Effects of SARPE and MISMARPE on correction of transverse maxillary deficiency: A preliminary comparative evaluation.

AIM: The present study was designed to compare, on cone-beam computed tomography imaging, the skeletal and dental effects of the SARPE (Surgically assisted rapid palatal expansion) and MISMARPE (Minimally Invasive Surgical and Miniscrew-Assisted Rapid Palatal Expansion) techniques. MATERIALS AND METHODS: The sample of adult patients with transverse maxillary deficiency (TMD) was divided into two groups, and scans were obtained preoperatively (T0) and immediately after completion of expansion (T1). The posterior and anterior linear transverse distances of the maxilla and the angulation of the maxillary first molars were evaluated. The data were entered into a generalized estimating equations model to verify the postoperative effects of the different techniques. RESULTS: None of the techniques caused any appreciable change in the angulation of the molars. The skeletal changes were similar, with significantly greater gains in the nasal fossa and intermaxillary distance when using the MISMARPE. CONCLUSION: The technique can be an effective and lower morbidity alternative to SARPE.

Conventional surgical-orthodontic approach with double-jaw surgery for a patient with a skeletal Class III malocclusion: Stability of results 10 years posttreatment.

This case report presents the treatment of a young man with a skeletal Class III malocclusion. He was treated with a conventional surgical-orthodontic approach in which 2 jaw surgeries were performed. The esthetic facial profile, pleasant smile, appropriate occlusion, and overall good treatment outcome remained stable 10 years after active orthodontic treatment.

Effect of surface treatment of prefabricated teeth on shear bond strength of orthodontic brackets.

OBJECTIVE:: The aim of this in vitro study was to evaluate and compare the effects of grinding, drilling, sandblasting, and ageing prefabricated teeth (PfT) on the shear bond strength (SBS) of orthodontic brackets, as well as the effects of surface treatments on the adhesive remnant index (ARI). METHODS:: One-hundred-ninety-two PfT were divided into four groups (n = 48): Group 1, no surface treatment was done; Group 2, grinding was performed with a cylindrical diamond bur; Group 3, two drillings were done with a spherical diamond bur; Group 4, sandblasting was performed with 50-µm aluminum oxide. Before the experiment, half of the samples stayed immersed in distilled water at 37oC for 90 days. Brackets were bonded with Transbond XT and shear strength tests were carried out using a universal testing machine. SBS were compared by surface treatment and by ageing with two-way ANOVA, followed by Tukey's test. ARI scores were compared between surface treatments with Kruskal-Wallis test followed by Dunn's test. RESULTS:: Surface treatments on PfT enhanced SBS of brackets (p< 0.01), result not observed with ageing (p= 0.45). Groups II, III, and IV showed higher SBS and greater ARI than the Group 1 (p< 0.05). SBS was greater in the groups 3 and 4 (drilling, sandblasting) than in the Group 2 (grinding) (p< 0.05). SBS and ARI showed a positive correlation (Spearman's R2= 0.57; p< 0.05). CONCLUSION:: Surface treatment on PfT enhanced SBS of brackets, however ageing did not show any relevance. Sandblasting and drilling showed greater SBS than grinding. There was a positive correlation between SBS and ARI.

Effect of surface treatment of prefabricated teeth on shear bond strength of orthodontic brackets

ABSTRACT Objective: The aim of this in vitro study was to evaluate and compare the effects of grinding, drilling, sandblasting, and ageing prefabricated teeth (PfT) on the shear bond strength (SBS) of orthodontic brackets, as well as the effects of surface treatments on the adhesive remnant index (ARI). Methods: One-hundred-ninety-two PfT were divided into four groups (n = 48): Group 1, no surface treatment was done; Group 2, grinding was performed with a cylindrical diamond bur; Group 3, two drillings were done with a spherical diamond bur; Group 4, sandblasting was performed with 50-µm aluminum oxide. Before the experiment, half of the samples stayed immersed in distilled water at 37oC for 90 days. Brackets were bonded with Transbond XT and shear strength tests were carried out using a universal testing machine. SBS were compared by surface treatment and by ageing with two-way ANOVA, followed by Tukey's test. ARI scores were compared between surface treatments with Kruskal-Wallis test followed by Dunn's test. Results: Surface treatments on PfT enhanced SBS of brackets (p< 0.01), result not observed with ageing (p= 0.45). Groups II, III, and IV showed higher SBS and greater ARI than the Group 1 (p< 0.05). SBS was greater in the groups 3 and 4 (drilling, sandblasting) than in the Group 2 (grinding) (p< 0.05). SBS and ARI showed a positive correlation (Spearman's R2= 0.57; p< 0.05). Conclusion: Surface treatment on PfT enhanced SBS of brackets, however ageing did not show any relevance. Sandblasting and drilling showed greater SBS than grinding. There was a positive correlation between SBS and ARI.

