Dental anomaly pattern and multiple ectopic teeth.

Treatment for a patient with a dental anomaly pattern is challenging and complex. This article presents a rare case with an association of multiple ectopic eruptions treated in 2 phases. An 8-year-old boy in the early mixed dentition showed a Class II, Division 2 malocclusion, and an ectopic eruption of the mandibular right lateral incisor. The treatment plan included extractions of the deciduous mandibular right lateral incisor and canine, followed by partial mandibular fixed appliances and a lingual arch. In the late mixed dentition, the panoramic radiograph showed bilateral ectopic eruptions of the maxillary canines. The deciduous maxillary canines were extracted, and a cervical headgear was installed. Within 12 months, both permanent maxillary canines spontaneously erupted. Comprehensive orthodontic treatment was initiated when the patient was aged 13 years to level the curve of Spee and reduce the overbite. Phase 2 lasted 15 months. In patients with dental anomaly patterns, longitudinal follow-up during the mixed dentition is highly important and might contribute to simplifying comprehensive orthodontic treatment and reducing complications and adverse effects.

Analysis of the dentoalveolar effects of slow and rapid maxillary expansion in complete bilateral cleft lip and palate patients: a randomized clinical trial.

OBJECTIVES: The purpose of this study was to compare the dentoalveolar effects of slow (SME) and rapid (RME) maxillary expansions in patients with complete bilateral cleft lip and palate (BCLP). MATERIAL AND METHODS: A sample of 50 patients with BCLP and maxillary arch constriction was randomly and equally allocated into two groups. Group SME comprised patients (mean age of 8.8 years) treated with quad-helix appliance. Group RME comprised individuals (mean age of 8.9 years) treated with Hyrax expander. Digital dental models obtained immediately pre-expansion (T1) and 6 months after the active expansion period (T2) were used for measuring maxillary dental arch widths, arch perimeter, arch length, palatal depth, buccolingual inclination of posterior teeth and differential amount of expansion accomplished at the canine and molar regions. Inter-phase and intergroup comparisons were performed using paired t tests and t tests, respectively (p < 0.05). RESULTS: SME and RME caused significant increase of arch widths and arch perimeter. Arch length and palatal depth decreased nonsignificantly with SME but significantly with RME. Buccal tooth inclination was significant only for maxillary deciduous canines in both groups. The quad-helix appliance showed a significant differential expansion between anterior and posterior regions. No differences were observed between SME and RME for all variables. CONCLUSIONS: Differences were not found between the dentoalveolar effects of SME and RME in patients with BCLP. SME demanded a greater therapy time compared to RME. CLINICAL RELEVANCE: Both expansion procedures can be similarly indicated to correct maxillary arch constriction in patients with BCLP in the mixed dentition.

Dentoskeletal outcomes of a rapid maxillary expander with differential opening in patients with bilateral cleft lip and palate: A prospective clinical trial.

