Svrha ovog istraživanja bila je ispitati zastupljenost nekih kliničkih obilježja kod ispitanika s pojedinim ortodontskim anomalijama te utvrditi postoje li razlike među skupinama. U istraživanju je sudjelovalo 90 ispitanika u dobi od 15 do 20 godina starosti,
podijeljenih u tri skupine; ispitanici s malokluzijom klase II/1 (30 ispitanika), ispitanici s malokluzijom klase II/2 (30 ispitanika) i ispitanici klase I, koji su činili kontrolnu skupinu (30 ispitanika). Protokol istraživanja sastojao se od ispunjavanja upitnika
kraniomandibularne disfunkcije (CMD), kliničkog pregleda uključujući i manualnu analizu po Bummanu, analize telerendgena i sadrenih modela u artikulatoru te instrumentalne analize Arcus Digma sustavom. Prikupljeni podaci statistički su obrađeni. Prema
samoprocijenjenom intenzitetu obilježja ispitivanih CMD upitnikom (škripanje zubima, osjetljivost zubi, smanjeno otvaranje usta, bolna žvačna muskulatura, bol kod žvakanja i pokreta donje čeljusti, bol čeljusnog zgloba, škripanje u čeljusnom zglobu, bolna vratna i ramena muskulatura, bolna vratna kralježnica, zujanje u ušima, smanjen sluh, stres, stiskanje zubima i depresija) u 83,3% ispitanika klase II/1 i 76,7% ispitanika klase II/2 zabilježena je minimalna disfunkcija prema tzv. Helkimo indeksu dok je u kontrolnoj skupini minimalna disfunkcija po Helkimu zabilježena u 43,3 % ispitanika. Niti u jednoj ispitivanoj skupini nitko od ispitanika nije imao umjerenu niti tešku disfunkciju prema Helkimu. Pojavnost obilježja analiziranih kliničkim pregledom (bol na palpaciju mišića i zgloba, raspon otvaranja usta, devijacija/defleksija kod otvaranja te brusne fasete na zubima) bila je statistički značajno veća kod ispitanika klase II nego kod kontrolne skupine. Devijacija je najčešće zabilježena u skupini klase II/2 (64,7%), a defleksija u skupini klase II/1 (51,3%). Rezultate koji se odnose na samoprocijenjen intenzitet obilježja stomatognatog sustava kao i za rezultate dobivene ostalim metodama primijenjenim u ovom istraživanju ne može se isključiti da su slučajan nalaz budući da nisu korišteni standardizirani upitnici i protokoli.
|Abstract (english)|| |
AIM: The purpose of the study was to examine the prevalence of some clinical features in subjects with Class I and orthodontic malocclusion Class II/1 and Class II/2 and to determine the differences between them (if any). The purpose of the study was to describe some of the characteristics of the occlusion and dental arches of the subjects on the plaster models mounted in the articulator, to make an Cephalometric analysis and to carry out instrumental analysis using the method of ultrasonic pantography. Also, the purpose of the study was to obtain information about the self-assessed intensity of the characteristics of the stomathognatic system by completing the Craniomandibular disorderds (CMD) questionnaire.
PARTICIPANTS AND METHODS: The study included a target group of 90 adolescent patients aged 15-20 divided into three groups: a group with malocclusion Class II/1 (30 patients), a group with malocclusion Class II/2 (30 patients) and a control group of healthy individuals with normoclussion (30 respondents). Diagnostic protocol included: CMD questionnaire, cephalometric analysis, evaluations of plaster models, clinical examination and manual analysis by Bumman, as well as instrumental analysis using Arcus Digma system (KaVo EWL GmbH, Leutkirch Germany). In statistical data processing, the p-value less than 0.05 was considered statistically significant. The data processing itself was performed using the STATISTICA 64 statistical analysis software package, version 10 for Windows.
