ABSTRACT
INTRODUCTION: Rapid maxillary expansion (RME) is the therapy of choice to correct skeletal transverse dimension in children and adolescents, associating orthopedic and dental effects. In an attempt to prevent the undesirable dentoalveolar effects and optimize the potential of skeletal expansion in individuals in advanced stages of skeletal maturation, the miniscrew-assisted rapid palatal expander (MARPE) was proposed by Lee et al. in 2010. OBJECTIVE: This paper presents a systematized protocol for selection of miniscrews indicated for MARPE, by the evaluation of cone-beam computed tomographies (CBCT). Variables related with the bone and soft tissue thicknesses at the palatal regions of interest, as well as in relation to the fixation rings of miniscrews of the palatal expander are analyzed and discussed to provide better performance in the clinical practice.
Subject(s)
Bone Screws , Malocclusion/therapy , Orthodontic Anchorage Procedures/methods , Palatal Expansion Technique , Clinical Protocols , Cone-Beam Computed Tomography , Dental Casting Technique , Dental Implantation/instrumentation , Dental Implantation/methods , Humans , Malocclusion/diagnostic imaging , Orthodontic Anchorage Procedures/instrumentation , Palatal Expansion Technique/instrumentationABSTRACT
Abstract Introduction: Rapid maxillary expansion (RME) is the therapy of choice to correct skeletal transverse dimension in children and adolescents, associating orthopedic and dental effects. In an attempt to prevent the undesirable dentoalveolar effects and optimize the potential of skeletal expansion in individuals in advanced stages of skeletal maturation, the miniscrew-assisted rapid palatal expander (MARPE) was proposed by Lee et al. in 2010. Objective: This paper presents a systematized protocol for selection of miniscrews indicated for MARPE, by the evaluation of cone-beam computed tomographies (CBCT). Variables related with the bone and soft tissue thicknesses at the palatal regions of interest, as well as in relation to the fixation rings of miniscrews of the palatal expander are analyzed and discussed to provide better performance in the clinical practice.
Resumo Introdução: a expansão rápida da maxila (ERM) é a terapia de escolha para a correção da dimensão transversa esquelética em crianças e adolescentes, associando-se efeitos ortopédicos e dentários. Com a finalidade de prevenir os efeitos dentoalveolares indesejáveis e otimizar o potencial de expansão esquelética em indivíduos com estágios avançados de maturação esquelética, a técnica de expansão rápida da maxila assistida por mini-implantes (MARPE) foi proposta por Lee e colaboradores em 2010. Objetivo: o presente estudo apresenta um protocolo sistematizado para seleção de mini-implantes indicados para a MARPE, mediante avaliação de imagens de tomografia computadorizada de feixe cônico (TCFC). Variáveis relacionadas à espessura de tecido ósseo e tecido mole nas regiões de interesse do palato, bem como em relação ao anel de fixação dos mini-implantes do parafuso expansor, são analisadas e discutidas para proporcionar melhor desempenho na prática clínica.
Subject(s)
Humans , Bone Screws , Palatal Expansion Technique/instrumentation , Orthodontic Anchorage Procedures/methods , Malocclusion/therapy , Clinical Protocols , Dental Casting Technique , Dental Implantation/instrumentation , Dental Implantation/methods , Orthodontic Anchorage Procedures/instrumentation , Cone-Beam Computed Tomography , Malocclusion/diagnostic imagingABSTRACT
ABSTRACT Introduction: In dental practice, low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are mainly used for dental surgery and biostimulation therapy. Within the Orthodontic specialty, while LLLT has been widely used to treat pain associated with orthodontic movement, accelerate bone regeneration after rapid maxillary expansion, and enhance orthodontic tooth movement, HILT, in turn, has been seen as an alternative for addressing soft tissue complications associated to orthodontic treatment. Objective: The aim of this study is to discuss HILT applications in orthodontic treatment. Methods: This study describes the use of HILT in surgical treatments such as gingivectomy, ulotomy, ulectomy, fiberotomy, labial and lingual frenectomies, as well as hard tissue and other dental restorative materials applications. Conclusion: Despite the many applications for lasers in Orthodontics, they are still underused by Brazilian practitioners. However, it is quite likely that this demand will increase over the next years - following the trend in the USA, where laser therapies are more widely used.
