Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults.

INTRODUCTION: This study aimed to compare the dentoskeletal and periodontal changes after miniscrew-assisted rapid palatal expansion (MARPE) in patients aged 18-29 and 30-45 years. METHODS: The sample comprised 28 subjects with transverse maxillary discrepancy successfully treated with MARPE. The young adult (YA) group comprised 14 subjects (mean age, 22.8 years; 3 male, 11 female). The middle adult (MA) group comprised 14 subjects (mean age, 36.8 years; 6 male, 8 female). All patients were treated with a 4-miniscrew MARPE expander. The activation protocol was one quarter turn twice a day until the midline diastema opening, followed by one quarter turn a day until overcorrection. Cone-beam computed tomography (CBCT) scans taken before and immediately after the expansion was analyzed using OnDemand3D Dental software. Using CBCT coronal images, transversal dentoskeletal and periodontal variables were measured in the preexpansion and postexpansion. Intergroup comparisons of expansion changes were performed using t and Mann-Whitney tests (P <0.05). RESULTS: Groups were compatible at preexpansion for most CBCT measurements. A success rate of midpalatal suture opening of 100% and 81% was observed for YA and MA groups, respectively. No intergroup differences were found for the maxillary and dental arch widths increases. The buccal tip of anchorage teeth was observed similarly in both groups. The buccal bone thickness of posterior teeth decreased, and the palatal bone thickness increased after expansion with no difference between groups. CONCLUSIONS: After MARPE, the MA group showed similar dentoskeletal and periodontal changes compared to the YA group.

Midpalatal suture bone repair after miniscrew-assisted rapid palatal expansion in adults.

BACKGROUND: Midpalatal suture (MPS) repair in growing patients after RPE has been previously reported. However, differences between young and adult patients for timing and pattern of MPS repair after rapid maxillary expansion are expected. The aim of this study was to evaluate the midpalatal suture repair pattern after miniscrew-assisted rapid palatal expansion (MARPE) in adult patients. MATERIALS AND METHODS: The study included 21 patients (six males, 15 females) successfully treated with MARPE with a mean initial age of 29.1 years of age (SD = 8.0; range = 20.1-45.1). MPS repair was evaluated using maxillary axial and coronal sections derived from CBCT exams taken 16 months after the expansion (SD = 5.9). Objective and subjective assessments of MPS repair were performed. Objective assessments were performed measuring MPS bone density at anterior, median and posterior region of hard palate. Pre-expansion and post-retention bone density changes were evaluated using paired t tests (p < 0.05). Midpalatal suture bone repair was scored 0 to 3 considering, respectively, the complete absence of bone repair in the MPS, the repair of less than 50% of the MPS, the repair of more than 50% of the MPS and the complete repair of the MPS. Intra- and interexaminer reliability evaluation were assessed using Kappa coefficient. RESULTS: The objective evaluation showed a significant higher bone density at the pre-expansion stage in all palatal regions. The reliability of the subjective method was adequate with intra- and interexaminer agreements varying from 0.807 to 0.904. Scores 1, 2 and 3 were found in 19.05%, 38.09% and 42.86% of the sample, respectively. The most common region demonstrating absence of bone repair was the middle third. The anterior third of the midpalatal suture was repaired in all patients. CONCLUSIONS: A decreased bone density was observed after the retention period when compared to pre-expansion stage. Most adult patients demonstrated incomplete repair of the midpalatal suture 16 months after MARPE. However, adequate bone repair covering more than half of the hard palate extension was observed in 80.95% of the patients.

Concerns of orthodontic patients during the COVID-19 quarantine period.

