Article

Two-stage treatment of a severe skeletal Class III, deep bite malocclusion.

Department of Orthodontics, School of Dentistry, National Taiwan University, Taipei.
American Journal of Orthodontics and Dentofacial Orthopedics (Impact Factor: 1.46). 06/1997; 111(5):481-6. DOI: 10.1016/S0889-5406(97)70283-X
Source: PubMed
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    ABSTRACT: In order to evaluate current attitudes to early interceptive treatment, 2001 orthodontic offices in Germany were asked to fill in a questionnaire comprising the following topics: indication, appliances for the early correction of Class-III malocclusions, diagnostic records, duration, and benefits to overall therapy. Based on the 677 evaluable questionnaires, the following statistically significant conclusions could be drawn: 92.6% of the orthodontists see Class-III malocclusion as an indication for early treatment. Early treatment of severe crowding, diastemata, Class-II malocclusion, deep bite, increased overjet and impacted incisors was declined by most orthodontists. The interceptive treatment of further malocclusions was controversially discussed. Functional appliances (67.5%), in particular the Frnkel III (47.3%), were dominant in correction of Class-III malocclusions. Typical orthodontic records relating to early interceptive treatment include panoramic radiographs, lateral headfilms, photos and dental casts. 2.5% of the orthodontists routinely take a hand-wrist radiograph. Although recently published studies support the use of facial masks in theory, they are rarely used in practice. To what extent early interceptive treatment of Class-III malocclusion influences the overall treatment is the subject of further studies. Zusammenfassung: Zur Evaluierung der aktuellen Auffassung zur kieferorthopdischen Frhbehandlung wurden alle kieferorthopdischen Fachpraxen innerhalb von Deutschland angeschrieben. Die 2001 verschickten Fragebgen enthielten Fragen zu der Indikationsstellung, Apparaturen zur frhen Klasse-III-Therapie, Umfang der diagnostischen Unterlagen, Zeitrahmen der Interzeptivbehandlung und Auswirkungen auf die Gesamtbehandlung. Von 677 auswertbaren Fragebgen konnten folgende statistisch signifikante Aussagen getroffen werden: 92,6% der Kieferorthopden sehen in der Klasse-III-Anomalie eine zwingende Indikation zur frhen Behandlung. Ausgeprgte Engstnde, Diastema, Klasse-II-Anomalie, Tiefbiss, vergrerte sagittale Stufe und Schneidezahnverlagerung werden mehrheitlich als nicht behandlungsbedrftig abgelehnt. Die Behandlung von anderen Anomalien wird kontrovers diskutiert. Zur Korrektur der Klase-III-Anomalie werden von 67,5% der Befragten FKO-Gerte, vor allem der Frnkel III (47,3%) eingesetzt. Als Anfangsunterlagen werden standardmig OPG, FRS, Fotos und Modelle angefertigt. 2,5% der Kieferorthopden bentigen auerdem eine Handwurzelaufnahme. Trotz aktueller erfolgversprechender Publikationen ist der Einsatz extraoraler Gerte in der Paxis vergleichsweise gering. Inwieweit die Gesamtbehandlung der Klasse III durch den frhen Therapieansatz positiv beeinflusst wird, ist Inhalt weiterfhrender Studien.
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    ABSTRACT: The purpose of this study was to determine the skeletal, dental, and soft-tissue changes in response to camouflage Class III treatment. Thirty patients (average age, 12.4 + or - 1.0 years) with skeletal Class III malocclusions who completed comprehensive nonextraction orthodontic treatment were studied. Skeletal, dental, and soft-tissue changes were determined by using published cephalometric analyses. The quality of orthodontic treatment was standardized by registering the peer assessment rating index on the pretreatment and posttreatment study models. The change in the level of gingival attachment with treatment was determined on the study casts. The results were compared with a group of untreated subjects. Data were analyzed with repeated measures analysis and paired t tests. The average change in the Wits appraisal was greater in the treated group (1.2 + or - 0.1 mm) than in the control group (-0.5 + or - 0.3 mm). The average peer assessment rating index score improved from 33.5 to 4.1. No significant differences were found for the level of gingival attachments between the treatment and control groups. The sagittal jaw relationship (ANB angle) did not improve with camouflage treatment. A wide range of tooth movements compensated for the skeletal changes in both groups. The upper and lower limits for incisal movement to compensate for Class III skeletal changes were 120 degrees to the sella-nasion line and 80 degrees to the mandibular plane, respectively. Greater increases in the angle of convexity were found in the treated group, indicating improved facial profiles. Greater increases in length of the upper lip were found in the treated group, corresponding to the changes in the hard tissues with treatment. Significant dental and soft-tissue changes can be expected in young Class III patients treated with camouflage orthodontic tooth movement. A wide range of skeletal dysplasias can be camouflaged with tooth movement without deleterious effects to the periodontium. However, proper diagnosis and realistic treatment objectives are necessary to prevent undesirable sequelae.
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