Comparison of dentoskeletal and soft tissue effects of Class II malocclusion treatment with Jones Jig appliance and with maxillary first premolar extractions.

OBJECTIVE: The aim of this study was to compare the cephalometric changes in Class II division 1 malocclusion patients treated with Jones Jig appliance or with maxillary first premolar extractions. METHODS: The sample consisted of 88 lateral cephalograms of 44 patients, divided into two groups. Group 1 consisted of 21 patients treated with Jones Jig appliance, with a mean initial age of 12.88 ± 1.23 years and final mean age of 17.18 ± 1.37 years, and a mean treatment time of 4.29 years. Group 2 comprised 23 patients treated with maxillary first premolar extractions, with a mean initial age of 13.59 ± 1.91 years and mean final age of 16.39 ± 1.97 years, and a mean treatment time of 2.8 years. Intergroup treatment changes were compared with t and Mann-Whitney tests. RESULTS: Class II correction in G2 (maxillary first premolar extractions) presented significantly greater maxillary retrusion, reduction of anteroposterior apical base discrepancy, smaller increase in the lower anterior face height and significantly greater overjet reduction than G1 (Jones Jig). CONCLUSIONS: Treatment with maxillary first premolar extractions produced greater overjet reduction, but the two treatment protocols produced similar changes in the soft tissue profile.

Force level of small diameter nickel-titanium orthodontic wires ligated with different methods.

BACKGROUND: The aim of this study was to compare the deflection force in conventional and thermally activated nickel-titanium (NiTi) wires in passive (Damon Q) and active (Bioquick) self-ligating brackets (SLB) and in conventional brackets (CB) tied by two different methods: elastomeric ligature (EL) and metal ligature (ML). METHODS: Two wire diameters (0.014 and 0.016 in.) and 10 specimens per group were used. The specimens were assembled in a clinical simulation device and tested in an Instron Universal Testing Machine, with a load cell of 10 N. For the testing procedures, the acrylic block representative of the right maxillary central incisor was palatally moved, with readings of the force at 0.5, 1, 2, and 3 mm, at a constant speed of 2 mm/min and temperature of 36.5 °C. RESULTS: The conventional NiTi released higher forces than the thermally activated NiTi archwires in large deflections. In general, the SLB showed lower forces, while the ML had higher forces, with both showing a similar force release behavior, constantly decreasing as the deflection decreased. The EL showed an irregular behavior. The active SLB showed smaller forces than passive, in large deflections. CONCLUSIONS: The SLB and the ML exhibit standard force patterns during unloading, while the elastomeric ligatures exhibit a randomly distributed force release behavior.

Classe II tratada com distalizador associado à ancoragem esquelética / Angle class II malocclusion treated with intraoral distalizer associated with skeletal anchorage

O caso relatado no presente artigo refere-se a uma paciente com má oclusão de Classe II de Angle que foi tratada em duas fases: a primeira consistindo na instalação de um distalizador intrabucal First Class modificado, associado a mini-implantes no palato e a segunda consistindo no aparelho fixo. A severidade da discrepância anteroposterior era moderada, com apinhamento leve em ambos os arcos, sem comprometimento esquelético significante. O aparelho promoveu distalização dos molares, bem como uma pequena perda de ancoragem nos dentes anteriores à distalização. A segunda fase com aparelho fixo visou promover o alinhamento e nivelamento dos arcos, bem como a retração anterior, auxiliada por uma ancoragem baseada em um botão de Nance associado aos mini-implantes. Ao final do tratamento foram observadas a correção da discrepância anteroposterior dos arcos, bem como uma oclusão balanceada e estética satisfatória.(AU)

The present case report refers to a patient with Angle Class II malocclusion who was treated in two phases: the first phase consisting of the installation of a modified First Class intraoral distalizer associated with mini implants on the palate, and the second phase consisting of a fixed appliance. The anteroposterior discrepancy severity was moderate, with light crowding in both arches, without significant skeletal component. The device promoted distalization of the molars, as well as a small loss of anchorage in the anterior teeth. The second phase with a fixed appliance promoted the alignment and leveling of the arches, as well as the anterior retraction, assisted by an anchorage reinforcement based on a Nance button associated to the mini implants. At the end of the treatment the anteroposterior discrepancy was corrected and a balanced and esthetic occlusion was observed.(AU)

Low-Level Laser Action on Orthodontically Induced Root Resorption: Histological and Histomorphometric Evaluation.

