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EXPERIENCE IN THE TREATMENT OF COMBINED CLASS II BITE ANOMALIES
OMURBEKOV ESEN
tutor, medical faculty of Osh State University Osh, Kyrgyzstan
KIM ALEXANDR
tutor, Stomatological faculty of IK Akhunbaev Kyrgyz State Medical Academy
Bishkek, Kyrgyzstan
NOHA SAMIR ABDELFATTAH HAMDY Resident of Stomatological faculty of IK Akhunbaev Kyrgyz State Medical Academy
Bishkek, Kyrgyzstan
ABDYRASULOV RASUL
resident, National Center for Childhood and Motherhood care Bishkek, Kyrgyzstan
YULDASHEV ILSHAT
Professor, Stomatological faculty of IK Akhunbaev Kyrgyz State Medical Academy
Bishkek, Kyrgyzstan
Resume. Bite anomaly - protruding upper anterior teeth - is a common pathology in orthodontics. The causes of its development are congenital and acquired conditions, bad habits, etc. It develops, as a rule, after the eruption of permanent teeth. Orthodontists are involved in the treatment and correction of bite anomalies. Appliances and other fixed and removable treatment methods are used. Treatment can be carried out in adolescence in one or several stages. Success in treatment is the correction of the bite pathology in a reasonable time and stable results over a long period. This article presents the experience of treatment of children with this bite anomaly.
Key words: bite anomalies in children, class II, treatment tactics.
Orthodontics is the branch of dentistry concerned with the growth of the jaws and face, the development of the teeth and the way the teeth and jaws bite together. It also involves treatment of the teeth and jaws when they are irregular or bite in an abnormal way or both. There are many reasons why the teeth may not bite together correctly. These include the position of the teeth, jaws, lips, tongue, or cheeks; or may be due to heredity, a habit or the way people breathe. The need for orthodontic treatment can be decided by looking at the effect any particular tooth position has on the life expectancy of the teeth, or the effect that the appearance of the teeth has on how people feel about themselves, or both [11,19].
Prominent upper front teeth are a common problem affecting about a quarter of 12-year-old children in many countries [4, 8, 9]. The condition develops when permanent teeth erupt. These teeth are more likely to be injured and their appearance can cause significant distress. Children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of their teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait and provide treatment in adolescence. [11].
Prominent upper front teeth (Class II malocclusion) may be due to any combination of the jaw, tooth and lip position. The upper jaw (maxilla) can be too far forward or, more usually, the lower jaw (mandible) is too far back [1,10]. The upper front teeth (incisors) may stick out if the lower lip catches behind them or due to a habit (e.g. thumb sucking). This gives the patient an appearance that may be a target for teasing [20] and bullying [19], which impacts on quality of life [15,21]. When front teeth
stick out (more than 3 mm to 5 mm), they are two to three times more likely to be injured [14,17]. Prominent upper front teeth (Class II malocclusion) is one of the most common problems seen by orthodontists and affects about a quarter of 12-year-old children in the UK[16]. However, there are racial differences: prominent upper front teeth (Class II malocclusion) are most common in whites of Northern European origin and least common in black and oriental races and some Scandinavian populations [13, 18, 22].
In the Cochrane systematic review of Batista KBSL, Thiruvenkatachari B, Harrison JE, O'Brien KD. 2018, authors conclude, that the evidence suggests that providing orthodontic early treatment to children with prominent upper front teeth reduces the incidence of damage to upper incisor teeth significantly (middle four teeth at the top) as compared to treatment that is provided in one phase in adolescence. There are no other advantages of providing a two-phase treatment (i.e. between age seven to 11 years and again in adolescence) compared to treatment in one phase in adolescence. [11].
The evidence also suggests that providing treatment with functional appliances for adolescents with prominent upper front teeth significantly reduces their prominence when compared to adolescents who did not receive any treatment. The studies did not suggest that any particular appliance was better than any other, for reducing teeth prominence [5,6,7].
The aim of this article is to present our clinical experience in treating patients with Class II bite anomalies combined with cross bite, with incisal overlap.
Patients came to the clinic with complaints of excessive protrusion of the anterior teeth, difficulty in chewing, dissatisfaction with the appearance of the teeth, and facial profile. Usually the anomaly developed gradually and became more visible after the permanent teeth erupted.
At the initial examination, there was a violation of the external contours of the face, the bite had a significant overlap. In the described cases, there was formation of crossbite and the ratio of molars according to the second class. The face had a convex profile. The oral cavity examination also showed exposure of the incisors and gingiva in the incisal area (gingival smile). There was a characteristic irregular ratio of molars and canines - class II, more often on both sides. The oral mucosa was usually without visible features.
Comprehensive examination of patients included traditional methods of examination in dentistry and orthodontics: panoramic radiography - orthopantomography, lateral cephalometric radiography with analysis, orthodontic models were made. TRG analysis was performed according to Steiner [12] (see Fig. 1).
Fig. 1. Steiner cephalometric analysis (by [1]).
The treatment plan usually consisted of correcting the Class II molar ratio, correcting crossbite, reducing the overbite height to a normal ratio, and improving the aesthetic appearance and facial profile.
We applied, like the above-mentioned authors [2,3,11], a stage method of correction of the bite anomaly. The stages were as follows. At the first stage of treatment, we used fixed hardware treatment (braces) on both jaws, also intermaxillary elastics - to correct crossbite. In the next stage, if it was necessary to create optimal space on the dental arches, we extracted the upper first premolars (teeth 14 and 24). After correction of the bite, retainers were used to maintain the result. The staged treatment lasted 3.5-4 years. After six months, initial alignment and leveling of the teeth was usually achieved. Then, after 10-15 months, reduction of jaw protrusion and correction of posterior crossbite were achieved. After 3.5 years, the ratio of the dentition was corrected to normal.
As a result, treatment goals were achieved according to the parameters of TRG analysis, as well as aesthetic and functional improvements. Patients were recommended to use retainers and follow-up visits every 6 months for the next 2 years.
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