Maxillary arch dimensions in bilateral cleft lip and palate in the age 0-5 months.

INTRODUCTION: The complete bilateral cleft lip and palate (BCLP) divides the maxillary arch into three segments, separated from each other, resulting in abnormal growth of the alveolar arch. This study evaluated the maxillary arch dimensions in BCLP and compared them with neonates without craniofacial anomalies. METHODS: This retrospective study was conducted in a tertiary cleft centre. Sixty-six neonates aged 0-5 months were divided into two groups: cleft group-children with BCLP (23 boys and 18 girls) and control group-children without craniofacial deformities (15 boys and 10 girls). The dental models were processed by a 3D scanner. Landmarks were marked to achieve inter-canine distance, inter-tuberosity distance and arch length measurements. t-Tests were used for intergroup comparisons (p < .05). RESULTS: The maxillary cleft arch was demonstrated to be wider and longer in the posterior region compared to the control group. The inter-canine distance did not present differences between the cleft and controls. The inter-canine distance of the control group was the only measurement influenced by the variable sex. CONCLUSIONS: The cleft significantly interfered with the arch posterior width and arch sagittal length, making them larger. There was no statistical difference in the measurements between sex in the cleft group.

Soft skills in Orthodontics: an analysis in residents and experienced professionals.

INTRODUCTION: Soft skills represent a range of personal skills, attitudes and characteristics relevant to success and adequate work performance. OBJECTIVE: This study aimed to evaluate the knowledge and usage of soft skills in Orthodontics. METHODS: The participants answered a questionnaire containing 27 objective questions on awareness and frequency of soft skills in their professional activities. Participants were also asked to rank the soft skills in a crescent order of importance. The sample was divided into subgroups: A) residents in Orthodontics; B) orthodontists with less than 5 years of experience and C) orthodontists with more than 5 years of experience. Intergroup comparisons were performed using the Kruskal-Wallis test. Sexual differences were compared using Mann-Whitney test (p< 0.05). RESULTS: The sample of this observational study comprised 129 experienced orthodontists and residents in Orthodontics (92 women, 37 men) with mean age of 35.3 years. From the total sample, 54,6% of respondents reported no previous instructions on soft skills. All respondents reported using the analyzed soft skills with a similar frequency (median 4-5). Residents reported accessing reliable sources in bibliographic research less frequently (46%). Female orthodontists reported to seek help from teachers and other professionals more often than males. Ethics and communication were frequently ranked as the most important soft skills. Information management and leadership were frequently less ranked as important soft skills. CONCLUSION: Poor knowledge of soft skills was demonstrated by residents and orthodontists. Communication skill was highly used and frequently ranked as the most important soft skill.

Evaluation of facial pleasantness in patients with complete and unilateral cleft lip and palate rehabilitated and submitted to orofacial harmonization.

OBJECTIVE: The objective of the present prospective case control study was to evaluate the facial pleasantness of patients with complete and unilateral cleft lip and palate at the end of interdisciplinary rehabilitation, submitted to facial fillers based on hyaluronic acid. METHODS: The study group consisted of 18 individuals with complete unilateral cleft lip and palate, aged between 18 and 40 years (mean age 29 years) of both sexes. The patients presented a concave profile with mild to moderate maxillary deficiency, with completed orthodontic treatment and conducted by means of dentoalveolar compensations without orthognathic surgery. Participants underwent facial filling procedures with hyaluronic acid (HA) in the midface, inserted by a single operator. Standard photographs in frontal norm at rest, right profile at rest, and left profile at rest were obtained from each patient at the following operative times: (T1) pre-filler and (T2) and one-month post-filler. The photographs in T1 and T2 were randomly placed on a page of a virtual album. A 5-point Likert scale was used to assess facial pleasantness. The photographs were evaluated by two groups of evaluators consisting of 18 individuals with cleft lip and palate (CLPG=18) and 18 orthodontists with experience in the treatment of clefts (OG=18). For comparison between phases T1 and T2, and between evaluators with orofacial clefts and orthodontists, the Wilcoxon test was used (p<0,05). RESULTS: People with cleft lip and palate rated their face as more pleasant after the midface filling procedure. In the perception of the orthodontists, on the other hand, the facial pleasantness remained similar after the facial filling procedure. CONCLUSIONS: The filling of the middle third of the face in patients with cleft lip and palate treated without orthognathic surgery increased the pleasantness of the face in the opinion of laypeople with cleft lip and palate.

