Zusammenfassung
Bei der neuen Dynamax-Apparatur handelt es sich um ein Gerät zur Therapie der skelettalen Klasse-II-Maloklusion, die durch eine Retrusion des Unterkiefers gekennzeichnet ist. Diese zweiteilige Apparatur ermöglicht die progressive Nachentwicklung des Unterkiefers, die Expansion des Oberkiefers, die Kontrolle des maxillären Wachstums und des frontalen Kronentorque sowie die Kontrolle der vertikalen Entwicklung des Gesichtes. Das Gerät ist einfach in Herstellung und Handhabung und wird von den Patienten gut angenommen. Es ermöglicht skelettale Veränderungen und Kontrolle über die dentofaziale Entwicklung sowie die Bewegung von Zähnen. Kern des Gerätes ist ein vorgefertigtes Federmodul, mit der sowohl eine Expansion des Oberkiefers, als auch die Nachentwicklung des Unterkiefers möglich ist. Seine leichte Aktivierbarkeit ermöglicht eine kontinuierliche progressive Protrusion des Unterkiefers. Ein Konstruktionsbiss ist dabei nicht erforderlich und die Apparatur lässt sich im Labor ohne Artikulator anfertigen. Durch das Federmodul ist das Gerät sehr stabil und besitzt nur geringe Kunststoffanteile, die sich hauptsächlich im Interokklusalraum befinden. Dadurch können sich die Seitenzähne ungehindert in die normale Interkuspidation durchbrechen, ohne dass sich die Untergesichtshöhe vergrößert. Die beiden Teile der Apparatur haben seitlich im Sublingualraum Kontakt, wo sich eine ausgedehnte Kontaktfläche befindet, mit der die Nachentwicklung des Unterkiefers durchgeführt wird. Dieser Kontakt stellt sicher, dass die protrudierte Unterkieferposition auch bei der Mundöffnung und während des Schlafes aufrecht erhalten wird. Der untere Teil der Apparatur kann festsitzend oder abnehmbar gestaltet werden. In beiden Kiefern kann gleichzeitig mit der orthopädischen Therapie eine Multibracket-Behandlung durchgeführt werden, was die Effektivität der gesamten Therapie deutlich erhöht.
Abstract
The new Dynamax appliance is a treatment mechanism for the correction of the Skeletal II malocclusion characterised by a mandibular retrusion. Progressive mandibular advancement, maxillary expansion, control of maxillary growth, incisor torque and control of vertical facial development are incorporated into a two-part appliance. The appliance provides ease of laboratory construction, clinical handling and patient acceptability, giving the possibility of skeletal changes and control over dento-facial development and tooth movements. A prefabricated spring module forms the basis of the appliance, allowing both maxillary expansion and mandibular advancement, with an easily adjustable progressive forward position of the lower jaw. A construction bite is unnecessary and the appliance can be made without the use of a laboratory articulator. The spring module provides most of the strength to the appliance so that minimal acrylic is required and the appliance is fully contained within the freeway space, allowing the posterior teeth to erupt into normal inter-digitation without increasing the lower face height. Contact between the upper and lower parts of the appliance occurs posteriorly in the lingual sulcus, where the depth permits an extended vertical contact to be used for mandibular advancement. This contact maintains a protrusive mandibular position throughout the range of mandibular opening, including during sleep. The lower portion of the appliance may be fixed or removable and multibracket treatment can be carried out in one or both arches at the same time as the orthopaedics, promoting efficiency in treatment.
Schlüsselwörter
Dynamax-System - funktionelle Therapie
Key words
Dynamax system - functional therapy
Literatur
-
1
Mills J R.
The stability of the lower labial segment. A cephalometric survey.
Dent Pract Dent Rec.
1968;
18
293-306
-
2
Bass N M.
The aesthetic analysis of the face.
Eur J Orthod.
1991;
13
343-350
-
3
Arnett G W, Bergman R T.
Facial keys to orthodontic diagnosis and treatment planning - Part I.
Am J Orthod Dentofacial Orthop.