INTRODUCTION: Quarantine protocols for coronavirus disease 2019 (COVID-19) pandemic has modified orthodontic appointments. OBJECTIVE: to evaluate self-reported experience and needs of orthodontic patients during the quarantine period without in-person appointments. METHODS: Thirty patients, aged 8 to 21 years, under active orthodontic treatment were randomly selected. A phone call questionnaire including questions on physical and emotional impacts of the quarantine of COVID-19 was applied during the second month of Brazilian quarantine. RESULTS: Sixteen percent of the patients reported pain related to the orthodontic appliance. Appliance breakage was observed in 23.33%. Twenty percent felt the need of an emergency orthodontic appointment and 3.33% visited a private practice. Moreover, 23% reported that even in an emergency need, they would not search for an appointment, preferring to communicate with the orthodontist by WhatsApp. Oral hygiene self-perception status showed improvement in 36.67% and worsening in 6.67% of the patients, while 56.66% reported maintenance of the same hygiene status. Sixty percent were concerned about the orthodontic treatment. General concerns were primary related to health and a possible extension of the quarantine time. CONCLUSIONS: During COVID-19 quarantine, orthodontic patients demonstrated a low frequency of orthodontic appliance interference in daily life, and most of them reported a maintenance of oral hygiene habits. The frequency of appliance related pain and breakage was 16.67% and 23.33%, respectively. Patients' main concern during the quarantine period was the fear of getting sick and the uncertainness about the extension of the quarantine period.

Mesioangulation of mandibular second molars: A case report.

This case report describes a simple alternative for treatment of mesioangulation of mandibular second molars. An 11-year-old girl was diagnosed with unilateral posterior crossbite, moderate incisor crowding and mesioangulation of the right mandibular second molar. The ectopic second molar was uprighted using a modified lingual arch with a distal hook and elastic chains. Orthodontic traction began after appliance installation and was activated once per month using 120 g of force. After six months, the right mandibular second molar was in an upright position. Orthodontic treatment continued with teeth levelling and alignment until acceptable occlusal and aesthetic results were achieved. Adequate stability was observed one year after debonding. The modified mandibular lingual arch with a distal hook is a simple and effective alternative to manage mesioangulation of mandibular second molars with minimum adverse effects and stable outcomes.

Cephalometric changes during aging in subjects with normal occlusion.

OBJECTIVE: To assess craniofacial changes from early adulthood to the seventh decade of life in individuals with normal occlusion. METHODOLOGY: The sample comprised lateral cephalograms of 21 subjects with normal occlusion (11 male, 10 female), taken at 17 (T1) and 61 years of age (T2). Anteroposterior and vertical maxillomandibular relationships, and dentoalveolar and soft tissue changes were analyzed. Interphase comparisons were performed using paired t-tests. Differences between sexes, and subgroups with and without tooth loss were evaluated using t-tests (p<0.05). RESULTS: Maxillary and mandibular anterior displacement, and facial and ramus height increased from T1 to T2. Maxillary molars showed significant mesial angulation. Maxillary and mandibular molars, and mandibular incisors developed vertically during the evaluation period. Soft tissue changes included a decrease of the nasolabial angle, upper and lower lip retrusion, decrease of upper lip thickness and increase of the lower lip and soft chin thickness. Maxillary incisor exposure by the upper lip decreased 3.6 mm in 40 years. Males presented counterclockwise rotation of the mandible, whereas females showed mandibular clockwise rotation and backward displacement of the chin. The group with tooth loss showed a greater increase of the posterior facial height and ramus height. CONCLUSION: We observed aging changes in dentoskeletal structures and soft tissue, as well as sexual differences for craniofacial changes during the maturational process. Subjects with multiple tooth losses showed a greater increase in mandibular ramus height.

Factors affecting the stability of maxillary extraction site closure.