Treatment stability with bonded versus vacuum-formed retainers after 12 months: A randomized clinical trial.

OBJECTIVE: To compare the clinical effectiveness of V-bend bonded retainers (BR) versus vacuum-formed retainers (VFR) regarding their capacity to maintain treatment stability and survival rates after 12 months. MATERIALS AND METHODS: Patients finishing orthodontic treatment were randomly allocated into two groups. The BR group received maxillary and mandibular BRs in the lingual surfaces of the anterior teeth. The VFR group received VFRs right after fixed appliances removal. The patients were evaluated at four time-points: at fixed appliances removal (T0), after 3 (T1), 6 (T2) and 12 months (T3). In each time-point digital models were obtained and analysed with the OrthoAnalyzer™ software. Treatment stability based on occlusal outcomes and retainers' survival rates were evaluated. Intergroup comparisons were performed using Mann-Whitney U-tests. The Kaplan-Meier survival plot and the log-rank test were employed to assess the retainers' survival. RESULTS: Both BR and VFR groups included 25 patients. The groups were comparable regarding their baseline characteristics. Up to 6 months, both retainers were equally effective; however, after 12 months, BRs were more effective in maintaining the incisors' alignment in the maxilla and the mandible compared to the VFRs. No differences were noticed in the intercanine and intermolar widths, overjet and overbite. There were no differences regarding the retainers' survivability in both arches. CONCLUSIONS: BRs were more effective in maintaining the alignment of the incisors in the maxilla and mandible compared to VFRs after 12 months. Both retainers presented the same survival rates after the same period.

Treatment of Class II malocclusion with 2-maxillary premolar extractions: Monthly vs biweekly appointments, which is more efficient?

INTRODUCTION: This study compared whether there is a difference in treatment time (TT) and efficiency when appointments are held once a month or at 2-week intervals in patients with Class II malocclusion treated with 2-premolar extractions METHODS: The patients of this retrospective sample were treated with the same orthodontic mechanics and divided into 2 groups according to frequencies of orthodontic appointments. Group 1 consisted of 18 patients (10 males, 8 females), with an initial mean age of 14.38 ± 1.38 years and appointments once a month. Group 2 consisted of 19 patients (9 males, 10 females), with an initial mean age of 14.12 ± 1.38 years and biweekly appointments. Edgewise fixed appliances with a slot size of 0.022 × 0.028 mm were used, and the anterior teeth were retracted en-masse with a rectangular wire and elastic chains. The Peer Assessment Rating and Objective Grading System indexes were measured in the dental models at the beginning and the end of treatment. Efficiency was assessed by dividing the percentage of improvement of each occlusal index concerning the multiplication of TT and the number of appointments. RESULTS: Both groups presented similar Peer Assessment Rating and Objective Grading System indexes at the end of treatment. Groups 1 and 2 presented different TTs (28.06 and 22.05 months, respectively); however, there were no differences regarding the efficiency of both protocols. CONCLUSIONS: Patients with Class II malocclusion treated with 2-maxillary premolars had significantly shorter treatment times when seen on biweekly appointments than those with monthly appointments; however, there was no difference in efficiency between protocols.

MARPE em adultos e a regeneração da sutura palatina mediana ­ relato de caso / Mini screw assisted rapid palatal expansion in adult patient and mid palatal suture regeneration ­ case report

