Abstract
Objectives
Analysis of the effects and side effects of treatment of patients with moderate skeletal Class III and vertical growth pattern by means of extraction of the second molars in the lower jaw.
Patients and methods
A total of 20 patients with a mean age of 12.9 years were examined retrospectively. Inclusion criteria consisted of a Wits value of 0 to −5, a posterior growth pattern of the mandible (Hasund analysis), an overjet of −2 to 1 mm, and an overbite of 0 to −3 mm. Treatment was performed using a straight-wire appliance. As part of the treatment, the lower second molars were extracted and Class III elastics attached. Cephalograms and orthopantomograms taken before and after treatment were used for evaluation.
Results
Treatment resulted in a significant change in the mean overjet from 0.5 mm to 2.1 mm and the attainment of a positive mean overbite of −1.0 mm to 0.9 mm. The occlusal plane rotated anteriorly from 18.8° to 13.7°. The skeletal parameters showed a change in the Wits value from −3.3 mm to −1.4 mm and an anterior mandibular rotation (ML-NSL 35.5° vs. 32.0°). The soft tissues revealed an increase in the distance between the lower lip and the “esthetic line” to the posterior (−2.0 mm vs. −3.9 mm).
Conclusion
Dental compensation of moderate skeletal Class III with a tendency to an anterior open bite with vertical growth pattern by extracting the lower second molars, combined with Class III elastics, resulted in an anterior rotation of the occlusal plane and mandible. Eighteen of 20 patients achieved a physiological overjet and positive overbite. A prerequisite for this therapy is the presence of lower wisdom teeth; a potential side effect is elongation of the upper second molars.
Zusammenfassung
Ziel
Analyse der Wirkungen und Nebenwirkungen der Behandlung von Patienten mit moderater skeletaler Klasse III und vertikalem Wachstumsmuster mittels Extraktion der 2. Molaren im Unterkiefer.
Patienten und Methodik
Es wurden 20 Patienten mit einem Durchschnittsalter von 12,9 Jahren retrospektiv untersucht. Einschlusskriterien bestanden aus dem Vorliegen eines Wits-Wertes von 0 bis −5, einem posterioren Wachstumsmuster der Mandibula (Hasund-Analyse) und dem Vorliegen eines Overjets von −2 bis 1 mm und Overbites von 0 bis −3 mm. Die Behandlung erfolgte mittels einer Straightwire-Apparatur. Im Rahmen der Behandlung erfolgte die Extraktion der 2. Molaren im Unterkiefer und das Einhängen von Klasse-III-Gummizügen. Zur Auswertung dienten die Fernröntgenseitenbilder und Orthopantomogramme vor und nach Abschluss der Behandlung.
Ergebnisse
Die Behandlung führte zu einer signifikanten Veränderung des mittleren Overjets von 0,5 auf 2,1 mm und Erreichen eines positiven mittleren Overbites von −1,0 auf 0,9 mm. Die Okklusionsebene erfuhr eine Rotation nach anterior von 18,8 auf 13,7°. Die skeletalen Werte zeigten eine Veränderung des Wits-Wertes von −3,3 auf −1,4 mm und eine anteriore Rotation der Mandibula (ML-NSL 35,5 vs. 32,0°). Die Untersuchung der Weichteile ergab eine vergrößerte Distanz der Unterlippe von der „Esthetic line“ nach dorsal (-2,0 vs. -3,9 mm).
Schlussfolgerung
Die dentale Kompensation einer moderaten skeletalen Klasse III mit Tendenz zum frontal offenen Biss bei vertikalem Wachstum mittels Extraktion der 2. Molaren im Unterkiefer kombiniert mit Klasse-III-Gummizügen führte zu einer anterioren Rotation der Okklusionsebene und der Mandibula. Bei 18 von 20 Patienten konnten ein physiologischer Overjet und ein positiver Overbite erreicht werden. Eine Grundvoraussetzung für diese Therapie besteht in der vorhandenen Anlage der unteren Weisheitszähne und als mögliche Nebenwirkung muss die Elongation der oberen 2. Molaren beachtet werden.
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Jacobs, C., Jacobs-Müller, C., Hoffmann, V. et al. Dental compensation for moderate Class III with vertical growth pattern by extraction of the lower second molars. J Orofac Orthop 73, 41–48 (2012). https://doi.org/10.1007/s00056-011-0065-9
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DOI: https://doi.org/10.1007/s00056-011-0065-9