ABSTRACT
BACKGROUND: Class II functional appliances have been used in orthodontics for over 100 years. Although the stability of corrections is one of the main goals of orthodontic treatment, there is a paucity of longitudinal studies on the long-term stability of treatment of Class II malocclusion based on functional appliances. METHODS: This narrative review attempts to summarize the limited related evidence available and discusses the clinical implications of important aspects related to occlusal and skeletal changes that arise after Class II malocclusion treatment with functional appliances. RESULTS: The occlusal changes obtained through Class II functional treatment do mostly exhibit long-term stability. While mild posttreatment changes occurred, they were most likely due to physiologic aging processes and not likely associated with actual treatment relapse. Long-term retention in the lower jaw would be particularly beneficial. A stable occlusion with good intercuspation in the posterior arches seems more likely to preserve a Class I occlusion after treatment through dentoalveolar compensatory mechanisms. After treatment, the maxilla and the mandible do grow anteriorly, with the mandible growing more than the maxilla. Patients treated with functional appliances are not likely to develop TMJ disorders over the long term. CONCLUSIONS: Long term skeletal corrections achieved with functional appliances seem to be overall stable. Class II molar and overjet relapses can be likely explained by a combination of tooth movement and an unfavorable posttreatment maxillomandibular growth pattern, especially when combined with unstable interdigitation of the posterior teeth. No specific intermaxillary retention approach has been assessed yet.
Subject(s)
Malocclusion, Angle Class II/therapy , Orthodontic Appliances, Fixed , Orthodontic Appliances, Removable , Tooth Movement Techniques/instrumentation , Humans , Mandible/growth & development , Maxilla/growth & development , Recurrence , Temporomandibular Joint Dysfunction Syndrome/etiology , Time Factors , Tooth Movement Techniques/adverse effectsABSTRACT
Resumo A agenesia dentária representa uma anomalia congênita de número, na qual ocorre a ausência da formação do germe dentário, por razões ainda não totalmente elucidadas. Nos casos de agenesias de incisivos laterais superiores, duas abordagens principais de tratamento podem ser utilizadas: o fechamento do espaço, com a substituição do incisivo lateral pelo canino e do canino pelo primeiro pré-molar, ou a abertura do espaço, com a substituição protética do incisivo ausente. Este trabalho teve como objetivo descrever um caso clínico de uma paciente adulta, com agenesia dos dois incisivos laterais superiores e do incisivo lateral inferior esquerdo, além de desvio de linha média superior e inferior, tratada com uma abordagem minimamente invasiva. A paciente sexo feminino, 22 anos de idade, leucoderma buscou tratamento ortodôntico com queixa sobre a estética facial e insatisfação com o sorriso. Considerando as expectativas da paciente e sua recusa em realizar cirurgia ortognática e/ou instalação de implantes dentários, optou-se pelo tratamento ortodôntico para fechamento dos espaços e correção da linha média, seguido de restaurações diretas para reanatomização dos caninos e dos primeiros pré-molares superiores. O tempo de tratamento foi de 23 meses. Ao final do tratamento a paciente apresentou oclusão adequada e melhora na estética facial e do sorriso, demonstrando satisfação com o resultado obtido (AU)
Abstract Dental agenesis is a congenital anomaly of number, in which the absence of dental germ formation occurs, for reasons not yet fully elucidated. In cases of agenesis of maxillary lateral incisors, two main treatment approaches can be used: space closure, replacing the lateral incisor by the canine and the canine by the first premolar, or space opening with prosthetic replacement of the missing incisor. This study aimed to describe a clinical case of an adult patient with agenesis of both upper lateral incisors and left inferior lateral incisor, as well as upper and lower midline deviation, treated with a minimally invasive approach. The female patient, 22 years old, leukoderma, sought orthodontic treatment complaining about facial aesthetics and dissatisfaction with the smile. Considering the patient's expectations and her refusal to perform orthognathic surgery and / or dental implant installation, orthodontic treatment for space closure and midline correction was chosen, followed by direct restorations for upper canine and first premolar reanatomization. Treatment time was 23 months. At the end of treatment, the patient presented adequate occlusion and improved facial and smile aesthetics, demonstrating satisfaction with the result obtained (AU)
