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Can we grow mandibles with bone-anchored plates for class 2 correction ? 6 MINUTE SUMMARY

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Farooq Ahmed

Can we grow mandibles with bone-anchored plates for class 2 correction ? 6 MINUTE SUMMARY 

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Join me for a summary exploring an innovation of the use of bone-anchored plates in class 2 correction. This was a clinically novel idea presented by Hugo De Clerck, who has been an innovator in the use of bone-anchored plates and has published seminal papers on the topic for class 3 treatment.

 

Hugo explores the use of bone-anchored plates in the mandible, combined with a Herbst appliance. He presents his data of 90 patients treated in Brussels by his research team.

 

PROTOCOL

  1. Customised bone anchored plates in lower anterior mandible – digitally designed per patient with surgical guide

  2. Transmucosal between lower canine and 1st premolar

  3. Herbst: modified to attach from upper 1st molar to the lower bone anchored plates

  4. Procline upper incisors prior to fitting Bone anchored-Herbst

  5. Expansion of the upper arch

  6. 2-3 modifications to Herbst piston to lengthen during treatment

  7. Duration 10 months

HOW DOES IT WORK

  • Growth of the mandibular body: mainly, bone modelling. Average growth 5-7mm, whereas conventional herbst 2-2.5mm of chin projection. New growth of bone as ramus moves backwards, resulting in lengthening of the mandible

  • Force generation:  in similar to the conventional functional appliance, with contraction of medial and lateral pterygoid and stretching of the suprahyoid and temporalis muscle

  • Lower incisor proclination: No lower incisor proclination: There is a distal force on the mandibular dentition instead of a forward force from conventional functional appliances, due to the appliance attaching to the mandibular body, not the dentition

  • Condylar displacement: Longer duration, of up to 10 months which results in stimulation of growth of the body of the mandible, conventionally this stops with a herbst as the lower incisors procaine, resulting in only 2 months of condylar displacement and therefore less stimulation of growth

  • Glenoid fossa remodelling. The glenoid fossa remodelled in a forwards direction, however it was small and unpredictable, with some posterior remodelling

  • Rotation of mandible – similar to the conventional functional appliance, a posterior rotation reduces the effects, anterior rotation enhances, for every 1 degree 1.1mm increase projection. Achieve via expansion and removable appliance

  • Upper molar distalisation: Hugo saw this as unfafourable and advised lengthening the herbst piston to reduce upper molar distalisation, therefore maximising mandibular lengthening

 

 

  • Age 13-15

  • Not possible with miniscrews, due to the quantity of force

  • Breakages of Herbst still occur

  • Is growth maintained long term – unable to state

  • No control as requirement for cbct of untreated patients.

 

 

Contributions

Contents: Farooq Ahmed

Edited and produced: Farooq Ahmed

 

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