Subject(s)
Humans , Animals , Orthodontics/instrumentation , Orthodontics/methods , Laser Therapy/instrumentation , Laser Therapy/methods , Surgery, Oral/instrumentation , Surgery, Oral/methods , Tooth Movement Techniques/instrumentation , Tooth Movement Techniques/methods , Low-Level Light Therapy/instrumentation , Low-Level Light Therapy/methods , Lasers, Semiconductor/therapeutic use , Gingivectomy/instrumentationABSTRACT
INTRODUCTION:: Etiology of dental crowding may be related to arch constriction in diverse dimensions, and an appropriate manipulation of arch perimeter by intervening in basal bone discrepancies cases, may be a key for crowding relief, especially when incisors movement is limited due to underlying pathology, periodontal issues or restrictions related to soft tissue profile. OBJECTIVES:: This case report illustrates a 24-year old woman, with maxillary transverse deficiency, upper and lower arches crowding, Class II, division 1, subdivision right relationship, previous upper incisors traumatic episode and straight profile. A non-surgical and non-extraction treatment approach was feasible due to the miniscrew-assisted rapid palatal expansion technique (MARPE). METHODS:: The MARPE appliance consisted of a conventional Hyrax expander supported by four orthodontic miniscrews. A slow expansion protocol was adopted, with an overall of 40 days of activation and a 3-month retention period. Intrusive traction miniscrew-anchored mechanics were used for correcting the Class II subdivision relationship, managing lower arch perimeter and midline deviation before including the upper central incisors. RESULTS:: Post-treatment records show an intermolar width increase of 5 mm, bilateral Class I molar and canine relationships, upper and lower crowding resolution, coincident dental midlines and proper intercuspation. CONCLUSIONS:: The MARPE is an effective treatment approach for managing arch-perimeter deficiencies related to maxillary transverse discrepancies in adult patients.
Subject(s)
Bone Screws , Dental Arch/pathology , Malocclusion, Angle Class II/therapy , Palatal Expansion Technique/instrumentation , Biomechanical Phenomena , Cephalometry , Dental Arch/diagnostic imaging , Female , Humans , Malocclusion, Angle Class II/diagnostic imaging , Orthodontic Appliance Design , Radiography, Panoramic , Young AdultABSTRACT
ABSTRACT Introduction: Etiology of dental crowding may be related to arch constriction in diverse dimensions, and an appropriate manipulation of arch perimeter by intervening in basal bone discrepancies cases, may be a key for crowding relief, especially when incisors movement is limited due to underlying pathology, periodontal issues or restrictions related to soft tissue profile. Objectives: This case report illustrates a 24-year old woman, with maxillary transverse deficiency, upper and lower arches crowding, Class II, division 1, subdivision right relationship, previous upper incisors traumatic episode and straight profile. A non-surgical and non-extraction treatment approach was feasible due to the miniscrew-assisted rapid palatal expansion technique (MARPE). Methods: The MARPE appliance consisted of a conventional Hyrax expander supported by four orthodontic miniscrews. A slow expansion protocol was adopted, with an overall of 40 days of activation and a 3-month retention period. Intrusive traction miniscrew-anchored mechanics were used for correcting the Class II subdivision relationship, managing lower arch perimeter and midline deviation before including the upper central incisors. Results: Post-treatment records show an intermolar width increase of 5 mm, bilateral Class I molar and canine relationships, upper and lower crowding resolution, coincident dental midlines and proper intercuspation. Conclusions: The MARPE is an effective treatment approach for managing arch-perimeter deficiencies related to maxillary transverse discrepancies in adult patients.
RESUMO Introdução: a etiologia do apinhamento dentário pode estar relacionada à constrição das arcadas dentárias em diversas dimensões, e a manipulação apropriada do perímetro da arcada, por meio da intervenção em casos de discrepâncias de base óssea, pode ser o fator chave para a dissolução do apinhamento, especialmente em casos onde a movimentação de incisivos é limitada em decorrência de problemas periodontais ou restrições relacionadas ao perfil facial. Objetivos: o presente relato de caso ilustra uma paciente de 24 anos de idade, com deficiência transversa de maxila, apinhamento das arcadas superior e inferior, má oclusão de Classe II, 1a divisão, subdivisão direita, incisivos superiores previamente traumatizados e perfil reto. A abordagem de tratamento não-cirúrgica e sem extrações foi viável devido à técnica de expansão rápida da maxila assistida por mini-implantes (MARPE, do inglês miniscrew-assisted rapid palatal expansion). Métodos: o dispositivo MARPE foi confeccionado a partir de um expansor Hyrax convencional apoiado em quatro mini-implantes. Foi adotado o protocolo de expansão lenta, com um período total de ativações de 40 dias e 3 meses de contenção. Uma mecânica de tração intrusiva apoiada em mini-implantes foi utilizada para a correção da relação de Classe II subdivisão direita, adequação do perímetro da arcada inferior e correção do desvio da linha média antes da inclusão dos incisivos centrais superiores. Resultados: os registros pós-tratamento demonstraram o aumento de 5,0 mm na distância intermolares, relação bilateral de Classe I de molares e caninos, resolução do apinhamento superior e inferior, linhas médias dentárias coincidentes e intercuspidação adequada. Conclusões: a técnica MARPE é uma abordagem de tratamento efetiva para a resolução da deficiência de perímetro das arcadas dentárias relacionada à discrepância maxilar transversa em pacientes adultos.
