Kieferorthopaˆdische Speisekarte

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  • Kieferorthopdische Speisekarte

    Kieferorthopdische Spezialitten aus aller Welt Angerichtet und serviert von Fachzahnarzt fr Kieferorthopdie Dr. Ulrich Kritzler

    Dr. Kritzler 1

  • Vorspeisen / Vor und Frhbehandlungen Dienen vor allem der Herstellung einer normalen Funktion durch die Beseitigung von Kreuzbissen, Rcklagen des Unterkiefers und Unterentwicklungen des Oberkiefers. Zum Einsatz kommen vorwiegend herausnehmbare Behandlungsgerte wie der U-Bgel Aktivator nach Karwetzky zur Behandlung von Rcklagen des Unterkiefers, der Funktionsregler 3 nach Frnkel zur Behandlung von Unterentwicklungen des Oberkiefers, Aufbissplatten nach Schwarz zur Kreuzbisskorrektur.

    21Budihardja: U bow activator

    canine to canine. Protrusion bow extends from middle of canine to canine at the palatal region, made from 0.7 mm stainless steel wire. The height of these two components depends on front teeth movements that want to be achieved. Expansion screw is placed in the upper plate, at the height of P1 or dm1. U Bow made from 1.2 mm wire, placed at both sides at the height of M1. U bow activation will define the mandible reposition.4

    There are three types of U bow activator developed by Karwetzky: a) UBA type 1. In type 1, the U bows are placed downward and this activator is used to correct class II malocclusion; b) UBA type 2. In type 2, the U bows are placed upward and this activator is used to correct class III malocclusion; c) UBA type 3a and 3b. The placements of the U bows are different between the right side and the left side. This type is usually used to correct asymmetry and functional midline shifting (Figure 2).

    From these three types of UBA, the one that used most is UBA type 1 to correct class II malocclusion. Ehmer, with the dysgnathy classification, said that indication of using UBA type 1 are mandible retrognathy, maxilla prognathy, upper front teeth protrusion and or lower front teeth retrusion, deck bite (Angle class II div 2), and skeletal or functional asymmetry that accompany class II malocclusion.4,5

    Just as other functional appliance, the optimal time of using UBA are during growth, between 811 years old. UBA can also be used earlier (47 years), usually in patients with class II div 1 malocclusion accompanied by extreme over jet. This kind of malocclusion can enhance the risk of front teeth trauma, caused negative functional pattern (lower lip is trapped behind upper front teeth and incompetence lip closure) and usually caused psychological stress to the patient (being mocked about appearance).4,5

    Figure 1. U bow activator from Karwetzky.

    Figure 2. Three types of UBA developed by Karwetzky.

    23Budihardja: U bow activator

    Figure 5. Intra oral photos before treatment.

    Figure 6. Panoramic radiograph before treatment.

    Figure 7. Cephalometry radiograph before treatment.

    Figure 8. Intra oral photos after 15 months using UBA.

    23Budihardja: U bow activator

    Figure 5. Intra oral photos before treatment.

    Figure 6. Panoramic radiograph before treatment.

    Figure 7. Cephalometry radiograph before treatment.

    Figure 8. Intra oral photos after 15 months using UBA.

    24 Dent. J. (Maj. Ked. Gigi), Vol. 40. No. 1 January-March 2007: 2026

    CASE MANAGEMENT

    Our treatment plan was using functional appliance to achieve anterior reposition of the mandible and to influence the growth of the mandible to reach its maximum. Functional appliance used was U Bow Activator type 1 from Karwetzky. The first construction bite made was 4 mm sagittal to anterior, vertical 4 mm and transversally lower midline was adjusted to midline of the face. Transversal expansion in upper jaw was also needed in this case.

    During the first six months, patients cooperation was not so good. He lost his UBA once that a new one has to be made. After that incident, patient was motivated during his visits to the clinic, and since that his motivation became better. He wore his UBA regularly, all night and during day time as well. The UBA was activated 2 mm every 23 months and the expansion

    screw once in a week. After 15 months using UBA (Figure 8), his over jet was reduced to 7 mm and he had no difficulties wearing the UBA at all.

    After using UBA for 25 months (Figure 9 and 10), over jet was reduced to 23 mm and the profile changed significantly. Molar relationships on both sides were class 1. Both patient and parents were happy and satisfied with the treatment result and they did not want any further orthodontic treatment with fixed appliance. It was decided to go to retention phase and during this stage the patient is told to wear UBA only at nights.

    After 15 months using UBA as retainer (Figure 11 and 12), the treatment result was stabile. Patient has stabile static and dynamic occlusion, nice profile, beautiful smile and his self confidence become better after orthodontic treatment. Patient and his parents were highly satisfied with treatment result.

    Figure 9. Extra oral photos after 25 months using UBA.

