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Informationen aus Orthodontie & Kieferorthopädie 2020; 52(03): 187-196
DOI: 10.1055/a-1200-5895
Übersichtsartikel

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

Is Orthopedic Correction of Growing Hyperdivergent Retrographic Class IIs possible?
Peter H. Buschang
1   Orthodontic Research, Texas A&M College of Dentistry, Dallas, USA
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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


Publication History

Article published online:
11 September 2020

© 2020. Thieme. All rights reserved.

© Georg Thieme Verlag KG
Stuttgart · New York

 

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