Introduction: Studies have been conducted to develop a means of preventing, controlling or reducing orthodontically induced root resorption. Phototherapy has demonstrated effectiveness as an anti-inflammatory and, considering the inflammatory origin of this pathology, this study evaluated the effects of laser on root resorption. Methods: The research was conducted among 54 80-day-old male Wistar rats, with weights of 280 ± 40 g. Phototherapy consisted of a diode laser (Ga-Al-As), calibrated with a wavelength of 808 nm, an output power of 100 mW, 2.1 J or 96 J of energy and area of 0.0028 cm2. The application was continuous, punctual and with contact. The left first maxillary molar was moved by a super-elastic closed spring with a pre-calibrated and constant force of 25 g. The specimens were irradiated every 48 hours, totaling three or six times, depending on the group to which they belonged. Euthanasia was made in the 7th or 10th day after the onset of movement. The histological and histomorphometric examination was performed with sections of 6 µm stained with hematoxylin and eosin (H&E). Results: Considering the dosimetry studied, when compared the subgroups with the same time of movement, 7 or 10 days, the low-level laser (LLL) has no statistically significant effect on the root resorption. As expected, differences were found between groups with different time of movement. Conclusion: Based on the result, this dosimetry does not seem to be clinically recommended to avoid or reduce inflammatory root resorption, but it also does not induce any root surface alteration.

Alternativa de tratamento da má oclusão de classe II com apinhamento severo sem extrações dentárias / Non extraction alternative treatment of class II malocclusion with severe crowding

Uma opção de tratamento da má oclusão de Classe II dentária com apinhamento severo em que não serão realizadas extrações dentárias pode ser através da distalização dos molares superiores, podendo, ainda, ser associada aos mini-implantes para melhor controle da ancoragem. O presente artigo teve como objetivo mostrar um caso clínico de um paciente com má oclusão de Classe II, com falta de espaço na arcada dentária para erupção dos caninos superiores. O tratamento foi realizado com distalizador de molar First Class em ancoragem esquelética. Os resultados mostraram que o planejamento sem extrações dentárias e a mecânica escolhida para a correção dessa má oclusão de Classe II promoveu obtenção do espaço para o irrompimento dos caninos com poucos efeitos colaterais, contribuindo para que os objetivos do tratamento ortodôntico fossem alcançados com estabilidade oclusal.

Non extraction treatment of Class II malocclusion with severe crowding can be performed through the distalization of the upper molars and may also be associated with the miniimplants for a better anchorage control. The aim of this article was to present a case-report of a patient with Class II malocclusion with lack of space in the dental arch for the eruption of the upper canines. The treatment was performed with First Class distalizer in skeletal anchorage. Results showed that planning without extractions and the chosen mechanics for the correction of this Class II malocclusion obtained sufficient space for the eruption of canines with few side effects, achieving the goals of orthodontic treatment with occlusal stability.

Effects of cervical headgear appliance: a systematic review.