RESUMO Objetivo: o objetivo desse estudo in vitro foi avaliar e comparar os efeitos de desgastes, perfurações, jateamento e envelhecimento de dentes pré-fabricados (Dpf) na resistência ao cisalhamento (RC) de braquetes ortodônticos, bem como os efeitos dos tratamentos de superfície no índice de adesivo remanescente (ARI). Métodos: 192 Dpf foram divididos em quatro grupos (n = 48): Grupo 1, sem tratamento; Grupo 2, desgaste de sulcos com broca diamantada cilíndrica; Grupo 3, duas perfurações com broca diamantada esférica; e Grupo 4, jateamento com partículas de óxido de alumínio de 50µm. Antes do experimento, metade das amostras ficou imersa em água destilada a 37oC durante 90 dias. Os braquetes foram colados com Transbond XT e os testes de cisalhamento foram realizados com uma máquina universal de ensaios. A RC foi comparada, por tratamento de superfície e por envelhecimento, utilizando-se análise de variância e teste de Tukey. Os escores ARI foram comparados entre os tratamentos de superfície usando o teste Kruskal-Wallis e o teste de Dunn. Resultados: os tratamentos de superfície aumentaram a RC dos braquetes (p < 0,01) e o envelhecimento não aumentou a RC (p = 0,45). Os Grupos 2, 3 e 4 mostraram maior RC e maior ARI do que o Grupo 1 (p < 0,05). A RC foi maior nos Grupos 3 e 4 (perfuração, jateamento) do que no Grupo 2 (desgaste) (p < 0,05). RC e ARI apresentaram correlação positiva (R2 = 0,57; p < 0,05). Conclusão: o tratamento de superfície dos Dpf aumentou a RC dos braquetes; porém, o envelhecimento não foi relevante. O jateamento e a perfuração mostraram maior RC do que o desgaste. Existe uma correlação positiva entre RC e ARI.

Crown and Root Lengths of Impacted Maxillary Central Incisors and Contralateral Teeth Evaluated with Cone Beam Computed Tomography

Objective: To assess and compare the crown and root lengths of impacted maxillary central incisors with contralateral teeth, using cone-beam computed tomography (CBCT). Material and Methods: Sample comprised twenty-six patients (15 males, 11 females), ranging from seven to 14 years old, with unilateral impaction of maxillary central incisors. Landmarks demarcation was performed (I) at the root apex, (II) at the incisal edge, and (III) at the midpoint between the buccal and lingual cementoenamel junction (CEJ). Linear measures were taken alongside teeth long axis, with the aid of the software tools. Crown length was considered the distance between the incisal edge and CEJ; and root length was the distance between CEJ and the root apex. Crown and root length measures were obtained in cone beam computed tomography images using the In Vivo® Software. Measurements were compared between the impacted maxillary central incisors and contralateral teeth using paired t-test. Results: Crown and root lengths were statistically shorter (0.56 mm and 3.22 mm, respectively) in the impacted maxillary central incisors when compared to their contralateral teeth (p<0.001). This trend with regard the root length was observed in 25 out of 26 subjects, as well as in 21 subjects with regard the crown length. Conclusion: Decision-making process on the treatment plan for impacted maxillary central incisors must consider that these teeth have in average the crown lengths five per cent shorter and the root lengths 25 per cent shorter than their contralateral teeth.

Eruption rates of lower second premolars at different development stages evaluated with cone-beam computed tomography.

