Frühbehandlung der Klasse III – Lohnt sich der Aufwand?

Zusammenfassung

Ziele: Ziel der vorliegenden Studie war der Vergleich der Auswirkungen einer Therapie mit Gesichtsmaske mit einer unbehandelten Klasse-III-Kontrollgruppe und mit den Ergebnissen einer chirurgischen Vorverlagerung des Oberkiefers mittels einer Le-Fort-I-Osteotomie. Material: Die Protraktions- und die Chirurgiegruppe bestanden aus jeweils 17 Patienten mit einem Durchschnittsalter von 8 Jahren, 7 Monaten bzw. 19 Jahren und 6 Monaten. Jede der Untersuchungsgruppen wurde mit einer entsprechenden Kontrollgruppe aus unbehandelten Klasse-III-Patienten verglichen. Zu den Untersuchungszeitpunkten T 1 (vor Beginn der Behandlung), T 2 (nach Abschluss der aktiven Protraktion bzw. zwei Wochen nach dem chirurgischen Eingriff) und T 3 (7 Jahre, 6 Monate nach Abschluss der Protraktion bzw. 1 Jahr und 5 Monate nach der chirurgischen Korrektur) wurden jeweils Fernröntgenseitenaufnahmen angefertigt und ausgewertet. Für die beschreibenden kephalometrischen Messwerte wurden Mittelwerte und Standardabweichungen berechnet. Zur Untersuchung von Unterschieden zwischen den Gruppen im Lauf der Zeit wurde eine ANOVA durchgeführt. Mithilfe von Tukeys Studentized Range Test wurde versucht, die Ursachen für die Veränderungen herauszufiltern. Die Unterschiede zwischen der Protraktions- und der Chirurgiegruppe und den entsprechenden Kontrollgruppen wurden mit einem paarweisen t-Test untersucht. Ergebnisse: Im Vergleich zur Kontrollgruppe war nach Abschluss der Protraktionstherapie ein fortgesetzt positives Wachstum des Oberkiefers zu beobachten. Bei der Chirurgiegruppe kam es nach der Le-Fort-I-Osteotomie nicht zur Rezidivbildung. Schlussfolgerung: Die auffälligsten Beobachtungen in unserer Studie betreffen die generelle Ähnlichkeit zwischen Protraktions- und Chirurgiegruppe zum Untersuchungszeitpunkt T 3 und die allgemeine Langzeitstabilität der Ergebnisse beider Therapieverfahren. Selbst wenn ein Klasse-III-Wachstumsmuster genetisch bedingt sein sollte, scheinen die Ergebnisse einer frühzeitigen Therapie langzeitstabil zu sein, wie an den klinischen Fallberichten abzulesen ist.

Abstract

Purpose: The goal of this study was to compare the effects of protraction facemask with untreated Class III controls and with LeFort I maxillary advancement. Material: The protraction and surgical groups each consisted of 17 subjects with a mean age of 8 yr 7 m and 19 y 6 m, respectively. Each group was compared with matched controls of untreated Class III subjects. Lateral cephalograms were evaluated at T 1 (initial records), T 2 (completion of protraction treatment or two weeks post surgery) and T 3 (7 years 6 months post-protraction or 1 year 5 months post-surgery). Means and standard deviations were calculated for descriptive cephalometric measurements. ANOVA was used to assess the differences between the groups over time. Tukey Studentized Range Test was performed to determine the source of the difference. Paired t-tests were used to compare the differences between the protraction and surgical groups and matched controls. Results: A favorable growth of the maxilla was sustained after protraction of the maxilla as compared to the control group. The surgical group did not show any relapse tendencies after the Le Fort osteotomy. Conclusion: The most striking finding of this study is the general similarity between the protraction and surgical group at T 3 and the overall stability of both treatment modalities over time. Even when strong genetic factors are the determinant of a Class III growth pattern early treatment appears to be stable over time, as illustrated by the clinical cases reported.