1993;
103
299-312
-
4
Arnett G W, Bergman R T.
Facial keys to orthodontic diagnosis and treatment planning - Part II.
Am J Orthod Dentofacial Orthop.
1993;
103
395-411
-
5
Fränkel R.
Decrowding during eruption under the screening influence of vestibular shields.
Am J Orthod.
1974;
65
372-406
-
6 Graber T M, Rakosi T, Petrovic A. Dentofacial Orthopedics with Functional Appliances. Mosby, St. Louis 1997
-
7
Bass N M.
Dento-facial orthopaedics in the correction of class II malocclusion.
Br J Orthod.
1982;
9
3-31
-
8
Bass N M.
Orthopedic coordination of dentofacial development in skeletal Class II malocclusion in conjunction with edgewise therapy. Part I.
Am J Orthod.
1983;
84
361-383
-
9
Bass N M.
Orthopedic coordination of dentofacial development in skeletal Class II malocclusion in conjunction with edgewise therapy. Part II.
Am J Orthod.
1983;
84
466-490
-
10
Bass N M.
Bass orthopedic appliance system. Part I. Design and construction.
J Clin Orthod.
1987;
21
254-265
-
11
Bass N M.
Bass orthopedic appliance system. Part II. Diagnosis and appliance prescription.
J Clin Orthod.
1987;
21
312-320
-
12
Bass N M.
Bass orthopedic appliance system. Part III. Case management.
J Clin Orthod.
1987;
21
384-394
-
13
Bass N M.
Update on the Bass appliance system.
J Clin Orthod.
1994;
28
421-428
-
14
Bass N M.
Simplified Bass Appliance.
J Clin Orthod.
1989;
23
756-762
-
15
Clark W J.
The twin block traction technique.
Eur J Orthod.
1982;
4
129-138
-
16 Clark W J. Twin Block Functional Therapy: applications in dentofacial orthopaedics. Mosby - Wolf, London 1995; 265-267
-
17
Cura N, Saraç M, Öztürk Y, Sürmeli N.
Orthodontic and orthopedic effects of Activator, Activator-HG combination and Bass appliances: a comparative study.
Am J Orthod Dentofacial Orthop.
1996;
110
36-45
-
18
Malmgren O, Ömblus J.
Treatment with an orthopaedic appliance system.
Eur J Orthod.
1985;
7
205-214
-
19
Malmgren O, Ömblus J, Hägg U, Pancherz H.
Treatment with an orthopedic appliance system in relation to treatment intensity and growth periods. A study of initial effects.
Am J Orthod Dentofacial Orthop.
1987;
91
143-151
-
20
Vargervik K, Harvold E P.
Response to activator treatment in Class II malocclusions.
Am J Orthod.
1985;
88
242-251
-
21
Pancherz H.
The Herbst appliance - its biologic effects and clinical use.
Am J Orthod.
1985;
87
1-20
-
22
Stöckli P W, Willert H G.
Tissue reactions in the temporomandibular joint resulting from anterior displacement of the mandible in the monkey.
Am J Orthod.
1971;
60
142-155
-
23
McNamara J A.
Functional adaptations in the temporomandibular joint.
Dent Clin North Am.
1975;
19
457-471
-
24
Pancherz H, Hansen K.
Occlusal changes during and after Herbst treatment: a cephalometric investigation.
Eur J Orthod.
1986;
8
215-228
-
25
Dahan J, Dombrowsky K J, Oehler K.
Static and dynamic morphology of the temporo-mandibular joint before and after functional treatment with the activator.
Rep Congr Eur Orthod Soc.
1969;
45
255-273
-
26
Pancherz H.
The mechanism of Class II correction in Herbst appliance treatment. A cephalometric investigation.
Am J Orthod.
1982;
82
104-113
-
27
Wieslander L.
Intensive treatment of severe Class II malocclusions with a headgear - Herbst appliance in the early mixed dentition.
Am J Orthod.
1984;
86
1-13
-
28
Woodside D G, Metaxas A, Altuna G.