OBJECTIVE: To evaluate and compare the eruption rates of lower second premolars (LPm2) at different developmental stages using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Retrospectively, 31 individuals (9.77 ± 1.25 years) had their LPm2 scored according to the Demirjian method, and afterwards they were split into three groups according to developmental stage, as follows: D = complete-formed crowns; E = root length less than crown height; and F = root length greater than or equal to crown height. Linear distances from the LPm2 crown tip to the anatomical reference line (ARL) and to the occlusal plane line (OPL) were measured in paired CBCT scans (T1, T2), taken with an average interval of 8.6 months between them. Eruption rates (mm/y) were calculated and then compared between groups. RESULTS: Eruption rates were greater for LPm2 at stage F than at stages D or E (P < .01) regardless of whether they were measured from the ARL (D = 2.84 mm/y; E = 2.55 mm/y; F = 5.38 mm/y) or from the OPL (D = 1.82 mm/y; E = 2.02 mm/y; F = 5.26 mm/y). Eruption rates evaluated from the ARL and the OPL had no statistically significant differences (P = .052), and a positive correlation (r = .79, P < .001) between them was observed. CONCLUSIONS: LPm2 at Demirjian stage F showed greater eruption rates than at stages D or E, regardless of whether rates were measured from the ARL or the OPL. Faster eruption is expected for LPm2 at stage F. Evaluation of the LPm2's developmental stage using CBCT can aid in clinical decision making regarding the correct timing for intervention.

Transdisciplinary treatment of Class III malocclusion using conventional implant-supported anchorage: 10-year posttreatment follow-up.

INTRODUCTION: Combined treatment offers advantages for partially edentulous patients. Conventional implants, used as orthodontic anchorage, enable previous orthodontic movement, which provides appropriate space gain for crown insertion. OBJECTIVE: This case report describes the treatment of a 61-year and 10-month-old patient with negative overjet which made ideal prosthetic rehabilitation impossible, thereby hindering dental and facial esthetics. CASE REPORT: After a diagnostic setup, conventional implants were placed in the upper arch to anchor intrusion and retract anterior teeth. Space gain for lateral incisors was achieved in the lower arch by means of an orthodontic appliance. CONCLUSIONS: Integrated planning combining Orthodontics and Implantology provided successful treatment by means of conventional implant-supported anchorage. The resulting occlusal relationship proved stable after 10 years.

Transdisciplinary treatment of Class III malocclusion using conventional implant-supported anchorage: 10-year posttreatment follow-up

INTRODUCTION: Combined treatment offers advantages for partially edentulous patients. Conventional implants, used as orthodontic anchorage, enable previous orthodontic movement, which provides appropriate space gain for crown insertion. OBJECTIVE: This case report describes the treatment of a 61-year and 10-month-old patient with negative overjet which made ideal prosthetic rehabilitation impossible, thereby hindering dental and facial esthetics. CASE REPORT: After a diagnostic setup, conventional implants were placed in the upper arch to anchor intrusion and retract anterior teeth. Space gain for lateral incisors was achieved in the lower arch by means of an orthodontic appliance. CONCLUSIONS: Integrated planning combining Orthodontics and Implantology provided successful treatment by means of conventional implant-supported anchorage. The resulting occlusal relationship proved stable after 10 years. .

INTRODUÇÃO: tratamentos combinados podem oferecer vantagens em casos de edentulismo parcial. O uso de implantes convencionais como ancoragem ortodôntica permite a movimentação ortodôntica prévia, fornecendo os espaços apropriados para inserção das coroas. OBJETIVO: este relato de caso descreve o tratamento de uma paciente, com 61 anos e 10 meses de idade, que possuía um overjet negativo que tornava impossível uma reabilitação protética ideal, comprometendo a estética dentária e facial. RELATO DO CASO: após um setup diagnóstico, os implantes convencionais foram colocados na mandíbula para ancorar a intrusão e retração dos dentes anteriores. Espaços para os incisivos laterais foram abertos na maxila, usando-se aparelho ortodôntico. CONCLUSÕES: o planejamento integrado entre Ortodontia e Implantodontia propiciou um tratamento bem-sucedido, usando implantes convencionais como ancoragem. A relação oclusal obtida apresenta estabilidade 10 anos pós-tratamento. .

Sagittal changes in lower incisors by the use of lingual arch.

OBJECTIVE: The objective of this study was to evaluate a sagittal variation on the lower incisors with the use of the lingual arch on the transition from mixed to permanent dentition. METHODS: The sample was constituted of 44 Caucasian patients (26 girls and 18 boys), divided in two groups: CG, control group, monitoring the lower arch space with no orthodontic/orthopedic treatment during the rated period (n = 14); EG, experimental group, presenting anterior inferior mild crowding and installation of the lingual arch for space maintenance (n = 30). The position of the lower incisors was analyzed on computerized cephalometric tracings performed at the beginning of the monitoring (T1) and at the end, on the permanent dentition (T2). In order to evaluate the position of the incisors it was used Tweed and Steiner measurements: IMPA, 1.NB and 1-NB. The alterations were analyzed through the "t" test for paired samples, while the differences between the groups were analyzed through the "t" test for independent samples, as for sexual dimorphism. RESULTS: The values in T2 were greater in relation to T1 for all measurements on EG (IMPA, p = 0.038; 1.NB, p = 0.007 and 1-NB, p < 0.0001). On comparing the differences (T2-T1) between CG and EG, it can be gauged differences significantly superior for measure 1.NB (p = 0.002) and 1-NB (p < 0.0001) on EG. There was no statistically significant difference between genres. CONCLUSIONS: It was concluded that the lower incisors were projected after using the lingual arch to control the space on the transition from mixed to permanent dentition, however, within acceptable standards, not having difference between genres.

