Ist die kieferorthopädische Korrektur einer wachsenden hyperdivergenten retrognathen Klasse II möglich?

Zusammenfassung

Ein großer Teil der Klasse-II-Fälle ist retrognath und hyperdivergent. Viele zeigen ein ungünstiges Wachstumsmuster, durch das sich die anteroposterioren, die vertikalen und die transversalen skelettalen Beziehungen immer weiter verschlechtern. Mit den bisherigen Behandlungsstrategien ließen sich zwar die dentalen Beziehungen korrigieren, bei den skelettalen Problemen waren sie jedoch wenig effektiv. Bei der Behandlung der dentalen und der skelettalen Probleme ist es daher wichtig, den Unterkiefer nach vorne zu rotieren, anstatt ihn nach vorne zu überstellen. Eine echte Rotationsbewegung der Mandibula nach vorne, durch die bei wachsenden Kindern hauptsächlich die Projektion des Kinns bestimmt wird, lässt sich am besten durch absolute oder relative Intrusion der Zähne durchführen. Dies führt bei Kindern im Wachstum zu einer stärkeren Kinnprojektion, zu einem verbesserten Skelettprofil, zur Verkleinerung von Grund- und Kieferwinkeln und zur Verringerung der vorderen unteren Gesichtshöhe. Die mit diesem Verfahren erreichten orthopädischen Veränderungen sind vergleichbar mit oder sogar besser als die Ergebnisse, die kieferorthopädisch mit skelettaler Verankerung oder chirurgisch bei Erwachsenen erreicht werden. Das Verfahren scheint außerdem zu stabileren Ergebnissen zu führen als die Behandlung erwachsener Patienten, da hier mit und nicht gegen das Wachstum gearbeitet wird.

Abstract

A large proportion of Class IIs are retrognathic and hyperdivergent. Many have unfavorable growth patterns, with their anteroposterior, vertical and transverse skeletal relationships worsening over time. While previous treatment approaches have been able to correct the dental relationships, they have largely been ineffective in dealing with the skeletal problems. To address both the dental and skeletal problems, treatment must be directed toward rotating the mandible forward, rather than displacing it forward. True forward rotation of the mandible, which is the primary determinant of chin projection in growing children, is best accomplished by absolute or relative intrusion of the dentition. When applied to growing children, this approach increases chin projection, improves the skeletal profile, decreases the mandibular plane and gonial angles, and reduces relative anterior lower facial height. The orthopedic changes obtained with this approach are similar or greater than produced orthodontically with skeletal anchorage or surgery in adults. This approach also appears to be more stable than adult treatments because the orthodontist is working with rather than against growth.

Schlüsselwörter

Klasse-II-Dysgnathie - dentales und skelettales Wachstumsmuster - Rotation des Unterkiefers nach vorne

Key words

Class II malocclusion - dental and skelal growth patterns - forward rotation of the mandible