The influence of functional appliance therapy on glenoid fossa remodeling.
Am J Orthod Dentofacial Orthop.
1987;
92
181-198
-
29
Ruf S, Pancherz H.
Temporomandibular joint remodeling in adolescents and young adults during Herbst treatment: A prospective longitudinal magnetic resonance imaging and cephalometric radiographic investigation.
Am J Orthod Dentofacial Orthop.
1999;
115
607-618
-
30
Voudouris J C, Woodside D G, Altuna G, Kuftinec M M, Angelopoulos G, Bourque P J.
Condyle-fossa modifications and muscle interactions during Herbst treatment, part 1. New technological methods.
Am J Orthod Dentofacial Orthop.
2003;
123
604-613
-
31
Voudouris J C, Woodside D G, Altuna G, Angelopoulos G, Bourque P J, Lacouture C Y, Kuftinec M M.
Condyle-fossa modifications and muscle interactions during Herbst treatment, part 2. Results and conclusions.
Am J Orthod Dentofacial Orthop.
2003;
124
13-29
-
32
Birkebaek L, Melsen B, Terp S.
A Laminagraphic study of the alterations in the temporo-mandibular joint following activator treatment.
Eur J Orthod.
1984;
6
257-266
-
33
Cura N, Saraç M.
The effect of treatment with the Bass appliance on skeletal Class II malocclusions: a cephalometric investigation.
Eur J Orthod.
1997;
19
691-702
-
34
Cura N, Saraç M.
Influence of Bass orthopaedic (Abstract).
Eur J Orthod.
1990;
12
484
-
35
Pancherz H, Malmgren O, Hägg U, Omblus J, Hansen K.
Class II correction in Herbst and Bass therapy.
Eur J Orthod.
1989;
11
17-30
-
36
Bass N M.
The Dynamax system: a new orthopedic appliance.
J Clin Orthod.
2003;
37
268-277
-
37
Sandler J, Di Biase A.
The inclined biteplane - a useful tool.
Am J Orthod Dentofacial Orthop.
1996;
110
339-350
-
38
Bass N M.
The holding appliance.
J Clin Orthod.
1988;
22
308-310
-
39
Rabie A BM, Hägg U.
Factors regulating mandibular condylar growth.
Am J Orthod Dentofacial Orthop.
2002;
122
401-409
-
40
Falck F, Fränkel R.
Clinical relevance of step-by-step mandibular advancement in the treatment of mandibular retrusion using the Fränkel appliance.
Am J Orthod Dentofacial Orthop.
1989;
96
333-341
-
41
Sessle B J, Woodside D G, Bourque P, Gurza S, Powell G, Voudouris J, Metaxas A, Altuna G.
Effect of functional appliances on jaw muscle activity.
Am J Orthod Dentofacial Orthop.
1990;
98
222-230
-
42
Lund D I, Sandler P J.
The effects of Twin Blocks: a prospective controlled study.
Am J Orthod Dentofacial Orthop.
1998;
113
104-110
-
43
Du X, Hägg U, Rabie A BM, Bakr M.
Effects of headgear Herbst and mandibular step-by-step advancement versus conventional Herbst appliance and maximal jumping of the mandible.
Eur J Orthod.
2002;
24
167-174
-
44
Hägg U, Du X, Rabie A BM.
Initial and late treatment effects of headgear - Herbst appliance with mandibular step-by-step advancement.
Am J Orthod Dentofacial Orthop.
2002;
122
477-485
-
45
Omblus J, Malmgren O, Pancherz H, Hägg U, Hansen K.
Long-term effects of Class II correction in Herbst and Bass Therapy.
Eur J Orthod.
1997;
19
185-193
-
46 Petrovic A G, Stutzman J J, Gasson N. The final length of the mandible: is it genetically predetermined?. In: Carlson DS (ed). Craniofacial biology. Craniofacial Growth Series Monograph 10. Center for Human Growth and Development. The University of Michigan, Ann Arbor 1987; 105-126
-
47
Bakr A, Rabie M, Chayaanupatkul A, Hagg U.
