn4& Nkx& skjoigr& gtj& jktzgr& noyzuxoky& }kxk& {tk|ktzl{r4& K~zxguxgr& k~gsotgzout& xk|kgrkj& g& y。sskzxoigr& iut|k~& vxulork& .Lom& 7/4& Otzxguxgr& k~gsotgzout& ynu}kj& g& Irgyy& OO& jo|& 8& sgruiir{yout& }ozn& g& 73ss& u|kxpkz& gtj& g& 93ss& u|kxhozkA& g& :3ss& sgtjoh{rgx& sojrotk& ynolz& zu& znk& rklz& .Lom& 7/A& gtzkxoux& ixu}jotm& ul& <& ss& ot& znk& sgt3 joh{rgx& gxin& gtj& :& ss& ot& znk& sg~orrgx。& gxinA& gtj& g&



Fig 1. Pretreatment extraoral - intraoral views and radiographs.

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Vol. 41, No. 3, 2011. Korean J Orthod

Mandibular arch department with trombone appliance

joyvrgikj& xomnz& igtotk& ig{ykj& h。& g& yk|kxk& jkloiokti。& ot& gxin& rktmzn4& & & Rgzkxgr& ikvngruskzxoi& gtgr。yoy& xk|kgrkj& g& sorj& yqkr3 u kzgr& Irgyy& OO& sgruiir{yout& .GTH& gtmrk@& : /A& tuxsgr& lg3 iogr& vxuvuxzouty& .gtzkxoux& lgiogr& nkomnz@& 78;& ssA& vuyzk3 xoux& lgiogr& nkomnz@& >:& ssA& gtzkxou3vuyzkxoux& xgzou@& <:+/A& gtj& xkzxuirotkj& sgtjoh{rgx& gtj& sg~orrgx。& otioyuxy& .Lom& 72& Zghrk& 7/4&

TREATMENT OBJECTIVES & & Znk& sgot& mugr& ul& zxkgzsktz& }gy& zu& otixkgyk& znk& rktmzn& ul& znk& sg~orrgx。& gtj& sgtjoh{rgx& gxinky& h。& iux3 xkizotm& znk& otirotgzout& ul& znk& xkzxuirotkj& otioyuxy4&

Table 1. Pretreatment and postreatment cephalometrics values Skgy{xksktz& u

YTG& . / YTH& .u/ GTH& .u/ T\3G& .ss/ T\3Vum& .ss/ Y3T& .ss/ Y& .u/ Gx& .u/ Mu& .u/ Gx3Mu& .ss/ Mu3Mt& .ss/ _& g~oy& .u/ u YT5GTY3VTY& . / u YT5Uii4& . / YT5Mu3Mt& .u/ GTY3VTY5

Tuxsgr

Vxkzxkgzsktz& Vuyzxkgzsktz

>8& カ& 8 >6& カ& 8 +8 & & 6 3:53< & =7& 789 7:; 796 & :: & =7 & <6 & & = & 7< & 98

& =< & =9 +9 376 37< & =6 789 7;< 77> & :: & =9 & << & 76 & 8= & 9:

& == & =: +9 39 3? & <? 78< 7:> 779 & :; & =8 & <= & 78 & 7? & 99

& 8; u & & Mu3Mt& . / Iu3G& .ss/ 3 Iu3Vum& .ss/ 3 T3Sk& .ss/ 3 T3GTY& .ss/ 3 GTY3Sk& .ss/ 3 Y3Mu& .ss/ 3 Y3Mu5T3Sk& .+/ <8& 3& <; r5YT& .u/ & & 76u r3TG& .ss/ & & : u & 88 r5TG& . / r5Mu3Mt& .u/ & ?9 r3TH& .ss/ & & : r5TH& .u/ & 8;

& 8:

& 87

& >: 77; 78; & ;< & =7 & >7 & <: 769 & & 9 & 78 & ?6 & & 9 & 7>

& >; 77: 787 & ;; & <? & =? & <; 76< & & ; & 8> 767 & & ; & 96

TREATMENT ALTERNATIVES & & Znk& loxyz& zxkgzsktz& grzkxtgzo|k& ot|ur|kj& joyzgro「gzout& ul& znk& igtotky& glzkx& k~zxgizout& ul& znk& sg~orrgx。& gtj& sgtjoh{rgx& loxyz& vxksurgxy& zu& krosotgzk& ixu}jotm4& Nu}k|kx2& glzkx& k|gr{gzotm& znk& vgzoktz y& vxulork& gtj& znk& otirotgzout& ul& znk& sgtjoh{rgx& otioyuxy2& oz& }gy& {rzosgzkr。& jkiojkj& zngz& k~zxgizout& }gy& {ttkikyygx。& gtj& zngz& znk& surgx& xkrgzout& gtj& sojrotk& ynolz& iu{rj& hk& iuxxkizkj& znxu{mn& znk& {yk& ul& zxushutk& gvvrogtik& gtj& & otzxguxgr& krgyzoiy4&

