by v8.1m



Mladen M. Kuftinec, DMD, ScD
Professor & Director of Orthodontics New York University College of Dentistry

43.) Cirugía Ortognatica en el paciente con deformidada Dentofacial Clase III


The presentation will deal with an efficient orthopedic treatment protocol for the correction of Class III malocclusion in the growing patient by means of the bonded rapid maxillary expander and the face mask. The bonded rapid maxillary expander is a treatment option for transverse discrepancies in Class III malocclusions. In this type of malocclusion, expansion is used as a preliminary therapeutical phase also in cases showing no deficiency in maxillary arch width. The expander, in fact, disrupts the circum-maxillary sutural system, thus facilitating maxillaryprotraction by means of the face mask.

The presentation will describe the construction features of the bonded rapid maxillary expander, how it is delivered to the patient, the technique for appliance removal, and aspects regarding the retention period following expansion.

As for the face mask, both the designs according to Delaire and to Petit will be illustrated. The treatment protocol for orthopedic maxillary protraction with the face mask includes the description of the sequential use of elastics and of appliances for efficient retention after the active phase of therapy.

Peculiar emphasis will be dedicated to the biological aspects of both maxillary expansion and protraction, with information pertaining growth changes in the maxillary sutures and their relevance for optimal responsiveness to orthopedic forces.

Clinical cases will be presented in order to highlight the treatment protocol with the facial mask, the short term results and the long term changes. Peculiar attention will be dedicated to the issue of retention after active therapy. At this respect, the presentation will introduce a functional appliance that we routinely use for retention afterfacial mask: the removable mandibular retractor.

Class III treatment with the facial mask

The topic of this presentation is to illustrate the outcomes of facial mask therapy for Class III malocclusion. The lecture will present the results of a series of investigations aimed to establish the effectiveness and the optimal treatment timing for orthopedic therapy of Class III malocclusion.

The speaker will describe treatment and post-treatment dento-skeletal changes in two different groups of subjects with Class III malocclusions in the early and late mixed dentitions (i.e. before and after the peak in skeletal growth as assessed by the Cervical Vertebral Maturation method – which will be illustrated in detail) treated with a bonded acrylic-splint expander and a facial mask.

Groups of subjects with untreated Class III malocclusions were used as controls in these studies, thus providing the opportunity to describe growth in untreated Class III malocclusion.

The results of the cephalometric analysis of the dento-skeletal changes during active treatment showed that a significant increase in the sagittal growth of the maxilla can be obtained only when treatment is performed in the early mixed dentition. A restraining effect on mandibular growth rate associated with a more upward and forward direction of condylar growth is found in both early- and late-treated subjects. An increase in vertical intermaxillary relationships is observed in Class III patients treated in the late mixed dentition.

The appraisal of post-treatment modifications reveals that the Class III craniofacial growth pattern is re-established in absence of any retention appliance. The combined outcomes of both active treatment and post-treatment periods suggest that orthopedic treatment of Class III malocclusion in the early mixed dentition is able to induce more favorable craniofacial adaptations than treatment in the late mixed dentition. Regardless of the treatment iming, facial mask therapy appears to be an efficient means to treat Class III malocclusion as three out of four cases show a good correction of the dentoskeletal problems at the completion of growth (after stage 4 in cervical vertebral maturation). The positive clinical factors to achieve a stable results will be discussed.

Huatulco, México 26-30 Nov. 2003
Encuentro Internacional de Ortopedia Dentofacial 8va.Reunión Anual Amom

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