Craniomandibular transverse tomographic evaluation after anterior open bite orthodontic treatment with miniplates anchorage.

BACKGROUND: Skeletal anterior open bite (SAOB) represents one of the most complex and challenging malocclusions in orthodontics. Orthodontic treatment supported by miniplates enable to reduce the need for orthognathic surgery. Transverse dimension may be affected by intrusion biomechanics. This study aims to assess transverse bone alterations in patients with SAOB who underwent orthodontic treatment with absolute anchorage using four miniplates. METHODS: A total of 32 patients of both sexes, with an average age of 33.8 years, diagnosed with SAOB and treated orthodontically with four miniplates (one in each hemiarch), were selected for this study. Tomographic examinations were performed before (T1) and after (T2) orthodontic treatment. Linear measurements (width of the maxillary base, maxillary alveolar, maxillary root, maxillary dental cusp, mandibular alveolar) and angular measurements (maxillary intermolar angle) were assessed in these images. The Shapiro-Wilks normality tests were applied to verify data distribution, and the paired t-test was used to compare the initial and final measures obtained. RESULTS: Among the evaluated parameters, the maxillary alveolar width, maxillary dental cusp width, mandibular alveolar cusp width, and intermolar angle showed statistically significant differences between T1 and T2 (p < 0.05). However, maxillary base and maxillary root widths showed no significant difference (p > 0.05). CONCLUSIONS: Intrusion and distalization with miniplates in SAOB therapy may lead to significant expansive changes, due to molars cusps width and buccal inclination increase restricted at the alveolar level.

Finite element analysis of a newly designed miniplate for orthodontic anchorage in the maxillary anterior region.

INTRODUCTION: Multiple force vector applications may be indicated when an arch segment or en masse intrusion is needed. This finite element method study aimed to evaluate the total deform the stress yielded in the bone and the miniplate when forces with different directions and magnitudes were applied. METHODS: First, the prototyped skull model was fabricated on the basis of computed tomography (CT) scans. On this model, the miniplate was fixed, and orthodontic appliances were attached. Then, a 3-dimensional finite element model was constructed by reproducing the characteristics of the physical model. Seven situations were investigated, which diverged in the point of force application, the direction and the number of force vectors, and the force magnitudes. RESULTS: When the force was applied at 1 point, similar behavior could be observed concerning the deformation and the stress in the miniplate, the maxilla, and the screw holes. Most deformation and stress appeared in the transmucosal arm below the step bend and at the force application point. The angled vectors (-45° and 30°) presented smaller values concerning the vertical vectors. Similar or better performances could be observed when the forces were simultaneously applied at the 2 points. CONCLUSIONS: The newly designed miniplate showed similar or improved performances when multiple vectors were applied at the 2 points simultaneously compared with the force applied at 1 point. This newly designed miniplate may present improved performance in a clinical situation when multiple forces are demanded.

Tomographic evaluation of the maturation stage of the midpalatal suture in postadolescents.

INTRODUCTION: In this study, we aimed at evaluating the maturation stage of the midpalatal suture based on its morphology, using cone-beam computed tomography images in young postadolescents. METHODS: The sample comprised 112 patients, 68 female and 44 male, aged 16 to 20 years, consecutively selected from 2 private orthodontic clinics. They had cone-beam computed tomography images in their initial orthodontic files, requested for orthodontic planning purposes. These images were exported to the Invivo 5 program (Anatomage, San Jose, Calif), where axial sections were obtained from the midpalatal suture for morphologic evaluation. Two previously calibrated examiners interpreted the images to establish the stage of sutural maturation of each patient according to its morphologic characteristics in 5 maturational stages (A, B, C, D, and E). The kappa coefficient was applied for intraexaminer and interexaminer agreements, and their values were 0.87 and 0.89, respectively. RESULTS: The maturational stages most often observed in this study were C, D, and E, (91.9%). In males, stage C was present in 52.3%; for females this prevalence was 39.7%. CONCLUSIONS: The high prevalence of stage C in this age group may justify a clinical study to confirm the good prognosis for rapid maxillary expansion in postadolescents.