A expansão rápida da maxila (ERM) representa o procedimento gold-standard para correção da deficiência transversal do arco dentário superior. Porém, a idade é fator limitante para o sucesso da ERM convencional. Recentemente, a expansão rápida da maxila assistida por mini-implantes (MARPE) ampliou o limite de idade para separação da sutura palatina mediana (SPM), permitindo a correção minimamente invasiva da atresia maxilar, em pacientes adultos. O objetivo deste artigo foi relatar um caso clínico de um paciente adulto com mordida cruzada posterior tratado com MARPE, avaliar os efeitos transversais, o reparo da sutura palatina mediana (SPM) e a estabilidade da expansão após 8 meses de contenção. Paciente de sexo masculino, de 25 anos de idade, apresentava-se com mordida cruzada posterior bilateral, má oclusão de Classe III bilateral e estágio de maturação da SPM avançado. Foi indicado o tratamento com MARPE com 4 parafusos, posicionados parassuturalmente, seguido de tratamento compensatório para Classe III. Após a fase ativa da expansão o aparelho foi mantido por 12 meses como contenção. Após os 6 meses foram removidas as hastes do expansor e foi instalado o aparelho fixo, com uso de elásticos intermaxilares O reparo completo da SPM foi observada após um período de 12 meses de contenção. Após a ortodontia corretiva, uma adequada relação oclusal de molar Classe I foi alcançada (AU)

Rapid palatal expansion (RPE) represents the gold-standard procedure for correcting transverse maxillary dental arch deficiency. However, age is a limiting factor for the success of conventional RPE. Recently, mini-implant-assisted rapid palatal expansion (MARPE) has extended the age limit for midpalatal suture (MPS) separation, allowing for minimally invasive correction of maxillary atresia in adult patients. The aim of this article was to report a clinical case of an adult patient with posterior crossbite treated with MARPE, to evaluate the cross-sectional effects, midpalatal suture (MPS) repair and expansion stability after 8 months of retention. A 25-year-old male patient presented with bilateral posterior crossbite, bilateral Class III malocclusion, and advanced PMS maturation stage. Treatment with MARPE with 4 screws, positioned parasuturally, was indicated, followed by compensatory treatment for Class III. After the active phase of expansion, the appliance was kept for 12 months as a retainer. After 6 months, the expander rods were removed and the fixed appliance was installed using inter maxillary elastics. Complete PMS repair was observed after a period of 12 months of retention. After corrective orthodontics, an adequate Class I molar occlusal relationship was achieved (AU)

Evaluation of facial pleasantness in patients with complete and unilateral cleft lip and palate rehabilitated and submitted to orofacial harmonization

ABSTRACT Objective: The objective of the present prospective case control study was to evaluate the facial pleasantness of patients with complete and unilateral cleft lip and palate at the end of interdisciplinary rehabilitation, submitted to facial fillers based on hyaluronic acid. Methods: The study group consisted of 18 individuals with complete unilateral cleft lip and palate, aged between 18 and 40 years (mean age 29 years) of both sexes. The patients presented a concave profile with mild to moderate maxillary deficiency, with completed orthodontic treatment and conducted by means of dentoalveolar compensations without orthognathic surgery. Participants underwent facial filling procedures with hyaluronic acid (HA) in the midface, inserted by a single operator. Standard photographs in frontal norm at rest, right profile at rest, and left profile at rest were obtained from each patient at the following operative times: (T1) pre-filler and (T2) and one-month post-filler. The photographs in T1 and T2 were randomly placed on a page of a virtual album. A 5-point Likert scale was used to assess facial pleasantness. The photographs were evaluated by two groups of evaluators consisting of 18 individuals with cleft lip and palate (CLPG=18) and 18 orthodontists with experience in the treatment of clefts (OG=18). For comparison between phases T1 and T2, and between evaluators with orofacial clefts and orthodontists, the Wilcoxon test was used (p<0,05). Results: People with cleft lip and palate rated their face as more pleasant after the midface filling procedure. In the perception of the orthodontists, on the other hand, the facial pleasantness remained similar after the facial filling procedure. Conclusions: The filling of the middle third of the face in patients with cleft lip and palate treated without orthognathic surgery increased the pleasantness of the face in the opinion of laypeople with cleft lip and palate.