Subject(s)
Humans , Female , Young Adult , Bone Screws , Palatal Expansion Technique/instrumentation , Dental Arch/pathology , Malocclusion, Angle Class II/therapy , Biomechanical Phenomena , Radiography, Panoramic , Cephalometry , Orthodontic Appliance Design , Dental Arch/diagnostic imaging , Malocclusion, Angle Class II/diagnostic imagingABSTRACT
INTRODUCTION: In dental practice, low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are mainly used for dental surgery and biostimulation therapy. Within the Orthodontic specialty, while LLLT has been widely used to treat pain associated with orthodontic movement, accelerate bone regeneration after rapid maxillary expansion, and enhance orthodontic tooth movement, HILT, in turn, has been seen as an alternative for addressing soft tissue complications associated to orthodontic treatment. OBJECTIVE: The aim of this study is to discuss HILT applications in orthodontic treatment. METHODS: This study describes the use of HILT in surgical treatments such as gingivectomy, ulotomy, ulectomy, fiberotomy, labial and lingual frenectomies, as well as hard tissue and other dental restorative materials applications. CONCLUSION: Despite the many applications for lasers in Orthodontics, they are still underused by Brazilian practitioners. However, it is quite likely that this demand will increase over the next years - following the trend in the USA, where laser therapies are more widely used.
Subject(s)
Laser Therapy/instrumentation , Laser Therapy/methods , Orthodontics/instrumentation , Orthodontics/methods , Animals , Gingivectomy/instrumentation , Humans , Lasers, Semiconductor/therapeutic use , Low-Level Light Therapy/instrumentation , Low-Level Light Therapy/methods , Surgery, Oral/instrumentation , Surgery, Oral/methods , Tooth Movement Techniques/instrumentation , Tooth Movement Techniques/methodsSubject(s)
Cancellous Bone/transplantation , Cortical Bone/transplantation , Maxilla/surgery , Tooth Movement Techniques/methods , Adult , Allografts/transplantation , Alveolar Bone Loss/surgery , Alveolar Ridge Augmentation/methods , Humans , Male , Malocclusion, Angle Class II/therapy , Orthodontic Space Closure/instrumentation , Orthodontic Space Closure/methods , Patient Care Planning , Tooth Movement Techniques/instrumentation , Treatment OutcomeABSTRACT
The aim of this study was to evaluate the effect of pitch distance on the primary stability (PS) of orthodontic mini-implants (MIs) in artificial bone. Twenty experimental MIs were allocated to two groups, according to their geometric design: G1 (30o X 0.6 mm) and G2 (45o X 0.8 mm), and inserted into artificial bone of different densities: D1 (0.32 g/cm3) and D2 (0.64 g/cm3). The maximum insertion torque (IT) and removal torque (RT) values were recorded in N.cm. Loss of torque (LT) values were obtained by calculating the difference between the IT and RT. MI mobility was measured by means of a Periotest assessment. Normality and homogeneity were determined by means of the Kolmogorov-Smirnov and Shapiro-Wilk tests, respectively. A two-way ANOVA was used to detect differences between the mini-implant design and density factors. The ANOVA/Tukey tests were used to determine the intergroup difference. Higher IT values were observed for G2 (p ≤ 0.05) in D2. No statistical difference for RT was observed between the groups, whereas G2 presented higher values only for LT (p ≤ 0.05). The Periotest values (PTV) were higher for G1, in comparison with G2, in D1. G1 presented better PS in D2 (IT, RT and LT), whereas G2 was found to be more stable in D1, after evaluation with Periotest.
