Tooth movement with dental anchorage vs. skeletal anchorage: A systematic review of clinical trials.

The aim of this study is to compare the time and movement of orthodontic treatment using dental anchorage and skeletal anchorage in adolescent and adult patients with dental malocclusions. A systematic search was conducted in the Embase, PubMed, Lilacs, Cochrane, Trip, and Scopus databases up to October 2022. All the articles were selected using title and abstract, applying the inclusion and exclusion criteria. Disagreements were resolved with a third author. Finally, a full-text selection took place. The data extraction was conducted by two authors who independently evaluated the risk of bias. The methodological quality of the randomized clinical trials was evaluated using the Cochrane tool for the evaluation of the randomized clinical trials. Six articles were included in the data analysis. There were four clinical trials and two randomized clinical trials. A total of 176 patients was obtained with an age range between 14 and 46 years. Four studies showed significant differences when comparing the two anchorages in retraction or distalization of tooth groups, and two showed no differences when using dental and skeletal anchorage for vertical movements; only the articles with vertical movements showed relapse. We can conclude that skeletal anchorage generates precise and stable horizontal movements without overloading or changing the position of the molar. Future studies must incorporate three-dimensional technology for greater clinical accuracy.

Protocolo BAMP: Reporte de Caso Clínico

El presente reporte tiene como objetivo presentar de manera secuencial y visual la protracción maxilar de un paciente clase III esqueletal, utilizando el protocolo BAMP. Una vez realizado el análisis clínico del caso se decidió realiza un tratamiento ortopédico a través del uso de miniplacas de titanio con elásticos intermaxilares de clase III siguiendo el protocolo BAMP, junto a un tratamiento ortodóncico dento alveolar con aparatología fija bimaxilar prescripción Roth 0.22" Mini sprint forestadent. Se observa el éxito del enfoque interceptivo utilizando el protocolo BAMP. Este enfoque logró reducir tanto el tiempo como la complejidad del tratamiento ortodóncico, y también disminuyó la necesidad de someterse a una cirugía ortognática en la edad adulta. El tratamiento BAMP, diseñado para ciertas edades y crecimiento, se demostró exitoso en un paciente de 12 años sin potencial de crecimiento. Las miniplacas como anclaje son efectivas para protracción maxilar en varios casos, aunque se necesita seguimiento y educación postquirúrgica. Se recomienda retirar las miniplacas cuando no sean necesarias, adaptando el protocolo a cada paciente. En resumen, el tratamiento con miniplacas es eficaz para corregir anomalías Clase III esqueléticas.

The present report aims to sequentially and visually present the maxillary protraction of a Class III skeletal patient using the BAMP protocol. After conducting a clinical analysis of the case, it was decided to perform orthopedic treatment using titanium miniplates with Class III intermaxillary elastics following the BAMP protocol, in conjunction with dentoalveolar orthodontic treatment using fixed bimaxillary appliances with Roth prescription 0.022" Mini Sprint Forestadent. The success of the interceptive approach using the BAMP protocol is observed. This approach managed to reduce both the time and complexity of orthodontic treatment and also decreased the need for orthognathic surgery in adulthood. The BAMP treatment, designed for specific ages and growth stages, proved successful in a 12-year-old patient without growth potential. Miniplates as anchorage are effective for maxillary protraction in various cases, although post-surgical follow-up and education are required. It is recommended to remove the miniplates when they are no longer necessary, adapting the protocol to each patient. In summary, miniplate treatment is effective in correcting Class III skeletal anomalies.

Miniplaca palatina versátil: um leque de possibilidades / Versatile mini palatal plate: a range of possibilities

O palato é uma região considerada ideal para a inserção de dispositivos de ancoragem temporária (DAT's). É conhecido por possuir áreas com boa quantidade e qualidade óssea, longe das raízes dos dentes, com uma gengiva de boa qualidade, e dispor de um fácil acesso para uma correta instalação. O objetivo desse artigo é apresentar uma miniplaca palatina com mecânica originada na Coréia do Sul (BOS ­ Biocreative Orthodontic Strategy) como uma alternativa de ancoragem esquelética, por meio de um caso clínico e a demonstração de um passo a passo de sua instalação. Ela se mostra muito útil e eficiente em casos de distalização de molares superiores, mesialização ou intrusão dos mesmos. Por esta versatilidade, aqui no Brasil esta miniplaca recebe o nome de miniplaca palatina versátil (MPV). A MPV representa uma alternativa bastante eficaz em casos onde é necessário ancoragem esquelética sem incisão, se destacando em pontos como: simplicidade de instalação; estética; controle biomecânico; versatilidade e valor acessível. (AU)