Comparative study of root resorption of maxillary incisors in patients treated with lingual and buccal orthodontics.

OBJECTIVE: To compare the magnitude of external apical root resorption (EARR) of maxillary incisors in patients with mild to moderate anterior crowding, treated with lingual and conventional (labial) orthodontics. MATERIALS AND METHODS: The sample comprised 40 patients divided into two groups: lingual (20 patients) and conventional buccal brackets (20 patients). Patient ages ranged from 11 to 45 years, and the study included 12 men and 28 women. Apical root resorption was measured from periapical radiographs obtained at the beginning of treatment (T1) and at the end of the leveling phase (T2). Periapical radiographs were scanned and transferred to the CorelDraw X7 image-processing program, in which measurements of root lengths were performed. For intragroup and intergroup comparisons between the T1 and T2 phases, paired and independent t-tests, respectively, were used at 5% significance. RESULTS: There was significant apical root resorption for all teeth evaluated; the magnitude of the EARR (T2-T1) ranged from -0.35 mm to -0.63 mm in the lingual group, and from -0.66 mm to -0.85 mm in the conventional group. Although there was an intergroup variation in the magnitude of EARR observed, no statistically significant differences were found. Neither group presented any teeth with resorption ≥1 mm. CONCLUSIONS: The magnitude of apical root resorption in maxillary incisors in patients with anterior crowding was similar regardless of orthodontic technique, lingual or conventional. Both techniques resulting in an apical rounding considered clinically insignificant.

Prevalence of the Short Face Pattern in Individuals of Bauru-Brazil.

AIM: This study aimed at assessing the prevalence and severity of short face pattern in ethnically different individuals. MATERIAL AND METHODS: The sample comprised 4,409 Brazilians (2,192 females and 2,217 males), with a mean age of 13 years, enrolled in secondary schools in the municipality of Bauru. The sample inclusion criteria involved subjects with vertically impaired facial relationship based on excessive lip compression, when standing at natural head position, with the lips at rest. Once short face syndrome had been identified, the individuals were classified into three severity subtypes: mild, moderate, and severe. The sample was then stratified by ethnic background as White (Caucasoid), Black (African descent), Brown (mixed Caucasian-African descent), Yellow (Asian descent), and Brazilian Indian (Native Brazilian descent), using the Brazilian Institute of Geography and Statistics classification. The chi-square test at the 5% significance level was used to compare frequency ratios of individuals with vertically impaired facial relationships and across different ethnicities, according to severity. RESULTS: The prevalence of short face pattern was 3.15%, as 1.11%, 1.99%, and 0.02% considered mild, moderate and severe subtypes, respectively. The severe subtype was rare (0.02%) and found only in one White individual. The White group had the highest relative frequency (45.53%) of the moderate subtype, followed by Brown individuals (43.40%). In the mild subtype, Yellow (68.08%) and White (62.21%) individuals showed similar and higher relative frequency values. CONCLUSION: The prevalence of short face pattern was 3.15%, and White individuals had the highest prevalence.

Cone Beam Computed Tomography-based Evaluation of the Anterior Teeth Position Changes obtained by Passive Self-ligating Brackets.

