Influence of frenotomy on breastfeeding in newborns with ankyloglossia.

PURPOSE: evaluate the influence of frenotomy on the breastfeeding of newborns diagnosed with ankyloglossia. METHODS: this is an intervention study performed with 50 newborns diagnosed with ankyloglossia. It was conducted in three stages: diagnosis, intervention and reassessment. In the diagnostic phase, the Protocol for the Assessment of Speech Language with Scores for Babies was applied to diagnose ankyloglossia and a questionnaire assessing the symptoms and coordination of sucking, swallowing and breathing during breastfeeding. In the intervention, frenotomy was performed, and at reassessment, the diagnostic protocol and questionnaire in order to compare the post-surgical effects. RESULTS: of the 50 babies participating in the study, 35 (70%) were boys and 15 (30%) girls. A total of 68% of ankyloglossia cases were reported in the family, a majority (38%) involving cousins. There was a statistically significant reduction in the average protocol score in the reassessment stage, from 8.38 (7-12 points) to 0.86 (0-5 points), as well as a statistically significant improvement in all variables related to the symptoms of breastfeeding. CONCLUSION: surgical intervention, known as frenotomy, made it possible to improve the negative symptoms of breastfeeding in newborns diagnosed with ankyloglossia.

Influence of frenotomy on breastfeeding in newborns with ankyloglossia / Influência da frenotomia na amamentação em recém-nascidos com anquiloglossia

ABSTRACT Purpose: evaluate the influence of frenotomy on the breastfeeding of newborns diagnosed with ankyloglossia. Methods: this is an intervention study performed with 50 newborns diagnosed with ankyloglossia. It was conducted in three stages: diagnosis, intervention and reassessment. In the diagnostic phase, the Protocol for the Assessment of Speech Language with Scores for Babies was applied to diagnose ankyloglossia and a questionnaire assessing the symptoms and coordination of sucking, swallowing and breathing during breastfeeding. In the intervention, frenotomy was performed, and at reassessment, the diagnostic protocol and questionnaire in order to compare the post-surgical effects. Results: of the 50 babies participating in the study, 35 (70%) were boys and 15 (30%) girls. A total of 68% of ankyloglossia cases were reported in the family, a majority (38%) involving cousins. There was a statistically significant reduction in the average protocol score in the reassessment stage, from 8.38 (7-12 points) to 0.86 (0-5 points), as well as a statistically significant improvement in all variables related to the symptoms of breastfeeding. Conclusion: surgical intervention, known as frenotomy, made it possible to improve the negative symptoms of breastfeeding in newborns diagnosed with ankyloglossia.

RESUMO Objetivo: avaliar a influência da frenotomia sobre a amamentação de recém-nascidos com diagnóstico de anquiloglossia. Método: trata-se de um estudo de intervenção realizado com 50 recém-nascidos com diagnóstico de anquiloglossia. Foi realizado em três etapas: diagnóstico, intervenção e reavaliação. Na fase diagnóstica, foram aplicados o Protocolo de Avaliação do Frênulo da Língua com Escores para Bebês para o diagnóstico de anquiloglossia e um questionário de avaliação dos sintomas e coordenação de sucção, deglutição e respiração durante a amamentação. Na intervenção, foi realizada a frenotomia e, na reavaliação, foram reaplicados o protocolo de diagnóstico e o questionário para comparação dos efeitos pós-cirúrgicos. Resultados: dos 50 bebês participantes do estudo, 35 (70%) eram do gênero masculino e 15 (30%) do gênero feminino. Foram relatados 68% dos casos de anquiloglossia na família, sendo primo (a) o grau de parentesco na maioria desses casos (38%). Houve redução estatisticamente significativa na média de pontuação no protocolo de 8,38 (7-12 pontos) para 0,86 (0-5 pontos), na etapa de reavaliação, assim como melhora estatisticamente significante em todas as variáveis relacionadas aos sintomas da amamentação. Conclusão: a intervenção cirúrgica, denominada frenotomia, possibilitou a melhora dos sintomas negativos da amamentação em neonatos com diagnóstico de anquiloglossia.

Long-term clinical outcome of rapid maxillary expansion as the only treatment performed in Class I malocclusion.

The purpose of this study was to investigate the long-term clinical responses of rapid maxillary expansion as the only treatment performed in Class I malocclusion using the Haas-type appliance. The longitudinal sample consisted of 90 sets of study models from 30 consecutive patients (12 males and 18 females) selected on the basis of the following inclusion criteria: all patients (1) had a Class I malocclusion with transverse maxillary/mandibular skeletal discrepancies, (2) were treated nonextraction in the early/ mid mixed dentition, (3) presented with mandibular dental arches with mild or no crowding, and (4) had no subsequent comprehensive orthodontic treatment implemented in either the maxilla or the mandible. The mean age was 8.2 years when treatment was initiated. Treatment outcomes were evaluated at pretreatment A1, short-term follow-up (one year after A1) A2, and long-term follow-up (four years after A2) A3. The changes in maxillary arch width and arch length were quantified and compared among assessment stages A1, A2, and A3 using the Student's t-test. The results demonstrated a highly significant increase in maxillary arch width in both the short- and long-term follow-ups. The arch width increased significantly during treatment and decreased slightly during the long-term follow-up. The long-term clinical response demonstrated the efficacy and stability of this type of treatment in achieving maxillary arch width. The follow-up examination during the early/mid/permanent dentition confirmed the validity of overtreatment.