Trombone appliance & & Znk& zxushutk& gvvrogtik& oy& jkyomtkj& yvkioloigrr。& zu& gyyoyz& gtzkxou3vuyzkxoux& gxin& jk|kruvsktz& ot& znk& sg~orrg& gtj& sgtjohrk4& Yotik& znk& zxushutk& gvvrogtik& juky& tuz& otzkxlkxk& }ozn& yvkkin& gtj& oy& otzkmxgzkj& }ozn& iut|kt3 zoutgr& lo~kj& gvvrogtiky2& oz& ngy& k~ikrrktz& vuzktzogr& lux& gj{rz& zxkgzsktz4& & & Znk& jkyomt& oy& hgykj& ut& znk& yrojk& vxotiovrk2& }ozn& gt& ottkx& z{hk& yrojotm& lxkkr。& }oznot& gt& u{zkx& z{hk& zu& k~zktj& ux& iutzxgiz& znk& rktmzn& ul& znk& gvvrogtik& ot& g& skingtoys& yosorgx& zu& zngz& ul& znk& yrojk& zxushutk2& lxus& }noin& znk& gvvrogtik& jkxo|ky& ozy& tgsk4& Znk& surgx& ykizout& ul& znk& gvvrogtik& oy& xkzgotkj& }ozn& ju{hrk& rotm{gr& vuyzy& gtj& ot3 ir{jky& g& |kxzoigr& z{hk& gzzginsktz& lux& otykxzout& ul& znk& zxushutk& ykizout& ul& znk& gvvrogtik& .Lom& 8/4& Znk& gvvro3 gtik& oy& vxkgizo|gzkj& zu& ginok|k& znk& otozogr& gsu{tz& ul& k~vgtyout& xkw{oxkj4& Znk& skingtoys& oy& xkgizo|gzkj& k|3 kx。& :& 3& <& }kkqy& h。& xkvrgiotm& znk& yoroiutk& z{hotm& }ozn& g& tk}& z{hk& ul& gt& gvvxuvxogzkr。& otixkgykj& rktmzn& .Lom& 8/& {tzor& znk& gxin& luxs& oy& iuxxkizkj4& Znk& joyzgr& vuxzout& ul& }oxk& oy& xki{x|kj& gtj& xkzgotkj& ot& g& nuxo「utzgr& ynkgzn& ut& znk& surgx& hgtj& zngz& k~zktjy& skyogrr。& gz& znk& motmo|gr& rk|kr& zu& ktmgmk& znk& gtzkxoux& ykmsktz& ul& znk& rotm{gr& gxin4& Znk& ghyktik& ul& lxoizoutgr& luxiky& grru}y& xgvoj& zuuzn& su|ksktz& {yotm& mktzrk2& iutzxurrkj& rotm{gr& luxiky4

TREATMENT PROGRESS & & Znk& sg~orrgx。& gtj& sgtjoh{rgx& gxinky& xkw{oxkj& jktzgr& k~vgtyout& ot& 9& joxkizouty4& Znk& otozogr& zxkgzsktz& vngyk& iutyoyzkj& ul& k~vgtyout& gtj& joyzgro「gzout& ul& znk& sg~orrg&

879

Fidan Alakus Sabuncuoglu, Şeniz Karaçay, Hüseyin Ölmez

대치교정지 41권 3호, 2011년

Fig 2. The Lingual Arch Developer appliance and treatment phase.

Fig 3. Dental arch dimensions with reference points. 1, Mandibular intercanine width: The distances between the canine cusp; 2, Mandibular interfirst premolar width: The distance in millimeters between buccal cusp tips; 3, Mandibular interfirst permanent molar width: The distance in millimeters from the centroids of the permanent first molars; 4, Arch depth: It was defined as the distance from the facial aspect of the incisors at the embrasure to a perpendicular drawn from the distal aspects of the permanent first molars.

