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DOI: 10.1055/s-2006-942182
© Georg Thieme Verlag
Die Bedeutung der Genetik für die moderne Kieferorthopädie
Relevance of Genetics for Contemporary OrthodonticsPublication History
Publication Date:
28 September 2006 (online)
![](https://www.thieme-connect.de/media/iok/200603/lookinside/thumbnails/10.1055-s-2006-942182-1.jpg)
Zusammenfassung
Die tägliche Arbeit der Kieferorthopädie besteht darin, den Phänotyp eines Patienten möglichst dauerhaft zu verändern. Gleichzeitig ist die Kieferorthopädie seit langem am Beitrag von Genen und Umweltfaktoren an den Variationen im dentofazialen Bereich interessiert und daran, wie sich die Interaktion zwischen Geno- und Phänotyp am besten beeinflussen lässt. Der Phänotyp ist die Expression des Genotyps unter Einwirkung epigenetischer und externer Faktoren. Daher kann man davon ausgehen, dass die Einflussmöglichkeiten der kieferorthopädischen Mechanotherapie umso geringer sind, je stärker ein Merkmal genetisch beeinflusst wird. Im Rahmen der Forschungen zu den genetischen Mechanismen, die während der Entwicklung und Morphogenese dentaler und kraniofazialer Strukturen aktiv sind, konnten auch Faktoren entdeckt werden, die ursächlich zur Entstehung einer ganzen Reihe von kraniofazialen und dentalen Fehlbildungen beitragen. Gleichzeitig ist unser Bild von der Vererbung, also der Art und Weise der Weitergabe von Merkmalen und Erkrankungen an die folgende Generation, immer komplexer geworden. Zu den klassischen Mendelschen Vererbungsregeln, die nur auf einzelne Gendefekte zutreffen, die autosomal dominant, autosomal rezessiv oder X-chromosomal vererbt werden, kam im 20. Jahrhundert die Entdeckung einer Vielzahl weiterer nicht-Mendelscher Vererbungswege hinzu. Zwar wird die überwiegende Mehrzahl der dentofazialen Charakteristika multifaktoriell vererbt und von einer Vielzahl von Genen und externen Umweltfaktoren beeinflusst. Jedoch konnten noch weitere nicht-Mendelsche Vererbungswege entdeckt werden, über die dentofaziale Merkmale an die folgende Generation weitergegeben werden. Disomie aufgrund eines Imprintingverlustes bei einem Elternteil und der Einfluss epigenetischer Faktoren kann die Expression eines Genotyps verändern, ohne dass der eigentliche DNA-Code betroffen ist. Unter diesen „epi-genetischen” (neben-den-Genen) Faktoren könnten DNA-Methylierung und die Acetylierung von Histonen an den phänotypischen Unterschieden bei genetisch identischen Individuen, wie etwa monochoriaten identischen Zwillingen, beteiligt sein. Das bisherige Wissen um Ätiologie und Variationsbreite dentofazialer Fehlbildungen wird nun um die molekulargenetische Grundlage kieferorthopädischer Therapie ergänzt. In Zukunft könnten auch die genetischen Hintergründe und molekularbiologische Erklärungen für negative Begleiterscheinungen so mancher kieferorthopädischer Behandlung, wie etwa Resorptionen an Zahnwurzeln oder parodontale Destruktion, gefunden werden.
Abstract
As it is the daily pursuit in orthodontics to change the dentofacial phenotypes of patients preferably in a permanent way, the orthodontist is interested of old in the relative contribution of the genes and environmental factors on the dentofacial variables and in how the genotype-phenotype interaction should best be influenced. As the phenotype is the expression of the genotype interacting with environmental and epigenetic factors, it is expected that the more a characteristic is genetically determined, the less is the impact of the orthodontic mechanotherapy. Along with the evidence being accumulated on the genetic mechanisms active during dental and craniofacial development and morphogenesis, causative factors of a number of craniofacial and dental abormalities and syndromes have been discovered. The picture of inheritance, the ways traits and diseases are transmitted to the next generation, has also become complex. Besides Mendelian patterns of inheritance which only apply to single gene defects - autosomal dominance, autosomal recessive and X-linked inheritance - a large number of non-Mendelian inheritance patterns have been discovered throughout the twentieth century. Although the majority of dentofacial characteristics shows multifactorial inheritance, including the effects of many genes and (multiple) environmental factors, also other non-Mendelian mechanisms have been demonstrated in the transmission of dentofacial traits to the next generation. Uniparental disomy due to loss of imprinting and epigenetic mechanisms can modulate the expression of the genotype, without an actual change in the DNA-code. From the “epi-genetic” (besides-the-genes) factors, methylation of the DNA and/or acetylation of the histones may contribute to phenotypic differences noticed in genetically identical individuals, like monochorial identical twins. Besides the knowledge on the etiology and variation of dentofacial deviations, the molecular genetic basis of orthodontic treatment itself, is now being elucidated and in the future this may also lead to the genetic background and molecular explanation of the harmful side effects - like root resorption and periodontal breakdown - sometimes seen after orthodontic treatment.
Schlüsselwörter
Genetik - Umwelt - Ätiologie - Epigenetik - Fehlbisslage - dentofaziale Entwicklung - kieferorthopädische Behandlung
Key words
genetics - environment - epigenetics - etiology - malocclusion - dento-facial development - orthodontic treatment
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Prof. Dr. C. C.
Department of Orthodontics KU Leuven
Kapucijnenvoer 7
B-3000 Leuven
Belgien
Phone: +32/16 33 24 75
Fax: +32/16 33 24 13
Email: Carine.Carels@uz.kuleuven.be