Auswirkungen der Behandlung mit Kopf-Kinn-Kappe auf das Kiefergelenk: eine systematische Übersicht

Zusammenfassung

Zielsetzung: Systematische Durchsicht der Literatur und Beurteilung der vorliegenden Nachweise für den Einfluss einer Therapie mit Kopf-Kinn-Kappe auf das Kiefergelenk in Bezug auf morphologische Anpassungsvorgänge und das Auftreten von Störungen im Kiefergelenk.

Material und Methoden: In elektronischen Datenbanken wurde nach veröffentlichter und unveröffentlichter Literatur gesucht. Dabei wurden folgende Datenbanken ohne Einschränkungen hinsichtlich Publikationssprache und Veröffentlichungsdatum durchsucht: MEDLIE (via Ovid und PubMed), EMBASE (via Ovid), das Cochrane Oral Health Group’s Trials Register und CENTRAL. Nach unveröffentlichter Literatur wurde auf ClinicalTrials.gov, im National Research Register und in der Pro-Quest Dissertation Abstracts and Thesis-Datenbank gesucht. Zusätzlich wurden die Bibliografien der in Frage kommenden Beiträge nach weiterer Literatur überprüft. 2 der Autoren der vorliegenden Studie führten die Datenerhebung unabhängig voneinander und 2-fach mithilfe von Datenerhebungsformularen durch. Unstimmigkeiten wurden ausdiskutiert oder eine dritte Person hinzugezogen.

Ergebnisse: Von den 209 gefunden Veröffentlichungen kamen 55 in die engere Auswahl. Nach dem Lesen der Volltexte verblieben 12 Studien für die endgültige Auswertung. Es wurde keine randomisierte klinische Studie gefunden. 8 der ausgewerteten Untersuchungen waren prospektiv und 4 retrospektiv angelegt. Sämtliche Studien wurden hinsichtlich ihrer Qualität beurteilt und schließlich mit einem geringen bis mittleren Evidenzwert versehen. Basierend auf der untersuchten Datenlage beeinflusst eine Therapie mit Kopf-Kinn-Kappe das Wachstumsmuster der Kondylen, obwohl 2 der Untersuchungen keine signifikanten Veränderungen in der Position des Diskus und der Arthroseanfälligkeit feststellen konnten. In Bezug auf das Auftreten von Kiefergelenkstörungen legt die vorhandene Evidenz den Schluss nahe, dass eine Therapie mit Kopf-Kinn-Kappe kein Risikofaktor für die Entstehung von Störungen im Kiefergelenk zu sein scheint.

Schlussfolgerung: Auf der Basis der vorliegenden Evidenzlage scheint eine Therapie mit Kopf-Kinn-Kappe kraniofaziale Anpassungsvorgänge auszulösen. In der kieferorthopädischen Literatur finden sich jedoch nur unzureichende oder qualitativ minderwertige Daten, wodurch sich klare Aussagen zu den Auswirkungen einer Therapie mit Kopf-Kinn-Kappe auf das Kiefergelenk verbieten.

Summary

Aim: To systematically search the literature and assess the available evidence for the influence of chin-cup therapy on the temporomandibular joint regarding morphological adaptations and appearance of temporomandibular disorders (TMD).

Materials and Methods: Electronic database searches of published and unpublished literature were performed. The following electronic databases with no language and publication date restrictions were searched: MEDLINE (via Ovid and PubMed), EMBASE (via Ovid), the Cochrane Oral Health Group’s Trials Register, and CENTRAL. Unpublished literature was searched on Clinical Trials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. The reference lists of all eligible studies were checked for additional studies. 2 review authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion or the involvement of an arbiter.

Results: From the 209 articles identified, 55 papers were considered eligible for inclusion in the review. Following the full text reading stage, 12 studies qualified for the final review analysis. No randomized clinical trial was identified. 8 of the included studies were of prospective and 4 of retrospective design. All studies were assessed for their quality and graded eventually from low to medium level of evidence. Based on the reported evidence, chin-cup therapy affects the condylar growth pattern, even though 2 studies reported no significance changes in disc position and arthrosis configuration. Concerning the incidence of TMD, it can be concluded from the available evidence that chin-cup therapy constitutes no risk factor for TMD.

Conclusion: Based on the available evidence, chin-cup therapy for Class III orthodontic anomaly seems to induce craniofacial adaptations. Nevertheless, there are insufficient or low-quality data in the orthodontic literature to allow the formulation of clear statements regarding the influence of chin-cup treatment on the temporomandibular joint.

Schlüsselwörter

Kopf-Kinn-Kappe - Kiefergelenk

Key words

chin-cup - temporomandibular joint

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