INTRODUCTION: The purpose of this 2-arm parallel study was to evaluate the dentoskeletal effects of rapid maxillary expansion with differential opening (EDO) compared with the hyrax expander in patients with complete bilateral cleft lip and palate. METHODS: A sample of patients with complete bilateral cleft lip and palate was prospectively and consecutively recruited. Eligibility criteria included participants in the mixed dentition with lip and palate repair performed during early childhood and maxillary arch constriction with a need for maxillary expansion before the alveolar bone graft procedure. The participants were consecutively divided into 2 study groups. The experimental and control groups comprised patients treated with rapid maxillary expansion using EDO and the hyrax expander, respectively. Cone-beam computed tomography examinations and digital dental models of the maxillary dental arches were obtained before expansion and 6 months postexpansion. Standardized cone-beam computed tomography coronal sections were used for measuring maxillary transverse dimensions and posterior tooth inclinations. Digital dental models were used for assessing maxillary dental arch widths, arch perimeters, arch lengths, palatal depths, and posterior tooth inclinations. Blinding was used only during outcome assessment. The chi-square test was used to compare the sex ratios between groups (P <0.05). Intergroup comparisons were performed using independent t tests with the Bonferroni correction for multiple tests. RESULTS: Fifty patients were recruited and analyzed in their respective groups. The experimental group comprised 25 patients (mean age, 8.8 years), and the control group comprised 25 patients (mean age, 8.6 years). No intergroup significant differences were found for age, sex ratio, and dentoskeletal variables before expansion. No significant differences were found between the EDO and the hyrax expander groups regarding skeletal changes. The EDO promoted significantly greater increases of intercanine width (difference, 3.63 mm) and smaller increases in canine buccal tipping than the conventional hyrax expander. No serious harm was observed other than transitory variable pressure sensations on the maxillary alveolar process in both groups. CONCLUSIONS: The EDO produced skeletal changes similar to the conventional hyrax expander. The differential expander is an adequate alternative to conventional rapid maxillary expanders when there is need for greater expansion in the maxillary dental arch anterior region. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement. FUNDING: This study received financial support from FAPESP (process number 2009/17622-9). As a possible conflict of interest, a patent with an EDO was submitted in March 2011 to the National Institute of Industry Property and is still in process. However, we believe that this is a natural step of translational research (bench-to-bedside), and we guarantee that the scientific results are true.

Periodontal status of maxillary central incisors after orthodontic traction: a longitudinal follow-up.

BACKGROUND: The aim of this study was to evaluate the clinical and radiographic periodontal status of impacted permanent maxillary central incisors (Mx.1) after a long term of orthodontic traction. METHODOLOGY: This split-mouth study evaluated a sample of 11 patients (five females, six males) treated with Mx.1 unilateral traction one to 28 years after the removal of orthodontic appliances. The traction Group (TG) consisted of 11 Mx.1 and the Comparison Group (CG) comprised 11 spontaneously erupted contralateral Mx.1. High-resolution CBCT exams of central incisors were performed using Accuitomo (J. Morita, Kyoto, Japan). Cross-section imagens passing through the center of maxillary central incisors were used to measure buccal and lingual alveolar bone level. Presence of fenestration, root dilacerations, root coverage, and position of the root apex were also assessed in the same images. Clinical parameters included periodontal probing depth, attachment level, gingival bleeding index, plaque index, degree of gingival recession, amount of gingival mucosa, and evaluation of interproximal papilla and black triangle. Digital model analysis included an assessment of clinical crown height and width. Intergroup comparisons were performed using paired t-, McNemar's, and Wilcoxon tests (p<0.05). RESULTS: Compared to CG, we found a significantly thinner labial bone plate thickness in TG at the middle (p=0.000) and apical (p=0.009) root level. We also observed an apical displaced labial bone crest level in TG (p=0.000). The Traction Group showed a greater frequency of root dilacerations and gingival recessions, a decreased amount of keratinized mucosa, and a decreased clinical attachment level at the labial aspect compared to contralateral teeth. CONCLUSIONS: A decreased thickness and height of labial alveolar bone and gingival recessions were found in maxillary central incisors 15 years after orthodontic traction. Though incisor traction might cause some periodontal impact, differences are acceptable under a clinical point of view considering the cost-benefit ratio.

Dental arch size and shape after maxillary expansion in bilateral complete cleft palate: A comparison of three expander designs.

OBJECTIVE: The objective of this study was to compare the effects on upper dental arch size and shape after maxillary expansion with Hyrax, Quad-helix, and a differential opening expander in bilateral cleft lip and palate (BCLP) patients. MATERIALS AND METHODS: Seventy-five BCLP patients were divided into three groups: Hyrax (H), Quad-helix (QH), and Expander with differential opening (EDO). Digital models were obtained before (T1) and after 6 months (T2) of maxillary expansion. Twelve landmarks were placed by one investigator on T1 and T2 dental models of each group, and x,y coordinates for each landmark were collected. For dental arch size analysis, centroid size of each dental arch at T1 and T2 was calculated from raw coordinates and was used as the measure of size. Procrustes Analysis was performed for dental arch shape analysis. Analysis of variance was used to compare the groups for size and shape differences (P < .05). RESULTS: There were no significant dental arch size differences among the expanders at T1 or T2. Differences in arch shape were found between all groups at T2. Intragroup arch shape showed a significant variation for the QH and EDO groups. while it remained stable in the H group. CONCLUSIONS: Both the QH and the EDO create dental arch shape changes with greater intercanine than intermolar increase. The H does not change the dental arch shape.