INTRODUCTION: A side effect observed in cases treated with extractions is the instability of orthodontic space closure. OBJECTIVE: The aim of this study was to investigate the influence of gingival invagination, presence of third molars and facial pattern, on the stability of orthodontic space-closure in the maxillary arch. METHODS: Ninety-nine subjects (41 male and 58 female) with Class I malocclusion treated with four premolars extraction were evaluated. Extraction sites reopening and gingival invaginations were evaluated in scanned dental models in the posttreatment and 1-year posttreatment stages (mean age 16.1 years). Third molars presence was evaluated at 1-year posttreatment panoramic radiographs, and the facial pattern (SN.GoGn) was evaluated in the initial lateral headfilms. Multiple logistic regression analysis was used to estimate the influence of the aforementioned independent variables on the frequency of extraction space reopening. RESULTS: Space reopening was observed in 20.20% of the subjects 1-year post-debonding. Gingival invaginations were present in 25.73% of quadrants after debonding and in 22.80% 1-year posttreatment. The mean pre-treatment SN.GoGn was 35.64 degrees (SD=5.26). No significant influence was observed of the three independent variables on the instability of extraction site closure. CONCLUSIONS: The presence of gingival invaginations, third molars and facial growth pattern do not seem to influence maxillary extraction sites reopening.

Pretreatment dentoskeletal comparison between individuals treated with extractions in the 1970s and in the new millennium.

OBJECTIVE: This retrospective study aimed to compare the occlusal and dentoskeletal initial features of patients treated with four first premolar extractions in the 1970s and after 2000. MATERIALS AND METHODS: Group 70' was composed by 30 subjects with Class I malocclusion (mean age of 12.8 years, 10 male, 20 female) treated in the 1970s with four first premolar extractions and comprehensive orthodontic treatment. Group NM comprised 30 subjects with Class I malocclusion (mean age of 13.4 years, 13 male, 17 female) treated in the new millennium, similarly to Group 70'. Initial dental models and lateral cephalograms were digitized and measured using OrthoAnalyzerTM 3D software and Dolphin Imaging 11.0 software, respectively. Initial occlusal and dentoskeletal features were analyzed and compared. Intergroup comparison was performed using t tests (p < 0.05). Holm-Bonferroni correction for multiple comparison was applied. RESULTS: Group NM showed significantly greater maxillary and mandibular effective lengths and greater maxillary and mandibular incisor protrusion in comparison with Group 70'. Group NM presented a significantly greater lower anterior facial height. Group NM also showed significantly smaller nasolabial angle and protruded inferior lip. CONCLUSION: Patients with Class I malocclusion treated with four first premolar extractions in the new millennium present a greater degree of dental and labial protrusion, increased lower anterior facial height, and more acute nasolabial angle compared with patients treated similarly in the 1970s. Greater dental and labial protrusion determines first premolar extractions in the new millennium. CLINICAL RELEVANCE: Despite the decrease of tooth extraction frequency, four first premolar extractions may be justified in cases with severe dental and skeletal protrusions.

Factors affecting the stability of maxillary extraction site closure

ABSTRACT Introduction: A side effect observed in cases treated with extractions is the instability of orthodontic space closure. Objective: The aim of this study was to investigate the influence of gingival invagination, presence of third molars and facial pattern, on the stability of orthodontic space-closure in the maxillary arch. Methods: Ninety-nine subjects (41 male and 58 female) with Class I malocclusion treated with four premolars extraction were evaluated. Extraction sites reopening and gingival invaginations were evaluated in scanned dental models in the posttreatment and 1-year posttreatment stages (mean age 16.1 years). Third molars presence was evaluated at 1-year posttreatment panoramic radiographs, and the facial pattern (SN.GoGn) was evaluated in the initial lateral headfilms. Multiple logistic regression analysis was used to estimate the influence of the aforementioned independent variables on the frequency of extraction space reopening. Results: Space reopening was observed in 20.20% of the subjects 1-year post-debonding. Gingival invaginations were present in 25.73% of quadrants after debonding and in 22.80% 1-year posttreatment. The mean pre-treatment SN.GoGn was 35.64 degrees (SD=5.26). No significant influence was observed of the three independent variables on the instability of extraction site closure. Conclusions: The presence of gingival invaginations, third molars and facial growth pattern do not seem to influence maxillary extraction sites reopening.