RESULTS: The average age of class II/1 subjects is 17.1 years, class II/2 is 17.3 years, and control group subjects are 18 years. Minimal dysfunction according to the so-called Helkimo index was recorded in 83.3% of class II/1 respondents, 76.7% of class II/2 respondents, and 43.3% subjects in class I. None of the subjects had moderate or severe dysfunction according to Helkimo index. The prevalence of painful muscles at palpation occurs in 63.3% of malocclusion Class II/2
subjects, 13.3% of malocclusion Class II/1 subjects, and in 10% of subjects in control group. The prevalence of deviation is more common in subjects with Class II/2 malocclusion than in other groups. Namely, 64.7% of all subjects with this malocclusion belong to this group. Deflection occurs most often in class II/1 (51.3% of all subjects with deflection). Reduced
mouth opening is also associated with a group with Class II/1 malocclusion. Namely, 72.2% of subjects with this problem belong to this group. TMJ clicking is present in 73.3% of subjects with malocclusion Class II/1, in 80% of subjects with malocclusion Class II/2, and in 16.7% subjects in the control group. Enamel abrasion is prevalent in the malocclusion Class II/2, while enamel and dentin abrasion is present in the malocclusion Class II/1. Overjet is, on average, the largest in malocclusion Class II/1 (9 mm), in the control group is more than twice smaller (4.1 mm), and in malocclusion Class II/2 is 2.1 mm. Overbite is on average the largest in the malocclusion Class II/2 group (7.3 mm), in malocclusion Class II/1 it is slightly smaller (5.9 mm), and in the control group is 2.3 mm. The average depths of the Spee curve in malocclusion Class II/1 were 3.6 mm (for left and right side), in malocclusion Class II/2, the average on the right is 4.4 mm and on the left 4.5
mm, while in the control group, the average on the right is equal to the average on the left (2.4 mm). The average incisor inclination measured on Cephalometric analysis is lowest in the malocclusion Class II/2 (100.3°), higher in the control group (111.5°), while the largest in the malocclusion Class II/1 (114.4°). The horizontal growth pattern characterizes primarily
male respondents, namely 86.8% of them belong to this growth pattern, and to the vertical pattern only 13.2%. In female subjects, the horizontal pattern occurs in 57.7%, and vertical in 42.3%. Differences of CR-MI movements by group are statistically significant in verticals and transversals of the right and left condyle. The largest inclinations of the condyle path were measured in the control group (39.6°on the right and 39.9° on the left), followed by the malocclusion Class II/2 (27.3° on the right and 25.2° on the left), and at least in the malocclusion Class II/1 (20.1° on the right and 23.9° on the left). The highest values of Benett's angle are in the malocclusion Class II/1 (11.9° on the right, and 10.5° on the left). The highest values of Benett's angle were measured in a group with Class II/I malocclusion (11,9° on the right and 10,5° on the left). The angle of incisal guidance, also differs statistically significantly by groups, but only on the left. The highest average value of the incisal guidance angle is in the Class II/1 malocclusion group on the left (62.7°). The mouth opening is on average 38.2 mm in the Class II/1 malocclusion group, and in the other two groups it is almost equal (42.6 mm in the group with
malocclusion Class II/2 and 42.8 mm in the control group). Statistically significant correlations between the parameters studied in this study were also found. CONCLUSION: Based on the results of this study, it can be concluded that there are some differences in clinical signs and characteristics between subjects with malocclusions Class II/1, Class II/2 and Class I. The incidence of parameters analyzed by clinical examination (pain on palpation of muscles, deviation/deflection, TMJ clicking, teeth abrasion) was higher in class II subjects than in the control group. Also, higher values of overjet, overbite and
Spee curve depth in class II subjects were found. The results related to the self-assessed intensity of the characteristics of the stomatognathic system assessed by CMD questionnaire completed by the participants and the results obtained by other methods used in the study can not be excluded as a random finding since questionnaries and protocols used were not