The palate is a region considered ideal for the insertion of temporary anchorage devices (DAT's). It is known for having areas with good bone quantity and quality, away from the roots of the teeth, with good quality gums, and having easy access for correct installation. The objective of this article is to present a mini palatal plate with mechanics originated in South Korea (BOS ­ Biocreative Orthodontic Strategy) as an alternative for skeletal anchorage, through a clinical case and a step-by-step and the installation procedure. It proves to be very useful and efficient in cases of maxillary molar distalization, mesialization or intrusion of the same. Due to this versatility, here in Brazil this miniplate is called versatile mini-palatal plate (MPV). The MPV represents a very effective alternative in cases where skeletal anchorage without incision is required, standing out in points such as: simplicity of installation; aesthetics; biomechanical control; versatility and affordable value (AU)

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results

ABSTRACT Introduction: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. Objective: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. Conclusion: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

RESUMO Introdução: A má oclusão de Classe III deve ser interceptada e tratada em idade precoce, a fim de evitar uma futura necessidade de procedimentos complexos e invasivos. O tratamento com máscara facial ortopédica tem o objetivo de obter alterações esqueléticas, minimizando os efeitos colaterais na dentição. O uso de ancoragem óssea em mini-implantes, associada ao protocolo Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) pode ser eficaz no tratamento de um grande número de pacientes Classe III em crescimento. Objetivo: Realizar uma síntese da literatura baseada em evidência sobre o tratamento da má oclusão de Classe III em pacientes adultos jovens, e ilustrar sua aplicação e eficácia por meio do relato de um caso emblemático. Conclusão: A resolução e o acompanhamento em longo prazo do caso apresentado, juntamente com estudos conduzidos em uma amostra maior, demonstram a eficácia da combinação estratégica dos tratamentos ortopédico e ortodôntico usando um expansor palatal híbrido e o protocolo Alt-RAMEC para corrigir a má oclusão de Classe III em pacientes adultos.

Assessment of influence of facemask treatment with skeletal anchorage on the temporomandibular joint using magnetic resonance imaging: a preliminary study

ABSTRACT Objective: The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. Methods: Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. Results: After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. Conclusion: Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.

RESUMO Objetivo: O objetivo desse estudo foi investigar a influência do tratamento com máscara facial com ancoragem esquelética na articulação temporomandibular (ATM), por meio de ressonância magnética (RM), em pacientes com má oclusão de Classe III acompanhada de retrusão maxilar. Métodos: Quinze pacientes com idade média de 12,1±1,43 anos foram incluídos no estudo. Todos os pacientes foram tratados com máscara facial com ancoragem esquelética após oito semanas de protocolo de Expansão Rápida da Maxila e Constrição Alternadas (Alt-RAMEC). Os exames de ressonância magnética foram realizados antes e imediatamente após o tratamento com máscara facial, para avaliação da ATM. Foram avaliados posição do disco, translação condilar, alterações degenerativas dos côndilos e derrame articular. Os testes de McNemar e de homogeneidade marginal foram utilizados para avaliar se as alterações associadas ao tratamento foram estatisticamente significativas. Resultados: Após o tratamento com máscara facial, uma mudança estatisticamente significativa foi observada na posição do disco (deslocamento anterior do disco com/sem redução em cinco ATMs) (p<0,05). A alteração na translação condilar não foi estatisticamente significativa (p>0,05). Esse tratamento não causou alterações degenerativas dos côndilos ou derrame em qualquer das ATMs. Conclusão: O tratamento com máscara facial com ancoragem esquelética ápós o protocolo Alt-RAMEC teve uma influência mínima na ATM, apenas quanto à posição do disco, que não foi desprezível. Resultados em longo prazo desse tratamento são necessários para acompanhar as mudanças observadas nas ATMs.

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.

Miniscrew insertion sites of infrazygomatic crest and mandibular buccal shelf in different vertical craniofacial patterns: A cone-beam computed tomography study.

OBJECTIVE: To identify optimal areas for the insertion of extra-alveolar miniscrews into the infrazygomatic crest (IZC) and mandibular buccal shelf (MBS), using cone beam computed tomography (CBCT) imaging in patients with different craniofacial patterns. METHODS: CBCT reconstructions of untreated individuals were used to evaluate the IZC and MBS areas. The participants were divided into three groups, based on the craniofacial pattern, namely, brachyfacial (n = 15; mean age, 23.3 years), mesofacial (n = 15; mean age, 19.24 years), and dolichofacial (n = 15; mean age, 17.79 years). In the IZC, the evaluated areas were at 11, 13, and 15 mm above the buccal cusp tips of the right and left first molars. In the MBS, the evaluated areas were at the projections of the first molars' distal roots and second molars' mesial and distal roots, at a 4- and 8-mm distance from the cementoenamel junction. Intergroup comparisons were performed with analysis of variance and the Tukey test. RESULTS: There was no statistically significant difference in the IZC bone thickness among the groups. For MBS bone availability, some comparisons revealed no difference; meanwhile, other comparisons revealed increased MBS bone thickness in the brachyfacial (first molars distal roots) and dolichofacial (second molars mesial and distal roots) patterns. CONCLUSIONS: There was no significant difference in the IZC bone thickness among the groups. The facial skeletal pattern may affect the availability of ideal bone thickness for the insertion of extra-alveolar miniscrews in the MBS region; however, this variability is unlikely to be clinically meaningful.