OBJECTIVE: Although much has been investigated about the effects of cervical headgear, there remains some controversy. Therefore, the objective of this systematic review is to disclose the actual effects of the cervical headgear appliance, based on articles of relevant quality. METHODS: A literature review was conducted using PubMed, Web of Science, Embase, Scopus and Cochrane databases. Inclusion criteria consisted of human studies written in English; published between 1970 and 2014; in which only the cervical headgear was used to correct Class II malocclusion; prospective or retrospective; with a clear description of cervical headgear effects; with a sample size of at least 15 individuals. No comparative studies, clinical cases or cases with dental extractions were included and the sample should be homogeneous. RESULTS: Initially, 267 articles were found. A total of 42 articles were selected by title and had their abstracts read. Finally, 12 articles were classified as with high quality and were used in this systematic review. CONCLUSIONS: The cervical headgear appliance proved efficient to correct Class II, Division 1 malocclusion. Its effects consisted in correction of the maxillomandibular relationship by restriction of maxillary anterior displacement; distalization and extrusion of maxillary molars; and slight maxillary expansion.

Effects of cervical headgear appliance: a systematic review

OBJECTIVE: Although much has been investigated about the effects of cervical headgear, there remains some controversy. Therefore, the objective of this systematic review is to disclose the actual effects of the cervical headgear appliance, based on articles of relevant quality.METHODS: A literature review was conducted using PubMed, Web of Science, Embase, Scopus and Cochrane databases. Inclusion criteria consisted of human studies written in English; published between 1970 and 2014; in which only the cervical headgear was used to correct Class II malocclusion; prospective or retrospective; with a clear description of cervical headgear effects; with a sample size of at least 15 individuals. No comparative studies, clinical cases or cases with dental extractions were included and the sample should be homogeneous.RESULTS: Initially, 267 articles were found. A total of 42 articles were selected by title and had their abstracts read. Finally, 12 articles were classified as with high quality and were used in this systematic review.CONCLUSIONS: The cervical headgear appliance proved efficient to correct Class II, Division 1 malocclusion. Its effects consisted in correction of the maxillomandibular relationship by restriction of maxillary anterior displacement; distalization and extrusion of maxillary molars; and slight maxillary expansion.

OBJETIVO: embora muitos estudos investiguem os efeitos do AEB cervical, ainda há algumas controvérsias sobre os seus efeitos. Portanto, o objetivo desta revisão sistemática é divulgar os efeitos reais do aparelho extrabucal cervical, com base em artigos com qualidade.MÉTODOS: os artigos foram pesquisados por meio das bases de dados PubMed, Web of Science, Embase, Scopus e Cochrane. Os critérios de inclusão consistiram em: estudos em humanos escritos em inglês; publicados entre 1970 e 2014; apenas o AEB cervical foi utilizado para corrigir má oclusão de Classe II; prospectivos ou retrospectivos; com uma descrição clara dos efeitos do aparelho; com um tamanho de amostra de pelo menos 15 indivíduos. Estudos comparativos, relatos de caso ou casos com extrações não foram incluídos e a amostra deveria ser homogênea.RESULTADOS: inicialmente, 267 artigos foram encontrados; e 42 artigos desses foram selecionados pelo título, tendo seus resumos lidos. Por fim, 12 artigos foram classificados como de alta qualidade e foram utilizados na presente revisão sistemática.CONCLUSÕES: o aparelho extrabucal cervical foi eficiente para corrigir a má oclusão de Classe II divisão 1. Seus efeitos são correção da relação maxilomandibular, com restrição do deslocamento anterior da maxila; distalização e extrusão dos molares superiores e ligeira expansão maxilar.

Correção da má-oclusão de classe II com o aparelho Forsus / Class II malocclusion correction with the Forsus device

