Board Brasileiro de Ortodontia e Ortopedia Facial: certificando excelência / Brazilian Board of Orthodontics and Facial Orthopedics: certifying excellence

O Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) é uma entidade de Certificação Nacional de padrão de excelência clínica no exercício da especialidade. O artigo, ora apresentado, traz o histórico da criação do BBO, sua estrutura e as fases que compõem a avaliação para obtenção da Certificação. Apresenta, ainda, o relato do primeiro exame aplicado no Brasil. O objetivo é multiplicar o conhecimento, entre os profissionais da área, sobre a importância da Certificação BBO como garantia do mais alto grau de qualidade no tratamento ortodôntico.

The Brazilian Board of Orthodontics and Facial Orthopedics (BBO) is the institution that certifies the standards of clinical excellence in the practice of this specialty. This article describes the history of BBO's creation and the examination structure and phases to obtain the BBO Certification. It also presents a detailed report of the first exam applied in Brazil. Its purpose is to expand the knowledge, among professionals in the area, about the importance of BBO Certification as assurance of the highest level of quality in orthodontic treatments.

Alterações na dimensão transversal pela expansão rápida da maxila / Transverse dimension alterations using rapid maxillary expansion

As deformidades transversais, que se manifestam tipicamente pela mordida cruzada unilateral ou bilateral, são os problemas esqueléticos que mais sequelas podem causar na região craniofacial. Entretanto, são as deformidades que melhor se adaptam às alterações ortopédicas. A expansão rápida da maxila tornou-se rotina na prática ortodôntica. Embora inicialmente tenha sido utilizada na correção da mordida cruzada posterior, atualmente sua indicação ampliou-se para a expansão indireta do arco inferior, obtenção de espaço para correção de apinhamento dentário, correção axial dos dentes posteriores, melhora na estética do sorriso e auxílio no tratamento de pacientes Classe II. A expansão ortopédica da maxila vem atraindo cada vez mais a atenção da comunidade científica devido, principalmente, à sua aplicação e capacidade de alterar o crescimento craniofacial em diversas situações clínicas. Esse tipo de intervenção ortopédica possui grande utilidade terapêutica, pois sua aplicação em diversas anormalidades apresenta maior versatilidade quando comparada aos aparelhos de modificação de crescimento disponíveis atualmente para o tratamento ortodôntico.

Transverse deformities, typically manifested by unilateral or bilateral crossbite, are the skeletal problems that can cause more sequels in the craniofacial region. However, such deformities are the most adaptable to orthopedic changes. Rapid maxillary expansion has become a routine in the orthodontic practice. Even though initially such procedure has been used for correction of posterior crossbite, today it has been applied for indirect expansion of the lower arch, obtaining space for correction of dental crowding, correction of axial inclination of posterior teeth, improvement in the smile aesthetics characteristics and on treatment of Class II patients. Orthopedic maxillary expansion has gained increasing attention of the scientific community due to its application and ability to change the craniofacial growth in many clinical situations. This type of orthopedic intervention has a positive therapeutic result in several abnormalities and is more versatile when compared to the growth modification devices currently available for orthodontic treatment.

Long-term maxillary changes in patients with skeletal Class II malocclusion treated with slow and rapid palatal expansion.

INTRODUCTION: In this study, we evaluated the long-term maxillary changes in skeletal Class II patients who had slow and rapid palatal expansion. METHODS: The sample consisted of 70 patients divided in 2 groups: 1 group was treated with cervical headgear with expanded inner bow (CHG) and the other with a Haas-type rapid palatal expansion appliance with cervical headgear (RPE-CHG). Data were collected in the molar and canine regions for basal width, alveolar width, and palatal depth at pretreatment (T1), posttreatment (T2), and postretention (T3). The Student paired t test was used to compare data and independent averages between phases. RESULTS: In both groups, from T1 to T2, there were significant increases in basal width, alveolar width, and palatal depth for the molar region; in the canine region, there was a significant increase only in the alveolar width. From T2 to T3, no significant changes were found for basal and alveolar widths in both groups and regions, but a significant increase was seen in palatal depth in the molar region in the RPE-CHG group. CONCLUSIONS: Slow and rapid palatal expansion can expand the maxillae and the maxillary teeth in skeletal Class II patients. Rapid palatal expansion was efficient in the treatment of skeletal Class II patients with severe transverse maxillary discrepancy. Skeletal Class II correction with slow and rapid palatal expansion produced long-term stability (10 years after orthodontic treatment).