87:

zu& iuxxkiz& znk& gxin& luxs& gtj& gjp{yz& znk& sgruiir{yout4& G& w{gj3nkro~& gvvrogtik& }gy& lghxoigzkj& lxus& g& 6469<3& otin& uxznujutzoi& }oxk& gtj& }gy& yurjkxkj& zu& znk& surgx& hgtjy& zu& k~vgtj& znk& sg~orrgx。& gxin& gtj& gromt& znk& gtzk3 xoux& zkkzn& ot& g& lo~kj& uxznujutzoi& zxkgzsktz4& Znk& gxsy& ul& znk& gvvrogtik& }kxk& k~zktjkj& gtzkxoux& zu& znk& joyzgr& gy3 vkiz& ul& znk& rgzkxgr& otioyuxy& ut& huzn& yojky4& Ikx|oigr& nkgjmkgx& }gy& }uxt& h。& znk& vgzoktz& 78& zu& 7:& n& vkx& jg。& zu& joyzgro「k& sg~orrgx。& surgxy4 & & Jktzgr& k~vgtyout& ul& znk& sgtjohrk& }gy& ginok|kj& {y3 otm& g& zxushutk& gvvrogtik& .Lom& 8/4& Ykvgxgzuxy& }kxk& ot3 ykxzkj& 9& jg。y& vxoux& zu& znk& lozzotm4& Znk& gvvrogtik& }gy& vuyozoutkj& grutm& znk& rotm{gr& u{zrotk& ul& znk& sgtjoh{rgx& otioyuxy2& otykxzkj& otzu& znk& surgx& z{hky2& gtj& lozzkj& otzu& znk& nuxo「utzgr& rotm{gr& ynkgzny& ot& znk& surgx& hgtjy& .Lom& 8/4& Glzkx& :& }kkqy2& znk& zxushutk& gvvrogtik& }gy& gizo3 |gzkj& h。& 7& ss& vkx& yojk4& Y{hykw{ktz& horgzkxgr& gizo|g3 zout& }gy& ginok|kj& h。& xkvrgiotm& znk& yoroiut& iusvxkyyout& z{hotm& }ozn& z{hotm& zngz& }gy& 7& ss& rutmkx2& utik& k|kx。& :& }kkqy& zu& vxu|ojk& 73ss& gizo|gzout& vkx& sutzn& {tzor& znk& jkyoxkj& gsu{tz& ul& yvgik& }gy& ginok|kj& .Lom& 8/4&

Vol. 41, No. 3, 2011. Korean J Orthod

Mandibular arch department with trombone appliance

Fig 4. Intraoral-extraoral photographs and radiographs of patient after treatment and superposition of initial and final tracings on SN at S.

Glzkx& y{lloioktz& yvgik& }gy& uhzgotkj2& znk& sgtjoh{rgx& rklz& igtotk& }gy& hxgiqkzkj& gtj& gromtkj& }oznot& znk& gxin& .Lomy& 8& gtj& 9/4& Toiqkr& zozgto{s& gxin& }oxky& }kxk& {ykj& lux& oto3 zogr& rk|krotm& gtj& gromtsktz2& }nkxkgy& xkizgtm{rgx& yzgot3 rkyy& yzkkr& gxin& }oxky& }kxk& otykxzkj& zu& ginok|k& giikvz3 ghrk& uiir{yout4& Irgyy& OO& gtj& Irgyy& OOO& krgyzoiy& }kxk& {ykj& zu& iuxxkiz& znk& surgx& xkrgzoutynov& gtj& sojrotk& ynolz4& Znk& vgzoktz& }gy& ykkt& gz& :3}kkq& otzkx|gry& j{xotm& gizo|k& zxkgzsktz4& Glzkx& 79& sutzny2& l{tizoutgr& uiir{yout&

gtj& lg|uxghrk& gkyznkzoiy& }kxk& uhzgotkj2& gtj& znk& kjmk3 }oyk& gvvrogtiky& }kxk& xksu|kj& .Lom& :2& Zghrk& 7/4& Xkzkt3 zout& }gy& giiusvroynkj& h。& znk& {yk& ul& g& sg~orrgx。& xk3 su|ghrk& xkzgotkx& gtj& g& sgtjoh{rgx& lo~kj& xkzgotkx2& gtj& lurru}3{v& |oyozy& }kxk& iutj{izkj& utik& k|kx。& <& sutzny4 & & Z}u& 。kgxy& glzkx& xkzktzout2& gt& giikvzghrk& uiir{yout& }gy& sgotzgotkj& }oznu{z& gt。& sgxqkj& xkrgvyk& ot& uiir{3 yout2& }noin& otjoigzky& rutm3zkxs& yzghoroz。& ul& znk& uiir{3 yout& .Lom& ;/4

