Presentation

Orthognathodontics started out as a pioneering discipline in Italy in the 1950s. Over time, however, through several masters, namely professors E. Muzi, G. May, and O. Hoffer, it has evolved. Notching up a series of important milestones - the first Italian study group in orthodontics (GISO, 1967), the Italian Society of Orthodontics (SIDO, 1968), the first School of Specialization (Cagliari 1973) followed by the creation of other postgraduate schools, the creation of university chairs devoted to the discipline, and advanced courses and masters degree courses - this field, once led by a few early pioneers, has come to interest thousands of professionals.

I was fortunate enough to know the first masters and to witness and appreciate their clinical and scientific work; I also count myself lucky to have been present in all the different stages in the formation, development and growth of Italian orthodontics. After publishing several books and monographs on the subject, I increasingly felt the need to introduce and develop a series of books on orthognathodontics, as a means of bringing together in a systematic and coordinated way the various contributions of the Italian schools of orthodontics. The character of each of the books in the series is, to different degrees, monographic, depending on the topic under consideration.

A particular focus has been the iconography, to which considerable space has been devoted so as to encourage the use of these texts as atlases and thus also their application in clinical practice. The concise text is always prepared with absolute scientific and bibliographic rigor, and adopting a logical and valid clinical and didactic approach. Since these books, whose aim is to facilitate learning of this discipline, are readily consultable, the user is able to get the most from them. Five years ago, to our great satisfaction, the series passed its “silver” landmark of 25 titles, thereafter forging on towards new goals that we would hardly have dared hope for when, back in 1996, we took our first timid steps with the first volume. This achievement is certainly down to all the Italian orthodontics schools, which readily supported the initiative and have, over the years, enriched the series with highly significant and important monographs; it is also due to the participation of established authors whose contribution has been critical to the success of this publishing venture, earning it widespread consensus and satisfaction among readers, and detailed and appreciative reviews in leading sector journals.

The success of the series has been crowned by the support of almost all the schools of specialization in Italy’s private and public universities which, as shown by the list of 13 new titles on the back cover, have undertaken to provide us, over the next few years, with their best results in their specific research areas. My efforts will be devoted to raising further the level of the topics selected, while the task of the publisher will be to further improve the graphics and layout, always with a view to providing practical texts, readily useable by the reader, while also guaranteeing exhaustive treatment of the topics under consideration. Having last year reached the landmark of 30 titles, with a book looking at the experience of the prestigious Aahrus school of Prof. Birte Melsen and colleagues, and in the wake of volume number 31, which deals with 3D imaging, I am now honoured and very pleased to present, with this new monograph, the School of the University of Naples Federico II, directed by Prof. Roberto Martina, which is one of the most valid and dynamic schools, evolving all the time.

I had the good fortune to get to know Roberto Martina when he was very young but already following in the footsteps of his father, a well-known and much esteemed orthodontist and one of the pioneers of the 1960s, who unfailingly showed great moral and ethical rigour and was always determined to be abreast of developments. Roberto inherited his father’s great qualities and from a young age devoted himself exclusively to orthodontics, attending the first - and, at the time, the only - Italian postgraduate school of orthodontics at the University of Cagliari run by Prof. Paolo Falconi, where I was also a teacher. In 1977, he completed his studies and specialized with full marks, emerging as a star pupil thanks to his professionalism, the thoroughness of his research, and the perfect clinical outcomes of the patients he treated.

I had the honour of supervising his specialization thesis. He then returned to the University of Naples Federico II, where he had done his medical training, and there lost no time in setting up a department of orthodontics which subsequently became a proper school of specialization. At the same time, his academic career advanced rapidly as he was appointed first associate professor and then full professor. His great interest in the study of orthodontics led him to attend many courses and university clinics abroad, as well as international congresses, and, at the same time, to create a high-level clinical and experimental scientific research centre at his clinic. In recognition of all this, in the 1990s he became, in spite of his young age, president of the Italian Society of Orthodontics (S.I.D.O.) and subsequently president of the European Orthodontic Society (E.O.S.).

This period culminated in a memorable international congress in Sorrento - a meeting of the highest scientific level quality. Today, the Naples school has a great many pupils who, having benefited from Roberto Martina’s valuable teaching and guidance, have gone on to secure important permanent appointments both in universities and in hospitals; many of them are highly respected professionals who are still actively involved with the school.

Volume 32 in this series marks a new and important change: thanks to the farsightedness and courage of our publisher, Dr Alfredo Martina, the series will, from now on, be printed simultaneously in English as well as in Italian.