Publikationsverlauf

Artikel online veröffentlicht:
11. September 2020

• Literatur

• 1 Akay MC, Aras A, Günbay T. et al. Enhanced effect of combined treatment with corticotomy and skeletal anchorage in open bite correction. J Oral Maxillofac Surg 2009; 67: 563-569
• 2 Araujo AM, Buschang PH, Melo ACM. Adaptive condylar growth and mandibular remodelling changes with bionator therapy - an implant study. Eur J Orthod 2004; 26: 515-522
• 3 Baccetti T, Franchi L, Toth LR. et al. Treatment timing for Twin-block therapy. Am J Orthod Dentofacial Orthop 2000; 118: 159-170
• 4 Baumrind S, Ben-Bassat Y, Korn EL. et al. Mandibular remodeling measured on cephalograms: 2. A comparion of information from implant and anatomical best-fit superimpositions. Am J Orthod Dentofacial Orthop 1992; 102: 227-238
• 5 Björk A. Prediction of mandibular growth rotation. Am J Orthod 1969; 55: 585-599
• 6 Björk A, Skieller V. Normal and abnormal growth of the mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years. Eur J Orthod 1983; 5: 1-46
• 7 Buschang PH, Santos-Pinto A. Condylar growth and glenoid fossa displacement during childhood and adolescence. Am J Orthod Dentofacial Orthop 1998; 113: 437-442
• 8 Buschang PH, Baume RM, Nass GG. A craniofacial growth maturity gradient for males and females between 4 and 16 years of age. Am J Phys Anthropol 1983; 61: 373-381
• 9 Buschang PH, Sankey W, English JP. Early treatment of hyperdivergent open-bite malocclusions. Semin Orthod 2002; 8: 130-140
• 10 Buschang PH, Carrillo R, Rossouw PE. Orthopedic correction of growing hyperdivergent, retrognathic patients with miniscrew implants. J Oral Maxillofac Surg 2011; 69: 754-762
• 11 Buschang PH, Jacob HB, Chaffee MP. Vertical control in Class II hyperdivergent growing patients using miniscrew implants: a pilot study. J World Fed Orthod 2012; 1: e13-e18
• 12 Buschang PH, Jacob H, Carrillo R. The morphological characteristics, growth, and etiology of the hyperdivergent phenotype. Semin Orthod 2013; 19: 212-226
• 13 Buschang PH, Jacob HB. Mandibular rotation revisited: what makes it so important. Semin Orthod 2014; 20: 299-315
• 14 Buschang PH. The development, phenotypic characteristics and etiology of Class II malocclusion. In: Araujo EA, Buschang PH (eds.). Recognizing and Correcting Developing Malocclusions: A Problem-Oriented Approach to Orthodontics Wiley-Blackwell; Hoboken NJ: 2015: 90-107
• 15 Carrillo R, Buschang PH. Palatal and mandibular miniscrew implant placement techniques. J Clin Orthod 2013; 47: 737-743
• 16 Cattell P. The eruption and growth of the permanent teeth. J Dent Res 1928; 8: 279-287
• 17 Croft RS, Buschang PH, English JD. et al. A cephalometric and tomographic evaluation of Herbst treatment in the mixed dentition. Am J Orthod Dentofacial Orthop 1999; 116: 435-443
• 18 Erverdi N, Keles A, Nanda R. The use of skeletal anchorage in open bite treatment: a cephalometric evaluation. Angle Orthod 2004; 74: 381-390
• 19 Fontes AM, Joondeph DR, Bloomquist DS. et al. Long-term stability of anterior open-bite closure with bilateral sagittal split osteotomy. Am J Orthod Dentofacial Orthop 2012; 142: 792-800
• 20 Greenlee GM, Huang GJ, Chen SS. et al. Stability of treatment for anterior open-bite malocclusion: a meta-analysis. Am J Orthod Dentofacial Orthop 2011; 139: 154-169
• 21 Ibitayo AO, Pangrazio-Kulbersh V, Berger J. et al. Dentoskeletal effects of functional appliances vs bimaxillary surgery in hyperdivergent Class II patients. Angle Orthod 2011; 81: 304-311
• 22 Janson G, Valarelli FP, Beltrão RT. et al. Stability of anterior open-bite extraction and nonextraction treatment in the permanent dentition. Am J Orthod Dentofacial Orthop 2006; 129: 768-774
• 23 Karlsen AT. Association between facial height development and mandibular growth rotation in low and high MP-SN angle faces: a longitudinal study. Angle Orthod 1997; 67: 103-110
• 24 Katsaros C, Berg R. Anterior open bite malocclusion: a follow-up study of orthodontic treatment effects. Eur J Orthod 1993; 15: 273-280
• 25 Kim YH, Han UK, Lim DD. et al. Stablity of anterior open-bite correction with multiloop edgewise archwire therapy: a cephalometric follow-up study. Am J Orthod Dentofacial Orthop 2000; 118: 43-54
• 26 Kuroda S, Sakai Yuichi, Tamamura Nagato. et al. of severe anterior open bite with skeletal anchorage in adults: comparison with orthognathic surgery outcomes. Am J Orthod Dentofacial Orthop 2007; 132: 599-605