Atualmente, há uma grande variedade de terapêuticas disponíveis para a correção da má-oclusão de classe II. Os protocolos mais eficientes são aqueles que não dependem da colaboração do paciente. Nos últimos anos, diversos aparelhos funcionais fixos foram idealizados e utilizados para o tratamento da má-oclusão de classe II na dentadura permanente. Os aparelhos funcionais fixos são vantajosos, pois eles são efetivos 24 horas por dia, não necessitam da colaboração dos pacientes em utilizá-los, podem ser associados ao aparelho fixo e o tratamento ativo é mais curto. Dentre estes aparelhos, destaca-se o Forsus, que foi desenvolvido em 1999 por William Vogt. O Forsus Fatigue Resistant Device é um aparelho de propulsão híbrido intrabucal de ancoragem intermaxilar recíproca, que utiliza uma combinação de um sistema de força flexível e rígido para corrigir a má-oclusão de classe II por meio da protrusão mandibular. O aparelho Forsus diferencia-se dos demais aparelhos funcionais fixos, pois apresenta fácil instalação e permite maior liberdade de movimentação da mandíbula. Dessa forma, o objetivo deste trabalho foi apresentar, por meio de um caso clínico, os efeitos do aparelho Forsus no tratamento da má-oclusão de classe II...

Currently, there is a variety of therapies available for the correction of class II malocclusion. The most efficient protocols are those that do not depend on patient compliance. In recent years, several fixed functional appliances were designed and used for the treatment of class II malocclusion in the permanent dentition. Fixed functional appliances are advantageous because they are effective 24 hours a day, do not require the cooperation of patients to use them, can be associated with fixed appliances and the active treatment is shorter. Among these devices, highlight the Forsus, which was developed in 1999 by William Vogt. The Forsus Fatigue Resistant Device is an intraoral hybrid propulsion device with reciprocal intermaxillary anchorage, which uses a combination of a system of flexible and rigid strength to correct class II malocclusions by mandibular protrusion. The Forsus device differs from other fixed functional appliances due to its features of easy installation and allows greater freedom of movement of the mandible. Thus, the aim of this paper is to show through a case report the effects of the Forsus device in the treatment of class II malocclusion...

Correção da má oclusão de Classe II com o aparelho Jasper Jumper - relato de caso / Correction of Class II malocclusion with Jasper Jumper appliance - case report

A má oclusão de Classe II caracteriza-se por fatores esqueléticos e dentários, nas quais as alterações observadas no sentido anteroposterior se concentram em estruturas esqueléticas e/ou dentoalveolar da maxila e mandíbula. A correção da Classe II pode ser alcançada por meio de diversas mecânicas ortodônticas, cabendo ao ortodontista determinar o melhor método para cada paciente. O Jasper Jumper é um aparelho fixo e flexível indicado para correção da Classe II, especialmente quando se diagnostica retrognatismo mandibular. Este aparelho é utilizado conjuntamente com a aparelhagem fixa, reduzindo o tempo total de tratamento. Além disso, o Jasper Jumper promove uma força contínua, sem a necessidade da colaboração do paciente em utilizá-lo. Este trabalho apresenta uma bordagem simples e eficaz do tratamento ortodôntico da má oclusão Classe II utilizando o aparelho Jasper Jumper que possibilitou, além da correção da má oclusão, a melhora no perfil da paciente.

The Class II malocclusion is characterized by skeletal and dental factors, in which the observed changes in the anteroposterior direction focus on skeletal and/or dentoalveolar structures of the maxilla and mandible. The Class II malocclusion correction can be achieved by means of several orthodontic mechanics being the orthodontist who determines the best method for each patient. The Jasper Jumper is a fixed and flexible appliance indicated for Class II malocclusion correction mainly when mandibular retrognathism is diagnosed. This appliance is worn in association with fixed appliances reducing in this way the total treatment time. Moreover, the Jasper Jumper promotes a continuous force without the patient’s compliance in wearing it. Therefore, this article presents a simple and effective approach to orthodontic treatment of Class II malocclusion with the Jasper Jumper appliance, which enabled not only the Class II malocclusion correction but also the improvement in the patient’s profile.

