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Szkeletaacutelis horgonylatok

szerepe az

aacutellcsontorthopeacutediaacuteban

Dr Nemes Baacutelint

Semmelweis Egyetem Gyermekfogaacuteszati eacutes

Fogszabaacutelyozaacutesi Klinika

III osztaacutely

Le Fort I advancement

Konzervatiacutev kezeleacutes

Graber Contemporary Orthodontics 2012 Ch 14 Optimizing Orthodontic and

Dentofacial Orthopedic Treatment Timing

RME + ARCMASZK

(Rapid Maxillary Expansion)

Liou EJ Effective maxillary orthopedic protraction for growing Class III patients a clinical application simulates distraction

osteogenesis Prog Orthod 20056(2)154-71

Masucci C1 Franchi L Giuntini V Defraia E Short-term effects of a modified Alt-RAMEC protocol for early treatment of Class

III malocclusion a controlled study Orthod Craniofac Res 2014 Nov17(4)259-69 doi 101111ocr12051 Epub 2014 Jul 7

Alt-RAMEC + ARCMASZK

(Alternating Rapid Maxillary

Expansion and Constriction)

Minilemez + arcmaszk

Baek et al 2010 Angle Orthodontist

Alt-RAMEC + arcmaszk + minilemez

Kaya et al 2011 Angle Orthodontist

15 patients with a mean skeletal age of 116 plusmn159 years undergoing 8

weeks of Alt-RAMEC followed by maxillary protraction maxilla moved

forward by 2 mm

Hybrid-hyrax + mentoplate

Wilmes et al 2011 JCO

Hybrid Hyrax Alt-RAMEC

Wilmes et al 2014

Bone Anchored Maxillary

Protraction (BAMP)

According to the present results

TAD-anchored MP might have a

greater maxillary advancement effect

and might reduce skeletal and dental

side effects compared with

toothanchored MP

(Feng et al Angle Orthod

2012821107ndash1114)

The overall success rate of miniplate

anchorage in terms of stability was

97 (De Clerck and Swennen 2011

Angle Orthodontist)

Bone Anchored Maxillary

Protraction (BAMP)

De Clerck et al 2010 J Oral Maxillofacial Surg

Remodeling of the glenoid fossa at the anterior eminence and bone resorption at the posterior wall

De Clerck et al 2012 AJODO

II osztaacutely

Bilateral Saggital Split Osteotomy

Graber Contemporary Orthodontics 2012 Ch 14 Optimizing Orthodontic and

Dentofacial Orthopedic Treatment Timing

Mandibular changes produced by

functional appliances in Class II

malocclusion a systematic review

bull from January 1966 to January 2005 RCT-s and CCT-s with

untreated Class II controls 22 articles qualified for the final analysis Four RCTs and 18 CCTs were retrieved

bull The amount of supplementary mandibular growth appears to be significantly larger if the functional treatment is performed at the pubertal peak in skeletal maturation

bull The Herbst appliance showed the highest coefficient of efficiency (028 mm per month) followed by the Twin-block (023 mm per month)

Cozza et al AJODO 2006 May129(5)599

Class II correction in patients treated with

Class II elastics and with fixed functional

appliances A comparative study

In the Begg group the maxilla moved forward 1 mm more than in the Herbst group and the mandible moved 1 mm more in the Herbst group than in the Begg group The skeletal improvement in the Herbst group exceeded the changes in the Begg group by on average 20 mm (P lt 01) The overjet reduction in the Begg group was larger (21 mm P lt 01) than in the Herbst group mostly because of dental movements The skeletal part of the overjet reduction was 4 in the Begg group compared with 51 in the Herbst group The molar correction was similar in both groups but in the Begg group the skeletal improvement was 10 compared with 66 in the Herbst group The overbite correction and the increase in the anterior lower facial height and in the NSLML angle were larger in the Begg group (P lt 05) The conclusions of this study were that the changes contributing to the Class II corrections in Begg and Herbst therapy were skeletal and dental The skeletal changes were however larger in the Herbsttreated group On the other hand favorable and unfavorable vertical changes were more pronounced in the group treated with Class II elastics