Influence of the growth pattern on cortical bone thickness and mini-implant stability

ABSTRACT Introduction: Controversial reports suggest a relationship between growth pattern and cortical alveolar bone thickness, and its effect in the use of mini-implants. Objective: The main purpose of this study was to assess the influence of the growth pattern on the cortical alveolar bone thickness and on the stability and success rate of mini-implants. Methods: Fifty-six mini-implants were inserted in the buccal region of the maxilla of 30 patients. These patients were allocated into two groups, based on their growth pattern (horizontal group [HG] and vertical group [VG]). Cortical thickness was measured using Cone Beam Computed Tomography. Stability of mini-implants, soft tissue in the insertion site, sensitivity during loading and plaque around the mini-implants were evaluated once a month. Intergroup comparisons were performed using t tests, Mann-Whitney tests, and Fisher exact tests. Correlations were evaluated with Pearson's correlation coefficient. Results: The cortical bone thickness was significantly greater in the HG at the maxillary labial anterior region and at the mandibular buccal posterior and labial anterior regions. There was a significant negative correlation between Frankfort-mandibular plane angle (FMA) and the labial cortical thickness of the maxilla, and with the labial and lingual cortical bone thicknesses of the mandible. No significant intergroup difference was found for mini-implant mobility and success rate. No associated factor influenced stability of the mini-implants. Conclusions: Growth pattern affects the alveolar bone cortical thickness in specific areas of the maxilla and mandible, with horizontal patients presenting greater cortical bone thickness. However, this fact may have no influence on the stability and success rate of mini-implants in the maxillary buccal posterior region.

RESUMO Introdução: Relatos controversos sugerem uma relação entre o padrão de crescimento e a espessura do osso alveolar cortical e seu efeito no uso de mini-implantes. Objetivo: Avaliar a influência do padrão de crescimento na espessura do osso cortical alveolar e na estabilidade e taxa de sucesso dos mini-implantes. Métodos: Cinquenta e seis mini-implantes foram inseridos na região vestibular da maxila de trinta pacientes. Esses pacientes foram alocados em dois grupos, com base em seu padrão de crescimento (grupo horizontal [GH] e grupo vertical [GV]). As espessuras corticais foram medidas por meio de tomografias computadorizadas de feixe cônico. A estabilidade dos mini-implantes, tecido mole no local de inserção, sensibilidade durante a carga e o acúmulo de placa ao redor dos mini-implantes foram avaliados uma vez por mês. As comparações intergrupos foram realizadas por testes t de Student, testes de Mann-Whitney e testes exatos de Fisher. As correlações foram avaliadas com o coeficiente de correlação de Pearson. Resultados: A espessura do osso cortical foi significativamente maior no GH na região vestibular anterior da maxila e nas regiões vestibulares posterior e anterior da mandíbula. Houve uma correlação negativa significativa entre o ângulo do plano mandibular (FMA) e a espessura da cortical vestibular da maxila, e com a espessura das corticais vestibular e lingual da mandíbula. Nenhuma diferença significativa entre os grupos foi encontrada com relação à mobilidade do mini-implante e taxa de sucesso. Nenhum fator associado influenciou a estabilidade dos mini-implantes. Conclusões: O padrão de crescimento afeta a espessura da cortical óssea alveolar em áreas específicas da maxila e mandíbula, com pacientes horizontais apresentando maior espessura da cortical óssea. No entanto, esse fato pode não ter influência na estabilidade e na taxa de sucesso dos mini-implantes na região vestibular posterior da maxila.

Stability of anterior open bite treatment with molar intrusion using skeletal anchorage: a systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review and meta-analysis is to assess the degree of stability of anterior open bite (AOB) treatment performed through the molar intrusion supported with skeletal anchorage at least 1 year posttreatment. METHODS: This study was registered in PROSPERO (CRD42016037513). A literature search was conducted to identify randomized (RCT) or non-randomized clinical trials based including those considering before and after design. Data sources were electronic databases including PubMed, Cochrane Library, Science Direct, Google Scholar, Scopus, Lilacs, OpenGrey, Web of Science, and ClinicalTrials.gov . The quality of evidence was assessed through the JBI tool and certainty of evidence was evaluated through the GRADE tool. Random effects meta-analysis was conducted when appropriate. RESULTS: Six hundred twenty-four articles met the initial inclusion criteria. From these, only 6 remained. The mean posttreatment follow-up time was 2.5 years (SD = 1.04). The overbite showed a standardized mean relapse of - 1.23 mm (95% CI - 1.64, - 0.81, p < 0.0001). Maxillary and mandibular incisors presented a non-significant mean relapse, U1-PP - 0.04 mm (95% CI - 0.55, 0.48) and L1-MP - 0.10 mm (95% CI - 0.57, 0.37). Molar intrusion showed a relapse rate around 12% for the maxillary molars and a 27.2% for mandibular molars. CONCLUSION: The stability of AOB through molar intrusion using TADs can be considered relatively similar to that reported to surgical approaches, since 10 to 30% of relapse occurs both in maxillary and mandibular molars. The level of certainty ranged between very low and low. RCTs reporting dropout during the follow-up are in dire need.

