Kieferorthopädische Dekompensation von Tiefbisspatienten– Kieferorthopädie am Limit in der kombiniert kieferorthopädisch/kieferchirurgischen Therapie

Zusammenfassung

Die Therapie von erwachsenen Patienten mit einer ausgeprägten skelettalen und dentalen Angle-Klasse II kann die Kieferorthopädie mit rein konservativen Behandlungsansätzen an ihre Grenzen bringen. Ein interdisziplinäres kieferorthopädisch-kieferchirurgisches Therapiekonzept ist in diesem Fall häufig die Therapie der Wahl. Hierbei stellt oft die präoperative Dekompensation eine entscheidende Schlüsselfunktion dar. Im nachfolgend dokumentierten Patientenfall soll der interdisziplinäre Therapieansatz unter der Verwendung einer individuellen skelettal verankerten, digital designten PIPA-Apparatur (Palatinal Inserierte Pins mit Aufbissplatte) vorgestellt werden.

Abstract

The treatment of adult patients with a pronounced skeletal and dental Angle Class II can push orthodontics to its limits with purely conservative treatment approaches. An interdisciplinary orthodontic and maxillofacial surgical treatment concept is often the treatment of choice in this case. Preoperative decompensation plays a key role here. In the following documented patient case, the interdisciplinary treatment approach using a skeletally anchored, individually designed PIPA appliance (Palatally Inserted Pins with Bite Plate) will be explained.

Schlüsselwörter

Prächirurgische Dekompensation - kombiniert kieferorthopädisch-kieferchirurgische Therapie - skelettale Verankerung - individualisierte digitale Apparaturen - Erwachsenenbehandlung

Keywords

Pre-surgical decompensation - combined orthodontic and maxillofacial therapy - skeletal anchorage - customised digital appliances - adult treatment

Publication History

Article published online:
19 June 2024

• Literatur

• 1 Cakan DG, Ulkur F, Taner TU. The genetic basis of facial skeletal characteristics and its relation with orthodontics. Eur J Dent 2012; 6: 340-345
• 2 Uzuner FD, Aslan BI, Dinçer M. Dentoskeletal morphology in adults with Class I, Class II Division 1, or Class II Division 2 malocclusion with increased overbite. American Journal of Orthodontics and Dentofacial Orthopedics 2019; 156: 248-256.e2 DOI: 10.1016/j.ajodo.2019.03.006.
• 3 Watted N, Witt E, Bill J. A therapeutic concept for the combined orthodontic surgical correction of angle Class II deformities with short-face syndrome: Surgical lengthening of the lower face. Clin Orthod Res 2000; 3: 78-93
• 4 Watted N, Bartsch A. Esthetic Aspects of Orthodontic-Surgical Treatment of Sagittal-Vertical Anomalies: The Example of the Short Face Syndrome. Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie 2002; 63: 129-142 DOI: 10.1007/s00056-002-0017-5.
• 5 Bollen A-M. Effects of malocclusions and orthodontics on periodontal health: evidence from a systematic review. J Dent Educ 2008; 72: 912-918
• 6 Gupta ND, Maheshwari S, Prabhat KC. et al. A critical review of the management of deep overbite complicated by periodontal diseases. European Journal of General Dentistry 2012; 1: 2-5 DOI: 10.4103/2278-9626.101343.
• 7 Huang GJ, Bates SB, Ehlert AA. et al. Stability of deep-bite correction: A systematic review. Journal of the World Federation of Orthodontists 2012; 1: e89-e96 DOI: 10.1016/j.ejwf.2012.09.001.
• 8 Stelzenmüller W, Wiesner J, Bias F. Therapie von Kiefergelenkschmerzen: ein Behandlungskonzept für Zahnärzte, Kieferorthopäden und Physiotherapeuten; 94 Tabellen; [inkl. CD-ROM]. 2., überarb. und erw. Aufl. Stuttgart: Thieme; 2010
• 9 Andersson L, Brattström V. Cephalometric analysis of permanently snoring patients with and without obstructive sleep apnea syndrome. International Journal of Oral and Maxillofacial Surgery 1991; 20: 159-162 DOI: 10.1016/S0901-5027(05)80007-4.
• 10 Riley R, Guilleminault C, Herran J. et al. Cephalometric Analyses and Flow-Volume Loops in Obstructive Sleep Apnea Patients. Sleep 1983; 6: 303-311 DOI: 10.1093/sleep/6.4.303.
• 11 Flores-Mir C, Korayem M, Heo G. et al. Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome. The Journal of the American Dental Association 2013; 144: 269-277 DOI: 10.14219/jada.archive.2013.0113.
• 12 Lowe AA, Ono T, Ferguson KA. et al. Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. American Journal of Orthodontics and Dentofacial Orthopedics 1996; 110: 653-664 DOI: 10.1016/S0889-5406(96)80043-6.
• 13 Terán-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The Association between Sleep Apnea and the Risk of Traffic Accidents. N Engl J Med 1999; 340: 847-851 DOI: 10.1056/NEJM199903183401104.
• 14 Young T, Evans L, Finn L. et al. Estimation of the Clinically Diagnosed Proportion of Sleep Apnea Syndrome in Middle-aged Men and Women. Sleep 1997; 20: 705-706 DOI: 10.1093/sleep/20.9.705.
• 15 Hussels W, Nanda RS. Analysis of factors affecting angle ANB. American Journal of Orthodontics 1984; 85: 411-423 DOI: 10.1016/0002-9416(84)90162-3.
• 16 Jacobson A. The “Wits” appraisal of jaw disharmony. American Journal of Orthodontics 1975; 67: 125-138 DOI: 10.1016/0002-9416(75)90065-2.
• 17 Brachvogel P, Berten JL, Hausamen JE. [Surgery before orthodontic treatment: a concept for timing the combined therapy of skeletal dysgnathias]. Dtsch Zahn Mund Kieferheilkd Zentralbl 1991; 79: 557-563
• 18 Brachvogel P, Berten JL, Hessling K-H. et al. Operative Korrekturmöglichkeiten von dentoalveolären Adaptationen im Rahmen der skelettalen Umstellungsosteotomie. Fortschritte der Kieferorthopädie 1991; 52: 21-25 DOI: 10.1007/BF02168154.
• 19 Koole R, Egyedi P. The case for postoperative orthodontics in orthognathic surgery. Journal of Cranio-Maxillofacial Surgery 1990; 18: 293-296 DOI: 10.1016/S1010-5182(05)80534-7.
• 20 Lee RT. The Benefits of Post-surgical Orthodontic Treatment. British Journal of Orthodontics 1994; 21: 265-274 DOI: 10.1179/bjo.21.3.265.
• 21 Frost HM. The biology of fracture healing. An overview for clinicians. Part I. Clin Orthop Relat Res 1989; 283-293
• 22 Frost HM. The biology of fracture healing. An overview for clinicians. Part II. Clin Orthop Relat Res 1989; 294-309
• 23 Liou EJW, Chen P-H, Wang Y-C. et al. Surgery-first accelerated orthognathic surgery: postoperative rapid orthodontic tooth movement. J Oral Maxillofac Surg 2011; 69: 781-785 DOI: 10.1016/j.joms.2010.10.035.
• 24 Liou EJW, Chen P-H, Wang Y-C. et al. Surgery-first accelerated orthognathic surgery: orthodontic guidelines and setup for model surgery. J Oral Maxillofac Surg 2011; 69: 771-780 DOI: 10.1016/j.joms.2010.11.011.