AIM: The objective of this study was to evaluate the anterior teeth position changes obtained by passive self-ligating brackets using cone beam computed tomography (CBCT). MATERIALS AND METHODS: Twenty patients with a mean age of 16.5 years, class I malocclusion, constricted maxillary arch, and teeth crowding above 5 mm were enrolled in this study, and treated by passive orthodontic self-ligating brackets. A sequence of stainless steel thermoset wire was implemented with ending wire of 0.019" × 0.025". The CBCT and dental casts were obtained prior to the installation of orthodontic appliances (T1), and 30 days after rectangular steel wire 0.019" × 0.025" installation (T2). The measurements in CBCT were performed with the Anatomage software, and the dental casts were evaluated with a digital caliper rule with an accuracy of 0.01 mm. RESULTS: The CBCT data demonstrated mean buccal inclination of the upper and lower central incisors ranging from 6.55° to 7.24° respectively. The upper and lower lateral incisors ranged from 4.90° to 8.72° respectively. The lower canines showed an average increase of 3.88° in the buccal inclination and 1.96 mm in the transverse intercuspal distance. The upper canines showed a negative inclination with mean average of -0.36°, and an average increase of 0.82 mm in the transverse distance, with negative correlation with the initial crowding. CONCLUSION: Treatment with passive self-ligating brackets without obtaining spaces increases buccal inclination of the upper and lower incisors with no correlation with the amount of initial teeth crowding. The intercanine distance tends to a small increase showing different inclinations between the arches. CLINICAL SIGNIFICANCE: When taking into account the self-ligating brackets, the amount of initial dental crowding is not a limitation factor that could increase the buccal inclination of the anterior teeth.

Facial and occlusal esthetic improvements of an adult skeletal Class III malocclusion using surgical, orthodontic, and implant treatment.

The aim of this clinical report is to describe the complex treatment of an adult Class III malocclusion patient who was disappointed with the outcome of a previous oral rehabilitation. Interdisciplinary treatment planning was performed with a primary indication for implant removal because of marginal bone loss and gingival recession, followed by orthodontic and surgical procedures to correct the esthetics and skeletal malocclusion. The comprehensive treatment approach included: (1) implant removal in the area of the central incisors; (2) combined orthodontic decompensation with mesial displacement and forced extrusion of the lateral incisors; (3) extraction of the lateral incisors and placement of new implants corresponding to the central incisors, which received provisional crowns; (4) orthognathic surgery for maxillary advancement to improve occlusal and facial relationships; and finally, (5) orthodontic refinement followed by definitive prosthetic rehabilitation of the maxillary central incisors and reshaping of the adjacent teeth. At the three-year follow-up, clinical and radiographic examinations showed successful replacement of the central incisors and improved skeletal and esthetic appearances. Moreover, a Class II molar relationship was obtained with an ideal overbite, overjet, and intercuspation. In conclusion, we report the successful esthetic anterior rehabilitation of a complex case in which interdisciplinary treatment planning improved facial harmony, provided gingival architecture with sufficient width and thickness, and improved smile esthetics, resulting in enhanced patient comfort and satisfaction. This clinical case report might be useful to improve facial esthetics and occlusion in patients with dentoalveolar and skeletal defects.

Impact of orthodontic treatment on self-esteem and quality of life of adult patients requiring oral rehabilitation.

OBJECTIVE: To evaluate whether orthodontic treatment in adults requiring oral rehabilitation is effective for increasing patients' self-esteem and quality of life (QoL). MATERIALS AND METHODS: The sample consisted of 102 adult patients (77 women and 25 men) aged between 18 and 66 years (mean, 35.1 years) requiring oral rehabilitation and orthodontic treatment simultaneously. Rosenberg's Self-Esteem (RSE) Scale and a questionnaire about QoL based on the Oral Health Impact Profile (OHIP-14) were used to determine self-esteem and QoL scores retrospectively. Questionnaires were carried out in two stages, T1 (start of treatment) and T2 (6 months after). To compare score changes between T1 and T2, the data obtained from the RSE Scale were evaluated with paired t tests, and data from the quality-of-life questionnaire were assessed by applying descriptive statistics. RESULTS: The results showed a statistically significant increase in self-esteem (P < .001) and a great improvement on patients' QoL. CONCLUSIONS: Orthodontic treatment causes a significant increase in self-esteem and QoL, providing psychological benefits for adult patients in need of oral rehabilitation.

Possibilities of Orthopedic Management of Pattern Ill Malocclusions During Growth.