Una Descripción General y Actualizada de Miniplacas y Minitornillos. Efectos Dentoalveolares y Esqueléticos / A General and Updated Description of Miniplates and Miniscrews. Dentoalveolar and Skeletal Effects

RESUMEN: En ortodoncia, las miniplacas se utilizan como dispositivo de anclaje temporal (TAD) para la realización de movimientos dentales que permiten el uso de fuerzas ortopédicas en ellos. En comparación con los mini tornillos, las miniplacas tienen la ventaja de una tasa de falla muy baja, pero la desventaja es que para la extracción se necesita el mismo acto quirúrgico que se realizó para la instalación. El objetivo de este estudio es realizar una revisión bibliográfica de las indicaciones de miniplacas en pacientes con mordidas abiertas, clase II y anomalías de clase III, y buscar cómo las miniplacas han mejorado los tratamientos de ortodoncia. La información principal se reunió buscando en PubMed con las palabras clave enumeradas a continuación. Afirmamos que las miniplacas están indicadas para la retracción en masa de la arcada, donde se observó que la fuerza de 150 g aplicada en los molares superiores es suficiente no solo para empujar los molares hacia atrás en una clase I corregida, sino también para iniciar la retracción de premolares, caninos e incisivos. En pacientes con mordida abierta, las miniplacas se definen como un método seguro, una alternativa rápida y menos costosa a la cirugía ortognática. Y en pacientes de las clases II y III se utilizan sin producir efectos dentoalveolares que sustituyan a los dispositivos extraorales como máscaras, con dispositivos intraorales y elásticos (BAMP).

ABSTRACT: In orthodontics, miniplates are used as a Temporary Anchoring Device (TAD) for the purpose dental movements, allowing the use of orthopedic forces. In comparison with mini-screws, miniplates have the advantage of a very low rate of failure. Nonetheless, their removal requires the same surgical procedure as during installation, which is an obvious disadvantage. The aim of this study is to review the indications of miniplates in patients with open bite, class II and class III anomalies, and review how miniplates improved orthodontics treatments. Information was obtained by a search in PubMed with the keywords listed below. Miniplates are indicated for retraction in mass of the arcade, where it was seen that the force of 150 g applied on maxillary molars, is sufficient not only to push the molars back into a corrected class I, but also to initiate retraction of premolars, canines, and incisors. In open-bite patients, mini plates, are achieved as a safe method, that is quick and a less expensive alternative to orthognathic surgery. Further, in class II and III patients they are used without producing dentoalveolar effects replacing extraoral devices as facemasks, with intraoral devices and elastics. (BAMP).

Management of skeletal Class III with facial asymmetry using skeletal anchorage: 4-year follow-up

ABSTRACT Introduction: Skeletal Class III malocclusion with asymmetry is one of the most difficult problems to correct in orthodontics. A functional shift of the mandible in growing patients may occur accompanying a Class III, due to constricted maxillary arch and occlusal interferences. Studies have indicated that posterior unilateral crossbite develops early and has a low rate of spontaneous correction. It may further lead to development of mandibular and facial asymmetry by growth and displacement of mandible if left untreated in growing patients. Objective: This article reports the clinical case of a thirteen-year-old female patient in CVMI transition stage that had maxillary hypoplasia with a developing facial asymmetry. Results: The case was successfully managed with bone-anchored facemask therapy and with elimination of occlusal interferences with guided occlusion. Reverse twin block in the retention phase maintained the results achieved. Conclusion: A four-year follow-up evaluation revealed successful maintenance of the treatment results.

RESUMO Introdução: A má oclusão de Classe III esquelética com assimetria é um dos problemas mais difíceis de se corrigir na Ortodontia. O desvio funcional da mandíbula em pacientes em fase de crescimento pode ocorrer acompanhado da Classe III, devido à atresia maxilar e interferências oclusais. Estudos têm indicado que a mordida cruzada posterior unilateral se desenvolve precocemente e apresenta baixo índice de correção espontânea. Isso pode levar ao desenvolvimento de assimetria mandibular e facial, resultante do crescimento e deslocamento da mandíbula, caso os pacientes não sejam tratados na fase de crescimento. Objetivo: O presente artigo relata o caso clínico de uma paciente com treze anos de idade, com IMVC em estágio de transição e que apresentava hipoplasia maxilar com assimetria facial em desenvolvimento. Resultados: O caso foi tratado com sucesso por meio de terapia com máscara facial osseossuportada, eliminando as interferências oclusais por meio de uma oclusão guiada. O uso do aparelho Twin-block reverso como contenção preservou os resultados atingidos. Conclusão: O acompanhamento após quatro anos confirmou a manutenção dos resultados do tratamento.

