Publication: Estudio cefalométrico sobre la estabilidad a largo plazo de pacientes con maloclusión de clase III tratados vs pacientes control de clase I
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2018-10-19
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Universidad Complutense de Madrid
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Abstract
La maloclusión de clase III ha sido considerada a lo largo de los años como la maloclusión más desconcertante para el ortodoncista debido a su etiología multifactorial y a la gran variedad de respuestas individuales existentes evolucionando en algunos casos de manera insatisfactoria a pesar de haberse realizado un adecuado tratamiento ortodóncico. A lo largo de los años han sido muchos los trabajos que se han publicado en la literatura sobre la maloclusión de clase III, a pesar de su baja prevalencia, con la finalidad de obtener información sobre el crecimiento de estos pacientes, pudiéndose así mejorar tanto la planificación del tratamiento por parte del ortodoncista como las expectativas que se deben tener ante la estabilidad del tratamiento. Se han realizado diversas investigaciones con el fin de ampliar los limitados conocimientos que en ortodoncia se tienen sobre el crecimiento esquelético de las clases III. Estudios longitudinales que evalúen sujetos con clase III a lo largo de su crecimiento son muy escasos en la literatura, aunque sería el mejor método para estudiar el crecimiento facial y su desarrollo. Sin embargo, la baja prevalencia de la maloclusión y el gran problema ético que se plantea debido a la necesidad de una intervención temprana por parte del ortodoncista, hacen que en la literatura escaseen los estudios longitudinales. Fundamentalmente se publican estudios transversales retrospectivos en los que los autores unifican las telerradiografías iniciales de un gran número de pacientes con clase III en un momento determinado y las dividen en diferentes intervalos de edad y a partir de ahí analizan cómo acontece el crecimiento en la maloclusión de clase III. En cuanto a la actitud terapéutica que el ortodoncista debe presentar ante esta maloclusión, se destaca la importancia de un tratamiento precoz. Existen diferentes modalidades de tratamiento en función de la preferencia del clínico y de dónde se sitúe el problema. Así en los prognatismos mandibulares se recomienda la mentonera, la máscara facial para la retrognacia o hipoplasia maxilar o clases III de causa mixta y el Fränkel de tipo III como terapia funcional. Debido a que en la mayoría de los casos el prognatismo mandibular va asociado a una deficiencia maxilar, la tracción del maxilar es el tratamiento de elección y el más eficaz en la mayoría de los casos con maloclusión de clase III. Uno de los aspectos clínicos más problemáticos del tratamiento ortodóncico en la maloclusión de clase III es la posibilidad de recidiva una vez finalizado el periodo de tratamiento activo. A pesar de que en la literatura se ha publicado mucho sobre los efectos dentoesqueléticos inducidos por los diferentes tratamientos ortopédicos en la maloclusión de clase III, se destaca la ausencia de información sobre la estabilidad a largo plazo del tratamiento ortodóncico. La mayoría de los estudios encontrados en la literatura son estudios a corto-medio plazo que realizan un seguimiento de los pacientes tras el final del tratamiento ortopédico o hasta el final de la segunda fase de aparatología fija. Por tanto, queda patente la falta de estudios publicados hasta la fecha que realicen un seguimiento de los pacientes con maloclusión de clase III hasta el final de su crecimiento activo, pudiendo así observar el patrón de crecimiento que siguen los pacientes una vez finalizado el tratamiento ortodóncico y el grado de estabilidad de los resultados obtenidos. El objetivo principal de nuestro estudio es evaluar a nivel cefalométrico la estabilidad a largo plazo de pacientes con maloclusión de clase III tratados con un tratamiento ortopédico y ortodóncico a 10 años post-tratamiento y con su crecimiento totalmente finalizado y conocer los cambios cefalométricos tanto en la muestra de pacientes con clase III como con clase I que se producen durante el tratamiento (T0-T1) y fundamentalmente durante el periodo post-tratamiento(T1-T2)...