    Figure 10. Intra oral photos after 25 months using UBA.

    Dr. Kritzler 2

  • Behandlungsbeispiel: Frhbehandlung einer Rcklage mit dem U-Bgel Aktivator nach Karwetzky

    Frhbehandlung einer Anomalie des progenen Formenkreises mit dem Frnkelschen Funktionsregler 3

    Aufheben eines einseitigen Kreuzbisses mit der Quadhelix nach Ricketts (links) oder der Dehnplatte nach Schwarz (rechts)

    REFERENCES

    1. Baik HS. Clinical results of maxillary protraction in Korean

    children. Am J Orthod Dentofacial Orthop 1995;108:583-92.

    2. Sung SJ, Baik HS. Assessment of skeletal and dental changes by

    maxillary protraction. Am J Orthod Dentofacial Orthop 1998;

    114:492-502.

    3. Proffit WR, White RP. Surgical-orthodontic treatment. St Louis:

    Mosby; 1991.

    4. Moss ML. The functional matrix hypothesis revisited. Am J

    Orthod Dentofacial Orthop 1997;112:8-11, 221-6, 338-42,

    410-7.

    5. Graber TM, Rakosi T, Petrovic AG. Dentofacial orthopedics

    with functional appliances. St Louis: Mosby; 1997.

    6. Frankel R. Maxillary retrusion in Class III and treatment with the

    function corrector III. Trans Eur Orthod Soc 1970;249-59.

    7. McNamara JA Jr, Huge SA. Functional regulator (FR-3) of

    Frankel. Am J Orthod 1985;88:409-24.

    8. Kohmura T, Tokuda N, Hara S. Effects of therapy using the

    function regulator (FR III) on the cases with the reversed

    occlusion. Jpn J Orthod 1986;45:693-711.

    9. Ulgen M, Firatli S. The effect of the Frankels function regulator

    on the Class III malocclusion. Am J Orthod Dentofacial Orthop

    1994;105:561-7.

    10. Loh MK, Kerr WJ. The function regulator III: effects and

    indications for use. Br J Orthod 1985;12:153-7.

    11. Kerr WJS, Ten Have TR. A comparison of three appliance

    systems in the treatment of Class III malocclusion. Eur J Orthod

    1988;10:203-14.

    12. Kerr WJS, Ten Have TR. McNamara JA Jr. A comparison of

    skeletal and dental changes produced by functional regulators

    (FR-2 and FR-3). Eur J Orthod 1989;11:235-42.

    13. Proffit WR. Contemporary orthodontics. St. Louis: Mosby; 2000.

    14. Dahlberg G. Statistical methods for medical and biological

    students. New York: Interscience Publications; 1940.

    Fig 4. Intraoral photographs. A, pretreatment; B, 1 year 3 months after FR III treatment; C,postretention (2 years after treatment).

    Fig 5. Lateral profile photographs. A, pretreatment; B, 1 year 3 months after FR III treatment; C,postretention (2 years after treatment).

    American Journal of Orthodontics and Dentofacial Orthopedics

    Volume 125, Number 3

    Baik et al 301

    verse relationship was achieved; no overcorrection wasproduced. The treatment result was retained for 6months. To prevent or compensate for buccal tipping,the appliance was adjusted for buccal root torque.

    The expansion plate consisted of acrylic with anexpansion screw and stainless steel clasps on thedeciduous and permanent first molars (Fig 3). The platewas activated 0.2 mm once a week by the patient untila normal transverse relationship was achieved; noovercorrection was produced. The dentist thoroughlyinstructed the patient to use the plate day and nightexcept for meals and tooth brushing. Treatment pro-gression was evaluated every 4 weeks, and the resultwas retained for 6 months.

    The composite onlay technique was based on thetheory that bite raising will inhibit the forced lateralmovement and consequently allow the maxilla to growand develop in the transverse dimension without lock-ing the mandible in occlusion.13 The bite raising wasachieved by bonding composite (Point Four, 3MUnitek) on the occlusal surfaces on both mandibularfirst molars (Fig 4). The composite onlay was checkedevery 6 weeks and removed after a year. In none of thepatients did the composite onlay need improvementprocedures.

    The untreated control group received no orthodon-tic treatment during the 1-year observation period.

    Twenty randomly selected study casts were mea-sured at 2 separate times. No significant mean differ-ences between the records were found by using pairedt tests. The method error according to the Dahlberg22

    formula did not exceed 0.2 mm for any measuredvariable.

    Statistical analysis

    The sample size for each group was calculated andbased on a significance level of ! " 0.05 and a power

    (1-#) of 90% to detect a mean difference of 2 mm($1.5 mm) in expansion between the treatment strate-gies. The sample size calculation showed that 12patients in each group were needed, and, to increase thepower even more and compensate for possible drop-outs, it was decided to select 15 patients for each group.

    The data were statistically