Orthodontically induced eruption of a horizontally impacted maxillary central incisor.

This case report presents the clinical features and periodontal findings in a patient with a horizontally impacted maxillary central incisor that had been exposed and aligned after a closed-eruption surgical technique. By combining 3 treatment stages-maxillary expansion, crown exposure surgery, and induced eruption-the horizontally impacted incisor was successfully moved into proper position. The patient finished treatment with a normal and stable occlusion between the maxillary and mandibular arches, and an adequate width of attached gingiva, even in the area surrounding the crown. The 5-year follow-up of stability and periodontal health demonstrated esthetic and functional outcomes after orthodontically induced tooth eruption. Clinical evaluation showed that the treated central incisor had periodontal clinical variables related to visible plaque, bleeding on probing, width of attached gingiva, and crown length that resembled the contralateral incisor.

Sagittal changes in lower incisors by the use of lingual arch

OBJECTIVE: The objective of this study was to evaluate a sagittal variation on the lower incisors with the use of the lingual arch on the transition from mixed to permanent dentition. METHODS: The sample was constituted of 44 Caucasian patients (26 girls and 18 boys), divided in two groups: CG, control group, monitoring the lower arch space with no orthodontic/orthopedic treatment during the rated period (n = 14); EG, experimental group, presenting anterior inferior mild crowding and installation of the lingual arch for space maintenance (n = 30). The position of the lower incisors was analyzed on computerized cephalometric tracings performed at the beginning of the monitoring (T1) and at the end, on the permanent dentition (T2). In order to evaluate the position of the incisors it was used Tweed and Steiner measurements: IMPA, 1.NB and 1-NB. The alterations were analyzed through the "t" test for paired samples, while the differences between the groups were analyzed through the "t" test for independent samples, as for sexual dimorphism. RESULTS: The values in T2 were greater in relation to T1 for all measurements on EG (IMPA, p = 0.038; 1.NB, p = 0.007 and 1-NB, p < 0.0001). On comparing the differences (T2-T1) between CG and EG, it can be gauged differences significantly superior for measure 1.NB (p = 0.002) and 1-NB (p < 0.0001) on EG. There was no statisticaly significant difference between genres. CONCLUSION: It was concluded that the lower incisors were projected after using the lingual arch to control the space on the transition from mixed to permanent dentition, however, within acceptable standards, not having difference between genres.

OBJETIVO: avaliar a alteração sagital ocorrida nos incisivos inferiores com o uso do arco lingual no período de transição da dentição mista para a permanente. MÉTODOS: a amostra foi composta por 44 pacientes leucodermas (26 meninas e 18 meninos), divididos em dois grupos: (GC) grupo controle, no qual foi efetuado monitoramento do espaço da arcada inferior, sem tratamento ortodôntico/ortopédico no período avaliado (n = 14); (GE) grupo experimental, presença de suave apinhamento anteroinferior e instalação do arco lingual para manutenção do espaço (n = 30). A posição dos incisivos inferiores foi analisada em traçados cefalométricos computadorizados realizados ao início (T1) e ao final do acompanhamento, já na dentição permanente (T2). Para avaliar a posição dos incisivos foram utilizadas as medidas das análises cefalométricas de Tweed e de Steiner: IMPA, 1.NB e 1-NB. As alterações ocorridas foram analisadas pelo teste t para amostras pareadas, enquanto as diferenças entre os grupos foram avaliadas pelo teste t para amostras independentes, bem como para o dimorfismo sexual. RESULTADOS: os valores em T2 foram maiores em relação a T1 para todas as medidas no GE (IMPA, p = 0,038; 1.NB, p = 0,007; e 1-NB, p < 0,0001). Na comparação das diferenças (T2-T1) entre o GC e GE pôde-se aferir diferenças significativamente superiores para as medidas 1.NB (p = 0,002) e 1-NB (p < 0,0001) no GE. Não houve diferença significativamente estatística entre os sexos. CONCLUSÃO: concluiu-se que os incisivos inferiores foram projetados após a utilização do arco lingual para o controle do espaço no período de transição da dentição mista para a permanente, porém a projeção esteve dentro dos padrões aceitáveis, não havendo diferença entre sexos.

