רפואת הפה והשיניים - עיתון ההסתדרות לרפואת שיניים בישראל - כרך ל"ז, גיליון מס' 2 אייר תש"פ

מאמרים

A Multidisciplinary cooperation model to improve skeletal class 3 treatment outcomes

Introduction Skeletal class III (SkCl3), is a rare deformity affecting 1% of the children worldwide, and is best treated when they are between 8 to 12 years old. It is characterized by an Angle’s historic Class III dental relationship (Fig 1) of the upper and lower first molars, where the buccal groove of the lower first molar is located mesially to the tip of the mesiobuccal incline of the upper first molar (1). Angle’s tooth classification was extended to describe skeletal jaw relationships and the patterns of growth, identifying a concave profile with the mandible protrusive with respect to the maxilla (2, 3) (for a recent review, see Zere et al. (4)). Following treatment planning and cephalometric evaluation, the parents and child must cooperate extensively with the dental team, interacting harmoniously for many years until reaching a stable occlusion in adulthood. Treatment during the pre-pubertal age has the best prognosis and may circumvent the need for complex, traumatic ortho-surgery after skeletal growth cessation. The chances for successful completion of SkCl3 treatment are strongly increased by good communication between the general dental practitioner and the orthodontist, because the appliances used can only work if there is excellent patient compliance, supervised by multiple caregivers.

By understanding the challenges, difficulties and rationale behind the various orthodontic treatment options, the general dental practitioner can support conservative treatment, thus directly contributing to its success. Furthermore, early diagnosis can make a huge difference for these patients, often requiring conservative treatment at an early age. Indeed, favorable treatment outcomes will depend, to a large extent, on sharing knowledge across a multi- disciplinary dental team. Patient cooperation is not guaranteed, yet it is an essential and integral part of the orthodontic treatment in young children (5). In most cases, treatment should commence in the late mixed dentition or permanent dentition (phase II), to achieve good esthetics and a stable occlusion. Nonetheless, in nearly one third of the patients (6), very early orthodontic treatment (phase I) is required prior to losing the deciduous dentition or during the early mixed dentition stage (7), which continues for 12-18 months. The rationale for the early treatment phase is to prevent early malocclusion, thus avoiding the need for correction of the outcome later. Because a long retention time is required in the transition between phase I and phase II of the treatment and also after finishing phase II of the treatment until adulthood, adherence at these ages is difficult and poses a real challenge. Moreover, throughout treatment, the patient has to eat

Dr. Bereznyak-Elias Y.* Dr. Fisher N.* Prof. Sarnat H.** Prof. Aizenbud D.* , *** Dr. Zaslansky P.**** Dr. Einy S.*

*Orthodontic and Craniofacial Dept., Graduate School of Dentistry,

Rambam Health Care Campus, Haifa, Israel.

** Pediatric Dentistry Dept., The Maurice and Gabriella Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. *** Bruce and Ruth Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. **** Restorative and Preventive Dentistry Dept., Centrum fur Zahn-, Mund- und Kieferheilkunde, Charit’ - Universittsmedizin Berlin, Germany.

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.2 רפואת הפה והשיניים, אייר תש״פ, כרך ל״ז, גיליון