Schlüsselwörter

orthopädische Behandlung - Therapie mit Gesichtsmaske - Klasse III - Le-Fort-I-Behandlung - Klasse-III-Stabilität

Key words

orthopedic treatment - facemask therapy - Class III - Le Fort I treatment - Class III stability

Literatur

• 1 Baccetti T, Franchi L, McNamara Jr J A. Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy.  Am J Orthod Dentofacial Orthop. 2000;  118 404-413
• 2 Baccetti T, Franchi L. Maximizing esthetic and protraction changes in Class III treatment by appropriate treatment timing. In: McNamara JA Jr, Kelly KA. Frontiers of Dental and Facial Esthetics. Craniofacial Growth Series Monograph 38. Department of Orthodontics and Pediatric Dentistry and Center for Human Growth and Development, The University of Michigan, Ann Arbor 2001
• 3 Bell W H. Le Fort I osteotomy for correction of maxillary deformities.  J Oral Surg. 1975;  33 412-426
• 4 Björk A. Variations in the growth pattern of the human mandible: longitudinal radiographic study by the implant method.  J Dent Res. 1963;  42 (Pt 2) 400-411
• 5 Björk A. Sutural growth of the upper face studied by the implant method.  Acta Odontol Scand. 1966;  24 109-127
• 6 Björk A, Skieller V. Growth of the maxilla in three dimensions as revealed radiographically by the implant method.  Br J Orthod. 1977;  4 53-64
• 7 Broadbent Sr B H, Broadbent Jr B H, Golden W H. Bolton Standards of Dentofacial Developmental Growth. CV Mosby, St. Louis 1975
• 8 Buckley M J, Tulloch J F, White Jr R P, Tucker M R. Complications of orthognathic surgery: a comparison between wire fixation and rigid internal fixation.  Int J Adult Orthodon Orthognath Surg. 1989;  4 69-74
• 9 Busby B R, Bailey L J, Proffit W R, Phillips C, White Jr R P. Long-term stability of surgical Class III treatment: a study of 5-year postsurgical results.  Int J Adult Orthodon Orthognath Surg. 2002;  17 159-170
• 10 Champy M. Surgical treatment of midface deformities.  Head Neck Surg. 1980;  2 451-465
• 11 Cheever D J. Displacement of the upper jaw.  Med Surg Rep Boston City Hosp. 1870;  1 163
• 12 Chong Y H, Ive J C, Artun J. Changes following the use of protraction headgear for early correction of Class III malocclusion.  Angle Orthod. 1996;  66 351-362
• 13 Dowling P A, Espeland L, Sandvik L, Mobarak K A, Hogevold H E. LeFort I maxillary advancement: 3-year stability and risk factors for relapse.  Am J Orthod Dentofacial Orthop. 2005;  128 560-567
• 14 Ellis 3rd  E 3, McNamara Jr J A. Components of adult Class III malocclusion.  J Oral Maxillofac Surg. 1984;  42 295-305
• 15 Franchi L, Baccetti T, McNamara Jr J A. Mandibular growth as related to cervical vertebral maturation and body height.  Am J Orthod Dentofacial Orthop. 2000;  118 335-340
• 16 Freihofer Jr H P. Results of osteotomies of the facial skeleton in adolescence.  J Maxillofac Surg. 1977;  5 267-297
• 17 Gallagher R W, Miranda F, Buschang P H. Maxillary protraction: treatment and posttreatment effects.  Am J Orthod Dentofacial Orthop. 1998;  113 612-619
• 18 Graber L W. Chin cup therapy for mandibular prognathism.  Am J Orthod. 1977;  72 23-41
• 19 Haas A J. Palatal expansion: just the beginning of dentofacial orthopedics.  Am J Orthod. 1970;  57 219-255
• 20 Hopkin G B, Houston W J, James G A. The cranial base as an etiological factor in malocclusion.  Angle Orthod. 1968;  38 250-255
• 21 Iseri H, Solow B. Growth displacement of the maxilla in girls studied by the implant method.  Eur J Orthod. 1990;  12 389-398
• 22 Lager H. The individual growth pattern and stage of maturation as a basis for treatment of distal occlusion with overjet.  Trans Eur Orthod Soc. 1967;  43 137-145
• 23 Lamparski D G, Nanda S K. Skeletal age assessment utilizing cervical vertebrae. In: McNamara JA Jr, Kelly KA. Treatment Timing: orthodontics in four dimensions. Craniofacial Growth Series Monograph 39. Department of Orthodontics and Pediatric Dentistry, and Center for Human Growth and Development, The University of Michigan, Ann Arbor 2002