RESUMO Objetivo: O objetivo do presente estudo caso-controle prospectivo foi avaliar a agradabilidade facial de pacientes com fissura labiopalatina completa e unilateral ao final da reabilitação interdisciplinar, submetidos a preenchimentos faciais à base de ácido hialurônico. Métodos: O grupo de estudo foi composto por 18 indivíduos com fissura labiopalatina unilateral completa, com idade entre 18 e 40 anos (média de 29 anos), de ambos os sexos. Os pacientes apresentavam perfil côncavo com deficiência maxilar leve a moderada, com tratamento ortodôntico concluído e realizado por meio de compensações dentoalveolares sem cirurgia ortognática. Os participantes foram submetidos a procedimentos de preenchimento facial com ácido hialurônico (AH) no terço médio da face, implantado por um único operador. Fotografias padrão em norma frontal em repouso, perfil direito em repouso e perfil esquerdo em repouso foram obtidas de cada paciente nos seguintes tempos operatórios: (T1) pré-preenchimento e (T2) um mês pós-preenchimento. As fotografias em T1 e T2 foram inseridas aleatoriamente em uma página de um álbum virtual. Uma escala Likert de 5 pontos foi utilizada para avaliar a agradabilidade facial. As fotografias foram avaliadas por dois grupos de avaliadores formados por 18 indivíduos com fissura labiopalatina (GFLP=18) e 18 ortodontistas com experiência no tratamento de fissuras (GO=18). Para comparação entre as fases T1 e T2, e entre avaliadores com fissura labiopalatina e ortodontistas, foi utilizado o teste de Wilcoxon (p<0,05). Resultados: As pessoas com fissura labiopalatina avaliaram seu rosto como mais agradável após o preenchimento do terço médio da face. Já na percepção do ortodontista, a agradabilidade facial permaneceu semelhante após o procedimento de preenchimento facial. Conclusões: O preenchimento do terço médio da face em pacientes com fissura labiopalatina tratados sem cirurgia ortognática aumentou a agradabilidade da face na opinião dos leigos com fissura labiopalatina.

Soft skills in Orthodontics: an analysis in residents and experienced professionals

ABSTRACT Introduction: Soft skills represent a range of personal skills, attitudes and characteristics relevant to success and adequate work performance. Objective: This study aimed to evaluate the knowledge and usage of soft skills in Orthodontics. Methods: The participants answered a questionnaire containing 27 objective questions on awareness and frequency of soft skills in their professional activities. Participants were also asked to rank the soft skills in a crescent order of importance. The sample was divided into subgroups: A) residents in Orthodontics; B) orthodontists with less than 5 years of experience and C) orthodontists with more than 5 years of experience. Intergroup comparisons were performed using the Kruskal-Wallis test. Sexual differences were compared using Mann-Whitney test (p<0.05). Results: The sample of this observational study comprised 129 experienced orthodontists and residents in Orthodontics (92 women, 37 men) with mean age of 35.3 years. From the total sample, 54,6% of respondents reported no previous instructions on soft skills. All respondents reported using the analyzed soft skills with a similar frequency (median 4-5). Residents reported accessing reliable sources in bibliographic research less frequently (46%). Female orthodontists reported to seek help from teachers and other professionals more often than males. Ethics and communication were frequently ranked as the most important soft skills. Information management and leadership were frequently less ranked as important soft skills. Conclusion: Poor knowledge of soft skills was demonstrated by residents and orthodontists. Communication skill was highly used and frequently ranked as the most important soft skill.

RESUMO Introdução: As soft skills representam uma variedade de habilidades pessoais, atitudes e características relevantes para o sucesso e desempenho adequado no trabalho. Objetivo: Este estudo teve como objetivo avaliar o conhecimento e o uso das soft skills em ortodontistas. Métodos: Os participantes responderam a um questionário contendo 27 perguntas objetivas sobre conhecimento e frequência das soft skills em suas atividades profissionais. Os participantes também foram solicitados a classificar as soft skills em uma ordem crescente de importância. A amostra foi dividida em subgrupos: A) residentes em Ortodontia; B) ortodontistas com menos de 5 anos de experiência e C) ortodontistas com mais de 5 anos de experiência. As comparações intergrupos foram realizadas usando o teste de Kruskal-Wallis. Diferenças entre os sexos foram comparadas usando o teste de Mann-Whitney (p< 0,05). Resultados: A amostra deste estudo observacional compreendeu 129 ortodontistas experientes e residentes em Ortodontia (92 mulheres, 37 homens) com idade média de 35,3 anos. Entre os entrevistados, 54,6% relataram não ter recebido instruções prévias sobre as soft skills. Todos os entrevistados relataram usar as habilidades interpessoais analisadas com uma frequência semelhante (mediana 4-5). Os residentes relataram acessar com menos frequência (46%) fontes confiáveis de pesquisa bibliográfica. Ortodontistas do sexo feminino relataram buscar ajuda de professores e outros profissionais com mais frequência do que os do sexo masculino. Ética e comunicação foram frequentemente classificadas como as soft skills mais importantes. Com frequência, o gerenciamento de informações e a liderança foram classificados como soft skills menos importantes. Conclusão: Foi demonstrado pouco conhecimento sobre as soft skills por parte de residentes e ortodontistas. A habilidade de comunicação foi frequentemente utilizada e considerada a soft skill mais importante.

