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• W2100692934 abstract "This viewpoint article will be confined to the problems encountered in the treatment of skeletal Class II malocclusions when making age the decisive factor for using either an orthopedic or a surgical approach. With respect to age and growth development, the contemporary approach in skeletal Class II treatment is: Growth adaptation: in children/adolescents Camouflage-orthodontics: in postadolescents Surgical correction: in adults Growth adaptation is usually accomplished by different kinds of removable (eg, activator, bionator, Fränkel) and fixed (Herbst) functional appliances affecting mandibular growth and position. Treatment with the removable appliances is successful only when performed during the main growth period around puberty. The most favorable age for therapy is said to be at 8 to 11 years for girls and at 10 to 13 years for boys. On the other hand, Class II correction is accomplished on a regular basis even in postpubertal patients using the Herbst appliance. Furthermore, in a systematic review of the literature comparing removable and fixed functional appliance, Aelbers and Dermaut1Aelbers CMF Dermaut LR Orthopedics in orthodontics: Part I, fiction or reality, a review of the literature.Am J Orthod Dentofacial Orthop. 1996; 110: 513-519Abstract PubMed Google Scholar found that only the Herbst appliance is able to change mandibular growth to a clinical significant degree. Camouflage orthodontics comprises mainly maxillary extractions with retrusion of the upper front teeth. This is most often the therapy of choice after the age of 13 or 14 years for girls and 15 or 16 years for boys. As the skeletal Class II problem (mandibular retrusion) will remain, therapy may have a deteriorating effect on facial appearance. Surgical correction implies that the mandible is advanced to a Class I skeletal jaw relationship by either sagittal split osteotomy or mandibular distraction osteogenesis. Mandibular sagittal split surgery is generally confined to the nongrowing patient and done after Radius union at the age of 18 to 20 years. Distraction osteogenesis is performed in adults and children. However, relapses in children may occur when craniofacial growth is not completed at the time of therapy. In my view, it is now time to revise the above concept in skeletal Class II therapy using age as a decisive factor when choosing between a growth adaptive or a surgical approach. This is because of the fact that research has disclosed that growth in the TMJ region can continue for many years after the age of 20 years or can be reactivated at this later age. The research data I am referring to are the following: •Behrents2Behrents RG. Growth of the aging craniofacial skeleton: Monograph 17, Craniofacial growth Series. The University of Michigan, Ann Arbor: Center for Human Growth and Development1985Google Scholar has demonstrated that craniofacial growth may continue to a considerable extent in both males and females after the age of 30 years .•Protrusion experiments in adult monkeys have disclosed that condylar growth can be stimulated and the glenoid fossa be remodeled.3Hinton RJ McNamara Jr, JA Temporomandibular bone adaptation in response to protrusive function in juvenile and young adult rhesus monkeys (Macaca mulatta ).Eur J Orthod. 1984; 6: 155-174PubMed Google Scholar, 4Woodside DG Altuna G Harvold E Herbert M Metaxas A Primate experiments in malocclusion and bone induction.Am J Orthod. 1983; 83: 460-468Abstract Full Text PDF PubMed Scopus (62) Google Scholar, 5Woodside DG Metaxas A Altuna G The influence of functional appliance therapy on glenoid fossa remodeling.Am J Orthod Dentofacial Orthop. 1987; 92: 98-108Abstract PubMed Scopus (167) Google Scholar, 6McNamara Jr, JA Hinton RJ Hoffman DL Histological analysis of temporomandibular joint adaptation to protrusive function in young adult rhesus monkey (Macaca mulatta ).Am J Orthod. 1982; 82: 288-298Abstract PubMed Scopus (93) Google Scholar•Histologically it has been shown that zones of unmineralized growth cartilage and undifferentiated mesenchyme are present in the adult mandibular condyle.7Blackwood HJJ. Adaptive changes in the mandibular joints with function.Dent Clin North Am. 1966; : 559-566PubMed Google Scholar, 8Carlson DS McNamara Jr, JA Jaul DH Histological analysis of the growth of the mandibular condyle in the rhesus monkey (Macaca mulata ).Am J Anat. 1978; 151: 103-113Crossref PubMed Scopus (59) Google Scholar, 9Durkin J Heeley J Irving JT The cartilage of the mandibular condyle.Oral Sci Rev. 1973; 2: 29-99Google Scholar, 10Ingervall B Carlsson GE Thilander B Postnatal development of the human temporomandibular joint. II. A microdiographic study.Acta Odontol Scand. 1976; 34: 133-139Crossref PubMed Scopus (36) Google Scholar, 11Öberg T Carlsson GE Makroskopische und mikroskopische Anatomie des Kiefergelenks.in: Physiologie und Pathologie des Kiefergelenks. Quintessence, Berlin1985: 115-133Google Scholar, 12Luder HU Schroeder HE. Light and electron microscopic morphology of the temporomandibular joint in growing and mature crab-eating monkeys (Macaca fascicularis ): the condyle calcified cartilage.Anat Embryol (Berlin). 1992; : 189-199PubMed Google Scholar, 13Hanson T Nordström B Thickness of the soft tissue layer and the articular disc in the temporomandibular joint with deviations in form.Acta Odontol Scand. 