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1.
Am J Orthod Dentofacial Orthop ; 156(4): 555-565, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31582127

RESUMEN

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.


Asunto(s)
Resorción Ósea/complicaciones , Resorción Ósea/terapia , Maloclusión de Angle Clase II/terapia , Cóndilo Mandibular/patología , Enfermedades Mandibulares/patología , Enfermedades Mandibulares/terapia , Mordida Abierta/etiología , Mordida Abierta/terapia , Ortodoncia Correctiva/métodos , Trastornos de la Articulación Temporomandibular/terapia , Resorción Ósea/diagnóstico por imagen , Cefalometría , Niño , Terapia Combinada , Estética Dental , Femenino , Humanos , Maloclusión de Angle Clase II/diagnóstico por imagen , Enfermedades Mandibulares/diagnóstico por imagen , Mordida Abierta/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Resultado del Tratamiento
2.
Am J Orthod Dentofacial Orthop ; 156(3): 303-311, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474260

RESUMEN

INTRODUCTION: One of the goals of malocclusion treatment is to improve the oral health-related quality of life (OHRQoL) of patients. The aim of this trial was to assess the OHRQoL of children before, during, and after anterior open bite (AOB) correction, compared with nontreated children, in a 2-arm parallel single-blind randomized controlled trial. METHODS: Eighty children with AOB aged 8-10 years were randomly assigned to 2 groups (n = 40 each): a group treated with the use of fixed palatal crib (FPC; TG) and a control group (nontreated; CG). Randomization was performed with the use of BioEstat software. The outcome (OHRQoL) was assessed with the use of the validated Brazilian Portuguese version of the Child Perceptions Questionnaire (CPQ8-10) applied before (baseline, phase 1), 3 months after FPC placement (phase 2), and 1 month after FPC removal (phase 3) in the TG. In the CG, CPQ8-10 was applied at baseline (phase 1), 3 months (phase 2), and 12 months (phase 3). Data were analyzed by means of a blinded statistic with the use of Friedman, Wilcoxon, and Mann-Whitney tests (α = 0.05). RESULTS: All participants finished the RCT, and demographic characteristics were similar between groups. In phase 1, the TG had lower scores for the "social well-being" domain (P = 0.02). In phase 2, the CG had higher scores than the TG for the "emotional well-being" and "social well-being" domains, but the opposite was observed for "oral symptoms" and "functional limitations" (P < 0.001). In phase 3, the TG showed a lower impact on OHRQoL than the CG in all domains and in the overall score (P < 0.001). In the 3 phases, the CG showed progressive increase (mean scores 70.37, 74.70, and 84.22, respectively; P < 0.001) and the TG a decrease (mean scores 70.20, 70.80, and 6.05, respectively; P < 0.001) in overall scores. The increase of scores in the CG was considered to represent a serious harm. CONCLUSIONS: Correction of AOB had a positive impact and failure to correct it had a negative impact on the OHRQoL of children. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement.


Asunto(s)
Mordida Abierta/psicología , Mordida Abierta/terapia , Salud Bucal , Calidad de Vida , Brasil , Niño , Estética Dental , Femenino , Humanos , Masculino , Maloclusión/complicaciones , Ortodoncia Correctiva , Método Simple Ciego , Encuestas y Cuestionarios
3.
Am J Orthod Dentofacial Orthop ; 156(3): 312-325, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474261

RESUMEN

INTRODUCTION: This aim of this paper is to describe and identify the practitioner and patient characteristics that are associated with treatment recommendations for adult anterior open bite patients across the United States. METHODS: Practitioners and patients were recruited within the framework of the National Dental Practice-Based Research Network. Practitioners were asked about their demographic characteristics and their treatment recommendations for these patients. The practitioners also reported on their patients' dentofacial characteristics and provided initial cephalometric scans and intraoral photographs. Patients were asked about their demographic characteristics, previous orthodontic treatment, and goals for treatment. Four main treatment groups were evaluated: aligners, fixed appliances, temporary anchorage devices (TADs), and orthognathic surgery. Extractions were also investigated. Predictive multivariable models were created comparing various categories of treatment as well as extraction/nonextraction decisions. RESULTS: Ninety-one practitioners (mostly orthodontists) and 347 patients were recruited from October 2015 to December 2016. Increased aligner recommendations were associated with white and Asian patients, the presence of tongue habits, and female practitioners. TADs were recommended more often in academic settings. Recommendations for orthognathic surgery were associated with demographic factors, such as availability of insurance coverage and practitioner race/ethnicity, and dentofacial characteristics, such as anteroposterior discrepancies, more severe open bites, and steeper mandibular plane angles. Extraction recommendations were largely associated with severe crowding and incisor proclination. CONCLUSIONS: Both doctor and patient demographic factors, as well as dentofacial characteristics, were significantly associated with treatment recommendations for adult anterior open bite patients.