• 24 Larsen A J, Van Sickles J E, Thrash W J. Postsurgical maxillary movement: a comparison study of bone plate and screw versus wire osseous fixation.  Am J Orthod Dentofacial Orthop. 1989;  95 334-343
• 25 Luyk N H, Ward-Booth R P. The stability of LeFort I advancement osteotomies using bone plates without bone grafts.  J Maxillofac Surg. 1985;  13 250-253
• 26 MacDonald K E, Kapust A J, Turley P K. Cephalometric changes after the correction of Class III malocclusion with maxillary expansion / facemask therapy.  Am J Orthod Dentofacial Orthop. 1999;  116 13-24
• 27 McGill J. Orthopedic Alteration Induced by Rapid Maxillary Expansion and Facemask Therapy. The University of Michigan, Ann Arbor 1995
• 28 McNamara Jr J A. An orthopedic approach to the treatment of Class III malocclusion in young patients.  J Clin Orthod. 1987;  21 598-608
• 29 Mouakeh M. Cephalometric evaluation of craniofacial pattern of Syrian children with Class III malocclusion.  Am J Orthod Dentofacial Orthop. 2001;  119 640-649
• 30 Ngan P. Early treatment of Class III malocclusion: is it worth the burden?.  Am J Orthod Dentofacial Orthop. 2006;  129 (4 Suppl) 82-85
• 31 Ngan P W, Hägg U, Yiu C, Wei S H. Treatment response and long-term dentofacial adaptations to maxillary expansion and protraction.  Semin Orthod. 1997;  3 255-264
• 32 Obwegeser H. Surgical correction of small or retrodisplaced maxillae. The “dish-face” deformity.  Plast Reconstr Surg. 1969;  43 351-365
• 33 Pangrazio-Kulbersh V, Berger J, Kersten G. Effects of protraction mechanics on the midface.  Am J Orthod Dentofacial Orthop. 1998;  114 484-491
• 34 Pangrazio-Kulbersh V, Berger J L, Janisse F N, Bayirli B. Long-term stability of Class III treatment: rapid palatal expansion and protraction facemask vs LeFort I advancement osteotomy.  Am J Orthod Dentofacial Orthop. 2007;  131 7.e9-7.e19
• 35 Petit H P. Adaptations following accelerated facial mask therapy. In: McNamara JA, Ribbens KA, Howe RP (eds). Clinical Alteration to the Growing Face. Craniofacial Growth Series Monograph 14. Center for Human Growth and Development, The University of Michigan, Ann Arbor 1983
• 36 Proffit W R, Phillips C, Turvey T A. Stability after surgical-orthodontic correction of skeletal Class III malocclusion. 3: combined maxillary and mandibular procedures.  Int J Adult Orthodon Orthognath Surg. 1991;  6 211-225
• 37 Reyes B C. The Class III Growth Pattern: a cross-sectional cephalometric study. The University of Michigan, Ann Arbor 2002; 20: 195
• 38 Riolo M L, Moyers R E, McNamara J A, Hunter S. An Atlas of Craniofacial Growth. Craniofacial Growth Series Monograph 2. Center for Human Growth and Development, The University of Michigan, Ann Arbor 1974
• 39 Ritucci R, Nanda R. The effect of chin cup therapy on the growth and development of the cranial base and midface.  Am J Orthod Dentofacial Orthop. 1986;  90 475-483
• 40 Savara B S, Singh I J. Norms of size and annual increment of seven anatomical measures of maxillae in boys from three to sixteen years of age.  Angle Orthod. 1968;  38 104-120
• 41 Shanker S, Ngan P, Wade D, Beck M, Yiu C, Hägg U, Wei S H. Cephalometric A point changes during and after maxillary protraction and expansion.  Am J Orthod Dentofacial Orthop. 1996;  110 423-430
• 42 Simonsen R. The Effect of Facemask Therapy. (Master's thesis) Eastman Dental Center 1982
• 43 Solow B. The dentoalveolar compensatory mechanism: background and clinical implications.  Br J Orthod. 1980;  7 145-161
• 44 Sue G, Chanoca S J, Turley P K, Itoh J. Indicators of skeletal Class III growth.  J Dent Res. 1987;  66 343
• 45 Tanabe Y, Taguchi Y, Noda T. Relationship between cranial base structure and maxillofacial components in children aged 3–5 years.  Eur J Orthod. 2002;  24 175-181
• 46 Turley P K. Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction headgear.  J Clin Orthod. 1988;  22 314-325
• 47 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
• 48 Wisth P J, Tritrapunt A, Rygh P, Bøe O E, Norderval K. The effect of maxillary protraction on front occlusion and facial morphology.  Acta Odontol Scand. 1987;  45 227-237