Skelettal verankerte maxilläre Protraktion – eine Falldarstellung

Zusammenfassung

Hintergrund Abweichungen der Kiefer im Sinne einer maxillären Retro- beziehungsweise mandibulären Prognathie resultieren in einer Klasse III-Anomalie. Die Kieferorthopädie hat verschiedene, insbesondere altersabhängige Therapiemöglichkeiten zur Korrektur derselben. Wird die Klasse III-Anomalie früh diagnostiziert, bietet sich die Therapie mittels Delaire-Maske an. Eine spätere Behandlung kurz vor dem pubertären Wachstumsmaximum erfordert eine skelettale Verankerung. Bollard-Platten sind hilfreich für Patienten, deren Therapie mittels Delaire-Maske nicht erfolgreich war oder um die Verlagerungsstrecke für eine spätere Umstellungsosteotomie zu verringern, besonders dann, wenn die Patienten für eine Therapie mittels Delaire-Maske zu alt waren.

Falldarstellung Eine 11-jährige Patientin mit einer Klasse III-Anomalie mit umgekehrter sagittaler Frontzahnstufe und Schwenkung des Unterkiefers nach links wurde mittels skelettal verankerter Klasse III-Mechanik (Bollard-Platten) mit Gummizügen therapiert. Nach Einstellung einer physiologischen sagittalen Frontzahnstufe konnten die Bollard-Platten zur weiteren Zahnbewegung im Rahmen einer Behandlung mit Multibracketapparatur genutzt werden.

Schlussfolgerungen In der Falldarstellung konnte durch Anwendung einer skelettalen Verankerung mittels Bollard-Platten die Klasse III-Anomalie zufriedenstellend therapiert werden. Die Notwendigkeit zur Umstellungsosteotomie war im weiteren Verlauf nicht zu erwarten. Trotz möglicher Komplikationen (Lockerung der Bollard-Platten, Granulationsgewebe, ungünstige Reaktion im Wachstumsverlauf) stellt diese Therapiemaßnahme ein probates Mittel für Patienten mit Klasse III-Anomalie zur Beeinflussung insbesondere des Oberkiefer-Wachstums dar.

Summary

Background Class III malocclusion is the result of maxillary retrognathia and/or mandibular prognathia. Orthodontists have different, age-dependent treatment options for class III anomalies. Treatment by means of Delaire-type facemask is an option, if the class III anomaly is diagnosed and treated early in age. Later treatment, previous to pubertal growth spurt, needs bone anchorage. Bone anchors are useful in patients, whose facemask therapy had not been successful or to avoid or decrease the amount of later orthognatic surgery, particularly if the patients have been too old for treatment with facemask.

Case Presentation An eleven-year-old female patient with class III malocclusion with reversed overjet and deviation of the mandible to the left side was treated with bone anchors (Bollard-type plates) and elastics. After the overjet was corrected, the bone anchors were used during the following treatment with fixed braces for changing the position of particular teeth.

Conclusions In this case report, bone anchors for skeletal anchorage were useful during treatment of the class III malocclusion. There was no need for orthognathic surgery during the course of the treatment. Despite some possible complications (loosening of the bone anchors, granulated tissue, unfavorable outcome during growth), the use of bone anchors and elastics for stimulation maxillary growth is effective in patients with class III malocclusion.

Schlüsselwörter

Maxilläre Retrognathie - mandibuläre Prognathie - Maxilläre Protraktion - Bollard-Platten

Keywords

Maxillary retrognathia - Mandibular prognathia - Maxillary protraction - Bone anchors

Publication History

Article published online:
27 March 2025

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