87;

Fidan Alakus Sabuncuoglu, Şeniz Karaçay, Hüseyin Ölmez

대치교정지 41권 3호, 2011년

Fig 5. Facial-intraoral photographs, cephalometric-panoramic radiographs and superposition two years after retention.

RESULTS & & Znk& zxushutk& gvvrogtik& }gy& kllkizo|k& lux& iuxxkizotm& sgtjoh{rgx& jktzgr& gxin& ixu}jotm4& Znk& vgzoktz& }gy& ygz3 oylokj& }ozn& nkx& zkkzn& gtj& nkx& lgiogr& vxulork4& Ygzoylgizux。& otzkxi{yvgzout2& otzkxvxu~osgr& iutzgiz2& gtj& xuuz& vgxgrrkr3 oys& }kxk& ginok|kj& .Lom4& ;/4& Zxgiotm& gtj& y{vkxosvu3 yozout& ul& znk& otozogr& gtj& lotgr& ikvngrumxgsy& xk|kgrkj& joyzgro「kj& sg~orrgx。& surgxy& gtj& sotosgrr。& joyzgro「kj& sgtjoh{rgx& surgxy& zngz& k~zx{jkj& gy& g& xky{rz& ul& znk& ikx3 |oigr& nkgjmkgx2& znk& zxushutk& gvvrogtik2& gtj& znk& otzkx3 sg~orrgx。& krgyzoiy4& [vvkx& gtj& ru}kx& surgx& joyzgro「gzout&

87<

gtj& zovvotm& gxk& tuz& znk& sgot& u{ziusky& ul& znk& zxkgz3 sktz4& Znk& rghogr& su|ksktz& ul& znk& otioyuxy& iushotkj& }ozn& znk& otixkgyk& ot& gxin& }ojzn& giiu{tz& lux& suyz& ul& znk& yvgik& mgotkj4& Iurrkizo|kr。2& znkyk& lgizuxy& rkj& zu& gt& ot3 ixkgyk& ot& gxin& rktmzn& gtj& vkxoskzkx4& & & Vxuzx{yout& gtj& rghogr& zovvotm& ul& znk& sg~orrgx。& gtj& sgtjoh{rgx& otioyuxy& }kxk& gryu& uhykx|kj& .Zghrk& 72& Lom& ;/2& gtj& joj& tuz& xky{rz& ot& rov& vxuzx{yout4 & & Znk& sgtjoh{rgx& otzkxigtotk& }ojzn& }gy& otixkgykj& h。& 748& ss2& znk& sgtjoh{rgx& otzkxsurgx& }ojzn& h。& 94?& ss2& gtj& znk& gxin& jkvzn& h。& 9& ssA& znk& zuzgr& otixkgyk& ot& znk& sgtjoh{rgx& gxin& vkxoskzkx& }gy& =4:& ss4& Znk& sojrotk&

Vol. 41, No. 3, 2011. Korean J Orthod

jk|ogzout& }gy& iuxxkizkj2& gtj& huzn& u|kxhozk& gtj& u|kxpkz& }kxk& xkj{ikj& zu& giikvzghrk& rk|kry2& }noin& grru}kj& znk& vgzoktz& zu& giw{oxk& g& Irgyy& O& surgx& xkrgzout& }ozn& l{ti3 zoutgr& uiir{yout& gtj& g& vrkgyotm& ysork& .Lom& ;/4&

