Dental alveolar bone and dental arch remodeling in children: orthodontic diagnosis and treatments based on individual child arch development / 华西口腔医学杂志

The etiology of malocclusions basically involves both congenital and environmental factors. Malocclusion is the result of the abnormal development of the orofacial complex (including tooth, dental alveolar bone, upper and lower jaws). Early orthodontic interceptive treatments involve the elimination of all congenital and environmental factors that contribute to the malformation of the orofacial complex, as well as interrupt the deviated development of the orofacial complex and the occlusion. Early orthodontic interceptive treatments mainly aim to use children's growth potential to correct abnormal developments of occlusions and orthodontically treat malocclusions more efficiently. The early orthodontic interceptive treatments include correcting the child's bad oral habits, training the abnormal functioned para-oral muscles, maintaining the normal eruptions of succeeding permanent teeth, applying interceptive treatments to the mal-developed teeth, and employing functional orthopedic treatments for abnormal growths of the upper and lower jaws. In orthodontics, correcting mal-positioned teeth is called orthodontic treatment, while rectifying the abnormal relationships of the upper and lower jaws is called functional orthopedic treatment. However, no clear definition is available as regards to the early orthodontic interceptive treatment of malocclusions caused by the deviated development of the dental alveolar bone. This new theory of "early dental alveolar bone and dental arch remodeling technique" was proposed by Professor Li Xiaobing of the Department of Pediatric Dentistry, Faculty of Pediatric Dentistry and Orthodontics in West China Hospital of Stomatology through his clinical analyses and investigation of his early orthodontic interceptive treatments. He defined the early orthodontic corrections of abnormal growth of dental alveolar bone as "remodel". The "early dental alveolar bone and dental arch remodeling theory and technique" is proved useful in malocclusion diagnosis and treatment planning during early orthodontic interceptive treatment with malformed dental arch. With the development of the theory and technique, the author intended to prevent and intercept the malocclusion development more effectively and efficiently. This review presents the development and clinical usages of the theory which to provide a new vision in the analysis of malocclusions on the basis of the developmental mechanism of the alveolar bone and dental arch. With clinical case illustration, the author demonstrateshis successful orthodontic clinical practices with this theory, which may contribute to the development of contemporary orthodontic theories and techniques.

Early Treatment Protocol for Skeletal Class III Malocclusion

Skeletal Class III malocclusion, with its unpredictable and unfavorable nature, has been characterized by a growth pattern with doubtful prognosis regarding orthodontic mechanics, even when performed early. For a long time, Class III malocclusion was regarded as a synonym of mandibular prognathism, regardless of the affected skeletal structures. Mandibular growth, essentially determined by genetic factors, could barely be controlled by early orthodontic interventions. Therefore, the treatment choice was to wait for the patient to grow, and then make an orthodontic intervention associated with an orthognathic surgery. Maxillary involvement in the etiology of Class III malocclusion was conclusive to change orthodontic therapeutics. Maxillary intramembranous growth has a better response to orthopedic treatment, based on growth control and redirection, thus contributing for early intervention success. In several cases, excellent results have been achieved with rapid maxillary expansion and protraction. The aim of this study was to describe and discuss the treatment of a patient with Class III malocclusion, whose treatment planning comprised two phases: interceptive (mechanical orthopedic appliances) and comprehensive (fixed orthodontic appliance). The results of this case showed that Class III malocclusion should be intercepted as early as possible to permit growth redirection, mainly when the maxilla is the primary etiologic factor or dental and/or functional factors are involved. Diagnosis, treatment planning and prognosis depend on patient age, growth potential and severity of malocclusion. Early intervention, adequate indication of appliances, and patient compliance are key factors for good outcomes.

Resumo A má oclusão de Classe III esquelética, com sua imprevisibilidade e natureza potencialmente desfavoráveis, caracteriza um padrão de crescimento com duvidoso prognóstico à mecânica ortodôntica, ainda que esta seja realizada precocemente. Durante muito tempo, a Classe III foi considerada sinônimo de prognatismo mandibular, independente das estruturas esqueléticas comprometidas. O crescimento mandibular, determinado essencialmente por fatores genéticos, dificilmente seria controlado pela intervenção ortodôntica precoce. Assim, optava-se por aguardar o crescimento e então realizar a intervenção ortodôntica associada à cirurgia ortognática. A constatação de envolvimento da maxila como etiologia primária na má oclusão de Classe III foi decisiva para a mudança da terapêutica. O crescimento maxilar, de origem intramembranoso, responderia melhor ao tratamento por meio do controle e direcionamento do crescimento, contribuindo para o sucesso da intervenção precoce. Em muitos casos, excelentes resultados são obtidos com a expansão rápida e protração da maxila. O presente trabalho objetiva descrever e discutir o tratamento de uma paciente com má oclusão de Classe III, cujo plano de tratamento consistiu de duas fases: interceptora, realizada com aparelhos ortopédicos mecânicos e corretiva, com aparelho ortodôntico fixo. Os resultados deste caso clínico demonstraram que a má oclusão de Classe III deve ser interceptada o mais precoce possível, com vistas a redirecionar o crescimento. Esta abordagem deve acontecer, especialmente, quando a maxila é o fator etiológico primário ou quando fatores dentários e/ou funcionais estiverem envolvidos na determinação desta má oclusão. O diagnóstico, ...