Facial profile esthetics in operated children with bilateral cleft lip and palate.

OBJECTIVE:: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. METHODS:: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall's test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. RESULTS:: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. CONCLUSIONS:: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

Periodontal status of maxillary central incisors after orthodontic traction: a longitudinal follow-up

Abstract The aim of this study was to evaluate the clinical and radiographic periodontal status of impacted permanent maxillary central incisors (Mx.1) after a long term of orthodontic traction. Methodology This split-mouth study evaluated a sample of 11 patients (five females, six males) treated with Mx.1 unilateral traction one to 28 years after the removal of orthodontic appliances. The traction Group (TG) consisted of 11 Mx.1 and the Comparison Group (CG) comprised 11 spontaneously erupted contralateral Mx.1. High-resolution CBCT exams of central incisors were performed using Accuitomo (J. Morita, Kyoto, Japan). Cross-section imagens passing through the center of maxillary central incisors were used to measure buccal and lingual alveolar bone level. Presence of fenestration, root dilacerations, root coverage, and position of the root apex were also assessed in the same images. Clinical parameters included periodontal probing depth, attachment level, gingival bleeding index, plaque index, degree of gingival recession, amount of gingival mucosa, and evaluation of interproximal papilla and black triangle. Digital model analysis included an assessment of clinical crown height and width. Intergroup comparisons were performed using paired t-, McNemar's, and Wilcoxon tests (p<0.05). Results Compared to CG, we found a significantly thinner labial bone plate thickness in TG at the middle (p=0.000) and apical (p=0.009) root level. We also observed an apical displaced labial bone crest level in TG (p=0.000). The Traction Group showed a greater frequency of root dilacerations and gingival recessions, a decreased amount of keratinized mucosa, and a decreased clinical attachment level at the labial aspect compared to contralateral teeth. Conclusions A decreased thickness and height of labial alveolar bone and gingival recessions were found in maxillary central incisors 15 years after orthodontic traction. Though incisor traction might cause some periodontal impact, differences are acceptable under a clinical point of view considering the cost-benefit ratio.

Is there a consensus for CBCT use in Orthodontics?

This article aims to discuss current evidence and recommendations for cone-beam computed tomography (CBCT) in Orthodontics. In comparison to conventional radiograph, CBCT has higher radiation doses and, for this reason, is not a standard method of diagnosis in Orthodontics. Routine use of CBCT in substitution to conventional radiograph is considered an unaccepted practice. CBCT should be indicated with criteria only after clinical examination has been performed and when the benefits for diagnosis and treatment planning exceed the risks of a greater radiation dose. It should be requested only when there is a potential to provide new information not demonstrated by conventional scans, when it modifies treatment plan or favors treatment execution. The most frequent indication of CBCT in Orthodontics, with some evidence on its clinical efficacy, includes retained/impacted permanent teeth; severe craniofacial anomalies; severe facial discrepancies with indication of orthodontic-surgical treatment; and bone irregularities or malformation of TMJ accompanied by signs and symptoms. In exceptional cases of adult patients when critical tooth movement are planned in regions with deficient buccolingual thickness of the alveolar ridge, CBCT can be indicated provided that there is a perspective of changes in orthodontic treatment planning.