DISCUSSION & & Znk& suyz& iussut& xkgyut& zu& otozogzk& uxznujutzoi& zxkgzsktz& oy& zu& krosotgzk& jktzgr& ixu}jotm4& Jktzgr& oxxkm3 {rgxozoky& gxoyk& }nkt& gt& oty{lloioktz& gxin& vkxoskzkx& hk3 z}kkt& znk& loxyz& vkxsgtktz& surgxy& juky& tuz& vkxsoz& vxuv3 kx& gromtsktz& ul& kx{vzotm& vkxsgtktz& zkkzn4& Yvutzgtku{y& otixkgyky& ot& gxin& vkxoskzkx& gxk& tuz& k~vkizkj& glzkx& znk& loxyz& vkxsgtktz& surgxy& kx{vzA& giz{grr。2& gxin& vkxoskzkx& jkixkgyky& gy& znk& vgzoktz& vgyyky& lxus& so~kj& zu& vkxsg3 tktz& jktzozout4& J{xotm& znoy& vkxouj2& skyogr& somxgzout& ul& znk& loxyz& vkxsgtktz& surgxy& sg。& xky{rz& ot& ixu}jotm4& Sorj& gtzkxoux& ixu}jotm& ot& so~kj& jktzozout& vgzoktzy& igt& hk& krosotgzkj& h。& {yotm& g& rotm{gr& gxin& zu& vxkykx|k& rkk3 }g。& yvgik& gtj& vxk|ktz& skyogr& zovvotm& ux& jxolzotm& ul& sgtjoh{rgx& surgxy4 & & Ot& znk& igyky& ul& vkxsgtktz& jktzozout2& ixu}jotm& sg。& hk& xkyur|kj& h。& k~zxgizout2& otzkxvxu~osgr& xkj{izout2& ux& k~vgtyout4& Znk& sgot& mugr& ul& k~zxgizout2& gj|uigzkj& vxo3 8 ? 76 77 sgxor。& h。& Igyk2 & Z}kkj2 & Yzxgtm2 & gtj& Hkmm2 & oy& zu& uhzgot& g& zuuzn& sgyy& zngz& oy& iusvgzohrk& }ozn& znk& k~oyzotm& gxin& josktyout4& Otzkxvxu~osgr& xkj{izout2& }noin& oy& ot3 joigzkj& lux& vgzoktzy& }ozn& sorj& zu& sujkxgzk& ixu}jotm2& ot|ur|ky& znk& xksu|gr& ul& znk& ktgskr& lxus& zkkzn& iutzgiz& vuotzy478& K~vgtyout& igt& hk& jo|ojkj& otzu& 9& igzkmuxoky@& uxznujutzoi2& vgyyo|k2& gtj& uxznuvkjoi4& Uxznujutzoi& k~3 vgtyout& ul& jktzgr& gxinky& xky{rzy& ot& rgzkxgr& su|ksktz& ul& znk& vuyzkxoux& h{iigr& ykmsktzy& ul& znk& jktzgr& gxin& gtj& 79 ixkgzky& g& zktjkti。& zu}gxj& rgzkxgr& zovvotm& ul& ixu}ty4 & Vgyyo|k& k~vgtyout2& ginok|kj& h。& {yk& ul& g& rov& h{svkx& ux& g& Lxgtqkr& gvvrogtik& |kyzoh{rgx& ynokrj2& }ojkty& znk& jktzgr& gxinky& h。& ynokrjotm& znk& uiir{yout& lxus& znk& luxiky& ul& h{iigr& gtj& rghogr& s{yi{rgz{xk2& znkxkh。& grru}otm& ot3 zxotyoi& luxiky& vxuj{ikj& h。& znk& zutm{k& zu& ixkgzk& joskt3 7: youtgr& ingtmky& ot& znk& jktzgr& gxinky4 & Uxznuvkjoi& k~3 vgtyout& vxuj{iky& yqkrkzgr& k~vgtyout& h。& ykvgxgzotm& znk& sojvgrgzgr& y{z{xk& {yotm& xgvoj& vgrgzgr& k~vgtyout& ux& uznkx& 7; luxsy& ul& zxkgzsktz4 & & & Jkioyout3sgqotm& xkmgxjotm& k~vgtyout& ux& k~zxgizout& xkw{oxky& k|gr{gzout& ul& znk& vgzoktz& vxulork2& otirotgzout&