Alterações transversais produzidas pela expansão rápida maxilar com diferentes parafusos expansores em pacientes com fissura de lábio e palato / Transverse changes produced by rapid maxillary expansion with different expander screws in cleft lip and palate patients

O objetivo deste estudo foi avaliar e comparar os efeitos da expansão rápida maxilar em pacientes portadores de fissura de lábio e palato, utilizando aparelhos expansores com dois diferentes tipos de parafusos. A amostra foi constituída por 32 indivíduos com fissura transforame incisivo, com média de idade de 10,6 anos ± 1,73, os quais apresentavam atresia maxilar. Destes, 16 pacientes foram submetidos à expansão com parafuso limitador posterior (Grupo LP) e 16 com parafuso convencional (Grupo C), sendo avaliados em telerradiografias póstero-anteriores em dois momentos: inicial e imediatamente após a expansão. Na comparação entre os grupos (LP e C), foi utilizado o teste de comparações de médias t-student para amostras independentes, com nível de significância de 5%. Verificou-se que houve um aumento das dimensões transversas maxilares em ambos os grupos, porém maior no Grupo C, além disso, observou-se quantidade semelhante de expansão da cavidade nasal em ambos os grupos.

The aim of this study was to evaluate and compare the effects of rapid maxillary expansion (RME) in patients with cleft lip and palate, using palatal expanders with two different jackscrews. The sample consisted of 32 patients, with maxillary constriction and mean age of 10.6 years ± 1.73. Sixteen of them were submitted to RME with fan type screw (Group FT) and 16 with conventional screw (Group C). Both groups were evaluated through postero-anterior cephalograms in two phases: initial and immediately after expansions. To compare LP and C groups Student’s t test was used with a 5% significance level. There was an increase in transverse dimensions for both groups, but it was higher in Group C. Similar expansion was observed in the nasal cavity of both groups...

Class III malocclusion with severe anteroposterior discrepancy

This study aims at reporting the clinical case of a patient with Class III skeletal malocclusion with severe maxillary deficiency, producing a reduced midface associated with severe mandibular prognathism. The pre-surgical orthodontic preparation was composed mainly by dentoalveolar expansion and repositioning of the incisors in the lower arch. Then, a combined maxillary and mandibular orthognathic surgery was performed. The treatment objectives were achieved, with significant improvement in facial esthetics and occlusion, followed by post-treatment stability. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO), as part of the requirements for obtaining the title of Diplomate by BBO.

O objetivo deste artigo é relatar o caso clínico de um paciente portador de má oclusão de Classe III esquelética com acentuada deficiência maxilar, causando redução do terço médio da face, associada a severo prognatismo mandibular. O preparo ortodôntico pré-cirúrgico foi composto, principalmente, pela expansão dentoalveolar da maxila e o reposicionamento dos incisivos na arcada inferior. Depois, foi realizada a cirurgia ortognática combinada maxilomandibular. Os objetivos do tratamento foram atingidos, com significativa melhora da oclusão e da estética facial, seguida de estabilidade pós-tratamento. Esse caso foi apresentado à Diretoria do Board Brasileiro de Ortodontia e Ortopedia Facial (BBO), como parte dos requisitos para obtenção do título de Diplomado pelo BBO.

Orthodontic-restorative treatment as an option for biologic replacement of a maxillary central incisor: 5-year follow-up.

The maxillary central incisor is the tooth most often affected by trauma, especially in the age range of 7 to 10 years, when high-impact sports are prevalent. The options for conservative treatment should be prioritized in these patients, aiming to achieve a biologic response that might provide continuity of growth of the alveolus, to provide functional and esthetic development of the affected region. This case report describes a patient with a history of trauma during the deciduous dentition with consequent intrusion, root dilaceration, and retention of the maxillary left central incisor. The treatment involved extraction of the traumatized tooth and mesial movement of the lateral incisor and posterior segments.

How to predict the timing of eruption of mandibular second premolars.

