TREATMENT OF VERTICAL BASAL ANOMALIES
Introduction
Basal anomalies of the vertical direction are defined by an imbalance of proportion between the lower level and the middle level, they are represented by 2 anomalies; the vertical excess or insufficiency of the lower level. These anomalies are rarely isolated, they are often associated with anomalies of the other senses especially the sagittal direction.
Anterior vertical excess is frequently of hereditary origin, as is hypodivergence; this hereditary transmission can occur either at the bone level or at the level of muscle tone. Local factors can be grafted, such as the position of the tongue in the resting position and during the various functions.
2. Treatment of anterior vertical excess
AVOID ALL THERAPIES THAT MAY INCREASE THE VERTICAL DIMENSION
2. 1. Therapeutic objectives
If detected early, the treatment will be interceptive and will aim to avoid the worsening of this anomaly. Certain therapeutic means can be used in the event of an associated moderate gap; the most complex cases will be managed by a surgical-orthodontic specialist.
The aim of the treatments would be to re-establish the incisal guide and, where appropriate, adequate canine and molar occlusion in order to allow the masticatory system as a whole to maintain its health in the medium and short term.
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2. Treatment of anterior vertical excess
1. Diagnostic reminder
See 3rd year course
2. 2. Interceptive processing
2. 2.1. Normalization of lingual function
Restore physiological lingual function in the resting position or during different functions.
This correction can be done by restoring nasal breathing if necessary, by resection of the lingual frenulum in the case of ankyloglossia, by removing parafunctions;
A stage of neuromuscular rehabilitation must be undertaken in order to allow the engramming of the cerebral circuit responsible for the different orofacial functions.
This rehabilitation can be better guided by the addition of certain passive elements in the removable appliance such as the lingual lodge, the Tucat pearl or the anti-tongue grid. In some cases, the Bonnet lingual night envelope or ELN is used.
2. 2. 2. High Pull Chin Sling
Some authors used this device to cause an anterior rotation of the mandible and therefore the reduction of vertical excess but currently many authors have doubts about the effectiveness of this procedure and reject it.
2. 3. Treatment of moderate gaping
2 3.1. Use of intermaxillary elastics
Integrated into the framework of fixed therapy, intermaxillary elastics can close the gap and thus re-establish the incisal guide.
.3. 2. Ingression of molars
Some authors recommend, in the context of fixed therapy, intruding the molars and thus causing an anterior rotation of the mandible, reducing the vertical anomaly.
This intrusion can also be obtained by using mini screws implanted in the palate and in the vestibule which will serve as anchoring for a force delivered by elastics.
3. 2.3. extraction of the first molars
Also integrated into the overall treatment of the case, the extraction of the 6-year-old teeth could lead to a reduction in the DV and correction of the gap.
2. 4. Surgical-orthodontic treatment
In severe cases, treatment will begin with an orthodontic step that will facilitate the surgical step that will be done either at the maxillary or mandibular level or both bone bases at the same time. This treatment will aim to obtain optimal occlusal function. This treatment can only be done once the growth of the facial mass is complete. Several surgical techniques are described
2.4.1. At the maxillary level
Two types of intervention can be described :
LEFORT 1 type total osteotomy of differential impaction of the maxilla associated with an advancement or expansion Schuchart posterior segmental osteotomies,
figure 4
II.4.2. At the mandibular level
Total mandibular osteotomies (mainly OBWEGESER DALPONT) which allow the sagittal and vertical movements of the entire mandible to be combined.
3. Anterior vertical insufficiency
AVOID ALL THERAPIES THAT MAY REDUCE DV
3.1. Interceptive processing
– Rehabilitation of functions
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Intercepting the overbite
PHILIPPE’s interincisive plate: Just after the baby teeth fall out when there is already an overbite in the temporary dentition, it prevents the tooth from coming out and it is the gum that rises.
Palatal plate with retro-incisal elevation surface.
Equiplan or PLANAS balance plane
3. 2. Orthopedic treatments
3. 2.1 FEO with cervical traction
Due to the decomposition of their vector of action, they tend to promote the eruption of the upper molars and to accentuate egression (Merrifield, Teuscher, Melsem, Poulton).
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3. 2.2 Activators
Their action is done by all the authors at the level of the lower molar which will be egressed, the supraclusion will then be reduced
Function regulators such as Fränkel, Balters and Bimler push back excessively anterior musculature and oppose hypertonic musculature, which could promote an increase in DV.
3. 3. Orthodontic Treatments
Avoid extractions as much as possible; if you extract, you should extract as little posteriorly as possible to preserve facial balance.
- Leveling the curve of Spee and unlocking the occlusion to free mandibular growth.
- Ingression of the upper incisor according to aesthetic and functional factors .
-DAC in case of class II: 2
-class II elastics if a skeletal class II is associated
3. 4. Surgical-orthodontic treatment
Total maxillary surgery type LEFORT I with egression of the entire arch or combined where the anterior segment will sometimes have to be ingressed.
-At the mandibular level, mandibular surgery will allow for correct vertical and sagittal restoration.
-Special case of hypodivergent with dental cl II 2: 3 types of surgical-orthodontic protocols are currently used:
- The technique of leveling the curve of Spee with mandibular sliding along the occlusal plane;
- A complementary genioplasty allows the vertical augmentation of the lower level of the face.
CONCLUSION
Vertical basal anomalies must be given great attention in the same way as the other spatial senses because their persistence could harm the proper functioning of the masticatory system. If their suppression proves impossible, everything must be done to avoid their worsening.
Good oral hygiene Regular scaling at the dentist Dental implant placement Dental x-rays Teeth whitening A visit to the dentist The dentist uses local anesthesia to minimize pain