Facial profile esthetics in operated children with bilateral cleft lip and palate

ABSTRACT Objective: The aim of this study was to evaluate the facial profile esthetics of rehabilitated children with complete bilateral cleft lip and palate (BCLP), comparing the judgment of professionals related and not related to cleft rehabilitation and laypersons. Methods: Thirty children in the mixed dentition (24 male; 6 female) with a mean age of 7.8 years were evaluated using facial profile photographs by 25 examiners: 5 orthodontists and 5 plastic surgeons with experience in cleft care, 5 orthodontists and 5 plastic surgeons without experience in oral cleft rehabilitation and 5 graduated laymen. Their facial profiles were classified into esthetically unpleasant (grade 1 to 3), esthetically acceptable (grade 4 to 6), and esthetically pleasant (grade 7 to 9). Intraexaminer and interexaminer errors were evaluated using Spearman correlation coefficient and Kendall's test, respectively. Inter-rater differences were analyzed using Friedman test and Student-Newman-Keuls test for multiple comparisons. Results: Orthodontists dealing with oral clefts rehabilitation considered the majority of the sample as esthetically pleasant. Plastic surgeons of the cleft team and laypersons classified most of the sample as esthetically acceptable. Most of the orthodontists and plastic surgeons not related to cleft care evaluated the facial profile as esthetically unpleasant. The structures associated to unpleasant profiles were the nose, the midface and the upper lip. Conclusions: The facial profile of children with BCLP was classified as esthetically acceptable by laypersons. Professionals related to cleft rehabilitation were more lenient and those not related to cleft care were stricter to facial esthetics than laypersons.

RESUMO Objetivo: o objetivo desse estudo foi avaliar a estética do perfil facial de crianças com fissura labiopalatina completa bilateral (FLCB) operadas, comparando o julgamento de leigos e de profissionais relacionados e não relacionados à reabilitação de fissuras. Métodos: fotografias do perfil facial de trinta crianças na dentadura mista (24 do sexo masculino e 6 do sexo feminino), com idade média de 7,8 anos, foram avaliadas por 25 examinadores: 5 ortodontistas e 5 cirurgiões plásticos com experiência em fissuras, 5 ortodontistas e 5 cirurgiões plásticos sem experiência na reabilitação de fissuras, e 5 leigos com formação superior. Os perfis faciais foram classificados como esteticamente desagradável (grau 1 a 3), esteticamente aceitável (grau 4 a 6) e esteticamente agradável (grau 7 a 9). Para verificar a concordância intraexaminadores e interexaminadores, foram utilizados o Coeficiente de Correlação de Spearman e o Coeficiente de Concordância de Kendall, respectivamente. Para comparação entre as categorias de acordo com os escores atribuídos, foram aplicados o teste de Friedman e o teste de Student-Newman-Keuls, para comparações múltiplas. Resultados: os ortodontistas que lidam com reabilitação de fissuras labiopalatinas consideraram a maioria da amostra como esteticamente agradável. Cirurgiões plásticos com experiência em fissuras e leigos classificaram a maioria da amostra como esteticamente aceitável. Grande parte dos ortodontistas e cirurgiões plásticos sem experiência na reabilitação de fissuras classificou o perfil facial como esteticamente desagradável. As estruturas associadas aos perfis desagradáveis foram o nariz, o terço médio da face e o lábio superior. Conclusões: o perfil facial de crianças com FLCB foi classificado como esteticamente aceitável pelos leigos; já os profissionais relacionados à reabilitação de fissuras foram mais complacentes, em comparação aos profissionais sem experiência na reabilitação de fissuras, que, por sua vez, foram mais rigorosos quanto à estética facial do que os leigos.

Is there a consensus for CBCT use in Orthodontics?

This article aims to discuss current evidence and recommendations for cone-beam computed tomography (CBCT) in Orthodontics. In comparison to conventional radiograph, CBCT has higher radiation doses and, for this reason, is not a standard method of diagnosis in Orthodontics. Routine use of CBCT in substitution to conventional radiograph is considered an unaccepted practice. CBCT should be indicated with criteria only after clinical examination has been performed and when the benefits for diagnosis and treatment planning exceed the risks of a greater radiation dose. It should be requested only when there is a potential to provide new information not demonstrated by conventional scans, when it modifies treatment plan or favors treatment execution. The most frequent indication of CBCT in Orthodontics, with some evidence on its clinical efficacy, includes retained/impacted permanent teeth; severe craniofacial anomalies; severe facial discrepancies with indication of orthodontic-surgical treatment; and bone irregularities or malformation of TMJ accompanied by signs and symptoms. In exceptional cases of adult patients when critical tooth movement are planned in regions with deficient buccolingual thickness of the alveolar ridge, CBCT can be indicated provided that there is a perspective of changes in orthodontic treatment planning.