OBJECTIVE: To evaluate the relationship between the stages of dental formation and the timing of eruption of mandibular second premolars. MATERIALS AND METHODS: The sample comprised panoramic radiographs of 25 children, 7 to 12 years old, observed by space supervision during development of dentition. The initial radiograph (T1) was taken in the mixed dentition period and the progress radiograph (T2) close to the eruption of mandibular second premolars. The stages of dental formation were determined by the proportion between crown length and total length (CL/TL) as well by the Simpson and Kunos index. Average values between right and left sides (35, 45) were correlated to the time elapsed until dental eruption (T2-T1). Statistical analysis was performed by Pearson correlation analysis. RESULTS: The proportion CL/TL presented higher correlation index with time to eruption than the Simpson and Kunos index. The linear regression equation for prediction of timing of eruption showed high coefficient of determination, low deviation, and good accuracy. According to survival analysis, mean deviation at 95% confidence level was between 3.6 and 6.4 months. There was no difference in contralateral measurements, with high intraclass correlation coefficient for both CL/TL proportion and Simpson and Kunos index. CONCLUSIONS: More advanced stages of dental formation indicate less time until dental eruption. The strong correlation with crown length/total length proportion (CL/TL) provides a linear regression equation for prediction of the timing of eruption of mandibular second premolars.

Cone-Beam computed tomography evaluation of maxillary expansion in twins with cleft lip and palate

OBJECTIVE: The establishment of normal occlusal relationships in patients with cleft lip and palate using rapid maxillary expansion may promote good conditions for future rehabilitation. OBJECTIVE: This study describes the clinical case of monozygotic twins with unilateral cleft lip and palate at the age of mixed dentition, who were treated using the same rapid maxillary expansion protocol, but with two different screws (conventional and fan-type expansion screw). Results were evaluated using plaster models, intraoral and extraoral photographs, and Cone-Beam computed tomography (CBCT) scans obtained before the beginning of the treatment, (T1). METHODS: The patients were followed up for 6 months after maxillary expansion, when the same tests requested at T1 were obtained again for review (T2). T1 and T2 results were compared using lateral cephalometric tracings and measurements of the intercanine and intermolar distances in the plaster models using a digital caliper. RESULTS: The two types of expansion screws corrected the transverse discrepancy in patients with cleft lip and palate. The shape of the upper arches improved at 10 days after activation. CONCLUSION: CBCT scans provide detailed information about craniofacial, maxillary and mandibular changes resulting from rapid maxillary expansion. The most adequate screw for each type of malocclusion should be chosen after detailed examination of the dental arches.

Análise comparativa da expansão maxilar com três marcas de parafusos com limitador posterior: ensaio laboratorial em Typodont / Comparative analysis of rapid maxillary expansion using three brands of fan-type expander screw: laboratory trial using typodont

INTRODUÇÃO: nos pacientes com fissura labiopalatina, observa-se, usualmente, uma severa atresia da maxila, especialmente na região anterior da arcada, cujo tratamento envolve expansão maxilar. OBJETIVO: o propósito desse estudo foi avaliar o padrão de expansão de três marcas de parafusos com limitador posterior na correção da deficiência transversa. MÉTODOS: foram realizadas 18 expansões em Typodont, com 6 simulações para cada grupo: G1 - parafuso Dentaurum®, G2 - parafuso Leone®, e G3 - parafuso Morelli®. Foram realizadas, para cada ensaio, 13 ativações de 2/4 de volta, totalizando 5,2mm de abertura do parafuso. Definiram-se os momentos das medições em inicial (T1), metade das ativações (T2) e final (T3). Com o auxílio de um paquímetro, foram medidas as seguintes distâncias: interprimeiros pré-molares (IP1), interssegundos pré-molares (IP2), intermolares (IM) e comprimento da arcada (CA). Os dados obtidos foram submetidos aos testes de Kolmogorov-Smirnov, de Tukey, de Friedman e ANOVA. RESULTADOS: observou-se que todos os grupos apresentaram um padrão de abertura em forma de "V" com maior expansão na região anterior da arcada, sendo mais expressivo no grupo G3 (29,58 por cento em IP1 e 9,73 por cento em IM). O aumento na medida CA foi semelhante para os grupos G1 e G3 (+12,65 por cento e +12,13 por cento, respectivamente), com menor valor para o G2 (+8,23 por cento). CONCLUSÕES: concluiu-se que todos os parafusos com limitador posterior utilizados nesse estudo podem ser empregados no tratamento da deficiência transversa da arcada. Entretanto, o parafuso Morelli® apresentou maior abertura na região anterior em relação à posterior, característica importante no tratamento de pacientes com fissura labiopalatina. Recomenda-se a realização de estudos clínicos para confirmação desses achados.

