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ARTÍCULOS CIENTÍFICOS

ORTOPEDIA MAXILAR

Dr. Tomas Rakosi. Suiza
Former Profesor and Director Department of Dentofacial Orthopedics,
University of Frieburg, Germany
Miembro Honorario AMOM, A.C.

31.) Diagnostic Presuppositions for the Functional Therepy

Resumen de Conferencias 5a Reunión Anual de Ortoedia dentofacial AMOM 2000 Acapulco, Mex.
International CONFERENCE in Dentofacial Orthopedics

In the last decades an improvement of our diagnostic tools can be observed, Instead of treatment philosopies to solve therapeutic problems with universal appliances, the orthodontists today tend to look pragmatically in all directions, that means an efficiency oriented way of therapy. The consequences of this development are high requirements on a comprehensive diagnostic with selective indication.

In dependence on the age of the patient, pecularities of the malocclusion and mode of the treatment, various aspects of the diagnosis can be more or less important.

In a functional therapy, beside the etiologic, clinical, cast analysis and radiographic examinations, the functional and cephalometric considerations are the presupposition for a successful treatment.

The registration of the rest position is important for the asessment of the possibilities of the mode of treatment and of the scope and limitations of the functional therapy.
The dysfunctions are one of the most frequent etiologic factors of the malocclusions.
An important goal of the functional therapy is the elimination of the noxious environmental influences.

The cephalometric analysis is important for the localisation of the malocclusion, the differentiation between skeletal and dento-alveolar anomalies. Not only for the diagnostic considerations, but also for the mode of construction of the activator, plan of trimming of the appliance and asessment of the requirements on the mechanism of movements of the incisors, we need the cephalometric analysis.In dependence on the localisation of the malocclusion we can also differentiate between
orthodontics and functional orthopedics.

In this first part the diagnostic sonsiderations will be discussed, with stress on the functional and cephalometric analysis, preconditions for the indication and planing of the functional therapy.

The funtional Therapy

According to Häupl, the functional orthopedic treatment is possible to perform only with appliances, which are "passive" and are only transfering muscle stimulus. Today we know, that each force application means a strain of the tissues, independent from the origin of the force.
Functional treatment means the elimination of noxious envirommental influences with force elimination or influencing the facial skeleton and dento-alveolar region with articicially activated muscle forces. We can differentiate between functional orthopedics and functional orthodontics.
The functional applainces primarily transmit, eliminate or guide natural forces.
Mechanical elements can be also used and the combination with other methods is possible.
The recent concept of the therapy is:
1) there ixists no universal appliances,
2) each method has its exact indication,
3) the applinaces are constructed individually, there exists no prototypes.

The screening therapy is working with force elimination. There are various screening appliances and applinaces with screening side effects. The construction, efficacy and indication of these appliances will be discussed.

For the development and principles of the functional treatment, the function regulator of Fränkl is of importance. He explained f. e. how to use pads and how to move anterior the mandible without tipping the lower incisours anterior. These principles can be utilised with other types (as activators) of applinaces.

The activator is working with force application and has an orthopedic and orthodontic efficacy.
It transfers forces on the facial skeletal components and in dependence on the trimming of the appliance on the teeth and alveolar process. Depending on the variation of the construction bite different mode of force application is possible. The types of the construction bites in different malocclusions will be described.
The principle and methods of trimming will be demonstrated, with stress on the differences between the activator and bionator.

Treatment of varios Maloclutions with functional Appliances

The successful management of the most frequent malocclusions with functional appliances
will be discussed.

Class II. malocclusions.
In the dento-alveolar class II malocclusions we use activators with only a slight anterior positioning of the mandible in the construction bite and a certain trimming of the appliance. In some cases a headgear with orthodontic effect can be used. In cases with vertical growth pattern the extraction of the upper first bicuspids can be indicated. If there is a dysfunction of the lips with interposing between the incisors, screening appliances can be used.- In the skeletal class II malocclusions the possibilities of treatment are dependent on the growth pattern andwhether the mandible is retrognathic or the maxilla prognathic. Various types of activators can be used, a headgear with orthopedic effect and extractions can be provided (sometimes of the second molars).

Class III malocclusions.
Can be treated by growth promotion in the maxillary region or growth inhibition of the mandible.- Activators, facial masks, plates or chin caps can be used. A skeletal improvement can be achieved only if the treatment is introduced early. Later only a partial skeletal improvement can be achieved and additional dento-alveolar compensation is necessary. Open bite molocclusion.

The possibilities of treatment are dependent on the stage of the dentition and localisation of the malocclusion.- In the dento-alveolar open bite screening appliances and activators can be used. In the skeletal open bite jaw orthopedics with vertical activators or extraoral high pull traction are indicated. In cases with crowding extractions are prefered instead of expansions.

Deep overbite malocclusion.
The dento-alveolar deep ovarbite treatmentcan be provided by extrusion of the molars and intrusion of the incisors; the activator can be prepared with capping of the incisors and trimmed for extrusion of the molars. The skeletal deep overbite can be treated by influencing the inclination of the jaw bases, distal driving and extrusion of the molars, especially after extraction of the second molars.

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