CAPITOLO III: CORRELAZIONE TRA LA TERZA CLASSE SCHELETRICA E
CASO CLINICO
Il paziente è un soggetto di sesso femminile adulto di circa 20 anni. Nulla da segnalare per quanto concerne l’anamnesi familiare e fisiologica, mentre all’anamnesi remota e prossima la paziente riferisce dolore all’apertura e chiusura della bocca, frequenti cefalee, dolori in zona preauricolare, stanchezza muscolare alla masticazione dei cibi duri. Riferisce di non essersi mai sottoposta a terapia ortodontica in precedenza.
All’ esame obiettivo la paziente presentava uno sviluppo corporeo normale, un viso lungo specialmente a carico del terzo inferiore con angoli nasolabiale e mento labiale aumentate. All’esame intraorale si rilevava una buona condizione di igiene orale. La paziente presentava una dentizione completa permanente. Si rilevava una III Classe dentale molare e canina sia destra che sinistra, un ovj negativo (-2 mm) ed un overbite nella norma (+1.5 mm), ed un affollamento dentale nel gruppo anteriore superiore. Gli incisivi inferiori si presentavano normoinclinati.
La lateralità destra e sinistra e la protrusione apparivano alterati. Era presente una deviazione della linea mediana sia superiore che inferiore. I movimenti di apertura e chiusura apparivano limitati. Erano rilevabili rumori di schiocco da ambo i
lati in apertura e chiusura; inoltre presentava una grave limitazione dell’apertura.
Era presente un accentuata dolorabilità e contrattura muscolare alla palpazione dei muscoli masseteri, pterigoidei e temporali.
All’OPT si è evidenziata la mancanza dell’elemento 46 e cura canalare dell’elemento 21. Nessun altra patologia in corso.
L’analisi cefalometrica sulla teleradiografia laterolaterale è stata eseguita secondo Jaraback. L’analisi cefalometrica indicava una III Classe scheletrica, con un angolo SNA di 82° che indicava una normale posizione del mascellare superiore ed un angolo di 88° che rifletteva un prognatismo mandibolare importante.
La paziente è stata sottoposta ad una terapia ortodontica prechirurgica per livellare e stabilizzare le arcate. Dopo questa prima fase sono stati studiati i modelli in gesso che, montati su articolatore, hanno consentito di studiare la posizione dei mascellari nei tre piani dello spazio e di eseguire il set up per simulare lo spostamento delle basi scheletriche che verrà effettuato in sede operatoria.
Quindi la paziente è stata sottoposta a trattamento chirurgico. Il piano chirurgico ha previsto: osteotomia mascellare Le Fort I ed
osteotomia bilaterale del ramo mandibolare. Dopo la fase operatoria è stato eseguito uno splint occlusale di stabilizzazione.
In seguito la paziente si è sottoposta ad un trattamento ortodontico post-chirurgico per perfezionare l’allineamento e l’intercuspidazione dentale.
La paziente dopo 1 anno, presentava un ottima stabilità occlusale e funzionale con un estetica ottima. I movimenti di apertura e lateralità erano rientrati nella norma ed i rumori articolari non erano più rilevabili. L’accentuata dolorabilità era inoltre scomparsa.
Foto prechirurgiche
Foto postchirurgiche
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