Corrección de la atresia maxilar y del plano oclusal utilizando MARPE y mini-implantes extra-alveolares / Correction of maxillary atresia and occlusal plane using MARPE and extra-alveolar mini-implants

Para el tratamiento no quirúrgico de la atresia maxilar en pacientes con osificación avanzada de la sutura palatina media, existe la alternativa de un disyuntor anclado en mini-implantes. El éxito no está garantizado, pero se puede hacer este intento antes de realizar una expansión asistida quirúrgicamente. Del mismo modo, el uso de mini-implantes extra-alveolares para el movimiento de grupos dentales en la corrección de maloclusiones es algo cada vez más aplicado debido a una mejor accesibilidad. El objetivo de este estudio es presentar el caso de un paciente adulto joven con atresia maxilar tratado con MARPE y la corrección del plano oclusal mediante mini-implantes extra-alveolares. Clínicamente se observó la apertura de la sutura media palatina; radiográficamente, la ligera rotación de la mandíbula en sentido antihorario, la mejora de la inclinación del plano oclusal, la disminución de la inclinación y protrusión de los incisivos superiores e inferiores, y la distalización de los molares mandibulares, estableciendo una relación molar en Clase I. La expansión con MARPE en el caso de este paciente adulto joven con atresia maxilar fue efectiva. Se consiguió la corrección del plano oclusal con el uso de mini-implantes extra-alveolares, así como resultados estéticos y funcionales muy satisfactorios. Entre varias alternativas de tratamiento, la técnica a realizar dependerá de factores como la efiencia, la conservación de los elementos dentales, la colaboración del paciente y la estabilidad.

For the non-surgical treatment of maxillary atresia in patients with an advanced degree of ossification of the midpalatal suture, there is an alternative of an expander anchored in miniscrews. Success is not guaranteed, but this attempt can be made before recommending surgically assisted expansion. Similarly, the use of extra-alveolar miniscrews for dental movement in the correction of malocclusions is something that is increasingly being applied due to better accessibility. The aim of this work is to present the case of a young adult patient with maxillary atresia treated with MARPE and the correction of the occlusal plane through the use of extra-alveolar miniscrews. Clinically, the opening of the midpalatal suture was observed, radiographically, the slight rotation of the mandible in an anti-clockwise direction, the improvement in the inclination of the occlusal plane, the decrease in the inclination and protrusion of the upper and lower incisors, and the distalization of the lower molars establishing a Class I molar relationship. The expansion with MARPE in the case of a young adult patient with maxillary atresia was effective. The correction of the occlusal plane with the use of extraalveolar miniscrews was achieved, as well as very satisfactory aesthetic and functional results. Among various treatment alternatives, the technique to be executed will depend on factors such as efficiency, conservation of dental elements, patient collaboration, and stability.

Analysis of factors associated with the success of microimplant-assisted rapid palatal expansion.

INTRODUCTION: Success-related factors of microimplant-assisted rapid palatal expansion (MARPE) were evaluated, including age, palatal depth, suture, and parassutural bone thickness, suture density and maturation, and the relation to corticopuncture (CP) technique, as well as skeletal and dental effects. METHODS: Sixty-six cone-beam computed tomography scans were analyzed before and after rapid maxillary expansion procedures in 33 patients aged 18-52 years for both sexes. The scans were generated in digital imaging and communications in medicine file format and analyzed in the multiplanar reconstruction of the regions of interest. Palatal depth, suture thickness, density and maturation, age, and CP were assessed. To evaluate dental and skeletal effects, the sample was divided into 4 groups: successful MARPE (SM), SM + CP technique (SMCP), failure MARPE (FM), and FM + CP (FMCP). RESULTS: Successful groups presented more skeletal expansion and dental tipping than failure groups (P <0.05). The mean age of the FMCP group was significantly higher than the SM groups; suture and parassutural thickness significantly related to the success, and patients who received CP showed a success rate of 81.2% compared with 33.3% in the no CP group (P <0.05). Suture density and palatal depth did not show a difference between the success and failure groups. Suture maturation was higher in SMCP and FM groups (P <0.05). CONCLUSIONS: Older age, thin palatal bone, and higher stage of maturation can influence the success of MARPE. CP technique in these patients appears to have a positive impact, increasing the chance of treatment success.

Nonendodontic lesions misdiagnosed as apical periodontitis lesions: series of case reports and review of literature.

INTRODUCTION: This study aimed to analyze cases referred from a reference service in oral pathology that were initially misdiagnosed as periapical lesions of endodontic origin and to perform a review of the literature regarding lesions located in the apical area of teeth with a nonendodontic source. METHODS: A survey was made of clinical cases derived from the service of oral pathology from 2002 to 2012. The pertinent literature was also reviewed using ScienceDirect and PubMed databases. The lesions were grouped into benign lesions mimicking endodontic periapical lesions (BLMEPLs), malignant lesions mimicking endodontic periapical lesions (MLMEPLs), and Stafne bone cavities. The clinical presentations were divided into lesions with swelling without pain, lesions with swelling and pain, and lesions without swelling but presenting with pain. RESULTS: The results showed that 66% (37/56) of cases represented benign lesions, 29% (16/56) malignant lesions, and 5% (3/56) Stafne bone cavities. The most commonly reported BLMEPLs were ameloblastomas (21%) followed by nasopalatine duct cysts (13.5%). The most frequently cited MLMEPLs were metastatic injuries (31.5%) followed by carcinomas (25%). The main clinical presentation of BLMEPLs was pain, whereas that of MLMEPLs was swelling associated with pain; Stafne bone cavities displayed particular clinical findings. CONCLUSIONS: Clinical and radiologic aspects as well as the analysis of the patients' medical history, pulp vitality tests, and aspiration are essential tools for developing a correct diagnosis of periapical lesions of endodontic origin. However, if the instruments mentioned earlier indicate a lesion of nonendodontic origin, a biopsy and subsequent histopathological analysis are mandatory.