Tratamento de má oclusão Classe II com a técnica 3dbot (Ortodontia fixa tridimensional sem bráquetes e ancoragem esquelética) / Class II malocclusion treatment with 3dbot (threedimensional fixed Orthodontic technique without brackets and skeletal anchorage)

A técnica 3DBOT (Tratamento Tridimensional Ortodôntico sem Bráquetes) recebe esse nome por realizar movimentos nas 3 dimensões do espaço sem a utilização dos bráquetes e com o auxílio da tecnologia por meio de set up 3D. Essa técnica contempla vantagens como controle absoluto da protrusão / lingualização, controle da forma do arco e da expansão planejada, controle dos movimentos verticais e anteroposteriores estabelecidos. Ela é imperceptível e confortável, além de ser uma técnica de arco contínuo, autoligada e que permite deslize, quando necessário. O objetivo deste trabalho é relatar um caso clínico de Classe II subdivisão, utilizando a técnica 3DBOT com ancoragem esquelética. A combinação do uso da Placa Versátil de Ancoragem Esquelética no palato e técnica 3DBOT mostrou ser uma opção viável para tratamento de má oclusão Classe II. (AU)

The 3DBOT technique (Three-Dimensional Orthodontic Treatment without Brackets) receives this name for performing movements in the 3 dimensions of the space without the use of brackets and with the help of technology through 3D set up. This technique includes advantages such as absolute control of protrusion / retrusion, control of the arch shape and the planned expansion, control of established vertical and anteroposterior movements. It is imperceptible and comfortable, in addition it is a straight and self-ligating technique that allows sliding when necessary. The objective of this work is to report a clinical case of Class II subdivision, using the 3DBOT technique with skeletal anchorage. The combination of the Versatile Skeletal Anchorage Plate on the palate and the 3DBOT technique proved to be a viable option for Class II malocclusion treatment. (AU)

Tratamento da Classe III com protração e retração em massa utilizando ancoragem esquelética / Treatment of Class III with mass Protection and retracting using skeletal anchorage

Resumo Introdução: Na busca do controle de ancoragem e da biomecânica ideal, surgem opções terapêuticas que associam ancoragem óssea e dispositivos biomecânicos. Os mini-implantes ortodônticos vieram constituir de maneira definitiva, um eficiente método de ancoragem, que são utilizados para otimização de resultados com mecânicas mais simples. O presente trabalho tem como objetivo apresentar um caso clínico de Classe III em paciente adulto tratado com o uso de uma Placa Versátil de Ancoragem Esquelética (PVAE) apoiada sobre mini-implantes instalados no palato e minimplantes instalados na região posterior da mandíbula. Resultados: Após 11 meses de tratamento, a mordida cruzada anterior foi completamente corrigida e um relacionamento molar e canino Classe I foi alcançado. Houve uma melhora significativa no perfil do paciente, mostram dose uma face harmoniosa e um perfil facial agradável. Conclusões: A combinação do uso da Placa Versátil de Ancoragem Esquelética no palato, mini-implantes na região posterior da mandíbula e da Ortodontia Lingual, para casos compensatórios de Classe III, mostrou ser uma opção viável. (AU)

Abstract Introduction: In the search for anchorage control and optimal biomechanics, therapeutic options arise that associate bone anchorage and biomechanical devices. The orthodontic mini-implants came to be a definitive method, an efficient anchoring method, which are used to optimize results with simpler mechanics. The present study aims to present a Class III clinical case in an adult patient treated with a Versatile Skeletal Anchoring Plate (PVAE) supported on mini-implants installed on the palate and minimplants installed in the posterior region of the mandible. Results: After 11 months of treatment, the anterior cross bite was completely corrected and a Class I molar and canine relationship was achieved. There was a significant improvement in the patient's profile, showing a harmonious face and a pleasant facial profile. Conclusions: The combination of the use of the Versatile Skeletal Anchoring Plate in the palate, mini-implants in the posterior mandible and Lingual Orthodontics, for Class III compensatory cases, was shown to be a viable option. (AU)

Tratamento compensatório paciente classe III esquelética vertical com técnica Buccal Shelf / Patient class III vertical skeletal compensatory treatment with buccal shelf technique

Resumo A má oclusão de Classe III é a relação dentária baseada na relação anteroposterior entre os primeiros molares, onde o indivíduo apresenta a cúspide mesio-vestibular do primeiro molar superior ocluindo no sulco mesio-vestibular do primeiro molar inferior. A compensação ortodôntica da má oclusão de Classe III, com mini-implantes, usada como ancoragem esquelética na mecânica ortodôntica vem revolucionando o tratamento Classe III esquelética. Optou-se por camuflagem ortodôntica com tratamento ortodôntico corretivo compensador, sendo utilizado aparelho fixo pela técnica Straight Wire (Capelozza III) e mecânica de distalização e verticalização de pré-molares mandibular com fio superior .019" x .025" de aço e inferior .020" de aço, através do Buccal Shelf, mini-implante de aço inserido na região retro molar entre primeiro e segundo molar inferior. Os apinhamentos foram satisfatoriamente corrigidos com um efetivo alinhamento e nivelamento dos arcos. Verticalmente, observou-se considerável alteração, pois houve correção da mordida aberta anterior por extrusão dos incisivos criando um adequado overbite e overjet. O uso de mini-implantes extra-radiculares adaptados na região de Buccal Shelf radicular como recurso de ancoragem mostrou-se eficaz no tratamento compensador da Classe III esquelética em paciente vertical (AU)