Longitudinal study of anteroposterior and vertical maxillary changes in skeletal class II patients treated with Kloehn cervical headgear.

This is a study to evaluate the posttreatment and long-term anteroposterior and vertical maxillary changes in skeletal Class II Division 1 patients (ANB > or = 5 degrees) who had received Kloehn cervical headgear treatment. The sample consisted of 120 lateral cephalograms obtained at pretreatment (T1), posttreatment (T2), and postretention (T3) phases of 40 patients (18 males and 22 females). The patients were of an average age of 10% years in phase T1, 13% years in phase T2, and 23% years in phase T3. They were treated with cervical traction and an expanded inner bow (4-8 mm) and a long outer bow bent upwards off the horizontal 10-20 degrees in relation to the inner bow. After correction of the molar relationship on both sides, a conventional edgewise fixed appliance was used to complement the correction of the malocclusion. The onset of treatment was either at the late mixed dentition or at the beginning of the permanent dentition. The force applied for the 40 patients averaged 450 g and the recommended use of the appliance was 12-14 hours per day with monthly adjustments. F-Snedecor test was applied to the entire sample and multiple comparisons between phases were tested by the Bonferroni method. Results revealed that treatment had reduced maxillary protrusion, inclined the palatal plane with an increase in the SN-PP angle with reduction at long-term. In conclusion, Kloehn cervical headgear with elevated external bow and expanded inner bow was efficient in correcting the skeletal Class II in late mixed-early permanent dentition. Skeletal Class II correction with Kloehn cervical headgear was found to be very stable long term.

Avaliação do grau de conversão de resinas compostas fotoativadas em diferentes tempos e potências

Introdução: uma polimerização adequada é crucial para a obtenção das propriedades físicas ideais e o desempenho clínico das resinas compostas. Objetivo: avaliar o grau de conversão (GC) e dureza de resinas compostas fotoativadas com diferentes potências e tempos de polimerização. Materiais e método: foram confeccionados oitenta (n = 80) corpos de prova de re-sina composta (FiltekTM Z350 XT na cor A2B) com 4 mm de diâmetro e 2 mm de espessura, desses, quarenta (n = 40) foram destinados à avaliação do grau de conversão e quarenta (n = 40) para dureza. Foram feitos dez (n = 10) corpos de prova para cada grupo avaliado, sendo cinco para avaliar o grau de conversão e cinco, a dureza (P10T2, P7T2, P4T2, P1T2, P10T4, P7T4, P4T4, P1T4). Tendo as resinas do grau de conversão e de dureza fotoativadas por LEDS em 20 segundos na intensidade de potência de 1.000 mW/cm2, 700 mW/cm2, 400 mW/cm2 e 100 mW/cm2, os grupos P10T2, P7T2, P4T2 e P1T2, respectivamente. Os grupos P10T4, P7T4, P4T4 e P1T4 foram polimerizados na mesma intensidade de potência de luz, no entanto, com tempo de 40 segundos. Resultado: em relação ao grau de conversão, as resinas do P1T2 tiveram o menor valor, alcançado em média 22,67%, e o P10T4, com média 87,09%, alcançou o maior valor. Em relação à dureza, as resinas do P1T2 tiveram também a pior média, com 30,93 Kgf/mm², e o P10T4, a melhor média, com 82,02 Kgf/mm². Conclusão: quanto maior a potência do aparelho foto-polimerizador, maior será o GC e a dureza das resinas compostas. Os resultados deste estudo sugerem que um aparelho com intensidade de 100 mW/cm² não oferece um grau de conversão e dureza satisfatório, comprometendo o desempenho do material restaurador.

Long-term outcome of skeletal Class II Division 1 malocclusion treated with rapid palatal expansion and Kloehn cervical headgear.

The treatment of a patient with a skeletal Class II Division 1 malocclusion, with excessive overjet, complete overbite, airway obstruction, and severe arch length deficiency in the mandibular dental arch, is presented. The maxilla was narrow compared with the mandible, and the posterior teeth were compensated, with the maxillary teeth inclined buccally and the mandibular teeth inclined lingually. The palatal vault was extremely high. Treatment included rapid palatal expansion to correct the transverse maxillary deficiency and Kloehn cervical headgear to correct the anteroposterior skeletal discrepancy. Long-term stability (12-year follow-up) is reported.

Long-term outcome in a patient with Class I malocclusion with severe crowding treated without extractions.

The treatment of a patient with a Class I malocclusion with significant skeletal transverse maxillary discrepancy and severe crowding is presented. The maxilla was narrow compared with the mandible, and the posterior teeth were compensated, with the maxillary teeth inclined buccally and the mandibular teeth inclined lingually. Treatment included rapid palatal expansion to correct the transverse maxillary deficiency and to gain arch length. Long-term follow-up (20 years) with a stable result is reported.

