歯科矯正治療における技術革新と顎変形症治療におけるパラダイムシフト

―顎変形症治療におけるミニマルインターベンション―

抄録

In recent years, orthodontic treatment involving the combined use of temporary anchorage devices, such as anchor screws and plates, and periodontal bone regeneration has been clinically applied, followed by improvements in diagnosis and treatment results. The emergence of anchor screws markedly changed the concept of anchorage units in dynamic orthodontic treatment, leading to effective tooth movement. Because the combined use of anchor plates enables orthodontic forces to be directly applied to bone, the effective application of an orthopedic force to the jaw became possible. Furthermore, orthodontic treatment with the combined use of periodontal bone regeneration increases the bucco-lingual width of the alveolar bone, expanding the alveolar bone housing and tooth movement region.
Jaw deformity is a skeletal maxillo-facial morphological abnormality composed of positional abnormality of the jaw bone and teeth, and deformation of the alveolar bone. In conventional surgical orthodontic treatment, jaw deformity is treated with decompensation of the tooth position, and repositioning of the jaw bone by orthognathic surgery. However, when the new orthodontic treatment technology mentioned above is applied to jaw deformity treatment, composite orthognathic surgery can be simplified, and safe and secure jaw deformity treatment becomes possible. Jaw deformity treatment in Japan, differing from that in European and other Asian countries, has markedly advanced owing to pioneers' devoted efforts, and it became covered by the national health insurance system in 1996. However, regarding the new treatment method with the technical innovation mentioned above, only anchor screws were adopted in the insurance coverage revision in April 2014. The paradigm shift of jaw deformity treatment is now at a turning point. This article explains the approach to orthodontic treatment by orthopedic application of anchor plates to the jaws - that to achieve compensation of the teeth and jaw - and the application of orthodontic treatment by the combined use of periodontal bone regeneration, which is a new treatment concept, and evaluates minimal intervention in jaw deformity treatment.