Subject(s)
Dental Implants , Orthodontic Anchorage Procedures/methods , Orthodontic Appliance Design , Analysis of Variance , Bone Density , Bone Screws , Materials Testing , Mechanical Phenomena , Reference Values , Reproducibility of Results , Statistics, Nonparametric , TorqueABSTRACT
The aim of this study was to evaluate the effect of pitch distance on the primary stability (PS) of orthodontic mini-implants (MIs) in artificial bone. Twenty experimental MIs were allocated to two groups, according to their geometric design: G1(30oX 0.6 mm) and G2(45o X 0.8 mm), and inserted into artificial bone of different densities: D1 (0.32 g/cm3) and D2 (0.64 g/cm3). The maximum insertion torque (IT) and removal torque (RT) values were recorded in N.cm. Loss of torque (LT) values were obtained by calculating the difference between the IT and RT. MI mobility was measured by means of a Periotest assessment. Normality and homogeneity were determined by means of the Kolmogorov-Smirnov and Shapiro-Wilk tests, respectively. A two-way ANOVA was used to detect differences between the mini-implant design and density factors. The ANOVA/Tukey tests were used to determine the intergroup difference. Higher IT values were observed for G2 (p ≤ 0.05) in D2. No statistical difference for RT was observed between the groups, whereas G2 presented higher values only for LT (p ≤ 0.05). The Periotest values (PTV) were higher for G1, in comparison with G2, in D1. G1 presented better PS in D2 (IT, RT and LT), whereas G2 was found to be more stable in D1, after evaluation with Periotest.
Subject(s)
Dental Implants , Orthodontic Appliance Design , Orthodontic Anchorage Procedures/methods , Analysis of Variance , Bone Density , Bone Screws , Materials Testing , Mechanical Phenomena , Reference Values , Reproducibility of Results , Statistics, Nonparametric , TorqueABSTRACT
OBJECTIVE: To verify whether bone mineral density (BMD) of cortical bone, trabecular bone, and total bone influence the primary stability of orthodontic miniscrews and to verify whether there is a correlation between the measurement of BMD by cone-beam computed tomography (CBCT) and central dual-energy x-ray absorptiometry (DEXA). MATERIALS AND METHODS: Twenty bovine bone sections were extracted from the pubic and iliac bones from regions with cortical thicknesses of approximately 1 mm. The BMD of the total bone block was evaluated using two methods: CBCT and DEXA. The BMD of cortical, trabecular, and total bone in the region of interest (ROI) were also evaluated by CBCT. After scanning the bone blocks, 20 self-drilling miniscrews (INP®) 1.4 mm in diameter and 6 mm long were inserted into them. The peak implant insertion torque (IT) was registered. After this, the pull-out test (PS) was performed and the maximum force registered. The Pearson correlation test was applied to verify the correlations between variables. RESULTS: The BMD of the total bone block verified by CBCT and DEXA showed a positive and strong correlation (r â=â 0.866, P â=â .000). The BMD of the ROI for cortical bone influenced the IT (r â=â 0.518, P â=â .40) and the PS of miniscrews (r â=â 0.713, P â=â .001, Table 2). However, the total bone BMD (verified by CBCT and DEXA) and trabecular bone BMD presented weak and not statistically significant correlations with primary stability. CONCLUSIONS: There was a positive correlation between total bone block BMD measured by DEXA and CBCT. The cortical BMD influenced the IT and PS.
Subject(s)
Bone Density , Bone Screws , Dental Implants , Dental Stress Analysis , Orthodontic Anchorage Procedures/instrumentation , Absorptiometry, Photon , Animals , Cattle , Cone-Beam Computed Tomography , Dental Prosthesis Retention , Device Removal , Statistics, Nonparametric , TorqueABSTRACT
The aims of this study were to determine and compare frictional resistance obtained by low-friction and conventional elastomeric ligatures in the presence of artificial saliva, and observe whether this variable changed after 21 days. Super Slick® low-friction elastomeric ligatures and conventional ligatures of the brands TP conventional® and Unitek® were placed on standard edgewise maxillary central incisor metal brackets, slot .022" × .028" tying rectangular orthodontic wires .018" × .025". Three experimental groups were arranged according to the type of ligature and a control group in which no wires were used. The friction values obtained between the bracket/wire/ligature set were measured using a Universal Test Machine at a speed of 20 mm/minute, at two experimental time intervals: T0 - immediately after specimen fabrication; and T1 - 21 days after fabrication and immersion in artificial saliva at 37 ºC. Conventional Unitek ligatures and the low-friction ligature (Super Slick) showed the lowest friction values at T0. After 21 days (T1), however, conventional Unitek ligatures presented the lowest value. All groups assessed from T0 to T1 showed a numerical reduction in friction values, suggesting that time, heat and humidity may cause elastic degradation, however this was not verified statistically (P > 0.05).