INTRODUCTION: Cleft lip and palate patients usually have severe maxillary deficiencies, particularly in the anterior region of this arch and their treatment should include maxillary expansion.OBJECTIVE: To evaluate the expansion pattern of three brands of fan-type expander screws to correct transverse deficiencies.METHODS: Eighteen expansions on typodonts were performed with 6 simulations for each group: G1 - Dentaurum® screw; G2 - Leone® screw; and G3 - Morelli® screw. For each trial 13 activations of 2/4 of a turn each were made with a 5.2 mm screw opening. Measurements were made at baseline (T1), after half of the activations (T2) and at the end of the trial (T3). A caliper was used to make the following measurements: Inter-first premolars (IP1), inter-second premolars (IP2) and intermolar (IM) widths and arch length (AL). The Kolmogorov-Smirnov, Tukey, Friedman and ANOVA tests were used to analyze data.RESULTS: All groups had a "V" shaped opening pattern and the greater expansion was found in the anterior region of the arch, which was more evident in the G3 (29.58% in IP1 and 9.73% in IM). The increase in AL was similar in G1 and G3 (+12.65% and +12.13%) and the lowest value was found in G2 (+8.23%).CONCLUSIONS: All the fan-type expander screws used in this study may be used to treat dental arch transverse deficiencies. However, the use of the Morelli screw resulted in a greater opening in the anterior region than in the posterior region, an important characteristic in the treatment of cleft lip and palate patients. Further clinical studies should be conducted to confirm these findings.

Immediate effects of rapid maxillary expansion with Haas-type and hyrax-type expanders: a randomized clinical trial.

INTRODUCTION: The purposes of this study were to evaluate and compare the immediate effects of rapid maxillary expansion (RME) in the transverse plane with Haas-type and hyrax-type expanders by using cone-beam computed tomography. METHODS: A sample of 33 subjects (mean age, 10.7 years; range, 7.2-14.5 years) with transverse maxillary deficiency were randomly divided into 2 groups: Haas (n = 18) and hyrax (n = 15). All patients had RME with an initial activation of 4 quarter turns followed by 2 quarter turns per day until the expansion reached 8 mm. Cone-beam computed tomography scans were taken before expansion and at the end of the RME phase. Maxillary transversal measurements were compared by using the mixed analysis of variance (ANOVA) model and the Tukey-Kramer method. RESULTS: RME increased all maxillary transverse dimensions (P <0.0001). There was less expansion at skeletal than dental levels. The hyrax group had greater statistically significant orthopedic effects and less tipping tendency of the maxillary first molars compared with the Haas group. CONCLUSIONS: Both appliances were efficient in correcting a transverse maxillary deficiency. The pure skeletal expansion was greater than actual dental expansion. The hyrax-type expander produced greater orthopedic effects than did the Haas-type expander, but this effect was less than 0.5 mm per side and might not be clinically significant.

Análises microbiológicas de alicates ortodônticos / Microbiological analysis of orthodontic pliers

OBJETIVO: avaliar a contaminação bacteriana presente na ponta ativa de alicates ortodônticos utilizados no meio acadêmico. MÉTODOS: selecionou-se 34 alicates, 17 do modelo 347 e 17 do modelo 139. O grupo controle foi composto por 3 alicates de cada modelo, previamente autoclavados. Os alicates do grupo experimental, após o uso, foram imersos em 10ml do meio de cultura líquido Brain-Heart Infusion (BHI) por 2 minutos, seguido de cultivo a 37°C (24 a 48h) e semeadura (duplicata) em diferentes meios de cultura sólidos à base de ágar, para detecção e identificação de agentes microbianos. RESULTADOS: as análises microbiológicas revelaram contaminação em ambos os tipos de alicates ortodônticos. Observaram-se variadas formas bacterianas, predominando estafilococos e cocos isolados gram-positivos. Os alicates removedores de anéis apresentaram maiores índices de contaminação, com médias entre 2,83 x 10(9) e 6,25 x 10(9) UFC/ml, variando de acordo com o tipo de meio de cultura. Os alicates 139 também continham bactérias da microbiota bucal, com variações entre 1,33 x 10(8) e 6,93 x 10(9) UFC/ml, sendo que a maior média obtida refere-se ao meio de cultura próprio para desenvolvimento de estafilococos, indicando, em certos casos, presença da espécie Staphylococcus aureus, microrganismos que não fazem parte da microbiota bucal normal, sendo comumente encontrados na cavidade nasal e superfícies epiteliais das mãos. CONCLUSÃO: constatou-se que os alicates ortodônticos apresentam-se contaminados, como qualquer outro instrumental odontológico, após serem empregados em atendimentos clínicos. Em razão disso, há necessidade de submetê-los previamente aos procedimentos de esterilização após cada utilização em pacientes.

