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Aparelhos funcionais: influência no crescimento mandibular em pacientes classe II, divisão 1
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Objectivo: Esta dissertação procurou analisar a capacidade dos aparelhos funcionais produzirem crescimento mandibular sagital suplementar em relação ao crescimento normalmente esperado, e se esse crescimento se mostra clinicamente significativo na correcção das discrepâncias que estão na base da Classe II, divisão 1. Estrutura: Para atingir o objetivo proposto foram revistas as controvérsias e ideias vigentes sobre o tema, analisadas as características chave da Classe II de Angle e revistas as teorias clássicas e recentes que explicam o crescimento mandibular. Foi apresentada a perspetiva histórica da evolução dos aparelhos funcionais ao longo dos tempos, focando cinco desses aparelhos Activador, Fränkel II, Bionator, Twin Block e Herbst e discutida a evidência científica publicada sob a forma de ensaios clínicos randomizados (ECRs) ou controlados (ECCs), prospetivos ou retrospetivos. Foram analisadas várias características dos estudos, incluindo a população estudada, resultados obtidos e conclusões. Discussão: Após análise de todos os pontos tratados e integração com os resultados obtidos na literatura publicada, foi patente a falta de uniformização dos métodos e medidas utilizadas e a necessidade de melhorar a avaliação do potencial e padrão de crescimento pré-tratamento. Poucos ECR foram publicados, sendo a maioria da literatura constituída por ECCs, cujo nível de evidência é inferior. Conclusões: Tendo em conta as limitações já discutidas, foram mais os estudos a suportar a tese de que os aparelhos funcionais potenciam o crescimento mandibular, especialmente quando aproveitado o pico de crescimento. Não deverá no entanto ser ignorado o “efeito rebound”, que representa uma diminuição dos incrementos sagitais após o tratamento. A estabilidade a longo prazo ficou associada a uma terapia funcional durante o pico de crescimento, seguido de um período de aparelho fixo para acerto da oclusão.
Objective: This research sought to analyze the functional appliances ability to enhance mandibular sagital growth in comparison to normally expected growth, and whether this growth appear to be clinically significant in the correction of Class II division 1 malocclusions. Structure: To achieve our goal, controversies and current ideas on the topic were revised; the key features of Class II malocclusion analyzed as well as classic and recent theories explaining mandibular growth were reviewed. A historical perspective of the evolution of functional appliances over time was presented, focusing on five functional appliances Activator, Fränkel II, Bionator, Twin Block and Herbst appliance and the scientific evidence published in the form of randomized clinical trials (RCT’s) or prospective and retrospective controlled clinical trials (CCT’s) were discussed. Several characteristics of the studies, including the study population, results and conclusions were examined. Discussion: After analysis of all the covered points and integration with the results published in the literature, lack of standardization of methods and measures was patent as the need to better assess the growth potential and growth pattern before starting the treatment. Few RCT’s have been published; most of the literature consists of CCT’s, whose level of evidence is lower. Conclusions: Given the limitations previously discussed, the thesis that functional appliances enhance mandibular growth was supported by the majority of the articles, especially when the treatment took place in the growth spurt. However the "rebound effect" should not be ignored since it represents a decrease of sagittal increments after the treatment. The long-term stability was associated with treatment during the growth spurt and followed by a period occlusion adjustment.
Objective: This research sought to analyze the functional appliances ability to enhance mandibular sagital growth in comparison to normally expected growth, and whether this growth appear to be clinically significant in the correction of Class II division 1 malocclusions. Structure: To achieve our goal, controversies and current ideas on the topic were revised; the key features of Class II malocclusion analyzed as well as classic and recent theories explaining mandibular growth were reviewed. A historical perspective of the evolution of functional appliances over time was presented, focusing on five functional appliances Activator, Fränkel II, Bionator, Twin Block and Herbst appliance and the scientific evidence published in the form of randomized clinical trials (RCT’s) or prospective and retrospective controlled clinical trials (CCT’s) were discussed. Several characteristics of the studies, including the study population, results and conclusions were examined. Discussion: After analysis of all the covered points and integration with the results published in the literature, lack of standardization of methods and measures was patent as the need to better assess the growth potential and growth pattern before starting the treatment. Few RCT’s have been published; most of the literature consists of CCT’s, whose level of evidence is lower. Conclusions: Given the limitations previously discussed, the thesis that functional appliances enhance mandibular growth was supported by the majority of the articles, especially when the treatment took place in the growth spurt. However the "rebound effect" should not be ignored since it represents a decrease of sagittal increments after the treatment. The long-term stability was associated with treatment during the growth spurt and followed by a period occlusion adjustment.
Descrição
Tese de mestrado, Medicina Dentária, Universidade de Lisboa, Faculdade de Medicina Dentária, 2013
Palavras-chave
Ortodontia Teses de mestrado - 2013