Nelson et al Am J Orthod Dentofacial Orthop 2000118142-9

Correction of Class II malocclusion with

Class II elastics a systematic review

bull Although Class II elastics have been widely used in the correction of Class II malocclusions there is still a belief that their side effects override the intended objectives The aim of this systematic review was to evaluate the true effects of Class II elastics in Class II malocclusion treatment

Based on the current literature we can state that Class II elastics are effective in correcting Class II malocclusions and their effects are primarily dentoalveolar Therefore they are similar to the effects of fixed functional appliances in the long term placing these 2 methods close to each other when evaluating treatment effectiveness Little attention has been given to the effects of Class II elastics on the soft tissues in Class II malocclusion treatment

Janson et al Am J Orthod Dentofacial Orthop 2013 Mar143(3)383-92

Jumping the bite

Dentaacutelis

Foumllső fogak disztalizaacutelaacutesa

Alsoacute fogak mezializaacutelaacutesa

Szkeletaacutelis

Kondilaacuteris noumlvekedeacutes

Mandibula hossznoumlvekedeacutes

Mandibula autorotaacutecioacute

Intermaxillaacuteris gumihuacutezaacutes

Foumllső front

Disztalizaacutecoacute

Extruacutezioacute

Alsoacute molaacuteris

Mezializaacutecioacute

Extruacutezioacute

Mandibula disztorotaacutecioacute

Herbst zsaneacuter

Alsoacute front

Proklinaacutecioacute

Foumllső molaacuteris

Disztalizaacutecioacute

Intruacutezioacute

Mandibula autorotaacutecioacute

Skeletal and dental changes in Class II division 1

malocclusions treated with splint-type Herbst

appliances A systematic review

bull Flores et alAngle Orthod 2007 Mar77(2)376-81

bull Three articles were finally selected and analyzed An individual analysis of these articles was made and some methodological flaws were identified The selected studies all showed statistically significant changes in the anteroposterior length of the mandible vertical height of the ramus lower facial height mandibular incisor proclination mesial movement of the lower molars and distal movement of the upper molars Posttreatment relapse in overjet and molar relationship was also observed

bull CONCLUSIONS

bull Dental changes are as important as skeletal changes to attaining the final occlusal results Long-term prospective double-blinded randomized clinical trials are needed to support these conclusions

Herbst zsaneacuter

Alsoacute front

Proklinaacutecioacute

Foumllső molaacuteris

Disztalizaacutecioacute

Intruacutezioacute

Mandibula autorotaacutecioacute

In all subjects (n=98) Herbst treatment resulted in varying degrees of lower-incisor proclination (mean = 89 degrees range = 05 degrees to 195 degrees)