It will therefore now be my task to invite the best foreign schools to contribute to the series and at the same time to make the validity of the Italian schools of orthodontics better known abroad. In the present volume Prof. R. Martina looks at the functional treatment of class II malocclusions with the Bite Jumping Appliance (BJA), a technique developed by Prof. Franz Gunter Sander. Thanks to this technique, it is possible to obtain significant and stable results in these particular pathological situations. After a chapter on the choice of functional appliance, the biomechanical and clinical advantages of the technique are considered, and finally the timing of the treatment. A large chapter, with a rich iconography, is given over to the presentation and description of clinical cases.

Two special chapters look at treatments in hyperdivergent patients or with deep bite. The monograph ends with final considerations and an extensive bibliography. Prof. R. Martina was assisted by Dr V. D’Antò and Dr A. Galeotti, head of the departmental dentistry unit at the Bambin Gesù Hospital in Rome, who verified the scientific validity of the results. Finally, the descriptions of the preparation of the appliances were provided by a specialist laboratory directed by M. Cicatiello (dental technician). This technique, in addition to the usual occlusal objectives, also allows the achievement of better aesthetic outcomes. This monograph has many merits, but I wish to underline two in particular. The first is the care taken over the diagnosis, in which every available means is used to decide exactly which type of class II the patient belongs to, with particular attention also being paid to the aesthetic assessment according to the Fränkel method, which is very reliable, especially in normo and hypodivergent cases, and to the careful and precise timing of the treatment.

The second is the analysis of the biomechanical and clinical advantages of the BJA. These include, in addition to solidity of the appliance and ease of reactivation, excellent mandibular propulsion even in the rest position, and thus the fact that it remains active, also during the night; another advantage is that it is possible to avoid using excessive elevations; finally, there is the fact that the reactive force, unloading on the upper jaw, passes close by the centre of resistance (key ridge), avoiding forms of maxillary rotation and mandibular postrotation. Finally, adopting an evidence-based medicine (EBM) approach, Prof. R. Martina’s school has conducted some excellent research including an efficient randomized clinical trial demonstrating the efficacy of BJA treatment. Thanks to the clarity of the exposition and the presentation of the various clinical steps, this book is an effective and practical clinical manual and working tool.

I hope that it will soon be used in the postgraduate schools and then by all professionals wanting more techniques at their disposal for dealing with particular diseases. Finally, I wish to congratulate and, once again, thank Dr Alfredo Martina for his boundless energy and enthusiasm for his work and for his constant commitment to further improving this series in its typography and iconography. I am also grateful for his constant support, encouragement and wisdom, especially at critical moments and when difficult decisions have to be made.

Prof. Damaso Caprioglio
Former Director of the Chair of Orthodontics and Gnathology
Professor of Ethics
University of Parma
Senior Member of the Italian Orthodontic Specialists

Preface

In this book of the prestigious orthodontic series directed by Professor Damaso Caprioglio and edited by Martina, we report on the clinical experience gained over the past fifteen years from the use of the Sander Bite Jumping Appliance (BJA). The treatment of Class II malocclusions with functional appliances is often considered to be a controversial subject due to the inconsistent findings of clinical trials investigating the efficacy of dentofacial orthopaedics.

These problems are further compounded by the endless variety of appliances available for the treatment of mandibular retrognathia. Therefore, two questions naturally arise: firstly, why do we promote functional treatments? and, secondly, why do we prefer the BJA? We will attempt to answer the first question using the results of a Randomized Controlled Clinical Trial that our group has recently completed and that are reported in the subsequent text.

This data may also be used to answer the second question, although it is important to note that the careful analysis of the biomechanical characteristics of the appliance and the clinical protocol are essential ingredients to consistently successful treatments. We had hoped that Professor Günter Sander would make a special contribution to this textbook, but sorrowfully, he passed away in March 2012.

We wish to dedicate this book to him in recognition of his invaluable teachings and intellectual collaborations. We are extremely grateful for the sincere friendship that he maintained with all of us at the Department of Orthodontics, University of Naples Federico II.

Index

PRESENTATION

PREFACE

THE FUNCTIONAL TREATMENT OF CLASS II MALOCCLUSIONS WITH THE BITE

JUMPING APPLIANCE

Chosing A functional apliance

The biomechanical and clinical advantages of the BJA

Timing of treatment with BJA

CASE REPORTS

The BJA in hyperdivergent PATIENTS

The BJA and the DEEP bite

CONCLUDING REMARKS

BIBLIOGRAPHY