Long-term anteroposterior and vertical maxillary changes in skeletal class II patients treated with slow and rapid maxillary expansion.

OBJECTIVE: To evaluate a 10-year follow-up of anteroposterior and vertical maxillary changes in skeletal Class II patients treated with slow and rapid maxillary expansion methods. MATERIALS AND METHODS: The sample consisted of 70 patients divided into two groups: (1) treated with a cervical headgear with expansion of the inner bow (CHG) and (2) using a Haas-type rapid maxillary expansion appliance in conjunction with cervical headgear (RME-CHG). The CHG group consisted of 40 patients (18 males and 22 females; average age 10.6 years at pretreatment [T1], 13.6 years at posttreatment [T2], and 23.6 years at postretention [T3]). The RME-CHG group consisted of 30 patients (14 males and 16 females; average age 10.4 years at T1, 14.0 years at T2, and 24.6 years at T3). The profiles of SNA and SN-PP angles showed no significant differences in either group at T1, T2, and T3 phases. RESULTS: For the entire sample, the profile analysis between the phases showed reduction in the SNA angle from T1-T2 and an increase from T2-T3. The SN-PP angle showed an increase from T1-T2 and a decrease from T2-T3. Treatment of skeletal Class II patients with slow and rapid maxillary expansions was efficient and stable over the long-term. CONCLUSIONS: The profiles of SNA and SN-PP at T1, T2, and T3 achieved with slow and rapid maxillary expansions were clinically equivalent.

Mandibular behavior with slow and rapid maxillary expansion in skeletal Class II patients: a long-term study.

OBJECTIVE: To evaluate anteroposterior and vertical mandibular changes in skeletal Class II patients treated with slow or rapid maxillary expansions at 10-year follow-up. MATERIALS AND METHODS: The sample consisted of 70 patients divided into two groups, treated with (1) a cervical headgear (CHG) with expansion of the inner bow or (2) a Haas-type rapid maxillary expansion (RME) appliance in conjunction with CHG (RME-CHG). The CHG group consisted of 40 patients (18 males and 22 females, with an average age of 10.6 years at pretreatment [T(1)], 13.6 years at posttreatment [T(2)], and 23.6 years at postretention [T(3)]), and the RME-CHG group consisted of 30 patients (14 males and 16 females with an average age of 10.4 years at T(1), 14.0 years at T(2), and 24.6 years at T(3)). RESULTS: The profiles of SNB, B-Hor, and Pog-Hor showed significant increases for all treatment phases in both groups. The SN-Go-Gn angle showed no significant decrease from T(1) to T(2) and a significant decrease from T(2) to T(3). CONCLUSIONS: For the entire sample (CHG + RME-CHG) the profile analysis between the phases showed mean increases in B-Ver and Pog-Ver for both phases.

Surface roughness of acrylic resins after different curing and polishing techniques.

OBJECTIVE: To conduct a laboratory evaluation of the surface roughness of self-curing acrylic resin after different curing and polishing techniques. MATERIALS AND METHODS: Sixty specimens were separated into four groups. The conventional curing process was followed by a second curing cycle in a microwave oven to decrease the residual monomer levels in two groups. After curing, two groups received manual polishing and the other groups underwent chemical polishing at 70 degrees C for 10 seconds. Roughness analysis was performed in a mechanical and laser profilometer. Analyses by Bartlett, Shapiro-Wilk, and Dunnett tests were used to compare whether the mean of the response variable was the same in all groups. RESULTS: The results suggested greater influences from the polishing method than the curing method and showed that the chemical polishing method yielded the highest surface roughness. CONCLUSIONS: The average pattern of roughness of the self-curing acrylic resin was statistically the same in the groups with different curing methods. However, chemical polishing increases the average pattern of roughness.