Class III malocclusion was considered over the years to be the most perplexing malocclusion for orthodontists due to its multi-factor aetiology and the wide variety of existing individual responses in some cases evolving unsatisfactorily despite having performed appropriate orthodontic treatment. Over the years many works have been published in the literature on class III malocclusion, despite its low prevalence, in order to obtain information on the growth of these patients, thereby improving both treatment planning for orthodontists and expectations that should be considered for treatment stability. Different investigations have been run in order to widen limited knowledge in orthodontia on the skeletal growth of class IIIs. Longitudinal studies that evaluate class III subjects throughout their growth are very scarce in the literature although this would be the best method to study facial growth and its development. However, the low prevalence of malocclusion and the great ethical problem that is raised due to the need for early intervention by the orthodontist means that longitudinal studies are scarce in the literature. Fundamentally retrospective transverse studies are published where authors bring together initial x-rays or scans from a large number of class III patients at a given time and divided them into different age ranges and from there they analyse how class III malocclusion growth occurs. As far as the orthodontist's choice of therapy is concerned for this malocclusion, the importance of early treatment is emphasised. There are different types of treatment depending on the clinic's preference and where the problem is located. So a chin guard is recommended for mandibular prognathisms, a face mask for retrognathia or maxillary hypoplasia or class III mixed cause cases or type III Fränkel as functional therapy. Due to the fact that, in most cases, mandibular prognathism is associated with a maxillary deficiency, maxillary traction is the treatment of choice and the most effective in the majority of cases with class III malocclusion. One of the most problematic clinical aspects of orthodontic treatment in class III malocclusion is the possibility of recurrence once the active treatment period has finished. Despite the fact that much has been published in the literature on the dentoskeletal effects caused by the different orthopaedic treatments in class III malocclusion, there is a clear lack of information on the long term stability of orthodontic treatment. The majority of studies found in the literature are short-medium term studies that monitor patients after the end of orthopaedic treatment or until the end of the second phase of a fixed brace. Therefore, it is clear that there is a lack of studies published to date that monitors patients with class III malocclusion until the end of their active growth, thereby showing the growth pattern followed by patients once orthodontic treatment has finished and the degree of stability for the results which were obtained. The main aim of our study is to perform a cephalometric analysis on long term stability of class III malocclusion patients treated with an orthopaedic or orthodontic treatment 10 years after treatment, with their growth completely finished, and find out about the cephalometric changes in both class III and class I patient samples that occur during treatment (T0-T1) and fundamentally during the post-treatment period (T1-T2)...
Class III malocclusion was considered over the years to be the most perplexing malocclusion for orthodontists due to its multi-factor aetiology and the wide variety of existing individual responses in some cases evolving unsatisfactorily despite having performed appropriate orthodontic treatment. Over the years many works have been published in the literature on class III malocclusion, despite its low prevalence, in order to obtain information on the growth of these patients, thereby improving both treatment planning for orthodontists and expectations that should be considered for treatment stability. Different investigations have been run in order to widen limited knowledge in orthodontia on the skeletal growth of class IIIs. Longitudinal studies that evaluate class III subjects throughout their growth are very scarce in the literature although this would be the best method to study facial growth and its development. However, the low prevalence of malocclusion and the great ethical problem that is raised due to the need for early intervention by the orthodontist means that longitudinal studies are scarce in the literature. Fundamentally retrospective transverse studies are published where authors bring together initial x-rays or scans from a large number of class III patients at a given time and divided them into different age ranges and from there they analyse how class III malocclusion growth occurs. As far as the orthodontist's choice of therapy is concerned for this malocclusion, the importance of early treatment is emphasised. There are different types of treatment depending on the clinic's preference and where the problem is located. So a chin guard is recommended for mandibular prognathisms, a face mask for retrognathia or maxillary hypoplasia or class III mixed cause cases or type III Fränkel as functional therapy. Due to the fact that, in most cases, mandibular prognathism is associated with a maxillary deficiency, maxillary traction is the treatment of choice and the most effective in the majority of cases with class III malocclusion. One of the most problematic clinical aspects of orthodontic treatment in class III malocclusion is the possibility of recurrence once the active treatment period has finished. Despite the fact that much has been published in the literature on the dentoskeletal effects caused by the different orthopaedic treatments in class III malocclusion, there is a clear lack of information on the long term stability of orthodontic treatment. The majority of studies found in the literature are short-medium term studies that monitor patients after the end of orthopaedic treatment or until the end of the second phase of a fixed brace. Therefore, it is clear that there is a lack of studies published to date that monitors patients with class III malocclusion until the end of their active growth, thereby showing the growth pattern followed by patients once orthodontic treatment has finished and the degree of stability for the results which were obtained. The main aim of our study is to perform a cephalometric analysis on long term stability of class III malocclusion patients treated with an orthopaedic or orthodontic treatment 10 years after treatment, with their growth completely finished, and find out about the cephalometric changes in both class III and class I patient samples that occur during treatment (T0-T1) and fundamentally during the post-treatment period (T1-T2)...
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Tesis inédita de la Universidad Complutense de Madrid de la Facultad de Odontología del Departamento de Estomatología IV, leída el 29 de Mayo de 2017.