Kritische Bewertung funktionskieferorthopädisch behandelter Klasse-II-Anomalien

Abstract

In the course of a clinical and radiological follow-up study of 55 patients with class II malocclusions, who had been treated with functional appliances, the dental and skeletal changes were critically studies and statistically analyzed in relation to long term aesthetic, dental, and skeletal changes. Differences between class II, division 1 cases and class II, division 2 cases were also compared. The study revealed that at the end of the treatment period 80% of the functionally treated patients displayed much better nose to upper lip relations than at treatment begin. Aesthetically the best treatment results were in the class II, first group patients with an average 4.2 degree reduction of the soft tissue H-angle in the course of functional therapy. It was shown that both dental and skeletal changes were responsible fo the in most cases good treatment results, whereas the changes in patients in the two subgroups with class II malocclusions showed significant differentiations. This paper describes these changes in detail. Viewed in its entirety this study clearly supports the efficacy of functional therapy in adolescents. In relation to long-term stability the results of functional balanced occlusion and the stability of the maxillo-mandibular relationship should be especially emphasized, whereas the therapeutically induced protrusion of the mandibular incisors and their relapse should be critically viewed.

Effectiveness of bionator therapy for Class II malocclusions

“…This change is due to several components: in addition to the appliance's influence, both natural growth and timing are critical [6,28]. Our results are consistent with those from earlier investigations which noted similar changes in these two angles after activator and bionator therapy [1,14,17,25,31]. There are studies in which the SNB changed only slightly during puberty and did not differ significantly between the treated cohort and an untreated control group [28,59].…”

“…As in other comparable studies, the maxillary incisor axes changed, revealing significant differences between the two groups [1,7,25]. We noted a highly significant retrusion of the maxillary incisors in the Class II, Division 1 patients due to activating the buccinator loop and dorsal muscular traction.…”

“…Furthermore, we noted significant post-therapeutic changes (between t2 and t3) in the ANB angle in the Class II, Division 2 group. Hirschfelder and Fleischer-Peters [25] observed a similar post-therapeutic decrease in the ANB as well. The causal factor for this is probably the residual growth of the mandibular complex in conjunction with previous decompensation of the upper front teeth [33].…”

“…For example, Obijou and Pancherz [48] studied Class II, Divisions 1 and 2 patients treated with a Herbst device. In contrast to Eckart et al [17] and Hirschfelder and Fleischer-Peters [25], who compared Class II, Division 1 and Division 2 patients treated with functional jaw orthopedic devices, Obijou and Pancherz observed no significant skeletal differences in the response between the two divisions.…”

“…Patients presenting other orthodontic pretreatments, craniofacial syndromes, cleft lip and palate, and early or late teethers were excluded, as were patients with poor compliance, or those discontinuing treatment or transferred for further treatment. ten im Gegensatz zu Eckart et al [17] und Hirschfelder und Fleischer-Peters [25], die funktionskieferorthopädisch behandelte Klasse-II/1-und Klasse-II/2-Patienten komparativ untersuchten, keine signifikanten skeletalen Unterschiede in der Reaktionsweise zwischen den beiden Gruppen feststellen.…”