Stabilität nach Therapie der Klasse II mit festsitzenden funktionskieferorthopädischen Geräten – systematische Übersicht und Metaanalyse^[*]

Zusammenfassung

Ziele: Systematische Suche nach wissenschaftlich evidenten Belegen zur Stabilität von Behandlungsergebnissen nach Therapie der Klasse II mit festsitzenden funktionskieferorthopädischen Apparaturen und Untersuchung möglicher Unterschiede zwischen einzelnen Geräten.

Suchstrategien: Gesucht wurde elektronisch in Datenbanken und kieferorthopädischen Fachzeitschriften (bis Dezember 2013) und zusätzlich per Hand. Neben den Namen der identifizierten Apparaturen wurde zusätzlich auch der Terminus „fixed functional“ in Kombination mit folgenden Begriffen abgefragt: „long-term“, „post-Tx“, „relapse“, „retention“ und „stability“.

Auswahlkriterien: Um in die Auswertung aufgenommen zu werden, mussten die Artikel genaue Daten zur Therapie der Klasse II mit festsitzenden funktionskieferorthopädischen Apparaturen (>5 Patienten), zum posttherapeutischen Zeitraum≥1 Jahr, zur Untersuchung des ANB-Winkels, der WITS-Wert, der Molarenbeziehung, der Konvexität des Weichteilprofils ohne Einbeziehung der Nase, zu Overjet bzw. Overbite enthalten.

Datenerhebung und Auswertung: Die Literatursuche erbrachte 20 wissenschaftliche Untersuchungen, die sich mit nur 2 von 76 identifizierten Apparaturen (Herbst-Scharnier und Twin Force Bite Corrector) beschäftigt hatten. Da nur eine Studie den Twin Force Bite Corrector untersucht hatte, konnte eine Metaanalyse nur zum Herbst-Scharnier durchgeführt werden. Die Daten wurden erhoben, gepoolt und nach der Anzahl der Patienten in den jeweiligen Untersuchungen gewichtet.

Ergebnisse: Die Durchschnittswerte für das Rezidiv nach Abschluss der Therapie (prozentual im Vergleich zu den Veränderungen im Verlauf der Behandlung) lauten: ANB-Winkel 0,2 Grad (12,4%), WITS-Wert 0,5 mm (19,5%), sagittale Molarenbeziehung 1,2 mm/0,1 PB (21,8%/6,5%), Konvexität des Weichteilprofils ohne Einbeziehung der Nase weniger als 0,1 Grad (1,0%), Overjet 1,8 mm (26,2%), Overbite Klasse II/1 1,4 mm (44,7%), Overbite Klasse II/2 1,0 mm (22,2%).

Schlussfolgerungen: Mit Ausnahme des Herbst-Scharniers liegen für die meisten festsitzenden funktionskieferorthopädischen Apparaturen bisher keinerlei wissenschaftliche Angaben zur Stabilität der Ergebnisse nach Abschluss der Behandlungsmaßnahmen vor. Auch wenn für die Mehrzahl der Studien zu festsitzenden Klasse-II-Mechaniken das Evidenz-Level eher gering ist, konnte dennoch für die meisten Variablen eine gute dentoskelettale Stabilität der Behandlungsergebnisse ohne klinisch relevante Veränderungen gefunden werden.

Summary

Objectives: To systematically search for scientific evidence concerning the stability of treatment (Tx) results achieved by means of Class II fixed functional appliance therapy and to assess possible differences between appliances.

Search Methods: An electronic search of databases and orthodontic journals was carried out (until December 2013), with supplemental hand searching. In addition to the names of all identified appliances, the term fixed functional was used in combination with each of the following search terms: long-term, post-Tx, relapse, retention, stability.

Selection Criteria: To be included in the review, the articles had to contain clear data on: Class II Tx with a fixed functional appliance (>5 patients), post-Tx period≥1 year, assessment of ANB angle, Wits appraisal, molar relationship, soft-tissue profile convexity excluding the nose, overjet and/or overbite.

Data Collection and Analysis: The literature search revealed 20 scientific investigations which corresponded to only 2 of the 76 identified appliances (Herbst and Twin Force Bite Corrector). As only one publication was found for the Twin Force Bite Corrector, a meta-analysis could only be performed for Herbst Tx. The data were extracted, pooled and weighted according to the number of patients in each study.

Results: The mean values for post-Tx relapse (percentages relative to the Tx changes) were: ANB angle 0.2 degrees (12.4%), Wits appraisal 0.5 mm (19.5%), sagittal molar relationship 1.2 mm/0.1 cusp widths (21.8/6.5%); soft-tissue profile convexity excluding nose less than 0.1 degrees (1.0%), overjet 1.8 mm (26.2%), overbite Class II:1 1.4 mm (44.7%), overbite Class II:2 1.0 mm (22.2%).

Conclusions: The scientific evidence concerning the stability of Tx results is inexistent for most fixed functional appliances for Class II correction except for Herbst appliance Tx. Even if the evidence level of most included studies is rather low, good dentoskeletal stability without clinically relevant changes was found for most variables.

Schlüsselwörter

festsitzenden funktionskieferorthopädischen Apparaturen - Stabilität

Key words

fixed functional appliances - stability

^* Dieser Artikel ist im englischen Original erschienen im: European Journal of Orthodontics, 2016, 38 (2): 129–139. Die Zweitveröffentlichung erfolgt auf Initiative der IOK. Für die Übersetzung zeichnen die Autoren nicht verantwortlich.

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