Asunto(s)
Mordida Abierta/terapia , Ortodoncia Correctiva/estadística & datos numéricos , Ortodoncistas/estadística & datos numéricos , Pautas de la Práctica en Odontología/estadística & datos numéricos , Anciano , Cefalometría , Femenino , Humanos , Incisivo , Masculino , Mandíbula , Persona de Mediana Edad , Mordida Abierta/diagnóstico por imagen , Mordida Abierta/epidemiología , Aparatos Ortodóncicos/estadística & datos numéricos , Ortodoncia Correctiva/instrumentación , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos , Encuestas y Cuestionarios , Técnicas de Movimiento Dental/instrumentación , Técnicas de Movimiento Dental/métodos , Técnicas de Movimiento Dental/estadística & datos numéricos , Estados Unidos/epidemiología
4.
J Med Case Rep ; 13(1): 252, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31409402

RESUMEN

BACKGROUND: Chronic insomnia and obstructive sleep apnea are both common sleep disorders. Chronic insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other's response to treatment; they interact. This report of three cases describes patients with both chronic insomnia and obstructive sleep apnea in whom the chronic insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement. CASE PRESENTATIONS: Our three Caucasians patients each presented with severe, chronic insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, chronic insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively. CONCLUSIONS: These three cases lend support to the hypothesis that chronic insomnia and obstructive sleep apnea share a pathophysiology of chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when chronic insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in chronic stress that causes the patient's chronic insomnia to remit.


Asunto(s)
Avance Mandibular/métodos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/terapia , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/terapia , Adulto , Trastorno Depresivo/complicaciones , Femenino , Humanos , Masculino , Enfermedades Maxilares/complicaciones , Enfermedades Maxilares/diagnóstico por imagen , Enfermedades Maxilares/cirugía , Mordida Abierta/complicaciones , Mordida Abierta/diagnóstico por imagen , Mordida Abierta/terapia , Polisomnografía , Autoinforme , Síndrome de la Disfunción de Articulación Temporomandibular/complicaciones , Síndrome de la Disfunción de Articulación Temporomandibular/diagnóstico por imagen , Síndrome de la Disfunción de Articulación Temporomandibular/cirugía , Adulto Joven
5.
Am J Orthod Dentofacial Orthop ; 156(1): 125-136, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31256825

RESUMEN

This case report describes the successful treatment of a 14-year-old girl with severe bilateral idiopathic condylar resorption and resultant mandibular retrusion, increased overjet, and anterior open bite. The nonextraction treatment plan included (1) aligning and leveling the teeth in both arches, (2) performing Le Fort I maxillary osteotomy, bilateral condylectomy, and mandibular joint replacement, and (3) postsurgical correction of the malocclusion. The orthodontic treatment was initiated with the use of custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Patient-fitted and customized temporomandibular joint implants were designed and manufactured based on the patient's stereolithic bone anatomic model. Treatment was concluded with detailed orthodontic finishing. Optimum esthetic and functional results were achieved with the cooperation of 2 specialties and the use of state-of-the-art technology.


