Behandlungsqualität der kieferorthopädischen Versorgung bei Angle-Klasse III

Beschreibung

The aim of the present study was to assess the quality of treatment of all Angle-Class III patients at the Department of Orthodontics of the Justus Liebig University Giessen during the survey period 1990-2020, regardless of whether they received early or main treatment. The PAR index (RICHMOND et al. 1992b; RICHMOND et al. 1992a) and the assessment according to AHLGREN (1988) served as main target parameters. Secondary outcome measures were habits and dysfunction, congenital anomalies, and retention and/or agenesis of teeth at baseline. Furthermore, the changes in occlusal variables, the occurrence of recessions, and the number of teeth in frontal crossbite were considered. Data were collected for early treatment, main treatment including retention, or both, early and main treatment including retention. Inclusion criteria contained: - Angle class III - Early treatment, main treatment or both - Treatment completed by the end of 2020 The study included 43 patients with early treatment and 148 patients with main treatment, including 17 patients who received both early and main treatment at the study center. With regard to treatment quality, the following results could be derived: - Early treatment: the initial PAR score of 32.6 ± 7.5 points was reduced by 15.0 ± 13.0 points to 17.5 ± 10 points. - After early treatment, 31% achieved the category "greatly improved", 43% "improved" and 26% the category "worse/no different". - Main treatment: the initial PAR score of 35.2 ± 9.5 points was reduced by 29.3 ± 10.8 points to 6.0 ± 5.0 points (T1) and remained largely stable at 6.7 ± 5.2 points in the follow-up phase (T2). - After the active main treatment, 71% achieved the category "greatly im-proved", 23% "improved" and 6% the category "worse/no different". After retention, 69% of the patients were in the "greatly improved" category, 23% in the "improved" category and 8% in the "worse/no different" category. - The AHLGREN (1988) evaluation, which only took place at T2, rated 11% as excellent, 34% as good, 41% as acceptable, and 14% as unacceptable treatment results. - The number of patients with frontal crossbite teeth was reduced by 64% during early treatment (T0*-T1*) and by 76% during main treatment (T0-T2). - During early treatment (T0*-T1*), the median occlusion in the molar region improved by ¼ Pb to neutral occlusion on the right side, while it deteriorated by ¼ Pb to ½ Pb mesial occlusion on the left side. During the main treatment (T0-T2), the median molar occlusion improved from ½ Pb mesial to neutral occlusion on both sides. - A moderate correlation of the variables ANB (r= 0.550) and ML/NSL (r= 0.506) for the PAR reduction during early treatment and for the variables overjet at T0 (ρ= -0.562) and the number of teeth in the frontal crossbite at T0 (ρ= 0.667) for the PAR reduction during main treatment could be determined. - Recessions were only investigated during the main treatment; at T0, 15% of the patients had recessions, under treatment the number increased to 48% at T1 and again to 53% at T2. The most frequently affected teeth were the mandibular anterior teeth 31 and 41. Early treatment can effectively serve to correct frontal crossbites and thus pave the way for normal dentition development. The PAR score reduction and also the occlusion must be evaluated less strictly due to the given limits under health insurance law. According to RICHMOND et al. (1992b), the percentage distribution during main treatment in the "worse/no different" category should be ≤5% (here 6%/8%) and the average PAR index improvement should be ≥70% (here 80%/77%). Thus, the treatment quality of Angle-Class III orthodontic care during the main treatment at the study center can be rated as good. Clearly predisposing factors for good or poor treatment quality outcome could not be identified.

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Sinah Pia Bohn

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Vorbiss Zahn- und Kieferfehlstellungen Ober- und Unterkiefer Neutralbiss Edward Angle Zahnfehlstellung ideale Zahnbogenform

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