Complex approach in the treatment of dento-maxillary anomalies, skeletal forms

Abstract

Introduction. Contemporary orthodontics has evolved significantly over the last decade due to the use of modern techniques which have allowed the orthodontist to approach the treatment of complex cases more efficiently. Depending on when the patient is referred to an orthodontist, the complexity of orthodontic treatment can range from the prophylactic methods to the combination between orthodontic and surgical methods. The treatment technique is determined by the patient’s age, the malocclusion severity, the patient’s accusations and the cephalometric analysis. Aim of study. Evaluation of methods of diagnosis and treatment plan of dento-maxillary anomalies through complex approach Methods and materials. For this study were selected 9 patients (4 boys and 5 girls), aged between 11 to 31 years, with dento-maxillary anomalies. The patients were selected according to: age, type of malocclusion by Angle and cephalometric parameters. The treatment of skeletal forms of malocclusion requires an early and interceptive treatment, in order to reduce the severity of the malocclusion. The treatment is based on growth changes with functional devices and extraoral forces, but after skeletal growth is finished, surgical and camouflage methods for the malocclusions treatment are used. Results. Following the study, according to the distribution by sex, the prevalence of females was 56% and the presence of males in 44%. According to the criterion of distribution by age, the patients from the group with 16 -31 years predominate in 67%, followed by those from group number 2 which represent 33% with the age between 11 and 15 years. Following the radiological examination- teleradiography and the cephalometric study, the results were divided based on Tweed’s triangle. Thus, analyzing the FMA angle, a prevalence of the normodivergent growth type was obtained in 5 cases, followed by the hypodivergent growth- 3 cases and the hyperdivergent growth present only in 1 case. The assessment of the position of the lower incisors in relation to the bone base is made according to the IMPA angle and we obtained in 4 cases retroclined and proclined incisors, and only in 1 case the incisors were positioned within the norm. Analyzing the FMIA angle dates to assess the location of the mandibular incisor in the facial diagram, in 4 cases the incisors were inclined and in 5 cases they were retroclined, and in none of the cases they were not positioned within the norm. According to the cephalometric study, especially after the Steiner analysis, which indicates the type of anomaly: dento-alveolar of skeletal. Following the ANB angle analysis, we determined a prevalence of skeletal class III- 45% and 44%- the presence of skeletal class II, within the norm being only 11%. Complex orthodontic treatment was used in 6 out of 9 cases, representing 66%. Conclusion. 1. From the data of the performed study, the correlation between the severity of dento-maxillary anomalies was established according to the analyzed cephalometric parameters (FMA, SNA, SNB, ANB). 2. The treatment methods selection is based on the severity of the ANB angle (2±2). Patients with values of the ANB angle that are exceeded by 6 from the normal value, are often rehabilitated by orthodontic and surgical treatment, with gnathosurgery elements.