Vertical and sagittal changes produced by an expander with differential opening and fan-type expander: A post-hoc analysis of a randomised controlled trial.

OBJECTIVE: To compare the sagittal and vertical cephalometric effects in participants treated with an expander with differential opening (EDO) versus the fan-type expander (FE). DESIGN: Two-arm parallel randomised clinical trial (RCT). METHODS: This study comprised cone-beam computed tomography-derived cephalometric images from 48 participants from a RCT. The sample was randomly allocated into two groups. The study was single-blinded. In total, 24 participants were treated with rapid maxillary expansion (RME) using EDO and 24 participants underwent RME using FE. The primary outcomes were the dentoskeletal vertical changes produced by RME. The secondary outcomes were the dentoskeletal sagittal changes. A cephalometric analysis was performed before treatment and 1 or 6 months after the active phase of RME using Dolphin Imaging Software. Intergroup comparisons of interphase changes were performed using the t-test and Mann-Whitney U test (P < 0.05). RESULTS: The final sample comprised 24 patients (11 men, 13 women; mean age = 7.6 ± 0.9 years) in the EDO group and 24 patients (10 men, 14 women; mean age = 7.8 ± 0.9 years) in the FE group. Both expanders produced a similar clockwise rotation of the mandible (FMA; mean difference [MD] = 0.09°, 95% confidence interval [CI] = -1.01 to 0.84). In the FE group, a greater increase of the SNA angle was observed after expansion compared to the EDO group (MD = 1.04°, 95% CI = -1.90 to -1.58). A greater palatal torque of maxillary incisors was observed in the FE group (MD = 1.32°, 95% CI = 0.05-2.56). Of the participants, 54% reported a little discomfort during the active phase of treatment and 46% of the participants did not report any discomfort. CONCLUSION: Both expanders produced similar vertical cephalometric changes. FEs caused slightly more maxillary anterior displacement after expansion with a compensatory palatal torque of the maxillary incisors compared to the EDOs. However, the amount of sagittal difference was not clinically relevant. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov, under the identifier NCT03705871.

Erosive Tooth Wear in Subjects with Normal Occlusion: A Pioneering Longitudinal Study up to the Age of 60.

The aim of this study was to assess the erosive tooth wear (ETW) at early and mature adulthood in subjects with natural normal occlusion. The sample consisted of 23 untreated subjects with normal occlusion. Dental models were taken longitudinally from the same subjects at 13 (T0), 17 (T1) and 60.9 years of age (T2) at a university. Evaluation of ETW was performed using a modified Basic Erosive Wear Examination (BEWE) index. Interphase changes were evaluated using Friedman and Dunn's test. Ordinal logistic regression was used to assess the influence of sex, dental arch, tooth and dental surfaces on the erosive tooth wear. Linear regression was used to evaluate whether the ETW degree at T1 could discriminate the degree of ETW at T2. The significance level adopted was 5%. ETW showed a significant increase with aging. The median ETW index at T0, T1 and T2 was 2, 4 and 7, respectively. ETW was greater in males in the incisors and canines and on the incisal/occlusal and lingual tooth surfaces. No significant differences were found between the maxillary and mandibular arches. Subjects with severe ETW at mature adulthood had greater tooth wear at age 17. In conclusion, ETW significantly increased during aging in subjects with normal occlusion. The greater the degree of tooth wear at early adulthood, the greater the tooth wear at mature adulthood. Preventive care should be recommended during early adulthood in patients demonstrating erosive tooth wear in order to avoid worsening with aging.

