Tidlig behandling af vaekstafvigelser i maksillen – interceptive behandlingsmuligheder med kombination af ortopaedi og kirurgi
Engelsk titel: Early treatment of growth deviations of the maxilla – interceptive treatment possibilities in combination with orthographhic surgery
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Författare:
Nörholt, Sven Erik
;
Pedersen, Thomas Klit
Email: svenoe@rm.dk
Språk: Dan
Antal referenser: 23
Dokumenttyp:
Översikt
UI-nummer: 18030105
Sammanfattning
Hypoplastic growth of the maxilla often causes class III malocclusion
that may necessitate orthodontic treatment. It is desirable
to perform an early treatment in order to modify the growth of
the jaws and the position of the teeth to obtain a result without
need for later correction with orthognathic surgery. The aim of
this paper is to provide an overview of the treatment options and
to give recommendations for choice of therapy for growth deviations
of the maxilla.
A posterior cross bite is often seen in presence of a maxillary
hypoplasia and the recommended treatment is to perform a rapid
palatal expansion before the pubertal growth spurt. If there is a
concomitant tendency for development of a class III relation, the
palatal suture expansion can be combined with protraction by
use of a face-mask, which is done at the age of 8-10 years.
An alternative to face-mask for class III malocclusions is the use
of four skeletally anchored hooks (bone anchors) on which elastic
traction is applied to stimulate an anterior growth of the maxilla
and a restriction of the mandibular growth. Bone anchors should
be inserted around the age of 11 years and the aim would be to
avoid a later orthognathic surgical treatment.
In young persons with a very narrow maxilla a surgically assisted
rapid maxillary expansion (SARME) is a treatment option. This
implies a Le Fort I osteotomy and a midline osteotomy with insertion
of a dentally or bone anchored device to expand the maxilla
transversally. The purpose of this procedure is to obtain a widening
of the basal maxillary skeleton, which may also have beneficial
effect on nasal respiration.
Finally, a sagittal correction of severe maxillary hypoplasias can
be performed distraction osteogenesis in which the maxilla is
gradually advanced 1 mm per day with formation of bone and
soft tissue.
In conclusion, early diagnosis of maxillary growth disturbances is
important in order to initiate an effective interceptive treatment,
which in high proportion of the patients can eliminate the need for
later orthognathic surgery