Evaluation of Sagittal and Vertical Changes in Maxillary Dental, Skeletal, and Soft Tissue Following Surgically Assisted Rapid Maxillary Expansion: A Retrospective Longitudinal Study.

OBJECTIVE: To evaluate whether the maxillary complex would be sagittally, vertically, or mutually displaced after the transverse maxillary correction by surgically assisted rapid maxillary expansion and how the facial profile would be affected. MATERIALS AND METHODS: The sample comprised 28 adult patients (mean age 25.8 [age range 19-39 years]; 50% women) with transverse maxillary deficiency greater than 7 mm who underwent the surgical rapid maxillary expansion. Cephalometric analysis (n  = 112), intra- and extra-oral registries, and radiographic records were taken before treatment (T1), right after the end of the expansion (T2), 4 months after the expansion (T3), and 10 months after the end of the expansion (T4). Dental and skeletal cephalometric measurements were evaluated at each time-point, whereas soft tissue cephalometric analyses were determined at 2 time points (T1 and T4). RESULTS: The results indicated that no sagittal, vertical, skeletal, or soft tissue variation was found after the surgical expansion. However, statistically significant dental changes (P  < 0.05) were observed in dental angles (1.NA/1.SN/1.PoOR/1.PP) throughout the different time-points. The authors found statistically relevant posterior inclination of the incisors from T2 to T3 based on multiple comparisons. CONCLUSIONS: Surgically assisted rapid maxillary expansion does not promote anterior and vertical displacement of the maxilla. Notwithstanding, the surgical intervention causes upper incisor palatal inclination.

Etiologia e tratamento do bruxismo - visão homeopática / Etiology and treatment of bruxism - homeopathic vision

Introdução: O Bruxismo é uma parafunção relacionada à distribuição desarmônica de forças, levando ao atrito de contato das superfícies oclusais dos dentes, podendo ocorrer o ranger ou o apertamento dos dentes, em vigília ou durante o sono. Objetivo: O trabalho em questão tem como objetivo analisar a contribuição da Homeopatia na etiologia e no tratamento do Bruxismo. Métodos: criou-se uma repertorização fictícia tomando-se por base como sintoma diretor a somatória das rubricas "ranger dos dentes ", "ranger os dentes durante a noite" e "inclinação constante a apertar os dentes" e como sintomas repertoriais alguns fatores relatados consistentemente e identificados na literatura como causas do bruxismo ou características clássicas associadas aos portadores do bruxismo. Resultados: Restou comprovado que os indivíduos estressados, com sono sensível a ruído, com excesso de responsabilidade, cheios de preocupações, intolerantes a contradição e que fazem uso de narcóticos, tem alta probabilidade de apresentarem o bruxismo associado. Conclusão: conclui-se que podemos optar pela terapêutica homeopática como excelente recurso no alívio e melhora dos sintomas relacionados ao bruxismo.(AU)

One-Step Surgical Correction of Transverse and Anteroposterior Maxillary Deficiencies Using Wire Fixation. A New Approach and Long-Term Stability.

PURPOSE: To describe a retrospective assessment of the long-term stability of a new approach using wire fixation for 1-step surgical correction of transverse and anteroposterior maxillary deficiencies. PATIENTS AND METHODS: The authors implemented a case series of 5 adult patients (3 men and 2 women; mean age, 31.4 yr) needing maxillary advancement less than 5 mm and had transverse maxillary deficiency greater than 7 mm who underwent total Le Fort I and median palatal suture osteotomies and had their maxilla advanced and stabilized bilaterally with stainless steel wire. Transverse expansion was performed using a Hyrax expander, which also was used for retention for 4 months after completion of the planned expansion. Follow-up included clinical examination and studies of lateral radiographs and plaster models preoperatively (T0), soon after completion of maxillary expansion (T1), 4 months after T1 (T2), 12 months after T1 (T3), and an average of 4.8 years (minimum, 4 yr 1 month; maximum, 5 yr; standard deviation, 0.3 yr) after T1 (T4). RESULTS: Maxillary expansions measured at the most cervical points on the palatal face of the upper first premolars and of the upper first molars at T2 were 7.8 and 7.4 mm on average, respectively. In all cases, surgery promoted maxillary anteroposterior advancement. Anteroposterior maxillary skeletal measurements of the angle formed by the sella, nasion, and A point; the distance from the vertical reference line to the A point (A-VRL); the distance of the VRL to the cementoenamel junction (CEJ); and the distance from the perpendicular line of the nasion (Nperp) to the CEJ showed a substantially increase at T1 (P < .05) and stability at T2, T3, and T4; however, A-VRL presented a significant relapse at T4 compared with T1 (P = .037) and T2 (P = .027). The soft tissues expanded at the same rate as the skeletal tissues. The anteroposterior soft tissue measurements Nperp to superior lip and Nperp to the A' point showed a substantial increase at T2 (P < .05) and stability at T3 and T4. The measurements associated with anteroposterior correction were stable at T4. CONCLUSION: The proposed technique provides long-term stability of maxillary expansion and anteroposterior repositioning with only 1 surgical intervention. However, considering the small number of patients, a multicenter study is needed before a definitive conclusion can be reached.