Challenges of a two-phase orthodontic treatment of a mandibular lateral incisor-canine transposition and a maxillary palatally displaced canine: A case report.

INTRODUCTION: The management of eruption disturbances in orthodontics may be challenging and requires a careful diagnosis and treatment planning. This case report discusses the challenges of a two-phase orthodontic treatment of a patient presenting with a dental eruption pattern anomaly. PATIENT CONCERNS: A 10-year-old boy was presented with no complaints for a routine orthodontic evaluation during mixed dentition. PRIMARY DIAGNOSES: The patient was diagnosed with a skeletal Class I malocclusion with unilateral posterior crossbite, incomplete mandibular lateral incisor-canine transposition and a unilateral maxillary ectopic canine. INTERVENTIONS: Phase 1 started with rapid maxillary expansion to correct maxillary constriction and the ectopic eruption of the right maxillary canine. In the mandibular arch, phase 1 included the extraction of the left primary lateral incisor and canine, alignment of the left permanent lateral incisor and orthodontic traction of the left permanent canine. The duration of phase 1 was 14 months. Phase 2 involved a comprehensive course of orthodontic treatment and started when the patient was aged 13 years. This phase lasted 18 months. RESULTS: An adequate dental occlusion was obtained, and the treatment results were stable after an 18-month follow-up. CONCLUSION: In this case, the early diagnosis of the dental anomalies was valuable as it allowed an early intervention to be undertaken, which resulted in overall treatment simplification and potentially minimised the adverse effects. This case report reinforces the importance of a careful follow-up during mixed dentition.

Growth Outcomes Audit for Unilateral Cleft Lip and Palate (UCLP) After 2-stage Palate Repair.

PURPOSE: To assess the impact of 1 and 2-stage palatoplasty protocol on the dental arch relationships in unilateral cleft lip and palate (UCLP) in a single center. METHODS: Our study consisted of 349 individuals divided into 2 groups according to the palatoplasty protocol. Two-stage group comprised 169 subjects with UCLP (mean age: 6.9 y, 110 male and 59 female) who underwent lip, nasal ala, and anterior palate repair with vomer flap from 3 to 6 months (first surgery stage). Soft palate repair occurred from 12 to 18 months (second surgery stage). The one-stage group comprised 180 subjects with UCLP (mean age: 7.2 y, 108 male and 72 female) who underwent 1-stage palatoplasty. Dental models were evaluated by 3 experienced orthodontists applying Goslon Yardstick and the 5-year-old index (FYOI). The influence of the palatoplasty technique and surgeon factor on the interarch relationship was evaluated. The weighted Kappa was used to assess intraexaminer and interexaminer agreements for comparisons of dental arch relationships. Intergroup comparisons were conducted using the χ 2 test ( P <0.05). RESULTS: The intraexaminer reliability was very good (0.81 to 0.98) and interexaminer reliability varied from satisfactory to very good (0.56 to 0.83). The mean occlusal index of the 2-stage and 1-stage groups was 2.77 and 3.03, respectively. The variability of the mean index between surgeons varied from 2.38 to 3.2 in the 2-stage group and 2.91 to 3.2 in the 1-stage group. There were significant differences in the frequency of Goslon 5 index ( P =0.002) between groups, with the 2-stage group presenting less cases (1.18%) than the group 1-stage (11.11%). CONCLUSION: The interarch relationship was similar for both palate repair protocols. Two-stage palatoplasty showed a decreased prevalence of Goslon index 5.

Comparison of nasal cavity changes between the expander with differential opening and the fan-type expander: a secondary data analysis from an RCT.

