دکتر عبدالرضا جمیلیان متخصص ارتودنسی و فلوشیپ ارتودنسی و شکاف لب و کام در کنگره 59 انجمن دندانپزشکی ایران که در سالن اجلاس در اردیبهشت ماه 1396 برگزار شد سخنرانی تحت عنوان تشخیص طرح درمان در بیمارانی که هم می توان ان ها را به روش ارتودنسی به تنهایی و یا با ارتودنسی به همراه جراحی درمان نمود پر داختند. در این سخنرانی به نکات مهم در طرح درمان اینکه بتوان این دو گروه بیماران را از هم جدا نمود پرداختند. جکیده این سخنرانی به زبان انگلیسی تحت عنوان چه بیماری نیاز به ارتودنسی به تنهایی و چه بیماری نیاز به ارتودنسی و جراحی دارد. در ادامه اورده شده است.
Introduction:
One of the most controversial issues in treatment planning of Class III malocclusion patients is the choice of treatment between orthodontic camouflage and orthognathic surgery. The aim of this study was to delineate diagnostic measures in borderline class III cases for choosing proper treatment modality and also to compare the treatment effects between them.
Materials and Method:
The pre-treatment lateral cephalograms of 65 patients exhibiting moderate skeletal Class III were analyzed. The inclusion criteria were ANB of 0° to −4° and Wits appraisal of less than 0mm. The camouflage group comprised of 36 patients with the mean age of 21.5 (SD 4.8) and the surgery group comprised of 29 patients with the mean age of 24.8 ( SD 3.1). The camouflage group was corrected by flaring of the upper incisors and retraction of the lower incisors and the surgical group was corrected by setback of the mandible, maxillary advancement, or bimaxillary surgery. Mann-Whitney U test was used to compare the variables between the two groups. Stepwise discriminant analysis was applied to identify the dentoskeletal variables that best separate the groups.
Results:
Holdaway H angle and wits appraisal were identified by stepwise discriminant analysis as the two variables to differentiate between the patients suitable for orthodontic camouflage or surgical treatment. Borderline class III malocclusion who have a Holdaway angle greater than 10.3° and wits appraisal greater than -5.8 mm would be treated successfully by camouflage alone; while, surgery should be the treatment of choice in borderline class III malocclusion patients with a Holdaway angle of less than 10.3° and with wits appraisal and less than -5.8 mm. Based on this model 81.5% of our patients were properly classified. Seven patients in the camouflage group and five patients in the surgical group were misclassified.
Conclusions:
Holdaway H angle and wits apprasial can be used as a critical diagnostic parameter for determining the treatment modality in Class III borderline cases.