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      Orthopedic cervical headgear in Class II treatment: case report

      case-report

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          Abstract

          Early treatment for Class II malocclusion was undertaken with the objective of correcting skeletal disproportion by altering the growth pattern. A case of Class II, Division 1 malocclusion in the mixed dentition was corrected to Class I molar relationship using orthopedic cervical headgear, with nonextraction edgewise therapy. Cephalometric analysis indicated a reduction in the maxillomandibular discrepancy (ANB) correcting the Class II malocclusion to Class I malocclusion. The treatment showed that this was achieved by downward displacement and inhibition of the forward growth of the maxilla and growth of the mandible. There was no downward rotation of the mandible nor maxillary first molar extrusion. There was improvement in the jaw relationship.

          Translated abstract

          O tratamento precoce da maloclusão de Classe II foi realizado, alterando o padrão de crescimento, com o objetivo de corrigir a desproporção esquelética. Um caso de maloclusão de Classe II, Divisão 1 na dentição mista foi corrigido com terapia edgewise sem extração para uma relação molar de Classe I, usando o aparelho extraoral cervical. A análise cefalométrica indicou que a redução da discrepância maxilo-mandibular (ANB) foi corrigida de maloclusão Classe II para Classe I. O tratamento mostrou que isto foi possível devido ao deslocamento e inibição do crescimento anterior da maxila e crescimento mandibular. Não houve rotação horária da mandíbula, assim como, extrusão dos primeiros molares superiores. Houve melhora na relação maxilo-mandíbular.

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          Most cited references18

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          Changes in dental arch dimensions by use of an orthopedic cervical headgear in Class II correction.

          Orthopedic cervical headgears are commonly used in Finland for early treatment of the Class II malocclusion, but there is a lack of follow-up studies on the effect of this treatment. We have evaluated the effects of the cervical headgear therapy with an expanded inner bow to treat Class II malocclusion and dental arches. Forty children, 20 boys and 20 girls, with Class II, Division 1 malocclusion, were treated with the orthopedic cervical headgear. No other appliances were used. The mean age of the subjects in the beginning of the treatment was 9.3 +/- 1.3 years (range 6.6 to 12.4 years). The mean treatment time was 1.8 +/- 0.6 years (range 0.8 to 3.1 years). The cervical headgear was used with a 10 mm expanded inner bow and a 15 degrees upward bend of the long outer bow, 12 to 14 hours a day with a force of 500 gm per side. Class I relationships were achieved in all subjects. At the same time, the maxillary and mandibular dental arches were widened. The annual increment in the intercanine and intermolar distances was significantly greater than in healthy control subjects (literature data), except for the mandibular intercanine distance in boys. The maxillary arch lengths were also significantly increased; there were no consistent changes of the mandibular arch lengths. Class II malocclusion may be treated with the orthopedic cervical headgear. The treatment results in increased growth of the dental arch widths by expansion of the inner bow of the headgear. The widening of the maxilla is followed by spontaneous widening of the mandible.
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            The dentomaxillary complex and overjet correction in Class II, division 1 malocclusion: objectives of skeletal and alveolar remodeling.

            M C Meikle (1980)
            In recent years it has become apparent that there are limitations to the amount of tooth movement that can be accomplished by alveolar remodeling. Retraction of the maxillary incisor teeth should therefore be avoided during overjet correction if penetration of the palatal alveolar cortex is a probability. Since the Class II, Division 1 phenotype is characterized by abnormalities in both dentoalveolar process and maxillomandibular reactions, trying to compensate for the skeletal discrepancy through alveolar remodeling alone does not have logic on its side. Indeed, treatment philosophies based entirely on a concept of alveolar remodeling cannot be justified on biologic grounds. The most reliable method of avoiding destruction of the palatal alveolar cortex during overjet correction is by means of headgear mechanics designed to produce clinically significant skeletal remodeling. This holds as a general principle, even where extractions are an essential part of the treatment program. Furthermore, because the facial skeleton responds to mechanical deformation more readily in the growing person, the policy adopted by many orthodontists of deferring treatment until the permanent teeth have erupted has little to recommend it.
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              Changes in mandibular growth direction during and after cervical headgear treatment

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                bdj
                Brazilian Dental Journal
                Braz. Dent. J.
                Fundação Odontológica de Ribeirão Preto (Ribeirão Preto )
                1806-4760
                June 2003
                : 14
                : 1
                : 63-66
                Affiliations
                [1 ] Universidade de São Paulo Brazil
                Article
                S0103-64402003000100012
                10.1590/S0103-64402003000100012
                082b559e-6847-474b-81ed-b198824c3b46

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0103-6440&lng=en
                Categories
                DENTISTRY, ORAL SURGERY & MEDICINE

                Dentistry
                Class II malocclusion,cervical headgear,extraoral traction,growth
                Dentistry
                Class II malocclusion, cervical headgear, extraoral traction, growth

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