Mandibular changes in skeletal class II patients treated with Kloehn cervical headgear.

This study evaluated the posttreatment and long-term anteroposterior and vertical mandibular changes in skeletal Class II Division 1 patients (ANB angle >or= 5 degrees ) treated with Kloehn cervical headgear. The sample consisted of 40 patients (18 males, 22 females, average age 10.5 years at pretreatment [T1], 13.5 years at posttreatment [T2], and 23.5 years at postretention [T3]) treated with cervical traction with an expanded inner bow (4-8 mm) and a long outer bow bent upwards off the horizontal 10 degrees to 20 degrees in relation to the inner bow. The force applied averaged 450 g, and the recommended use of the appliance was 12 to 14 hours per day, with monthly adjustments. The Student t test was used for comparison between stages. Results showed that during treatment no significant change was found in the mandibular plane angle, but a significant decrease was detected at T3. Kloehn cervical headgear was efficient in the skeletal Class II correction. The superimposition of tracings suggests that much of the treatment effect occurs when the mandible is displaced forward. Skeletal Class II correction with Kloehn cervical headgear was found to be stable over the long term.

Spontaneous mandibular arch response after rapid palatal expansion: a long-term study on Class I malocclusion.

The purpose of this study was to investigate the spontaneous mandibular arch response to rapid palatal expansion as the sole orthodontic intervention. Particular attention was paid to clinically significant effects and long-term (mean age, 11.3 years) posttreatment stability in 30 Class I malocclusion patients treated during the early and mid mixed dentition. Measurements were made directly on 120 dental casts obtained at 4 assessment stages: pre-expansion (A1), short-term follow-up (A2), progress (A3), and long-term follow up (A4). Comparisons between A1 and A2 showed statistically significant (P < .001) increases for intermolar widths (lingual and occlusal values). During the transition to the permanent dentition, a significant (P < .001) decrease occurred in arch length and arch perimeter. There was a 25% intermolar width (occlusal value) decrease from the initial net gain, whereas the lingual values remained unchanged. Comparisons between A2 and A4 showed an intermolar width (occlusal value) net gain of 50% and a significant (P < .001) decrease for the arch length and arch perimeter. There was remarkable stability in intermolar width (lingual value) and intercanine width (occlusal value), indicating that the increase in the mandibular arch width dimension was in response to the orthopedic effects of rapid palatal expansion in the early and mid-mixed dentition and that the stability was maintained until adulthood.

Tratamento da Classe II esquelética e deficiência maxilar transversal com traçäo extra-oral cervical e expansäo rápida da maxila / A skeletal Class II transverse maxillary deficiency treatment with cervical traction and rapid palatal expansion

A discrepância esquelética anteroposterior muitas vezes aparece associada à deficiência maxilar transversal. Este relato demonstra a utilizaçäo da expansäo rápida da maxila e traçäo extra-oral cervical no tratamento de paciente portador de Classe II divisäo 1 esquelética de Angle, deficiência maxilar transversal e mordida aberta anterior. Os procedimentos adotados possibilitaram relaçäo oclusal normal e estável entre os arcos maxilar e mandibular, dentes em relaçöes transversais ideais e inclinaçöes vestibulolinguais adequadas. Um notável efeito ortopédico na correçäo da Classe II esquelética foi obtido com traçäo extra-bucal

Estudo longitudinal das alterações no ângulo ANB em pacientes Classe II esquelética, tratados com aparelho extra-oral de Kloehn / Longitudinal study of ANB Angle changes in skeletal Class II patients treated with Kloehn cervical headgear

Foi realizado estudo longitudinal para avaliar alterações no ângulo ANB em pacientes Classe II esquelética, submetidos a tratamento com aparelho extra-oral de Kloehn. A amostra constituiu-se de 120 rediografias cefalométricas laterais obtidas nas fases pré-tratamento (T1), pós-tratamento (T2) e pós-contenção (T3), de 40 pacientes, sendo 18 do gênero masculino e 22 do feminino, apresentando média de idade na fase T1 de 10 anos e 6 meses, na fase T2 de 13 anos e 6 meses e na fase T3 de 23 anos e 6 meses. O arco interno do aparelho extra-oral foi expandido de 4 a 8 mm e o arco externo angulado (10 a 20º) para cima em relação ao interno. O tratamento iniciou-se no final da dentição mista ou início da permanente. A magnitude média das forças empregadas nos aparelhos extra-orais dos 40 pacientes foi de 450g. Foi recomendado o uso do aparelho de 12 a 14 horas por dia de ajuste mensal. As medidas cefalométricas foram analisadas para comparação entre as fases utilizando o teste "t" de Student. Os resultados indicaram que a discrepância maxilomandibular foi corrigida com o uso do aparelho extra-oral do tipo Kloehn, sendo o tratamento eficaz na correção da Classe II esquelética, que se manteve estável a longo prazo