Ruf et alAJODO 1998 Jul114(1)100-6

The Miniscrew-Anchored Herbst

Luzi et al JCO 2012

Miniscrew anchored Herbst

The mean increase in lower incisor inclination at the end of treatment was 1deg

(range 0deg to 2deg) for the EG and 7deg (range 4deg to 10deg) for the CG n=10

Luzi et al 2103

The Miniscrew anchored Herbst

This study showed that the Herbst appliance associated to miniscrews

allowed a better control of the incisor flaring with a greater

mandibular skeletal effect n=28

Manni et al 2014

Miniplate anchored Forsus

Although both appliances were successful in correcting the skeletal Class II

malocclusion the skeletally anchored Forsus FRD EZ appliance did so

without protruding the mandibular incisors n=32

Celikoglu et al Angle Orthodontist Vol 86 No 2 2016

I Osztaacutely nyitott

harapaacutes

Le Fort I Impakcioacute

Steinhaumluser et al 2008 J Orofac Orthoped

Graber Contemporary Orthodontics 2012 Ch 14 Optimizing Orthodontic and

Dentofacial Orthopedic Treatment Timing

Gurton et al 2004

Rapid Molar Intruder Appliance

Cinsar et al 2007

Sherwood et al 2002 AJODO

Kuroda et al 2004

Edgewise vs Molar intrusion

From the cephalometric values in the non-

IA group open-bite patients were generally

treated by extrusion of the maxillary and

mandibular incisors that resulted in

clockwise rotation of the mandibular plane

angle In the IA group intrusion of the

maxillary and mandibular molars that

resulted in counterclockwise rotation was

noted (n=30 with 2 years followup) Deguchi et al 2011 AJODO

Xun et al 2007 Angle Orthodontist

Foot et al 2014 Progress in Orthodontics

Stabil Deguchi et al 2011 AJODO 2 eacuteves utaacutenkoumlveteacutessel (n=15)

Scheffler et al 2014 AJODO 2 eacuteves utaacutenkoumlveteacutessel (n=33)

Dalci et al 2015 EOS Venice OP44 36 eacutev utaacutenkoumlveteacutessel (n=30)

Intrusion of the maxillary posterior teeth can give satisfactory correction of moderately severe anterior

open bites but 05 to 15 mm of reeruption of these teeth is likely to occur Controlling the vertical

position of the mandibular molars so that they do not erupt as the maxillary teeth are intruded is important in

obtaining a decrease in face height Scheffler et al 2014 AJODO

Transverzaacutelis

elteacutereacutesek

SARME ndash palat szutura

elcsontosodaacutesa utaacuten

bull Altataacutesos műteacutet

bull Melleacutekhataacutesok (műteacuteti dentaacutelis

Hyrax-naacutel)

bull Boumllcsesseacutegfogak eltaacutevoliacutetaacutesa 6

hoacutenappal a műteacutet előtt

bull Időigeacutenyes (szaacutejsebeacuteszekkel valoacute

egyezteteacutes 2-4 nap bentfekveacutes)

bull Disztraktor eseteacuten 2 műteacutet

bull Koumlltseacutegek

Fog elhorgonyzaacutesuacute RME

időziacuteteacutese

Graber Contemporary Orthodontics 2012 Ch 14 Optimizing Orthodontic and

Dentofacial Orthopedic Treatment Timing

Hybrid-Hyrax mit vaacuterunk tőle

- Kombinaacutelt csont- eacutes fogelhorgonyzaacutes

- Fogvaacuteltaacutes koumlzben is alkalmazhatoacute

- Az erők koumlzvetlenuumll hatnak a palatinaacutelis

csontra

- Nagyobb szkeletaacutelis hataacutes mert az

erőhataacutes koumlzelebb esik a maxilla

rezisztenciakoumlzpontjaacutehoz

- Kevesebb olyan melleacutekhataacutes mint a

fenesztraacutecioacute eacutes a bukkaacutelis dőleacutes

- Irodalom hateacutekony expanzioacutes moacutedszer

Hyrax vs Hybrid hyrax

20 growing girls (ages 12 6 06 years)

There were significant increases in facial and maxillary widths for the BBME

group and in nasal width for the TBME group Both expanders produced basal

bone expansion at the level of the hard palate The TBMEs produced more

dental expansion buccal rolling and a greater increase in nasal width than did

the BBMEs

Hyrax vs Hybrid hyrax

Toklu et al 2015 AJODO

143 plusmn23 years 138 plusmn 22 years

1 Both tooth-borne and tooth-bone-borne RME are effective methods for the treatment of maxillary constriction

2 The hyrax and the hybrid hyrax expanders resulted in similar skeletal effects

3 The hyrax appliance resulted in greater expansion in the premolar region than did the hybrid hyrax

4 Both appliances reduced the buccal bone thickness and increased the palatal bone thickness in the molar area

5 Buccal bone thickness decreased in the premolar area in the purely tooth-borne group whereas the buccal bone

thickness in the hybrid hyrax group was maintained

MICRO 4 MICRO 6

Winsauer et al 2013 JCO (n=31)