RESUMO Introdução: Um efeito colateral observado nos casos tratados com extrações é a instabilidade do fechamento ortodôntico do espaço. Objetivo: O objetivo do presente estudo foi investigar a influência da invaginação gengival, da presença de terceiros molares e do padrão facial na estabilidade do fechamento ortodôntico dos locais de extração na arcada superior. Métodos: Noventa e nove indivíduos (41 homens e 58 mulheres) com má oclusão de Classe I tratados com extração de quatro pré-molares foram avaliados. A reabertura dos locais de extração e as invaginações gengivais foram avaliadas nos modelos dentários digitalizados nos estágios pós-tratamento e um ano pós-tratamento (idade média de 16,1 anos). A presença dos terceiros molares foi avaliada em radiografias panorâmicas de um ano pós-tratamento, e o padrão facial (SN.GoGn) foi avaliado nas radiografias laterais iniciais. Análise de regressão logística múltipla foi utilizada para estimar a influência das variáveis independentes citadas na frequência de reabertura do espaço de extração. Resultados: A reabertura do espaço foi observada em 20,20% dos sujeitos um ano após a remoção do aparelho. Invaginações gengivais estiveram presentes em 25,73% dos quadrantes após a remoção do aparelho e em 22,80% após um ano pós-tratamento. O SN.GoGn pré-tratamento médio foi de 35,64 graus (DP = 5,26). Não foi observada influência significativa das três variáveis independentes sobre a instabilidade do fechamento do local de extração. Conclusões: A presença de invaginações gengivais, terceiros molares e padrão de crescimento facial não parece influenciar na reabertura dos locais de extração maxilar.

Cephalometric changes during aging in subjects with normal occlusion

Abstract Objective To assess craniofacial changes from early adulthood to the seventh decade of life in individuals with normal occlusion. Methodology The sample comprised lateral cephalograms of 21 subjects with normal occlusion (11 male, 10 female), taken at 17 (T1) and 61 years of age (T2). Anteroposterior and vertical maxillomandibular relationships, and dentoalveolar and soft tissue changes were analyzed. Interphase comparisons were performed using paired t-tests. Differences between sexes, and subgroups with and without tooth loss were evaluated using t-tests (p<0.05). Results Maxillary and mandibular anterior displacement, and facial and ramus height increased from T1 to T2. Maxillary molars showed significant mesial angulation. Maxillary and mandibular molars, and mandibular incisors developed vertically during the evaluation period. Soft tissue changes included a decrease of the nasolabial angle, upper and lower lip retrusion, decrease of upper lip thickness and increase of the lower lip and soft chin thickness. Maxillary incisor exposure by the upper lip decreased 3.6 mm in 40 years. Males presented counterclockwise rotation of the mandible, whereas females showed mandibular clockwise rotation and backward displacement of the chin. The group with tooth loss showed a greater increase of the posterior facial height and ramus height. Conclusion We observed aging changes in dentoskeletal structures and soft tissue, as well as sexual differences for craniofacial changes during the maturational process. Subjects with multiple tooth losses showed a greater increase in mandibular ramus height.

Expansão rápida da maxila apoiada em mini-implantes (MARPE) em adulto com fissura labiopalatina / Miniscrew assisted rapid palatal expansion (MARPE) in an adult with cleft lip and palate