Abstract Class III malocclusion is the dental relationship, based on the anteroposterior relationship between the first molars, in which the individual presents the mesiovestibular cusp of the first maxillary molar occluding in the mesiovestibular groove of the first mandibular molar. Orthodontic compensation of Class III malocclusion with mini-implants used as skeletal anchorage in orthodontic mechanics has been revolutionizing the Class III skeletal treatment. Orthodontic camouflage with compensating corrective orthodontic treatment was chosen, using a fixed appliance in the Straight Wire technique (Capelozza III) and distalization and verticalization mechanics of mandibular premolars with a 19×25 upper steel wire and 20 lower steel wire through the Buccal Shelf, a mini steel implant inserted in the retromolar region between the first and second mandibular molars. Crowding was satisfactorily corrected with effective arches alignment and leveling. Vertically, a considerable change was observed, as there was correction of the anterior open bite by extrusion of the incisors creating an adequate overbite and overjet. The use of extra-radicular mini-implants adapted in the root Buccal Shelf region as an anchorage resource proved to be effective in the patient Class III vertical skeletal compensatory treatment (AU)

The Use of Mini-Plates for the Treatment of a High-Angle, Dual Bite, Class II Malocclusion.

To present a case report of an orthodontic treatment of a high-angle, dual bite, Class II malocclusion without extractions and with the use of mini-plates. Class II malocclusion treatment protocols vary according to the morphological component of the malocclusion and the magnitude and direction of craniofacial growth. It is generally agreed that the cooperation of the patient and careful planning of anchorage are the key determinants of successful treatment. Protrusion of the upper and lower lip and a retrognathic mandible were the patient's chief concerns. The patient had learned to project her mandible forward to disguise the overjet. The patient's parents elected to correct the malocclusion with the use of bilateral infrazygomatic mini-plates. Pre-treatment condylar stabilization with an orthotic established a stable centric relation position, followed by mounting of the models on a semi-adjustable Panadent articulator. This allowed diagnosis and treatment planning from a stable condylar position and eliminated possible misdiagnosis due to the dual bite. Distal retraction and vertical control of the upper teeth enabled correction of the Class II malocclusion with minimal patient cooperation. Mini-plate-assisted treatment corrected the excessive overbite and overjet. The patient completed treatment with a stable occlusion and no longer postured her jaw forward. The parents and patient were completely satisfied with the positive treatment outcome. A 2-year follow-up confirmed the clinical stability.

Occlusal plane canting: a treatment alternative using skeletal anchorage

ABSTRACT A canted occlusal plane is the cause of unaesthetic smile, and also represents a challenge, due to the complex orthodontic procedures involved in its treatment. The skeletal anchorage allows successful treatment of this asymmetry in the majority of cases, with less dependency on the patient cooperation and reducing the necessity of orthognatic surgery. Given this condition, this article aims at discussing the main aspects related to the diagnosis of occlusal plane canting, treatment plan, and orthodontic mechanics using skeletal anchorage either by mini-implants or miniplates. In this context, five cases will be reported, showing the main details related to the orthodontic mechanics used to correct the occlusal plane, avoiding side effects and successfully reaching treatment objectives and long-term stability.

RESUMO O plano oclusal inclinado é causa de um sorriso esteticamente desagradável e representa um desafio, devido à complexidade dos procedimentos ortodônticos envolvidos no seu tratamento. A ancoragem esquelética permite a correção da inclinação do plano oclusal, na maior parte dos casos, sem a necessidade de cirurgia ortognática e com menor dependência da colaboração dos pacientes. Com base nisso, o objetivo desse artigo é discutir os principais aspectos relacionados ao diagnóstico, plano de tratamento e mecânica ortodôntica envolvida no tratamento do plano oclusal inclinado com mini-implantes ou miniplacas. Nesse contexto, cinco casos serão apresentados, demonstrando os principais detalhes relacionados à mecânica utilizada na correção do plano oclusal inclinado com a utilização de ancoragem esquelética.

