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Long-term effects of Class II orthodontic treatment on oral health

Langfristige Effekte einer kieferorthopädischen Klasse-II-Behandlung auf die Mundgesundheit

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Abstract

Aim

To investigate the long-term (≥15 years) benefit of orthodontic Class II treatment (Tx) on oral health (OH).

Subjects and methods

All patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who underwent Class II correction (Herbst-multibracket Tx, end of active Tx ≥ 15 years ago) and agreed to participate in a recall (clinical examination, interview, impressions, and photographs) were included. Records after active Tx were used to assess the long-term OH effects. Data were compared to corresponding population-representative age-cohorts as well as to untreated Class I controls without orthodontic Tx need during adolescence.

Results

Of 152 treated Class II patients, 75 could be located and agreed to participate at 33.7 ± 3.0 years of age (pre-Tx age: 14.0 ± 2.7 years). The majority (70.8%) were fully satisfied with their teeth and with their masticatory system. The Decayed, Missing, Filled Teeth Index (DMFT) was 7.1 ± 4.8 and, thus, almost identical to that of the untreated Class I controls (7.9 ± 3.6). In contrast, the DMFT in the population-representative age-cohort was 56% higher. The determined mean Community Periodontal Index (CPI) maximum score (1.6 ± 0.6) was also comparable to the untreated Class I controls (1.7 ± 0.9) but in the corresponding population-representative age-cohort it was 19–44% higher. The extent of lower incisor gingival recessions did not differ significantly between the treated Class II participants and the untreated Class I controls (0.1 ± 0.2 vs. 0.0 ± 0.1 mm).

Conclusion

Patients with orthodontically treated severe Class II malocclusions had a lower risk for oral health impairment than the general population. The risk corresponded to that of untreated Class I controls (without orthodontic Tx need during adolescence).

Zusammenfassung

Ziel

Untersucht werden sollten mögliche langfristige (≥15 Jahre) Effekte einer kieferorthopädischen Klasse-II-Behandlung auf die Mundgesundheit.

Material und Methode

Alle Patienten (Abteilung für Kieferorthopädie, Justus-Liebig-Universität Gießen, Deutschland), bei welchen eine Klasse-II-Behandlung (Herbst-Multibracket-Apparatur, Ende der aktiven Behandlung vor ≥15 Jahren) durchgeführt worden war und die zu einer Nachuntersuchung (Befragung, klinische Untersuchung, Anfertigung von Studienmodellen und Fotos) bereit waren. Zur Beurteilung der Langzeiteffekte auf die Mundgesundheit wurden außerdem die Unterlagen von unmittelbar nach der Behandlung verwendet. Die Daten wurden mit denen korrespondierender bevölkerungsrepräsentativer Alterskohorten sowie unbehandelter Klasse-I-Kontrollen ohne kieferorthopädischen Behandlungsbedarf während der Adoleszenz verglichen.

Ergebnisse

Von 152 Patienten konnten 72 lokalisiert werden, diese nahmen im Alter von 33,7 ± 3,0 Jahren an der Studie teil (Alter vor Behandlung: 14,0 ± 2,7). Die Mehrheit (70,8 %) gab an, mit ihren Zähnen und der Funktion des Kauorgans vollständig zufrieden zu sein. Der DMFT(„decayed, missing, filled teeth“)-Index zeigte einen Wert von 7,1 ± 4,8 und war damit fast identisch mit dem der unbehandelten Kontrollen (7,9 ± 3,6). Im Gegensatz dazu zeigte die korrespondierende bevölkerungsrepräsentativer Alterskohorte (DMS[Deutsche Mundgesundheitsstudie] V) einen um 56 % höheren Wert. Der durchschnittliche Maximalwert des CPI („community periodontal index“) zeigte bei den Teilnehmern einen Wert von 1,6 ± 0,6. Bei den unbehandelten Kontrollen war der Wert vergleichbar (1,7 ± 0,9), während er in der korrespondierenden bevölkerungsrepräsentativen Alterskohorte (DMS V) um 19–44 % höher war.

Das Ausmaß gingivaler Rezessionen an den unteren Schneidezähnen unterschied sich nicht systematisch zwischen den behandelten Klasse-II-Patienten und den unbehandelten Klasse-I-Kontrollen (0,1 ± 0,2 vs. 0,0 ± 0,1 mm).

Schlussfolgerung

Patienten, die eine kieferorthopädische Behandlung bei ausgeprägter Klasse-II-Malokklusion erfahren hatten, zeigten ein geringeres Risiko für eine Beeinträchtigung der Mundgesundheit als die Allgemeinbevölkerung. Das Risiko entsprach dem von unbehandelten Klasse-I-Kontrollen (ohne kieferorthopädischen Behandlungsbedarf während der Adoleszenz).

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Authors and Affiliations

  1. Department of Orthodontics, University of Giessen, Schlangenzahl 14, 35392, Giessen, Germany

    N.C. Bock & S. Ruf

  2. Private Practice, Mainz, Germany

    M. Saffar

  3. Department of Medical Statistics, University of Giessen, Giessen, Germany

    H. Hudel

  4. Orthodontics, Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland

    M. Evälahti, K. Heikinheimo & D.P.C. Rice

  5. Helsinki University Hospital, Helsinki, Finland

    D.P.C. Rice

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  1. N.C. Bock
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  2. M. Saffar
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Correspondence to N.C. Bock.

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Conflict of interest

N. Bock, M. Saffar, H. Hudel, M. Evälahti, K. Heikinheimo, D. Rice and S. Ruf declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Caption Electronic Supplementary Material

Supplementary Table 1

Structure of the relevant data of the Fourth and Fifth German Oral Health Studies (DMS IV and DMS V), which were population-representative cross-sectional studies with randomly chosen participants of different age cohorts selected on the basis of the relevant WHO criteria and the customary principles of international oral epidemiology.

Ergänzende Tabelle 1 Struktur der relevanten Daten der vierten und fünften deutschen Mundgesundheitsstudie (DMS IV und DMS V), die als bevölkerungsrepräsentative Querschnittsstudien durchgeführt wurden mit zufällig ausgewählten Teilnehmern verschiedener Alterskohorten, selektiert auf Basis der relevanten WHO-Kriterien und üblicher Prinzipien internationaler oraler Epidemiologie.

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Bock, N., Saffar, M., Hudel, H. et al. Long-term effects of Class II orthodontic treatment on oral health. J Orofac Orthop 79, 96–108 (2018). https://doi.org/10.1007/s00056-018-0125-5

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