Stepwise advancement using fixed functional appliances: Experimental perspective.
Semin Orthod.
2003;
9
41-46
-
48
Bass N M.
Innovation in skeletal II treatment including effective incisor root torque in a preliminary removable appliance phase.
Br J Orthod.
1976;
3
223-230
-
49
O'Brien K, Wright J, Conboy F, Sanjie YeWeng, Mandall N, Chadwick S, Connolly I, Cook P, Birnie D. et al .
Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part I: Dental and skeletal effects.
Am J Orthod Dentofacial Orthop.
2003;
124
234-243
-
50
Caldwell S, Cook P.
Predicting the outcome of twin block functional appliance treatment: a prospective study.
Eur J Orthod.
1999;
21
533-539
-
51
Brennan M M, Gianelly A A.
The use of the lingual arch in the mixed dentition to resolve incisor crowding.
Am J Orthod Dentofacial Orthop.
2000;
117
81-85
-
52
Droschl H.
The effect of heavy orthopaedic forces on the maxilla in the growing Saimiri sciureus (squirrel monkey).
Am J Orthod.
1973;
63
449-461
-
53
Elder J R, Tuenge R H.
Cephalometric and histologic changes produced by extra oral high-pull traction to the maxilla in Macaca mulata.
Am J Orthod.
1974;
66
599-617
-
54
Pearson L E.
Vertical control through use of mandibular posterior intrusive forces.
Angle Orthod.
1973;
43
194-200
-
55
Pearson L E.
Vertical control in treatment of patients having backward-rotational growth tendencies.
Angle Orthod.
1978;
48
132-140
-
56 Stockli P W, Teuscher V M. Combined activator headgear orthopedics. In: Graber TM, Swain BF (eds). Orthodontics: Current principles and techniques. Mosby, St. Louis 1985; 405-480
-
57
Teuscher U.
An appraisal of growth and reaction to extraoral anchorage. Simulation of orthodontic-orthopedic results.
Am J Orthod.
1986;
89
113-121
-
58
Bendeus M, Hägg U, Rabie A BM.
Growth and treatment changes in patients treated with a headgear-activator appliance.
Am J Orthod Dentofacial Orthop.
2002;
121
376-384
-
59
Hägg U, Du X, Rabie A BM, Bendeus M.
What does headgear add to Herbst treatment and to retention?.
Sem Orthod.
2003;
9
57-66
-
60
Woodside D G.
Do functional appliances have an orthopedic effect?.
Am J Orthod Dentofacial Orthop.
1998;
113
11-14
-
61
Williams S, Melsen B.
The interplay between sagittal and vertical growth factors. An implant study of activator treatment.
Am J Orthod.
1982;
81
327-332
-
62
McDonagh S, Moss J P, Goodwin P, Lee R T.
A prospective optical surface scanning and cephalometric assessment of the effect of functional appliances on the soft tissues.
Eur J Orthod.
2001;
23
115-126
-
63
Bass N M.
Chin support for orthopedic and functional appliances.
J Clin Orthod.
1996;
30
110-114
-
64
Sander F G.
Der Einfluss herausnehmbarer kieferorthopädischer Apparate auf den Nachtschlaf der Patienten.
Fortschr Kieferorthop.
1982;
43
57-63
-
65
Sander F G.
Der Nachteffekt bei der Anwendung der Vorschubdoppelplatte.
Prakt Kieferorthop.
1989;
3
97-106
-
66
Samuels R, O'Neill J, Bhavra G, Hills D, Thomas P, Hug H, Brown M, Haining C, Stern M, DiBiase A. et al .
A clinical evaluation of a locking orthodontic facebow.
Am J Orthod Dentofacial Orthop.
2000;
117
344-350
-
67
Petit H P, Chateau M.
The K test and the condylar test.
J Clin Orthod.
1984;
18
726-732
Dr. Neville Bass
4 Queen Anne Street
GB-London W1G 9LQ
Email: DrNBass@aol.com