Diferentes sistemas de distalização de molares utilizando ancoragem esquelética indireta - relato de casos / Different systems of molar distalization using indirect skeletal anchorage - case reports

Uma opção de tratamento da má oclusão de Classe II dentária é a utilização de distalizadores intrabucais que costumam apresentar efeitos de perda de ancoragem nos dentes anteriores quando utilizado uma ancoragem convencional. Para minimizar esses efeitos a distalização pode ser realizada com apoio em mini-implantes que devido à sua versatilidade podem ser instalados em diferentes locais na cavidade bucal, proporcionando diferentes maneiras de se realizar essa mecânica. O objetivo deste artigo é apresentar dois casos clínicos da correção da má oclusão de Classe II com o uso de diferentes sistemas de distalização de molares associados à ancoragem esquelética indireta. No primeiro caso foi utilizado ancoragem esquelética por meio de mini-implantes instalados entre os pré-molares e molares superiores por vestibular e a distalização realizada com molas de NiTi. No segundo caso foi utilizado o aparelho distalizador First Class ancorado em mini-implantes no palato. Ambos mecanismos apresentaram distalização eficiente. O sistema com ancoragem no palato possui a vantagem de realizar apenas uma etapa cirúrgica de inserção dos mini-implantes, enquanto que na ancoragem por vestibular deve ser realizada outra cirurgia para reposicioná-los e permitir a retração anterior. A utilização desses sistemas minimizou os efeitos colaterais mostrando que mecânicas de distalização podem ser melhor controladas quando se utiliza ancoragem esquelética.

An option for treatment of Class II malocclusion is the use of intraoral distalizers, which often show effects of anchorage loss in anterior teeth when a conventional anchorage is used. To minimize these effects, mini-implant supported distalization can be performed. Due to their versatility, mini-implants can be placed in different locations in the oral cavity, enabling different ways of performing orthodontic mechanics. The objective of this paper was to present two cases of correction of Class II malocclusion with the use of different molar distalization systems associated with indirect skeletal anchorage. In the first case, skeletal anchorage was obtained by mini-implants inserted between maxillary premolars and molars buccally, and distalization performed with NiTi springs. In the second case, the First Class appliance was used, anchored to mini-implants in the palate. Both mechanisms presented efficient distalization. The system with anchorage in the palate has the advantage of requiring only one surgical step for mini-implant insertion, while for anchorage in the buccal region, another surgery is required to reposition them and allow anterior retraction. The use of these systems has minimized side effects of distalization, showing that mechanics can be better controlled when using skeletal anchorage.

Aplicação dos distalizadores de molares superiores no tratamento da má oclusão de Classe II predominantemente dentária / Application of intraoral distalizing appliances in the treatment of dental Class II malocclusion

O tratamento da má oclusão de Classe II dentária pode ser realizado por meio da distalização dos molares superiores. Atualmente, os aparelhos distalizadores intrabucais vêm se destacando com sucesso, dentre os quais, pode-se citar o Jones Jig. O aparelho Jones Jig é eficiente na distalização dos molares superiores pela liberação de força constante de 75 gramas quando ativado. Apesar de sua eficácia, este dispositivo promove efeitos colaterais de perda de ancoragem, protrusão dos incisivos e aumento da altura facial. Deste modo, o Jones Jig é contraindicado para pacientes dolicofaciais. O propósito deste artigo é apresentar um caso clínico de má oclusão de Classe II dentária tratado com o aparelho distalizador Jones Jig, assim como demonstrar cefalometricamente as alterações dentoesqueléticas e tegumentares que contribuíram para a correção.

Class II malocclusion can be treated by distalization of the maxillary molars. Currently intraoral distalizing appliances have stood out successfully, among which we can mention the Jones Jig appliance. The Jones Jig appliance is effective in distalization of maxillary molars by releasing constant force of 75 grams when activated. Despite its effectiveness, this appliance promotes side effects such as loss of dental anchorage, incisor protrusion and facial height increase. Thus, the Jones Jig is contraindicated in dolichofacials patients. The purpose of this article is to present a case of dental Class II malocclusion treated with Jones Jig appliance, as well as demonstrate cephalometrically dental, skeletal and soft tissue changes that contributed to the correction.