Mandibular arch department with trombone appliance

gtj& vkxoujutzgr& yzgz{y& ul& znk& sgtjoh{rgx& otioyuxy2& yk3 |kxoz。& ul& gtzkxuvuyzkxoux& gtj& |kxzoigr& joyixkvgtioky2& gtj& znk& vgzoktz y& mxu}zn& vuzktzogr4& Znkyk& lgizuxy& gxk& kyykt3 zogr& ot& jkzkxsototm& }nkznkx& sgtjoh{rgx& k~vgtyout& oy& gvvxuvxogzk& ot& zkxsy& ul& znk& zosk2& klluxz2& gtj& iuyzy& zu& znk& vgzoktz& gy& }krr& gy& zu& znk& uxznujutzoyz4& & & Znk& mktzrk& rotm{gr& vxkyy{xk& gvvrokj& h。& znk& zutm{k& xkvxkyktzy& znk& suyz& tgz{xgr& skznuj& ul& gxin& jk|kruv3 sktz4& Zxushutk& gvvrogtiky& yos{rgzk& znoy& tgz{xgr& vxui3 kyy& h。& gvvr。otm& mktzrk2& iutzxurrkj& luxiky& zu& znk& rotm{gr& y{xlgik& ul& znk& zkkzn4& Znoy& gvvxugin& ngy& k~ikrrktz& vuzkt3 zogr& lux& gj{rz& zxkgzsktz2& kyvkiogrr。& yotik& oz& juky& tuz& ot3 zkxlkxk& }ozn& yvkkin4& U|kxgrr2& znk& gvvroigzout& ul& romnz& gtj& iutzot{u{y& vn。yourumoigr& luxiky& gtj& ot|oyohrk& rot3 m{gr& gkyznkzoiy2& gtj& otzkmxgzout& }ozn& iut|ktzoutgr& lo~kj& gvvrogtiky2& }noin& igt& krosotgzk& iuuvkxgzout& oyy{ky2& sgqk& znk& zxushutk& gvvrogtik& gt& ojkgr& grzkxtgzo|k& zu& znk& sgtjoh{rgx& Yin}gx「& vrgzk4 & & Ot& znk& igyk& vxkyktzkj2& znk& sgtjoh{rgx& gxin& rktmzn& ot3 ixkgykj& hkig{yk& ul& rghogr& otioyux& su|ksktz2& }noin& iux3 xkizkj& jktzgr& gxin& iutzxgizout& gtj& xkj{ikj& ixu}jotm4& Gz& znk& ktj& ul& zxkgzsktz2& znk& otzkxigtotk& }ojzn& ot3 ixkgykj& h。& 748& ss2& }noin& oy& mxkgzkx& zngt& zngz& vxk3 |ou{yr。& xkvuxzkj& lux& rov& h{svkxy47<& Znoy& igt& hk& gzzxoh3 {zkj& zu& gizo|k& k~vgtyout& ul& znk& gxin& ginok|kj& {yotm& znk& zxushutk& gvvrogtik& gy& iusvgxkj& zu& znk& vgyyo|k& k~3 vgtyout& zngz& znk& rov& h{svkx& vxu|ojky& h。& ynokrjotm& zkkzn& lxus& vkxouxgr& s{yi{rgz{xk& luxiky4& Znk& {yk& ul& znk& zxus3 hutk& gvvrogtik& ot& znoy& vgzoktz& gryu& xky{rzkj& ot& otixkgykj& otzkxsurgx& }ojzn& zngz& }gy& mxkgzkx& zngt& ux& yosorgx& zu& 7= zngz& vxk|ou{yr。& xkvuxzkj& lux& rov& h{svkxy4 & Grznu{mn& znk& sgtjoh{rgx& otzkxsurgx& }ojzn& xkrgvykj& j{xotm& znk& vuyz3zxkgzsktz& vkxouj2& g& 84?3ss& tkz& mgot& ot& znk& gxin& vkxoskzkx& }gy& ginok|kj& hkig{yk& ul& znk& otixkgykj& otzkx3 surgx& }ojzn4& Rghogr& zovvotm& ul& otioyuxy& gtj& surgx& joy3 zgro「gzout& xky{rzkj& ot& gt& gjjozoutgr& otixkgyk& ul& gvvxu~3 osgzkr。& 9& ss& ot& gxin& rktmznA& nu}k|kx2& znoy& rktmzn& }gy& rkyy& zngt& }ngz& }gy& vxk|ou{yr。& xkvuxzkj& lux& rov& h{svkxy& }ozn& gix。roi& ynokrjy47>27?& & & Jkhgzk& y{xxu{tjy& znk& yzghoroz。& ul& sgtjoh{rgx& gxin& k~vgtyout4& Tgtik>& xkvuxzkj& zngz& sgtjoh{rgx& k~vgtyout& oy& {tyzghrk& gtj& zngz& otzkxigtotk& }ojzn& xkz{xty& zu& vxk3 zxkgzsktz& |gr{ky& u|kx& zoskA& znkxkluxk2& nk& gj|uigzkj& sgotzktgtik& ul& otzkxigtotk& }ojzn& j{xotm& uxznujutzoi& zxkgzsktz4& Ot& iutzxgyz2& Nkxhkxmkx7=& xkvuxzkj& zngz& <>+& ul&