Asunto(s)
Tirantes , Prótesis Articulares , Cóndilo Mandibular/cirugía , Mordida Abierta/cirugía , Mordida Abierta/terapia , Ortodoncia Correctiva/métodos , Procedimientos Quirúrgicos Ortognáticos/métodos , Trastornos de la Articulación Temporomandibular/terapia , Adolescente , Puntos Anatómicos de Referencia , Resorción Ósea/complicaciones , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/cirugía , Resorción Ósea/terapia , Cefalometría , Estética Dental , Femenino , Humanos , Imagenología Tridimensional , Mandíbula/cirugía , Cóndilo Mandibular/diagnóstico por imagen , Maxilar/cirugía , Mordida Abierta/diagnóstico por imagen , Aparatos Ortodóncicos , Aparatos Ortodóncicos Fijos , Ortodoncia Correctiva/instrumentación , Osteotomía , Planificación de Atención al Paciente , Radiografía Panorámica , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/cirugía , Resultado del Tratamiento
6.
Ortodoncia ; 82(164-165): 48-54, jun. 2019. ilus
Artículo en Español | LILACS, BINACIS | ID: biblio-1024543

RESUMEN

La mordida abierta anterior esquelética representa un escenario clínico de complejo abordaje para el ortodoncista. Actualmente, existen numerosas alternativas terapéuticas para su manejo, pero aún se tiene escasa evidencia respecto a su efectividad y estabilidad. Este reporte de caso describe el tratamiento de una mujer de 22 años con diagnóstico de mordida abierta esquelética severa que involucraba los dientes anteriores y posteriores hasta el segundo premolar, relación molar bilateral Clase III y mordida cruzada posterior bilateral. El plan de tratamiento consistió en realizar disyunción maxilar asistida quirúrgicamente, SARPE (acrónimo de Surgically Assisted Rapid Palatal Expansion) y posterior manejo con terapia mecánica de arcos multiloop con elásticos, terapia MEAW (Multiloop Edgewise Archwire). Dentro del período de estabilización de la disyunción, se comenzó la mecánica de arcos multiloop con elásticos, con lo que se redujo significativamente la mordida abierta. Después de 14 meses de tratamiento se consiguieron el control vertical y el sagital. La rápida y efectiva evolución de este caso indica que es posible que el procedimiento SARPE provoque aceleración de la terapia ortodóncica, en este caso MEAW, lo que se traduce clínicamente en resultados favorables para la corrección de la mordida abierta(AU)


The anterior skeletal open bite represents a complex clinical scenario for the orthodontist. Currently there are numerous therapeutic alternatives for its management, but there is still little evidence regarding its effectiveness and stability. This case report describes the treatment of a 22year-old woman with a diagnosis of severe skeletal open bite involving anterior and posterior teeth up to second premolar, bilateral Class III molar relationship and bilateral posterior crossbite. The treatment plan consisted of performing Surgically Assisted Rapid Palatal Expansion (SARPE) and subsequent management with mechanical Multiloop Edgewise Archwire therapy with elastics (MEAW therapy). Within the period of stabilization of the disjunction, the mechanics of multiloop arches with elastics was started, thereby significantly reducing the open bite. After 14 months of treatment, vertical and sagittal control was achieved. The speedy and effective evolution of this case indicates that it is possible that SARPE procedure causes orthodontic therapy acceleration, the MEAW therapy in this case, which is clinically translated into favourable results for the correction of the open bite(AU)


Asunto(s)
Adulto , Aparatos Ortodóncicos , Técnica de Expansión Palatina , Mordida Abierta/cirugía , Mordida Abierta/terapia , Maloclusión de Angle Clase III , Elastómeros
7.
Am J Orthod Dentofacial Orthop ; 155(4): 560-571, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30935611

RESUMEN

INTRODUCTION: We report the successful treatment of a 38-year-old woman with bilateral idiopathic condylar resorption and anterior open bite. She had incompetent lips, a gummy smile, increased lower facial height, high mandibular plane angle, skeletal and dental Class II malocclusion with mild mandibular crowding, increased overjet, and mandibular midline deviation to the right. METHODS: The treatment plan included: (1) presurgical alignment and leveling of the teeth in both arches; (2) jaw motion tracking (JMT) to detect mandibular movement; (3) 3-piece maxillary osteotomies with mandibular reconstruction and bilateral coronoidectomies; and (4) postsurgical correction of the malocclusion. The orthodontic treatment was performed with the use of custom lingual braces and clear brackets and the orthognathic surgery was planned with the use of virtual surgical planning. RESULTS: The idiopathic condylar resorption and anterior open bite were treated, crowding was eliminated in the lower anterior segment, correction of skeletal and dental Class II malocclusion was obtained, mandibular plane angle was reduced, and facial profile improved. CONCLUSIONS: The results suggest that esthetic and functional results can be achieved with the cooperation of 2 specialties and with the use of state-of-the-art technology.