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.

Tratamento da maloclusão classe III com expansão rápida da maxila e máscara facial / Treatment of class III malocclusion with rapid maxillary expansion and facemask therapy

A malocusão Classe III é uma deformidade dentofacial relacionada ao crescimento. Seu tratamento apresenta dificuldades devido à discrepância no osso basal e limitações pelo uso de procedimentos convencionais. Este relato apresenta tratamento com expansão rápida da maxila e máscara facial de paciente portador de maloclusão Classe III durante a dentição mista

Tratamento de Classe II, Divisão 1, com ausência congênita de incisivo lateral superior / Treatment of Class II Division 1 with congenitally absent maxillary lateral incisor

Este relato mostra tratamento Ortodôntico efetuado em paciente portador de Classe II, Divisão 1, de Angle, com sobremordida profunda e agenesía do incisivo lateral superior esquerdo, em que o espaço foi fechado ortodonticamente e o canino ocupou o lugar do incisivo lateral. Os procedimentos adotados possibilitaram a obtenção de estética agradável e relação oclusal normal. A linha mediana não apresentou desvio ao término do tratamento e a discrepância vertical foi devidamente corrigida

Tratamento ortodôntico sem extração: métodos e épocas ideais para intervenção / Nonextration orthodontic treatment: methods and ideal timing of intervation

Na decisão sobre a escolha do tratamento, a fase de desenvolvimento do paciente deve ser considerada. Métodos como expansão rápida da maxila e distalização de molares são versáteis e eficientes no tratamento sem extração, quando realizados no final da dentição mista. Este estudo analisa mecânicas utilizadas na terapia sem extração, enfatizando a terapia ideal para início da correção

Efeitos da expansão rápida da maxila e tração cervical em má oclusão Classe II, divisão 1 / Effects of rapid palatal expansion and cervical traction in class II division 1 malocclusion

Este relato de caso mostra a utilização da expansão rápida da maxila e aparelho extra-oral de ancoragem cervical no tratamento de má oclusão Classe II, Divisão 1, com deficiência maxilar transversal, acentuada falta de espaço no arco superior, mordida profunda esquelética e perfil reto. O tratamento possibilitou estabelecer uma relação oclusal normal e estável entre os arcos maxilar e mandibular, com os dentes em relação transversa e inclinação vestibulolingual ideais. A expansão do arco maxilar e a tração cervical foram suficientes para produzir os espaços necessários para a erupção dos dentes permanentes. A mordida cruzada anterior foi corrigida propiciando inclinação vestibulolingual adequada ao incisivo lateral superior direito

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

Crescimento e mecânica extra-oral no tratamento da maloclusão Classe II / Growth and extraoral mechanics in Class II malocclusion treatment

No estudo do crescimento craniofacial a variação é a regra, ocorrendo tanto em diferentes pessoas como no próprio indivíduo, durante o crescimento. Alterações no crescimento em pacientes portadores de maloclusão Classe II são possíveis pelo uso de mecânica extra-oral. O objetivo deste trabalho foi revisar o crescimento craniofacial e suas alterações, pela utilização de mecânica extra-oral na correção de casos Classe II

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.

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.

Spontaneous correction of Class II malocclusion after rapid palatal expansion.

A case of a Class II, division 1 malocclusion with reduced transpalatal width is reported. The only treatment provided for this patient was rapid palatal expansion. After expansion, the mandible seemed to be carried forward to its normal position, resulting in a spontaneous correction of the Class II malocclusion. This case report illustrates the outcome of the method of treatment used with a long-term (14-year posttreatment) follow-up.