Very early orthodontic treatment: when, why and how?

ABSTRACT Introduction: Several orthodontic problems should already be treated at an early age to prevent the necessity of future complex and expensive procedures. Scientific evidence suggests that posterior crossbites, mild to moderate Class III, as well as certain Class II malocclusions, open bites and arch length discrepancies can benefit from simple, but efficient interceptive therapy. Objective: To summarize the existing evidence-based literature on early orthodontic treatment, and to illustrate its application and effectiveness by showcasing multiple clinical examples. Conclusion: Early short-term interceptive orthodontic treatment with simple appliances, in the deciduous or early mixed dentition phase, can efficiently correct certain malocclusions and help to either reduce the complexity or even avoid the necessity of complex and expensive procedures during puberty. For certain patients with significant arch length discrepancy the concept of serial extractions should be part of the orthodontic armamentarium.

RESUMO Introdução: Vários problemas ortodônticos devem ser tratados já em idade precoce, para evitar a necessidade de procedimentos futuros de maior complexidade e custo. A evidência científica sugere que as seguintes más oclusões podem se beneficiar de terapias interceptivas simples mas eficientes: mordidas cruzadas posteriores, Classe III leve a moderada, certas más oclusões de Classe II, mordidas abertas e discrepâncias no tamanho das arcadas. Objetivo: Resumir a evidência científica existente sobre o tratamento ortodôntico precoce e ilustrar sua aplicação e efetividade, por meio da exposição de múltiplos casos clínicos. Conclusão: O tratamento ortodôntico interceptivo precoce de curto prazo com aparelhos simples na fase da dentição decídua ou início da dentição mista pode corrigir eficientemente certas más oclusões e ajudar a reduzir a complexidade ou, até mesmo, evitar a necessidade de procedimentos complexos e onerosos durante a puberdade. Para certos pacientes com discrepância significativa no comprimento das arcadas, o conceito de extrações seriadas deve fazer parte do arsenal de recursos ortodônticos.

Prospective Evaluation of Changes in Pain Levels, Quality of Life and Functionality After Low Dose Radiotherapy for Epicondylitis, Plantar Fasciitis, and Finger Osteoarthritis.

Background: The objective benefits of low dose radiotherapy (LDRT) for non-malignant joint disorders are controversial. This study evaluated changes in pain, quality of life (QoL) and function after LDRT for epicondylitis, plantar fasciitis, and finger osteoarthritis. Materials and Methods: Patients over 40 years old with epicondylitis, plantar fasciitis, and finger osteoarthritis were had pain following at least 6 months of conservative therapy. Patients received 0.5 Gy LDRT twice weekly for 4 weeks repeated once after 8 weeks in patients who failed to achieve complete pain relief. Patients assessed their pain according to the visual analog scale. Handgrip strength was measured with an isometric dynamometer and the fast self-paced walking test was used in patients with plantar fasciitis. QoL was evaluated according to the EQ-5D and HAQ-DI questionnaires. Results: Outcomes for 157 patients (204 sites) were documented at 2, 6, and 12 months after last LDRT. Pain reduction at rest (p < 0.001), during activity (p < 0.001) and increase in handgrip strength (extension p < 0.001, flexion p = 0.002) were highly significant for patients with lateral epicondylitis. Patients with medial epicondylitis reported pain relief at rest (p = 0.041) and during activity (p = 0.041) and significant increase in handgrip strength (p = 0.022). Patients with plantar fasciitis reported pain reduction at rest (p < 0.001), during activity (p < 0.001) and faster walking times (p < 0.001). A trend toward improved QoL was observed. Patients with finger osteoarthritis reported significant pain relief during activity (p < 0.001) and a gain in handgrip strength (p = 0.004), with a trend to both pain relief at rest (p = 0.056) and stronger pinch grip (p = 0.099). Conclusions: LDRT achieved significant pain relief at rest and during activity and a corresponding objective improvement in handgrip strength in patients with epicondylitis. Pain relief at rest, during activity and improvement in walking time were demonstrated in patients with plantar fasciitis. LDRT achieved pain relief during activity, and handgrip strength was improved in patients with finger osteoarthritis. No significant effect was seen on quality of life measures for these conditions. The observed benefits were maintained 12 months after LDRT for all 3 indications and we recommend this low cost, safe intervention for patients over 40 who have failed prior conservative therapy.