INTRODUCTION: The aim of this study was to compare the nasal cavity skeletal changes between the expander with differential opening (EDO) and the fan-type expander (FE). METHODS: This study was a secondary analysis of a previous randomized clinical trial. Forty-eight patients with posterior crossbite were randomly allocated into two study groups. Twenty-four patients (11 male, 13 female) with a mean initial age of 7.6 ± 0.9 years were treated with rapid maxillary expansion (RME) using the EDO. Twenty-four patients (10 male, 14 female) with a mean initial age of 7.8 ± 0.9 years were treated with the FE. Cone-beam computed tomography (CBCT) was performed before treatment and 1 to 6 months after the active phase of RME. Using frontal CBCT slices passing at the level of maxillary permanent first molars and maxillary deciduous canines, the width of the nasal cavity was measured in the lower, middle and upper thirds. Nasal cavity height was also evaluated in both slices. Intergroup comparisons of interphase changes were performed using t or Mann-Whitney tests (P < 0.05). RESULTS: The two groups were similar regarding baseline data. EDO showed a greater transverse increase in the lower third of the nasal cavity in both canine (P = 0.007) and molar regions (P < 0.001). No intergroup difference was observed for changes in middle and upper widths and height of the nasal cavity. CONCLUSIONS: Both expanders are effective in promoting an increase of the nasal cavity skeletal dimensions. The expander with differential opening produced a greater transverse increase in the lower third of the nasal cavity compared to the fan-type expander, both at the anterior and posterior regions of the maxilla. CLINICAL RELEVANCE: EDO might be more beneficial to pediatric patients with oral breathing and obstructive sleep apnea compared to FE.

Aging changes in maxillary anterior teeth in untreated individuals: an observational longitudinal study.

OBJECTIVE: The aging of the occlusion and tooth wears influence the smile design This study aimed at evaluating the aging changes of maxillary anterior teeth in nontreated subjects. METHODS: The sample comprised dental models of 23 subjects (13 male, 10 female) with normal occlusions, taken at 13 (T1), 17 (T2) and 61 (T3) years of age. The following variables were measured in the maxillary anterior teeth using digital dental models: crown width/height proportion, anterior view width, crown angulation, gingival and incisal steps between central/lateral incisors and central incisors/canines. Interphase comparisons were evaluated using repeated measures analysis of variance followed by Tukey tests or Friedman tests. Sexual differences were evaluated using t tests (P < 0.05). RESULTS: From 13 to 61 years of age, a decrease of crown width/height proportion (P = 0.008 and P = < 0.001, for the lateral incisor and canines, respectively) and mesiodistal angulation (P = < 0.001, P = 0.001 and P = 0.025 for the central incisor, lateral incisor and canines, respectively) of the maxillary anterior teeth were observed. The steps of the gingival margin and the incisal steps decreased with aging. CONCLUSIONS: From adolescence to late adulthood, untreated individuals with normal occlusions demonstrated changes in the maxillary anterior teeth that may impair the smile esthetics and attractiveness.

Mandibular second premolar distoangulation: a longitudinal follow-up from the mixed to the permanent dentition.

OBJECTIVE: The aim of this study was to assess the frequency of mandibular second premolar (MnP2) distoangulation among orthodontic patients and the angular changes after a longitudinal follow-up. METHODS: The sample was collected from the orthodontic records of 865 patients. The distoangulation group was composed of 42 patients (mean age 9.29 ±â€…1.24 years, 16 male, 26 female) with distoangulation of MnP2. The control group was composed of 32 patients (mean age 9.38 ±â€…1.10 years, 15 male, and 17 female) without distoangulation of MnP2. Panoramic radiographs taken in the mixed (T1) and the early permanent dentition (T2) were analyzed in both groups. Longitudinal angular changes (distal angle θ and premolar-molar angle γ), degree of root formation, second premolar depth, and prevalence of associated dental anomalies were analyzed. Intergroup comparison was performed with Mann-Whitney, t-tests, and chi-square tests (P < 0.05). RESULTS: The prevalence of MnP2 distoangulation in the mixed dentition was 4.85%. The distoangulation group showed a smaller initial distal angle (59.34o ±â€…8.41) when compared to control group (79.88o ±â€…7.60). The spontaneous eruption of the MnP2 with distoangulation was observed in 76.57% of the sample. MnP2 distoangulation was significantly associated with agenesis of its antimere, small maxillary lateral incisors, and deciduous molar infraocclusion. LIMITATIONS: Severe cases of MnP2 distoangulation were absent in this study. CONCLUSIONS: The frequency of MnP2 distoangulation among orthodontic patients was 4.85%. Mild to moderate distoangulated Mnp2 spontaneously uprighted from the mixed to the permanent dentition. Small lateral incisors, second premolar agenesis, and infraocclusion of deciduous molar were frequently found in cases with MnP2 distoangulation.