Subject(s)
Elastomers , Friction , Orthodontic Wires , Analysis of Variance , Materials Testing , Orthodontic Brackets , Saliva, Artificial/chemistry , Statistics, Nonparametric , Time FactorsABSTRACT
The aims of this study were to determine and compare frictional resistance obtained by low-friction and conventional elastomeric ligatures in the presence of artificial saliva, and observe whether this variable changed after 21 days. Super Slick® low-friction elastomeric ligatures and conventional ligatures of the brands TP conventional® and Unitek® were placed on standard edgewise maxillary central incisor metal brackets, slot .022" × .028" tying rectangular orthodontic wires .018" × .025". Three experimental groups were arranged according to the type of ligature and a control group in which no wires were used. The friction values obtained between the bracket/wire/ligature set were measured using a Universal Test Machine at a speed of 20 mm/minute, at two experimental time intervals: T0 - immediately after specimen fabrication; and T1 - 21 days after fabrication and immersion in artificial saliva at 37 ºC. Conventional Unitek ligatures and the low-friction ligature (Super Slick) showed the lowest friction values at T0. After 21 days (T1), however, conventional Unitek ligatures presented the lowest value. All groups assessed from T0 to T1 showed a numerical reduction in friction values, suggesting that time, heat and humidity may cause elastic degradation, however this was not verified statistically (P > 0.05).
Subject(s)
Elastomers , Friction , Orthodontic Wires , Analysis of Variance , Materials Testing , Orthodontic Brackets , Statistics, Nonparametric , Saliva, Artificial/chemistry , Time FactorsABSTRACT
Candidíase oral é a infecção oportunista mais comum em pacientes imunocomprometidos, sendo a clorexidina um importante antimicrobiano auxiliar no seu tratamento. O objetivo do presente estudo foi avaliar o efeito antifúngico de diferentes soluções de clorexidina (Periogard®, NoPlak Max®, Noplak®, Perioxidin®, Clorexidina 0.06%, Paradontax® e Clorexidina 1%) sobre biofilmes artificiais de Candida spp.: C. albicans (ATCC36801); C. parapsilosis (ATCC22019); C. krusei (ATCC6258); C. glabrata (ATCC2001) e C. tropicalis (ATCC750). As cepas foram cultivadas em meio de cultura BHI ágar sobre fragmentos de esmalte bovino por 72 horas a 37 °C. Após o crescimento, cada fragmento de esmalte bovino foi imerso nas diferentes soluções de Clorexidina por 3 minutos. Nistatina e solução salina foram utilizadas como controle negativo e positivo, respectivamente. Para remoção das células não aderidas, os fragmentos foram então imersos em solução salina por 10 minutos e agitados em vortex. Alíquotas de 100 µL foram inoculadas em placas contendo BHI ágar por 24 horas a 37 °C para contagem de unidades formadoras de colônias (UFC). Observamos que o número de UFC de C. albicans e C. parapsilosis, apresentou um percentual de redução variando de 79 a 99% quando do uso das diferentes soluções (p < 0,001), o mesmo não foi observado para o NoPlak Max® (2,94 e 1,3%, respectivamente); Para C. krusei e C. glabrata, a solução menos efetiva foi a Nistatina (23 e 3,4%, respectivamente) enquanto que para C. tropicalis, todas as soluções apresentaram um alto percentual de redução (99 a 100%). As soluções de clorexidina foram capazes de reduzir significativamente o número de UFC provenientes de biofilme de Candida spp. in vitro.
Oral candidiasis is the most common opportunistic infection in immunocompromised patients and chlorhexidine is an important antimicrobial for its treatment. The antifungal effect of different CHX solutions (Periogard®, NoPlak Max®, Noplak®, Perioxidin®, Chlorhexidine 0.06%, Paradontax® and Chlorhexidine 1%) was evaluated on artificial biofilms of Candida spps: C. albicans (ATCC36801), C. parapsilosis (ATCC22019), C. krusei (ATCC6258), C. glabrata (ATCC2001) and Candida tropicalis (ATCC750). The strains were grown, in a BHI agar medium on bovine teeth enamel for 72 hours at 37 °C. After growth, the fragments were immersed in the CHX solutions for 3 minutes. Nystatin and saline solutions were used as positive and negative controls respectively. To remove the non-adhered cells, the fragments were inoculated in saline solution for 10 minutes, transferred to Falcon tubes containing saline solution and mixed in a vortex. Aliquots of 100 µL were inoculated on BHI agar for 24 hours at 37 °C to count the number of colony forming units (CFU). We observed that the number of (CFU) of C. albicans and C. parapsilosis, showed a reduction rate ranging from 79 to 99% with the use of different solutions (p < 0.001), except for NoPlak Max® (2.94 and 1.3%, respectively). For C. krusei and C. glabrata, nystatin was the least effective solution (23 and 3.4%, respectively); and for C. tropicalis, all the substances presented a high reduction percentage (99-100%). The chlorhexidine solutions were able to reduce the colony forming units of Candida biofilm.