Zusammenfassung
Bei Patienten mit einer Klasse-III-Dysgnathie benötigt man neben der Differenzialdiagnose
einen dynamischen Behandlungsplan, d. h. die Möglichkeit zu bestimmten Zeitpunkten
der Therapie das Vorgehen anhand der Entwicklung zu überdenken und ggf. umzustellen.
Da der Allgemeinzahnarzt und auch die Eltern beim Vorliegen einer Klasse-III-Dysgnathie
häufig früh reagieren und einen Kieferorthopäden zur Rate ziehen, können Diagnose
und Behandlungsplan bereits im Milch- oder Wechselgebiss aufgestellt werden. Im vorliegenden
Artikel werden effektive Schritte im Hinblick auf Diagnose, Behandlungsplanung, Therapie
der Klasse-III-Dysgnathie und zur Bestimmung der Wachstumsfaktoren vorgestellt: -
Für die Differenzialdiagnose werden drei häufig angewandte kephalometrische Verfahren
verglichen; - Unterschiedliche Behandlungsverfahren werden vorgestellt, wobei die
zentralen Punkte Compliance, Aktivierung der Suturen, Korrektur der Schneidezahnstellung
und Bestimmung der Wachstumsfaktoren sind. - Da das Ergebnis der Behandlung nicht
exakt vorhergesagt werden kann, ist die Abstimmung zwischen Kieferorthopäden und Patient
/ Eltern während der einzelnen Behandlungsphasen besonders wichtig. - Das Hauptziel
ist das Vermeiden einer chirurgischen Intervention. Um herauszufinden, ob ein Patient
ohne chirugischen Eingriff behandelt werden kann, haben die Autoren bestimmte kephalometrische
Grenzwerte erarbeitet, die eine zuverlässige Entscheidungshilfe vermitteln.
Abstract
The patient with a Class III malocclusion requires differential diagnosis and treatment
plan that is dynamic, that is, a diagnosis and treatment plan that has mechanisms
to allow for reassessment of response as specific stages of treatment are carried
out. The general dentist and parental awareness allows many Class III patients to
visit the orthodontist earlier than in the past, and orthodontists are frequently
required to develop a diagnosis and treatment plan with the patient in the primary
dentition or mixed dentition. This paper presents effective steps in the clinical
management of the Class III patient who may present at different stages of growth
and development: - Differential Diagnosis - three frequently used cephalometric tools
to assess the Class III skeletal imbalance are compared; - Several therapeutic approaches
are considered with the emphasis on compliance, sutural activation, inter-incisal
correction, and assessment of growth vectors. - Treatment Response and patient / parent
communication are discussed in the same section as to emphasize the importance of
involving both the parent and patient in progress of treatment. This is necessary
since the outcome of early Class III is uncertain and updates are very helpful. -
Since one of the key goals of early intervention of the Class III patient is the avoidance
of jaw surgery, the last section of the paper discusses what the authors have found
to be an acceptable cephalometric threshold range for Class III patients who can be
managed non-surgically.
Schlüsselwörter
Klasse-III-Dysgnathie - chirurgische / nicht-chirurgische Behandlung
Key words
Class III malocclusion - surgical / non-surgical treatment
Literatur
- 1
Stellzig-Eisenhauer A, Lux C J, Schuster G.
Treatment decision in adult patients with Class III malocclusion: orthodontic therapy
or orthognathic surgery?.
Am J Orthod Dentofacial Orthop.
2002;
122
37-38
- 2
Guyer E C, Ellis 3rd
E E, McNamara Jr J A, Behrents R G.
Components of Class III malocclusion in juveniles and adolescents.
Angle Orthod.
1986;
56
7-30
- 3a
McNamara Jr J A.
A method of cephalometric evaluation.
Am J Orthod.
1984;
86
449-469
- 4
Jacobson A.
The proportionate template as a diagnostic aid.
Am J Orthod.
1979;
75
156-172
- 5
Steiner C C.
Cephalometrics for you and me.
Am J Orthod.
1953;
39
729-755
- 6 Pershing M, Katz S, Musich D. Threshold Limits of non-surgical treatment for the
Class III Skeletal Patient. Thesis, University of Pennsylvania School of Dental Medicine,
Department of Orthodontics 2005
- 7
Sugawara J, Asano T, Endo N, Mitani H.
Long-term effects of chincup therapy on skeletal profile in mandibular prognathism.
Am J Orthod Dentofacial Orthop.
1990;
98
127-133
- 8
Wendell P D, Nanda R, Sakamoto T, Nakamura S.
The effects of chin cup therapy on the mandible: a longitudinal study.
Am J Orthod.
1985;
87
265-274
- 9a
Westwood P V, McNamara Jr J A, Baccetti T, Franchi L, Sarver D M.
Long-term effects of Class III treatment with rapid maxillary expansion and facemask
therapy followed by fixed appliances.
Am J Orthod Dentofacial Orthop.
2003;
123
306-320
- 10a
Hägg U, Tse A, Bendeus M, Rabie A B.
Long-term follow-up of early treatment with reverse headgear.
Eur J Orthod.
2003;
25
95-102
- 11
Merwin D, Ngan P, Hagg U, Yiu C, Wei S H.
Timing for effective application of anteriorly directed orthopedic force to the maxilla.
Am J Orthod Dentofacial Orthop.
1997;
112
292-299
- 12
Kapust A J, Sinclair P M, Turley P K.
Cephalometric effects of face mask / expansion therapy in Class III children: a comparison
of three age groups.
Am J Orthod Dentalfacial Orthop.
1998;
113
204-212
- 13
Yüksel S, Uçem T T, Keykubat A.
Early and late facemask therapy.
Eur J Orthod.
2001;
23
559-568
- 14
Ackerman J L, Proffitt W R.
Treatment response as an aid in diagnosis and treatment planning.
Am J Orthod.
1970;
57
490-496
- 15 Musich D R. Report of 100 orthodontic retreatment cases: Learning from “failures”. Unpublished
report presented to Eastern Component Angle Society 1988
- 16
Musich D R, Busch M J.
Early orthodontic treatment: current clinical perspectives.
Alpha Omegan.
2007;
100
17-24
- 17
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
Dr. D. R. Musich
1701 E. Woodfield Rd. # 500
USA-Schaumburg, IL 60173
eMail: Drm4drmltd@aol.com