1977; 35: 281-288Crossref PubMed Scopus (85) Google Scholar, 14Paulsen HU Thomsen JS Hougen HP Moskilde L A histomorphometric and scanning microscopy study of human condylar cartilage and bone tissue changes in relation to age.Clin Orthod Res. 1999; 2: 67-78PubMed Google Scholar•Observations in connection with condylar fracture therapy,15Jacobsen PU Lund K Unilateral overgrowth and remodeling processes after fracture of the mandibular condyle.Scand J Dent Res. 1972; 80: 68-74PubMed Google Scholar, 16Lindahl L Hollender L Condylar fractures of the mandible. II: a radiographic study of remodeling processes in the temporomandibular joint.Int J Oral Surg. 1977; 6: 153-165Abstract PubMed Scopus (155) Google Scholar mandibular osteotomies,17Edlund J Hansson T Willmar K Sagittal splitting of the mandibular ramus.Scand J Plast Reconstr Surg. 1979; 13: 437-443Crossref PubMed Scopus (50) Google Scholar, 18Hollender L Ridell A Radiography of the temporomandibular joint after oblique sliding osteotomy of the mandibular rami.Scand J Dent Res. 1974; 82: 466-469PubMed Google Scholar and mandibular repositioning in disk displacement therapy19Hellsing G Hollender LG Carlsson GE Johansson B Temporomandibular joint adaptation to mandibular repositioning in adult occlusal rehabilitation.J Craniomand Pract. 1985; 3: 273-279Google Scholar, 20Sato H Fujii T Uetani M Kitamori H Anterior mandibular repositioning in a patient with temporomandibular disorders: a clinical and tomographic follow-up case report.J Craniomand Pract. 1997; 15: 84-88Google Scholar, 21Westesson PL Lundh H Temporomandibular joint disk displacement: arthrographic and tomographic follow-up after 6 months treatment with disk-repositioning onlays.Oral Surg Oral Med Oral Pathol. 1988; 66: 271-278Abstract PubMed Scopus (32) Google Scholar, 22Yatani H Kuboki T Matsuka Y Amano Y Yamashita A Temporomandibular joint remodeling following conservative treatment of patients with disk displacement.in: Advances prothodontics world-wide. WCP Hiroshima Publication Committee, Hiroshima1991: 406-407Google Scholar have proven that the adult TMJ is capable of remodeling.•In 2 recent well-controlled prospective longitudinal studies, Ruf and Pancherz23Ruf S Pancherz H Temporomandibular joint remodeling in adolescents and young adults during Herbst treatment: a prospective longitudinal magnetic resonance imaging and cephalometric radiographic investigation.Am J Orthod Dentofacial Orthop. 1999; 115: 607-618Abstract PubMed Scopus (161) Google Scholar, 24Ruf S Pancherz H Dentoskeletal effects and facial profile changes in young adults treated with the Herbst appliance.Angle Orthod. 1999; 69: 239-246PubMed Google Scholar have shown that young adults (Radius union) with Class II malocclusions could be treated successfully with the Herbst appliance. The age range was 14 to 18 years for the female and 16 to 20 years for the male patients. Mandibular prognathism was increased and the skeletal and soft tissue profile convexity was reduced in all subjects. Magnetic resonance imaging (MRI) of the temporomandibular joints revealed condylar and glenoid fossa remodeling in almost all joints (Fig 1).•In a still unpublished investigation by Ruf and Pancherz comparing Class II-adults treated successfully by either orthognathic surgery (sagittal mandibular split osteotomy) or dentofacial orthopedics (Herbst appliance), it was revealed that the hard and soft tissue profile convexity was significantly reduced by both methods. The age range was 15 to 34 years for the Herbst and 17 to 35 years for the surgery subjects. Total treatment time (including postsurgical and post-Herbst orthodontics with multibracket appliances) was comparable in the two groups and amounted to 2 years.•Furthermore, recent MRI-TMJ studies at our department have shown that Herbst treatment does not result in temporomandibular disorders on a long-term basis25Ruf S Pancherz H Long-term TMJ effects of Herbst treatment: a clinical and MRI study.Am J Orthod Dentofacial Orthop. 1998; 114: 475-483Abstract PubMed Scopus (54) Google Scholar or cause any adverse changes in articular disk position.26Pancherz H Ruf S Thomalske-Faubert C Mandibular articular disk position changes during Herbst treatment: a prospective longitudinal MRI study.Am J Orthod Dentofacial Orthop. 1999; 116: 207-214Abstract PubMed Scopus (49) Google Scholar On the contrary, the Herbst appliance could possibly be useful in the therapy of patients with milder forms of anterior disk displacement. Thus, when considering the results from the above research and especially from our recent adult Herbst studies, it is my strong feeling that orthopedic growth adaptation with the use of the Herbst appliance is a useful alternative to orthognathic surgery in borderline adult skeletal Class II cases particularly when the two methods are compared with respect to costs and risks as well as to total treatment time. With respect to age and growth development the following new concept for skeletal Class II treatment is suggested: Growth adaptation: in children/adolescents/post-adolescents/young adults Camouflage-orthodontics: in elderly adults Surgical correction: in elderly adults In children (especially in the early mixed dentition) and adolescents (in the late mixed dentition), removable functional appliances are to be preferred, whereas in adolescents (in the permanent dentition), postadolescents and young adults, the Herbst appliance should be used. This new concept for Class II treatment implies that growth adaptive therapy with the Herbst appliance is possible even after the age of 20 years and could thus replace surgery especially in milder skeletal Class II cases. The upper age limit for successful Herbst treatment is, however, still unknown (Fig 2)." @default.
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• W2100692934 title "Dentofacial orthopedics or orthognathic surgery: Is it a matter of age?" @default.
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