A expansão rápida da maxila (ERM) é um procedimento terapêutico frequentemente requerido em pacientes com fissura labiopalatina completa para correção da constrição do arco dentário superior, da mordida cruzada posterior e do desalinhamento dos segmentos maxilares. Quando a janela terapêutica ortopédica é perdida e os pacientes são reabilitados tardiamente em um estágio de maturação óssea avançado, a expansão maxilar assistida cirurgicamente pode ser indicada. Porém, com o advento do MARPE (Miniscrew Assisted Rapid Palatal Expansion), a ERM ortopédica passou a ser uma opção em pacientes adultos sem fissuras labiopalatinas. O objetivo desse trabalho foi desenvolver um design de aparelho expansor com ancoragem esquelética para pacientes com fissuras labiopalatinas. Secundariamente, também se objetivou descrever um caso clínico de uma paciente adulta com fissura completa unilateral não tratada ortodonticamente. A referida paciente do sexo feminino, 24 anos de idade, apresentava má oclusão Classe III severa com mordida cruzada posterior e anterior. Foi realizada ERM com ancoragem esquelética usando um expansor Hyrax ancorado em 2 bandas nos primeiros molares e 4 mini-implantes nas lâminas palatinas distante da fissura palatina. Como não houve ancoragem esquelética suficiente, os resultados obtidos foram predominantemente dentoalveolares. A morfologia singular do paciente com fissura labiopalatina causada por deficiências ósseas no palato e pela presença de mucosa palatina mais espessa exige uma avaliação única para cada paciente. Mais estudos são necessários com o objetivo de detectar singularidades em tecido mole e ósseo, encontrando sítios com suporte suficiente para efeito ortopédico e menores efeitos colaterais. (AU)

Rapid maxillary expansion (RME) is a therapeutic procedure often required in patients with complete cleft lip and palate for correction of the upper dental arch constriction, posterior crossbite and maxillary segments misalignments. When the orthopedic therapeutic window is lost and late rehabilitation procedures are performed with advanced bone maturation stage, surgically assisted maxillary expansion may be indicated. However, with the advent of Miniscrew Assisted Rapid Palatal Expansion (MARPE), orthopedic RME has become an option in adult patients without cleft lip and palate. The aim of this study was to develop an expander device with skeletal anchor for patients with cleft lip and palate. Secondarily, it also aimed to describe a case report of an adult patient with complete unilateral cleft lip and palate not treated orthodontically previously. The female, 24 years old patient, presented severe Class III malocclusion with posterior and anterior crossbite. RME skeletally anchored was performed using a Hyrax expander anchored in 2 bands on the first molars and 4 mini-implants on the palatine bone distant from the cleft palate. As there was not enough skeletal anchorage, the results obtained were predominantly dentoalveolar. The singular morphology of the patient with cleft lip and palate caused by palate bone deficiencies and the presence of thicker palatal mucosa requires a unique assessment for each patient. More studies are needed to detect soft and bone tissue singularities, finding sites with sufficient support for orthopedic effect and minor side effects.(AU)

Cephalometric evaluation of rapid and slow maxillary expansion in patients with BCLP: Secondary data analysis from a randomized clinical trial.

OBJECTIVE: To compare the dentoskeletal effects of rapid (RME) and slow (SME) maxillary expansion in patients with bilateral complete cleft lip and palate (BCLP). MATERIALS AND METHODS: This was a secondary analysis of a previous randomized controlled trial (RCT). Forty-six patients (34 male, 12 female) with BCLP and posterior crossbite (mean age of 9.2 years) were randomly assigned to two study groups. Group RME comprised subjects treated with Haas/Hyrax expander. Group SME included patients treated with quad-helix appliance. Cone-beam computed tomography (CBCT) was performed before expansion (T1) and after appliance removal at the end of a 6-month retention period (T2) for a previous RCT that compared the transverse skeletal effects of RME and SME. CBCT-derived cephalometric images were generated and cephalometric analysis was performed using Dolphin Imaging Software (Chatsworth, Calif). Intergroup comparisons were performed using t tests (P < .05). RESULTS: Baseline forms were similar between groups. No significant differences between RME and SME groups were found. CONCLUSIONS: Rapid and slow maxillary expansion produced similar sagittal and vertical changes in patients with BCLP. Both Haas/Hyrax and quad-helix appliances can be used in patients with vertical facial pattern. Clinical relevance: RME and SME can be equally indicated in the treatment of maxillary arch constriction in patients with BCLP.