Spontaneous changes in mandibular incisor crowding from mixed to permanent dentition: a systematic review.

INTRODUCTION: Dental crowding is the most prevalent malocclusion in the mixed and permanent detitions and can have a major impact on dentofacial esthetics. However, adjustments to the development and growth of the dentition can potentiate self-correction of dental crowding during childhood. OBJECTIVE: To evaluate the physiological behavior of mandibular incisor crowding in the transition from mixed to permanent dentition. METHODOLOGY: Five electronic databases (PubMed, Scopus, Web of Science, LILACS and LIVIVO) and part of the gray literature (Proquest and Google Scholar) were investigated, based on the eligibility criteria associated with the acronym PECO, until June 2022. The risk of bias was assessed using the ROBINS-E tool and the certainty of evidence, the GRADE tool. RESULTS: Among the 2.663 studies identified, five were selected for qualitative analysis, of which one have a low risk of bias, and four, a moderate risk. A total of 243 patients were evaluated. Evidence with a high level of certainty was generated indicating a tendency for improvement in mandibular incisor crowding from mixed to permanent dentition, with mandibular incisor crowding decreasing from 0.17 to 4.62 mm on average. The mandibular incisor crowding reduction seems to be associated with the amount of initial crowding and spontaneous dental arch dimensional changes that occur in the mixed dentition and culminate in the increase in arch perimeter, leeway space, incisor protrusion and transverse growth of the maxillary and mandibular arch. CONCLUSION: Based on moderate scientific evidence, spontaneous longitudinal changes in dental arch in the transition from the mixed to the permanent dentition demonstrate a spontaneous improvement in mandibular incisor crowding by up to 4.62 mm. These evidence provide a scientific basis for planning only longitudinal follow-up in patients with mild to borderline moderate mandibular incisor crowding in the mixed dentition avoiding overtreatment.

Closure of maxillary lateral incisor agenesis space in unilateral cleft lip and palate: a digital model assessment.

OBJECTIVE: To compare dental positional and gingival parameters of maxillary anterior teeth in unilateral cleft lip and palate (UCLP) after orthodontic treatment with canine substitution due to lateral incisor agenesis. METHODS: This split-mouth study comprised 57 subjects with UCLP (31 male, 26 female) and agenesis of maxillary lateral incisor at the cleft side, from a single center. Canine substitution was completed after the secondary alveolar bone graft. Dental models were taken between 2 to 6 months after debonding (mean age: 20.4 years). The following variables were measured in the maxillary anterior teeth: crown height, width, proportion, and symmetry, as well as steps between incisal edges, gingival margins, tooth mesiodistal angulation and labiolingual inclination. Paired t-tests with Bonferroni post-hoc correction was used for comparisons between cleft and non-cleft sides (p<0.05). RESULTS: At the cleft side, canines replacing missing lateral incisors had a higher crown height (0.77mm) and an increased width (0.67mm), and first premolars showed a shorter crown height (1.39mm). Asymmetries were observed in the gingival level of central and lateral incisors, with a greater clinical crown at the cleft side (0.61 and 0.81mm, respectively). Cleft side central incisors were more upright than their contralaterals (2.12º). CONCLUSIONS: Maxillary anterior teeth demonstrated positional, size and gingival height differences between cleft and non-cleft side after space closure of maxillary lateral incisor agenesis. Slight asymmetries in tooth position and gingival margin in the maxillary anterior teeth should be expected after orthodontic treatment in UCLP patients.

Early orthognathic surgery with postsurgical bone-anchored retention in unilateral cleft lip and palate: A case report.

We present a case report of early Le Fort I osteotomy with maxillary advancement retained postoperatively by Class III elastics anchored on miniplates in a growing patient with complete unilateral cleft lip and palate (UCLP). A 14-year-old boy who underwent orthognathic surgery at the pubertal growth spurt was presented. During surgery, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics anchored on miniplates were used at night (8-10 h) starting 60 days after surgery. The force of the elastics progressively increased from 100 g to 250 g. The elastics were replaced daily. The positive overjet remained stable over 15 months of postoperative follow-up. Maxillary advancement was adequately retained using Bollard miniplates and the facial profile remained stable until the end of facial growth.