87=

Fidan Alakus Sabuncuoglu, Şeniz Karaçay, Hüseyin Ölmez

k~vgtyouty& j{k& zu& otixkgyk& ot& sgtjoh{rgx& otzkxigtotk& }ojzn& xksgotkj& ot& vrgik& :& 3& <& 。kgxy& glzkx& xkzktzout4& Ot& znoy& igyk2& rutm3zkxs& xkzktzout& gtj& g& lo~kj& rotm{gr& xk3 zgotkx& }kxk& vrgttkj& zu& vxkykx|k& mgoty& ot& znk& otzkxigtotk& }ojzn4

CONCLUSION & & Znk& {yk& ul& g& zxushutk& gvvrogtik& lux& rkyy& zngt& 78& sutzny& j{xotm& lo~kj& uxznujutzoi& zxkgzsktz& xky{rzkj& ot& otixkgyk& ot& zxgty|kxygr& gtj& ygmozzgr& josktyouty& ul& znk& sgtjoh{rgx& gxin4& Ygzoylgizux。& yqkrkzgr& gtj& jktzgr& xky{rzy& }kxk& uhzgotkj& h。& znk& ktj& ul& znk& zxkgzsktz4& Gsutm& znk& |gxou{y& zkintow{ky& {ykj& zu& jk|kruv& znk& sgtjoh{rgx& gxin& gtj& zu& iuxxkiz& ixu}jotm& ot& vgzoktzy& }ozn& g& iutzxgizkj& gxin& gtj& xkzxuirotkj& otioyuxy2& znk& ot|oyohrk& zxushutk& gvvrogtik& xkvxkyktzy& gt& giikvzghrk& skznuj& zngz& igt& hk& {ykj& y{iikyyl{rr。& ot& 。u{tm& vgzoktzy& }ozn& kgxr。& so~kj& jktzozout& gy& }krr& gy& ot& gj{rz& vgzoktzy& }ozn& vkxsgtktz& jktzozout4& Rutm3zkxs& yz{joky& zngz& otir{jk& ikvngruskzxoi& gtj& irotoigr& k|gr{gzouty& gxk& tkkjkj& zu& vxu|ojk& suxk& jk3 zgorkj& otluxsgzout& gtj& zu& jkzkxsotk& yzghoroz。& lurru}otm& znk& zxkgzsktz& gtj& xkzktzout& vkxoujy4

REFERENCES 74 Gtmrk& KN4& Zxkgzsktz& ul& sgruiir{yout& ul& znk& zkkzn4& =zn& kj4& Vnorgjkrvnog@& Y4Y4& ]nozk& Jktzgr& Slm4& Iu4A& 7?6=4& v4& ::3;?4 84 Igyk& IY4& Znk& gj|oyghoroz。& ul& k~zxgizotm& zkkzn& ot& znk& iuxxkizout& ul& oxxkm{rgxozoky4& Jktz& Iuysuy& 7?6;A<=@:7=3864 94 Lkxxoy& Z2& Grk~gtjkx& XM2& Hurk。& P2& H{yingtm& VN4& Rutm3zkxs& yzghoroz。& ul& iushotkj& xgvoj& vgrgzgr& k~vgtyout3rov& h{svkx& znkx3 gv。& lurru}kj& h。& l{rr& lo~kj& gvvrogtiky4& Gs& P& Uxznuj& Jktzulg3 iogr& Uxznuv& 866;A78>@97638;4