O presente artigo visa discutir as evidências e recomendações atuais concernentes à indicação da tomografia computadorizada de feixe cônico (TCFC) em Ortodontia. Devido à dose de radiação mais elevada em relação às radiografias, a TCFC não é o método padrão de diagnóstico em Ortodontia. O seu uso rotineiro, em substituição à documentação convencional, é considerado uma prática inaceitável. A TCFC deve ser indicada com muito critério, e somente após uma análise clínica, quando os benefícios para o diagnóstico e tratamento superarem os riscos de uma dose mais elevada de radiação. Deve ser requisitada estritamente quando houver um potencial de prover novas informações não demonstradas em exames radiográficos convencionais, modificando o plano de tratamento ou facilitando a sua execução. As indicações mais frequentes em Ortodontia, que demonstram algum nível de evidência sobre sua eficácia clínica, podem ser resumidas em casos de dentes permanentes retidos; anomalias craniofaciais complexas; discrepâncias faciais severas com indicação de tratamento ortodôntico-cirúrgico; e malformações ou irregularidades ósseas na ATM acompanhadas de sinais e sintomas. Em casos excepcionais, em pacientes adultos em que se planeja movimentos dentários críticos em áreas com espessura óssea vestibulolingual deficiente, a TCFC pode ser indicada, desde que se vislumbre uma perspectiva de alteração no plano de tratamento ortodôntico.

Alterações sistêmicas detectadas em pacientes em tratamento periodontal / Systemic alterations detected in patients with periodontal treatment

Introdução: Periodontite é a alteração patológica crônica dos tecidos periodontais, sendo que sua etiologia inclui a interação entre fatores de risco, defesa do hospedeiro e biofilme bacteriano. Em décadas mais recentes foi levantada a possibilidade da associação entre doença periodontal e alterações sistêmicas. Objetivo: avaliar a prevalência de algumas alterações sistêmicas em indivíduos com diagnóstico de periodontite. Métodos: foram selecionados 200 pacientes, divididos em dois grupos: com doença periodontal e sem doença periodontal, com idade entre 18 e 60 anos, e no mínimo, 20 dentes presentes, atendidos nas clínicas de odontologia da Universidade do Sagrado Coração, Bauru. Dados sobre hemorragia, alergia, reumatismo infeccioso, doenças cardiovasculares, gastrite/úlcera, diabetes e ansiedade/depressão, obtidos por meio de anamnese, foram confrontados com a presença ou ausência de doença periodontal. Foi realizada análise descritiva e o teste de Chi-quadrado, para verificar a significância entre amostras. Resultados: a diferença entre os grupos com relação à presença de alergia, reumatismo infeccioso, gastrite e diabetes não foi significante. Episódios hemorrágicos, relato de ansiedade/depressão e presença de alterações cardíacas, incluindo hipertensão, apresentaram diferença significante entre os grupos, predominando nos pacientes com doença periodontal. O número de pacientes com 3 ou mais alterações sistêmicas foi duas vezes maior neste grupo. Conclusões: verificamos que alterações sistêmicas estiveram presentes com maior frequência naqueles pacientes que apresentavam doença periodontal. Com isto, evidencia-se a importância do conhecimento da história médica do paciente para estabelecimento de um plano de tratamento.