OBJECTIVE: To evaluate bacterial contamination in the active tip of orthodontic pliers used in an academic setting. METHODS: Thirty-four pliers were selected: 17 debonding pliers and 17 model 139 pliers. The control group was composed of 3 previously autoclaved pliers of each model. After use, the pliers in the experimental group were immersed in 10 ml of brain-heart infusion (BHI) culture medium for 2 minutes, incubated at 37º C for 24 to 48 h and seeded in duplicates in different agar-based solid culture media to detect and identify microbial agents. RESULTS: Microbiological analyses revealed that there was contamination in both types of orthodontic pliers. Several bacteria were detected, predominantly staphylococcus and isolated Gram-positive (G+) cocci. The debonding pliers had a greater contamination rate and mean values of 2.83 x 10(9) and 6.25 x 10(9) CFU/ml, with variations according to the type of culture medium. The 139 pliers also had all types of bacteria from the oral microbiota at values that ranged from 1.33 x 10(8) to 6.93 x 10(9) CFU/ml. The highest mean value was found in the medium to grow staphylococci, which confirmed, in certain cases, the presence of Staphylococcus aureus, which are not part of the normal oral microbiota but are usually found in the nasal cavity and on the skin of the hands. CONCLUSION: Orthodontic pliers were contaminated as any other dental instrument after use in clinical situations. Therefore, they should undergo sterilization after each use in patients.

Traumatic injuries during the postoperative period after orthognathic surgery in patient with complete bilateral cleft lip and palate / Injúria traumática durante o período pós-operatório após cirurgia ortognática em paciente com fissura transforame incisivo bilateral

PURPOSE: Cleft lip and palate are the most common congenital deformities affecting the face and oral cavity. The procedure to be adopted when facing cleft lip and palate depends on their complexity, comprising treatment by an interdisciplinary team aiming at rehabilitation. Esthetic, functional and emotional implications occur in different manners and intensities, depending on the type of cleft. The aim of this paper is to guide professionals in this field, especially oral surgeons, for the treatment of patients with these congenital deformities and cases of postoperative complications. CASE DESCRIPTION: The present case illustrates the treatment of a patient with complete bilateral cleft lip and palate, who suffered facial trauma in the postoperative period after orthognathic surgery. The clinical and radiographic success could be observed two years after the trauma by fall. CONCLUSION: Patients submitted to orthognathic surgery are subject to postoperative complications. Infection, vehicle accidents, firearm accidents and domestic violence are among the most common causes of complications in the postoperative period. Knowledge on these problems allows the adoption of preventive measures to avoid serious complications mainly in patients with clefts who require an interdisciplinary team approach comprising multiple health care professionals.

OBJETIVO: As fissuras de lábio e palato representam as mais comuns das malformações congênitas que envolvem a face e a cavidade bucal. A conduta a ser tomada frente às fissuras de lábio e palato depende da severidade e complexidade das mesmas, através de um tratamento, por meio de uma equipe multidisciplinar, que vise à reabilitação. O propósito deste trabalho é fornecer orientação aos profissionais da área, especialmente, ao cirurgião-dentista, para realização do tratamento em pacientes com estes defeitos congênitos e em situações de complicações pós-operatórias. DESCRIÇÃO DO CASO: O caso clínico aqui relatado ilustra o tratamento de uma paciente portadora de fissura transforame incisivo bilateral completa de lábio e palato, que sofreu trauma facial no período de reabilitação, após a cirurgia ortognática. O sucesso clínico e radiográfico pôde ser observado dois anos após o trauma por queda. CONCLUSÃO: Pacientes que realizaram cirurgia ortognática estão sujeitos a complicações pós-operatórias; infecção, acidentes com veículo motor, armas de fogo, violência doméstica estão entre as causas mais comuns citadas de complicações no pós-operatório tardio. O conhecimento dessas intercorrências possibilita que medidas preventivas sejam adotadas para evitarem-se complicações graves principalmente em pacientes com fissuras que necessitam da abordagem de uma equipe interdisciplinar composta por profissionais de saúde.