Consistently performed by most orthodontists, the orthopedic treatment involves rapid maxillary expansion (RME) combined with maxillary protraction (MP). When this treatment protocol is performed up to the intertransitional period of the mixed dentition (around 9 years of age), it allows a positive influence on the maxilla and zygomatic projection, even though there are also effects on the dentition. The ideal orthopedic treatment should influence the growth and spatial arrangement of bone bases (maxilla and mandible), so as to achieve balance and maintain it until growth completion. This goal may seem utopic, especially when the problem involves the mandible; and, assuming some genetic influence for such disorder, it is difficult to predict its future magnification during the growth period. Notwithstanding, despite the uncertain prognosis, the search for function and better facial esthetics, though temporary, should be considered This paper discusses this topic, based on the treatment progress of a youngpatient with Class III, with monitoring ofgrowth from the deciduous dentition up to adulthood, and treatment performed in two periods, using the RME and MPprotocol. Positive outcomes were achieved.

Ortho-surgical management of a Conradi-Hünermann syndrome patient: rare case report.

The Conradi-Hünermann Disease is a rare syndrome, which affects the cranial development and the anatomy of dental occlusion. After interdisciplinary treatment completion, the patient reached satisfactory facial anatomy, as well as regular occlusal relationship, attested 2 years of accompaniment.

The immunomodulation to diabetes control: New proposals for the reversion of this disease.

The diabetes mellitus is a metabolic disorder, characterized by the hyperglycemia with deficiency in the use of carbohydrates, fats and proteins, resultant of the impairment in secretion and/or insulin action. Severely, the type 1 diabetes provokes the compromise of several organs, causing different disorders and until death of patient. In this way, the literature has shown the general treatments for the type 1 diabetes and currently the focus in immunotherapy and/or immunomodulation, to control of this hyperglycemic condition. The use of new therapies is necessary due to the high increase of incidence of this disease around the world. Recent studies showed an increase of 40% in the cases since 1997. This disease affects different organs, including the glandular tissues, mainly the pancreas. Despite all therapies for diabetes control, the damages occurred remain irreversible. Thus, in addition to general treatments, the use of immunotherapy may open new perspectives for treatment of this disease. Within this aspect, the anti-CD3 monoclonal antibodies may be effective, mainly by protect and maintain the pancreatic acinar cells. Thus, these treatments based in the immunomodulation can be an option for diabetes control and to reverse the damage caused by this disease.

Six-year follow-up of maxillary anterior rehabilitation with forced orthodontic extrusion: achieving esthetic excellence with a multidisciplinary approach.

Orthodontic extrusion with multidisciplinary treatment can provide predictable outcomes in selected situations, reducing the costs and the adaptation times of gingival tissues after implant integration. Forced orthodontic extrusion is strongly related to interactions of teeth with their supportive periodontal tissues. This article reports a case of orthodontic extrusion of the maxillary incisors for later implant rehabilitation in a patient with periodontal disease. Slow forces were applied for 14 months. After this time, the teeth were extracted, and the implants were placed on the same day. Also in the same session, the provisional crown was fabricated for restoration of the anterior maxillary interdental papillae loss and for gingival contouring. Clinical and radiographic examinations at the 6-year follow-up showed successful tooth replacement and an improved esthetic appearance achieved by this multidisciplinary treatment. The decision to perform orthodontic extrusion for implant placement in adult patients should be multidisciplinary.

Using the HERBST appliance with atypical extractions in the lower dental arch.

This article reports the case of a patient with severe mandibular deficiency and crowding in the mandibular arch treated with atypical extractions of two premolars followed by mandibular advancement with the Herbst appliance. It became clear that this therapy corrected the malocclusion while improving facial.

Multidisciplinary approach for the aesthetic treatment of maxillary lateral incisors agenesis: thinking about implants?

Missing maxillary lateral incisors create an esthetic problem with specific orthodontic and prosthetic considerations. Implants are commonly used to replace congenitally missing lateral incisors in adolescent orthodontic patients. However, an interdisciplinary approach should be observed during the diagnosis, prognosis, and treatment plan to provide a result with good predictability and meet the esthetic and functional expectations of the patient. The present study describes a case of a young patient with tooth agenesis of maxillary lateral incisors, which was conducted with an integrated planning. After 5-year follow-up of 2 fixed implant-supported prostheses, clinical and radiographic examination showed the treatment to be successful.