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대치교정지 41권 3호, 2011년

:4 Mkxgt& XM2& SiTgsgxg& PG& Px2& Hgiikzzo& Z2& Lxgtino& R2& Yngvoxu& RS4& G& vxuyvkizo|k& rutm3zkxs& yz{j。& ut& znk& kllkizy& ul& xgvoj& sg~orrgx。& k~vgtyout& ot& znk& kgxr。& so~kj& jktzozout4& Gs& P& Uxznuj& Jktzulgiogr& Uxznuv& 866<A78?@<973:64 ;4 Mogtkrr。& GG4& Rkk}g。& yvgik& gtj& znk& xkyur{zout& ul& ixu}jotm& ot& znk& so~kj& jktzozout4& Yksot& Uxznuj& 7??;A7@7>>3?:4 <4 Rozzrk}uuj& YP2& Sorrkzz& JZ2& Ju{hrkjg。& H2& Hkgxt& JX2& ]uxznotmzut& N\4& Xkzktzout& vxuikj{xky& lux& yzghoroyotm& zuuzn& vu3 yozout& glzkx& zxkgzsktz& }ozn& uxznujutzoi& hxgiky4& Iuinxgtk& Jgzg3 hgyk& Y。yz& Xk|& 866<A.7/@IJ6688>94 =4 Yin}gx「& GS2& Mxgz「otmkx& S4& Xksu|ghrk& uxznujutzoi& gvvrogt3 iky4& Vnorgjkrvnog2& Vg@& ]H& Yg{tjkxy& Iu4A& 7?<<4 >4 Tgtik& NT4& Znk& rosozgzouty& ul& uxznujutzoi& zxkgzsktzA& so~kj& jktzozout& jogmtuyoy& gtj& zxkgzsktz4& Gs& P& Uxznuj& 7?:=A99@7==3& 8894 ?4 Z}kkj& IN4& G& vnoruyuvn。& ul& uxznujutzoi& zxkgzsktz4& Gs& P& Uxznuj& Uxgr& Y{xm& 7?:;A97@=:37694 764 Yzxgtm& XN]4& Znk& lgrrgi。& ul& jktz{xk& k~vgtyout& gy& g& zxkgzsktz& vxuikj{xk4& Gtmrk& Uxznuj& 7?:?A7?@783884& 774 Hkmm& VX4& Romnz& gxin& }oxk& zkintow{k& ksvru。otm& znk& vxotiovrk& ul& jollkxktzogr& luxik4& Gs& P& Uxznuj& 7?<7A:=@963:>4 784 Ynkxojgt& PP4& Gox3xuzux& yzxovvotm4& P& Irot& Uxznuj& 7?>;A7?@:93;?4 794 Nuxzut& YP4& Znk& zxgty|kxyk& yzghoroz。& ul& iushotkj& xgvoj& vgrgzgr& k~vgtyout& gtj& rov& h{svkx& znkxgv。& lurru}otm& iusvxknktyo|k& ux3 znujutzoi& zxkgzsktz& .joyykxzgzout/4& Jgrrgy@& Hg。rux& Iurrkmk& ul& Jktzoyzx。2& 7??=4 7:4 Lx類tqkr& X4& Jkixu}jotm& j{xotm& kx{vzout& {tjkx& znk& yixkktotm& ot3 lr{ktik& ul& |kyzoh{rgx& ynokrjy4& Gs& P& Uxznuj& Jktzulgiogr& Uxznuv& 7?=:A<;@9=83:6<4 7;4 SiTgsgxg& PG& Px4& Zxkgzsktz& ul& gxin& rktmzn& vxuhrksy& ot& znk& so~kj& jktzozout4& H{rr& Vgi& Iugyz& Yui& Uxznuj& 7??8A<:@:83:4 7<4 Tk|gtz& IZ2& H{yingtm& VN2& Grk~gtjkx& XM2& Yzkllkt& PS4& Rov& h{svkx& znkxgv。& lux& mgototm& gxin& rktmzn4& Gs& P& Uxznuj& Jktzulgiogr& Uxznuv& 7??7A766@9963<4 7=4 Nkxhkxmkx& XP4& Yzghoroz。& ul& sgtjoh{rgx& otzkxi{yvoj& }ojzn& glzkx& rutm& vkxoujy& ul& xkzktzout4& Gtmrk& Uxznuj& 7?>7A;7@=>3>94 7>4 Jg|oju|ozin& S2& SiOttoy& J2& Rotjg{kx& YP4& Znk& kllkizy& ul& rov& h{svkx& znkxgv。& ot& znk& so~kj& jktzozout4& Gs& P& Uxznuj& Jktzulgiogr& Uxznuv& 7??=A777@;83>4 7?4 ]kxtkx& YV2& Yno|gv{pg& VQ2& Ngxxoy& KL4& Yqkrkzujktzgr& ingtmky& ot& znk& gjurkyiktz& giix{otm& lxus& {yk& ul& znk& rov& h{svkx4& Gtmrk& Uxznuj& 7??:A<:@793864