Festsitzende Behandlung einer Klasse-III-Malokklusion mit anterior offenem Biss ohne orthognathe Chirurgie

Zusammenfassung

Die Korrektur einer stark ausgeprägten Angle Klasse-III-Dysgnathie mit anterior offenem Biss impliziert in vielen Fällen eine orthognath-chirurgische Therapie. Der vorliegende Fallbericht stellt eine Patientin vor, der man eine chirurgische Korrektur der zuvor genannten Dysgnathie vorgeschlagen hat, die Patientin jedoch die Osteotomie ablehnte. Die orthodontische Korrektur wurde mittels Multiloop-Edgewise-Archwires und kurzen Klasse-III-Gummizügen durchgeführt. Nach Entfernung aller Weisheitszähne wurde die Okklusionsebene nach posterior steiler eingestellt. Die aktive Behandlungszeit lag bei 23 Monaten und vollführte eine Aufrichtung der Zähne, Molarenintrusion, Schließen des anterior offenen Bisses, Einstellen einer Front-Eckzahnführung und eine geringfügige Verbesserung des Profils. Zwei Jahre nach Therapieende bestand eine bilaterale Angle-Klasse-I ohne anterior offenen Biss.

Abstract

The correction of a combined dento-skeletal open bite with Class III malocclusion represents one of the most difficult treatment modalities suggesting orthognathic surgery. This report presents a patient who was recommended for surgical correction of the dysgnathia, but refused osteotomies. The orthodontic correction was carried out using multiloop edgewise archwires and short Class III elastics. After extraction of all third molars the occlusal plane was inclined steeper. The orthodontic correction comprised an active treatment period of 23 months including uprighting of teeth, molar intrusion, closure of the anterior open bite, establishing anterior guidance, and slight improvement of the facial profile. The two-year post-treatment follow-up showed a bilateral Angle class I without open bite.

Klasse III - anterior offener Biss - Okklusionsebene

Class III - anterior open bite - occlusal plane

Literatur

• 1 Baek S-H, Shin S-J, Ahn S-J, Chang Y-I. Initial effect of multiloop edgewise archwire on the mandibular dentition in Class III malocclusion subjects. A three-dimensional finite element study.  Eur J Orthod. 2008;  30 10-15
• 2 Björk A, Skieller V. Normal and abnormal growth of mandible. A synthesis of longitudinal cephalometric implant studies over a period of 25 years.  Eur J Orthod. 1983;  5 1-46
• 3 Björk A, Skieller V. Study on enlargement of the maxilla with implantation technique.  Mondo Ortod. 1977;  19 18-28
• 4 Dhopatkar A, Bhatia S, Rock P. An investigation into the relationship between the cranial base angle and malocclusion.  Angle Orthod. 2002;  72 456-463
• 5 Elgoyhen J C, Riolo M L, Graber L W, Moyers R E, McNamara Jr J A. Craniofacial growth in juvenile Macaca mulatta: a cephalometric study.  Am J Phys Anthropol. 1972;  36 369-376
• 6 Hopkin G B, Houston W J, James G A. Cranial base angle associated with the various classes of malocclusion.  Angle Orthod. 1968;  38 250-255
• 7 Kim Y H, Vietas J J. Anteroposterior dysplasia indicator: An adjunct to differential diagnosis.  Am J Orthod. 1978;  73 619-633
• 8 Kim Y H. Anterior openbite and its treatment with Multiloop Edgewise archwire.  Angle Orthod. 1987;  57 290-321
• 9 Mehta N R, Forgione A G, Maloney G, Greene R. Different effects of nocturnal parafunction on the masticatory system: the Weak Link Theory.  Cranio. 2000;  18 280-286
• 10 Richardson E. Occlusal plane and mandibular adaptation. Atlas of craniofacial growth in Americans of African descent (2). Craniofacial Growth Monograph Series 1991
• 11 Sato S. Alteration of occlusal plane due to posterior discrepancy related to development of malocclusion - Introduction to Denture Frame Analysis.  Bulletin of Kanagawa Dental College. 1987;  5 115-123
• 12 Sato S, Suzuki N, Suzuki Y. Longitudinal study of the cant of the occlusal plane and the denture frame in cases with congenitally missing third molars. Further evidence for the occlusal plane change related to the posterior discrepancy.  Nippon Kyosei Shika Gakkai Zasshi. 1988;  47 517-525
• 13 Sato S, Suzuki Y. Relationship between the development of skeletal mesio-occlusion and posterior tooth-to-denture base discrepancy - its significance in the orthodontic reconstruction of skeletal Class III malocclusion.  Nippon Kyosei Shika Gakkai Zasshi. 1988;  47 796-810
• 14 Sato S, Takamoto K, Suzuki Y. Posterior discrepancy and development of skeletal Class III malocclusion: its importance in orthodontic correction of skeletal Class III malocclusion.  Orthod Rev. 1988;  2 16-29
• 15 Sato S, Endo N, Yamauchi M, Takeuchi M, Suzuki Y. Importance of posterior discrepancy in the development of skeletal Class III malocclusion.  Kanagawa Shigaku. 1989;  24 219-229
• 16 Sato S, Sasaguri K, Kamoi S, Goto M, Suzuki Y. Importance of posterior tooth-to-denture base discrepancy in the development of skeletal open-bite malocclusion.  Nippon Kyosei Shika Gakkai Zasshi. 1990;  49 322-330
• 17 Sato S, Yoshinari Y, Murai S, Hatakeyama Y, Orikasa M, Suzuki Y. Some aspects of third molars with regard to the development of malocclusions.  Kanagawa Shigaku. 1990;  25 99-108
• 18 Sato S. An approach to the treatment of malocclusion in consideration of dentofacial dynamics. Torin Books, Tokyo 1991
• 19 Sato S, Sakai H, Sugishita T, Matsumoto A, Kubota M, Suzuki Y. Growth changes of the Denture Frame in Japanese subjects.  Int J MEAW Tech Res Found. 1994;  1 33-46
• 20 Sato S. The posterior discrepancy is an important etiologic factor in the development of a skeletal Class III malocclusion.  Angle Orthod. 1994;  64 88
• 21 Sato S. Case report: developmental characterization of skeletal Class III malocclusion.  Angle Orthod. 1994;  64 105-111 , discussion 111-112
• 22 Sato S, Akimoto S, Shinji H. Entstehung und orthodontische Behandlung der Klasse-III-Malokklusion.  Inf Orthod Kieferorthop. 2005;  37 87-99
• 23 Wong R WK, Wu C. Orthodontic treatment using round Multiloop Edgewise Arch-Wire (MEAW_R): A case report.  Hell Orthod Rev. 2007;  10 93-102