Tratamento precoce da Classe III esquelética com ancoragem absoluta ­ relato de caso / Skeletal Class III early treatment with absolute anchorage ­ case report

Diante da má oclusão de Classe III esquelética por deficiência da maxila, a protração maxilar, precedida ou não pela disjunção palatina, é o procedimento mais utilizado pelos ortodontistas. Entretanto promove compensações dentárias e está limitada a idades muito precoces. O presente artigo tem como objetivo demonstrar, por meio de relato de caso clínico, o tratamento da Classe III esquelética com ancoragem óssea, potencializando os resultados da protração e minimizando os efeitos dentários indesejáveis preconizados pelo protocolo Manhães. Esse tratamento foi utilizado em uma paciente antes do pico do surto de crescimento puberal e incluiu a expansão rápida da maxila, com Hyrax híbrido, associado a elásticos de Classe III sob uso de 24 horas/dia, ligados a um dispositivo suportado por dentes e mini-implantes (MI) e ancoragem mandibular implanto-suportada (Barra Manhães), além do uso da máscara facial noturna. Observou-se considerável avanço maxilar, melhor colaboração, ausência de compensações dentárias e efetivo custo-benefício ao paciente (AU)

Abstract In the presence of skeletal Class III malocclusion due to maxillary deficiency, maxillary protraction preceded or not by palatine disjunction is the procedure most frequently used by orthodontists. However, it promotes dental compensations and it is limited to very early ages. The present article aims to show, through a clinical case report, the treatment of skeletal Class III with bone anchorage, potentiating protraction results and minimizing the undesirable dental effects as recommended by Manhães. This protocol was used in one patient prior to pubertal growth spurt and included rapid maxillary expansion with Hyrax hybrid associated to Class III elastics used 24 hours/day attached to a supported device. by teeth and mini-implants (IM) and implant-supported mandibular anchorage (Barra Manhães) besides the use of nocturnal facial mask. Considerable maxillary advancement, better collaboration, absence of dental compensations and effective cost-benefit to the patient were observed. (AU)

Fracture strength of orthodontic mini-implants

ABSTRACT Objective: This study aimed at evaluating the design and dimensions of five different brands of orthodontic mini-implants, as well as their influence on torsional fracture strength. Methods: Fifty mini-implants were divided into five groups corresponding to different manufactures (DEN, RMO, CON, NEO, SIN). Twenty-five mini-implants were subjected to fracture test by torsion in the neck and the tip, through arbors attached to a Universal Mechanical Testing Machine. The other 25 mini-implants were subjected to insertion torque test into blocks of pork ribs using a torquimeter and contra-angle handpiece mounted in a surgical motor. The shape of the active tip of the mini-implants was evaluated under microscopy. The non-parametric Friedman test and Snedecor's F in analysis of variance (ANOVA) were used to evaluate the differences between groups. Results: The fracture torque of the neck ranged from 23.45 N.cm (DEN) to 34.82 N.cm (SIN), and of the tip ranged from 9.35 N.cm (CON) to 24.36 N.cm (NEO). Insertion torque values ranged from 6.6 N.cm (RMO) to 10.2 N.cm (NEO). The characteristics that most influenced the results were outer diameter, inner diameter, the ratio between internal and external diameters, and the existence of milling in the apical region of the mini-implant. Conclusions: The fracture torques were different for both the neck and the tip of the five types evaluated. NEO and SIN mini-implants showed the highest resistance to fracture of the neck and tip. The fracture torques of both tip and neck were higher than the torque required to insert mini-implants.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar o desenho e as medidas de cinco marcas diferentes de mini-implantes ortodônticos, e sua influência na resistência à fratura em torção. Métodos: cinquenta mini-implantes foram divididos em cinco grupos, correspondentes a diferentes fabricantes (DEN, Dentaurum; RMO, Rocky Mountain Orthodontics; CON, Conexão; NEO, Neodent; SIN, Sistema de Implantes Nacional). Vinte e cinco mini-implantes foram submetidos ao teste de fratura por torção no pescoço e na ponta, com mandris fixados a uma máquina universal de testes mecânicos. Os outros 25 mini-implantes foram submetidos ao teste de torque de inserção em blocos de costelas suínas, utilizando-se um torquímetro e um contra-ângulo montado em motor cirúrgico. O formato da ponta ativa dos mini-implantes foi avaliado por microscopia. O teste não-paramétrico de Friedman e o teste F de Snedecor na análise de variância (ANOVA) foram utilizados para avaliar as diferenças entre os grupos. Resultados: o torque de fratura do pescoço variou de 23,45 N.cm (DEN) a 34,82 N.cm (SIN); e o da ponta, entre 9,35 N.cm (CON) e 24,36 N.cm (NEO). O valor do torque de inserção variou de 6,6 N.cm (RMO) a 10,2 N.cm (NEO). As características que mais influenciaram os resultados foram: diâmetro externo, diâmetro interno, razão entre o diâmetro interno e o externo, e a presença de fresagem na região apical do mini-implante. Conclusões: os torques de fratura foram diferentes entre os cinco tipos avaliados, tanto no pescoço quanto na ponta. Os mini-implantes NEO e SIN foram os mais resistentes à fratura do pescoço e da ponta. Os torques de fratura tanto na ponta quanto no pescoço foram maiores do que o torque necessário para a inserção dos mini-implantes.