• 27 Kuroda S, Katayama A, Takano-Yamamoto T. Severe anterior open-bite case treated using titanium screw anchorage. Angle Orthod 2004; 74: 558-567
• 28 LaHaye MB, Buschang PH, Wick Alexander RG. et al. Orthodontic treatment changes of chin position in Class II Division 1 patients. Am J Orthod Dentofacial Orthop 2006; 130: 732-741
• 29 Maia FA, Janson G, Barros SE. et al. Long-term stability of surgical-orthodontic open-bite correction. Am J Orthod Dentofacial Orthop 2010; 138: 254.e1-254.e10
• 30 McNamara Jr JA, Carlson DS. Quantitative analysis of temporomandibular joint adaptations to protrusive function. Am J Orthod 1979; 76: 593-611
• 31 Miller S, Kerr WJ. A new look at mandibular growth - a preliminary report. Eur J Orthod 1992; 14: 95-98
• 32 Mojdehi M, Buschang PH, English JD. et al. Postsurgical growth changes in the mandible of adolescents with vertical maxillary excess growth pattern. Am J Orthod Dentofacial Orthop 2001; 119: 106-116
• 33 Oliveira JA, Bloomquist DS. The stabilitiy of the use of bilateral sagittal split osteotomoy in the closure of anterior open bite. Int J Adult Orthodon Orthognath Surg 1997; 12: 101-108
• 34 Pancherz H, Ruf S, Kohlhas P. “Effective condylar growth” and chin position changes in Herbst treatment: a cephalometric roentgenographic long-term study. Am J Orthod Dentofacial Orthop 1998; 114: 437-446
• 35 Pancherz H, Ruf S, Erbe C. et al. The mechanism of Class II correction in surgical orthodontic treatment of adult Class II, division 1 malocclusions. Angle Orthod 2004; 74: 800-809
• 36 Paulsen HU. Morphologicial changes of the TMJ condyles of 100 patients treated with the Herbst appliance in the period of puberty to adulthood: a long-term radiographic study. Eur J Orthod 1997; 19: 657-668
• 37 Pearson LE. Vertical control in treatment of patients having backward-rotational growth tendencies. Angle Orthod 1978; 48: 132-140
• 38 Rice AJ, Carrillo R, Campbell PM. et al. Do orthopedic corrections of growing retrognathic hyperdivergent patients produce stable results?. Angle Orthod 2019; 89: 552-558
• 39 Rogers K, Campbell PM, Tadlock L. et al. Treatment changes of hypo- and hyperdivergent Class II Herbst patients. Angle Orthod 2018; 88: 3-9
• 40 Proffit WR, Fields Jr HW, Larson BE. et al. Contemporary Orthodontics. 6^th ed.. Elsevier-Mosby; Oxford: 2019
• 41 Remmers D, Van’t Hullenaar RWG, Bronkhorst EM. et al. Treatment results and long-term stability of anterior open bite malocclusion. Orthod Craniofac Res 2008; 11: 32-42
• 42 Ruf S, Baltromejus S, Pancherz H. Effective condylar growth and chin position changes in activator treatment: a cephalometric roentgenographic study. Angle Orthod 2001; 71: 4-11
• 43 Serbesis-Tsarudis C, Pancherz H. “Effective” TMJ and chin position changes in Class II treatment: orthodontics versus orthopedics. Angle Orthod 2008; 78: 813-818
• 44 Sankey WL, Buschang PH, English JD. et al. Early treament of vertical skeletal dysplasia: the hyperdivergent phenotype. Am J Orthdont Dentofacial Orthop 2000; 118: 317-327
• 45 Seres L, Kocsis A. Closure of severe skeletal anterior open bite with zygomatic anchorage. J Craniofac Surg 2009; 20: 478-482
• 46 Sherwood KH, Burch JG, Thompson WJ. Closing anterior open bites by intruding molars with titanium miniplate anchorage. Am J Orthod Dentofacial Orthop 2002; 122: 593-600
• 47 Spady M, Buschang PH, Demirjian A. et al. Mandibular rotation and angular remodeling during childhood and adolescence. Am J Human. Biol 1992; 4: 683-689
• 48 Subtelny JD, Sakuda M. Open-bite: diagnosis and treatment. Am J Orthod 1964; 50: 337-358
• 49 Sugawara J, Baik UB, Umemori M. et al. Treatment and posttreatment dentoalveolar changes following intrusion of mandibular molars with application of a skeletal anchorage system (SAS) for open bite correction. Int J Adult Orthodon Orthognath Surg 2002; 17: 243-253
• 50 Ueno H, Behrents RG, Oliver DR. et al. Mandibular rotation during the transitional dentition. Angle Orthod 2013; 83: 29-35
• 51 Wang MK, Buschang PH, Behrents R. Mandibular rotation and remodeling changes during early childhood. Angle Orthod 2009; 79: 271-275
• 52 Washburn MC, Schendel SA, Epker BN. Superior repositioning of the maxilla during growth. J Oral Maxillofac Surg 1982; 40: 142-149
• 53 Xun C, Zeng X, Wang X. Microscrew anchorage in skeletal anterior open-bite treatment. Angle Orthod 2007; 77: 47-56
• 54 Zarrinkelk HM, Throckmorton GS, Ellis 3^rd E. et al. Functional and morphological alterations secondary to superior repositioning of the maxilla. J Oral Maxillofac Surg 1995; 53: 1258-1267