Introduction: periodontitis is a chronic pathological alteration of periodontal tissues, and its etiology includes the interaction between risk factors, host defense and bacterial biofilm. In more recent decades has raised the possibility of the association between periodontitis and systemic diseases. Objective: the purpose of this assay was to verify the prevalence of systemic alterations in patients with and without periodontitis. Methods: 200 patients between 18 and 60 years were selected, with a minimum of 20 teeth present, admitted in the clinics of odontology of the University of Sacred Heart, Bauru. Data on hemorrhage, allergy, infectious rheumatism, cardiovascular diseases, gastritis/ulcer, diabetes and anxiety/depression, were compared with the presence or absence of periodontal disease. Statistical analysis included descriptive statistic and the Chi-square test, to verify the significance between samples. Results: the difference enters the groups with regard to the allergy presence, infectious rheumatism, gastritis and diabetes was not significant. Hemorrhagic episodes, story of anxiety/depression and presence of cardiac alterations, including hypertension, had presented significant difference between the groups, predominating in the patients with periodontal disease. The number of patients with 3 or more systemic alterations was two times in this group. Conclusions: we found that in patients with periodontal disease, systemic alterations were present more frequently. With this, it is evident the value of knowledge of the patient's medical history to establish a treatment plan, and also the importance of periodontal treatment on general health.

Efeitos oclusais das expansões lenta e rápida da maxila nas fissuras completas bilaterais – estudo-piloto / Occlusal effects of slow and rapid maxillary expansions in complete bilateral cleft lip and palate – pilot study

O objetivo deste estudo-piloto foi comparar os efeitos oclusais das expansões lenta e rápida da maxila, em pacientes com fissuras labiopalatinas completas bilaterais. Um total de 30 indivíduos com fissuras labiopalatinas completas bilaterais, diagnosticados com constrição do arco dentário superior, foi aleatoriamente e igualmente dividido em dois grupos. O grupo ELM foi composto por pacientes submetidos à expansão lenta da maxila com quadri-hélice, enquanto que o grupo ERM consistiu de indivíduos submetidos à expansão rápida maxilar com Hyrax. Foram obtidos modelos de gesso nos períodos imediatamente pré-expansão e seis meses após a expansão, na ocasião da remoção do aparelho. Após a digitalização dos modelos de gesso superiores por meio do uso do scanner 3Shape R700 3D, foram mensurados a largura e o perímetro do arco dentário superior, e as inclinações dos dentes posterossuperiores através do programa de computador Orthoanalyzer. As comparações interfases e intergrupos foram avaliadas por meio do teste t pareado e do teste t de Student, respectivamente (p < 0,05). Ambas as modalidades de expansão provocaram aumentos significantes na largura e no perímetro do arco dentário superior. Apenas os caninos superiores de ambos os grupos apresentaram um aumento significante da inclinação vestibular. Não foram encontradas diferenças significantes entre os efeitos oclusais das duas modalidades de expansão maxilar. As expansões lenta e rápida da maxila parecem ser igualmente efetivas para a correção da constrição do arco dentário superior de pacientes com fissuras labiopalatinas completas bilaterais...

The aim of this pilot study was to compare the occlusal effects of slow and rapid maxillary expansions in patients with complete bilateral cleft lip and palate. Thirty individuals with complete bilateral cleft lip and palate diagnosed with maxillary dental arch constriction were equally and randomly divided into two groups. Group SME was comprised by patients who underwent slow maxillary expansion using Quad helix appliance, and Group RME was composed by individuals submitted to rapid maxillary expansion using Hyrax expander. Dental models were obtained immediately pre-expansion and 6 months after expansion, at the occasion of the appliance removal. After scanning the maxillary dental models using the 3Shape R700 3D scanner, the arch widths, the arch perimeter, and the buccolingual inclination of the maxillary posterior teeth were measured using Orthoanalyzer. The inter-phase and intergroup comparisons were performed using paired t test and Student’s t test, respectively (p < 0.05). Both expansion modalities have promoted significant increases in the maxillary dental arch widths and perimeter. Only the maxillary canines of both groups had a significant increase of the buccal inclination. No differences were found between the occlusal effects of both expansion modalities. Both slow and rapid maxillary expansions seem to be equally effective for the correction of maxillary dental arch constriction in patients with complete bilateral cleft lip and palate...