Microimplantes, una nueva opción en el tratamiento de Ortodoncia

Los microimplantes son pequeños pines de titanio o de aleación de titanio de 1,2 mm de diámetro y 6 mm de longitud. Están diseñados con una superficie suave para que no se oseointegren. Son utilizados en Ortodoncia como anclaje temporal. Han sido usados como anclaje esqueletal, también para distalizar y protraer molares, intruir molares e incisivos, para el cierre de espacios edéntulos extensos que con los métodos convencionales en ortodoncia habría sido imposible. Los microimplantes son removidos con relativa facilidad una vez efectuado el procedimiento. Como toda técnica nueva, es importante que los clínicos sepan elegir bien en qué casos van a utilizar los micro implantes y los sitios de su colocación.

The miniimplants are small devices of 1,2 mm of wide and 6 mm of length. Manufactured with a smooth machined surface that is not designed to osseointegrate. In orthodontics they are used as temporary anchorage for molar distalization, protraction and intrusion of molars and incisors. Also for closing wide edentulous spaces once considered impossible with conventional orthodontics.. The miniimplants are easily removed. As with any new technique clinicians should be aware in which cases use this devices and the sites of placing them.

Distalización de molares maxilares utilizando dispositivos de anclaje esqueletal directo en pacientes con maloclusiones Clase II. Revisión bibliográfica

Introducción: La relación molar de Clase II de Angle se encuentra aproximadamente en un 20% de la población. Cuando la maloclusión es de origen dentario, generada principalmente por una migración de los segmentos laterales, la opción de tratamiento más frecuente para generar espacio y establecer una relación molar de Clase I, es la distalización molar. Un gran número de aparatos y protocolos de tratamiento se han descrito en la literatura. Uno de los más utilizados es el Péndulo, pero debido a su diseño que utiliza anclaje dentario, y a que su fuerza pasa a nivel de la corona de los primeros molares, presenta muchas desventajas. Objetivo: El propósito de esta revisión es analizar los dispositivos de distalización molar que utilizan anclaje esqueletal directo, en los que la fuerza aplicada pasa cerca del centro de resistencia del primer molar superior, con el objetivo de determinar si son superiores en cuanto a eficiencia y minimización de los efectos adversos, cuando se compara con los aparatos convencionales. Resultado: De un total de 25 artículos seleccionados con base en el año de publicación y el empleo de anclaje esqueletal, se utilizaron 7 artículos para revisión, basados en criterios de inclusión y exclusión. Discusión: Al comparar los aparatos, se observa gran variabilidad en duración de tratamiento, cantidad y tasa de distalización. A pesar de estas diferencias todos mostraron éxito clínico el finalizar la mecánica de distalización. Por otra parte, existe una distalización espontánea de los segundos premolares superiores e incluso de los primeros premolares, pero con estos dispositivos que no utilizan estas piezas dentarias como anclaje y que, por lo tanto, quedan libres y son distalizados con la ayuda de las fibras transeptales. Conclusión: Se concluye que la distalización molar ha demostrado ser un procedimiento eficaz cuando se utilizan aparatos con anclaje esqueletal directo y con un vector de fuerza que pase cerca del centro de resistencia de los primeros molares. Estos métodos no generan efectos secundarios en la región de anclaje cuando se compara con aparatos convencionales, donde existen migración mesial de premolares y piezas anteriores. En todos los casos analizados los molares superiores se distalizaron a una relación de clase I en un corto período , incluso a pesar de la presencia de los segundos y terceros molares maxilares.

Introduction: The Angle Class II molar ratio is approximately 20% of the population. When malocclusion is of dental origin, mainly generated by a migration of lateral segments, the most frequent treatment option to generate space and to establish a Class I molar relationship is molar distalization. A large number of treatment devices and protocols have been described in the literature. One of the most used is the Pendulum, but because of its design that uses dental anchorage and its force happens at the level of the crown of the first molars, presents many disadvantages. Objective: The purpose of this review is to analyze molar distalization devices using direct skeletal anchors, in which the applied force passes near the center of resistance of the upper first molar, in order to determine if they are superior in efficiency and minimization of adverse effects when compared with conventional appliances. Results: The search process included a total of 25 articles selected based on year of publication and use of skeletal anchorage, 7 articles were finally used for review, based on inclusion and exclusion criteria. Discussion: When comparing the devices, there is great variability in duration of treatment, amount of distalization and rate of distalization. In spite of these differences all showed clinical success to finalize the mechanics of distalization. On the other hand, here is a spontaneous distalization of the second upper premolars and even the first premolars with these devices that do not use these dental pieces as an anchorage, therefore, they remain free and are distalized with the help of the transseptal fibers. Conclusion: It is concluded that molar distalization has proved to be an effective procedure when using devices with direct skeletal anchors and with a force vector passing close to the resistance center of the first molars. These methods do not generate side effects in the anchoring region when compared to conventional apparatus where there is mesial migration of premolars and anterior parts. In all the cases analyzed, the maxillary molars were distalized to a class I relationship in a short period of time, even in spite of the presence of the second and third maxillary molars.