Asunto(s)
Resorción Ósea/cirugía , Mordida Abierta/cirugía , Aparatos Ortodóncicos Fijos , Trastornos de la Articulación Temporomandibular/cirugía , Adulto , Resorción Ósea/complicaciones , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/terapia , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Imagenología Tridimensional , Mordida Abierta/complicaciones , Mordida Abierta/diagnóstico por imagen , Mordida Abierta/terapia , Aparatos Ortodóncicos , Ortodoncia Correctiva/instrumentación , Ortodoncia Correctiva/métodos , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/terapia
8.
J Orofac Orthop ; 80(1): 1-8, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30242441

RESUMEN

PURPOSE: Aim of the present study was to investigate the prevalence of gingival recession and related factors in teeth with low occlusal function (open bite and infraversion) after orthodontic treatment. METHODS: From January 2014 to December 2017, 403 patients received orthodontic treatment. Their gingival recession and related factors before and after treatment were retrospectively analyzed. RESULTS: The prevalence of gingival recession in patients with infraversion and open bite after orthodontic treatment were 80.6 and 75.0%, respectively; these values were 43.4 and 47.5% before treatment, respectively. Notably, the Miller index of gingival recession increased after orthodontic treatment (P < 0.05). The risk of gingival recession in patients with infraversion or open bite after orthodontic treatment was remarkably higher than the risk in other patients (odds ratio [OR] = 16.712 and 5.073, respectively); the gingival recession rate was related to treatment with tooth extraction (OR = 2.043), as well as gingival biotype (OR = 0.341) and gingival index (GI) before orthodontic treatment (OR = 97.404; P < 0.05). CONCLUSIONS: Patients with these two types of low occlusal function are more likely to exhibit gingival recession after orthodontic treatment. Moreover, the prevalence of gingival recession after orthodontic treatment is higher among patients who have undergone tooth extraction during orthodontic treatment, and among those who exhibit thin gingival biotype and high gingival index before orthodontic treatment.


Asunto(s)
Recesión Gingival/etiología , Maloclusión/terapia , Mordida Abierta/terapia , Técnicas de Movimiento Dental/efectos adversos , Adolescente , Femenino , Recesión Gingival/epidemiología , Humanos , Masculino , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Técnicas de Movimiento Dental/métodos , Adulto Joven
9.
Am J Orthod Dentofacial Orthop ; 155(1): 108-116.e2, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30591154

RESUMEN

A 26-year-old man with an anterior open bite was treated with orthodontics combined with 2-jaw surgery. Total treatment time was 19 months. Both his occlusion and facial appearance were significantly improved by the surgical-orthodontic treatment.


Asunto(s)
Mordida Abierta/cirugía , Ortodoncia Correctiva , Procedimientos Quirúrgicos Ortognáticos , Adulto , Cefalometría , Terapia Combinada , Humanos , Imagenología Tridimensional , Maxilares/diagnóstico por imagen , Masculino , Mandíbula/anomalías , Mordida Abierta/terapia , Radiografía Panorámica
10.
Eur J Paediatr Dent ; 19(4): 282-286, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30567444

RESUMEN

CASE REPORT: This case report shows a compliance-free treatment of an anterior open bite in a 11-year-old girl. This treatment is also non invasive, therefore well accepted by the patient and her parents.


Asunto(s)
Mordida Abierta/terapia , Aparatos Ortodóncicos , Ortodoncia Correctiva/instrumentación , Cefalometría , Niño , Femenino , Humanos , Mordida Abierta/diagnóstico por imagen , Diseño de Aparato Ortodóncico , Cooperación del Paciente , Radiografía Panorámica
11.
Georgian Med News ; (283): 30-34, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30516486

RESUMEN

In orthodontic practice, removable orthodontic devices are used to treat anomalies and deformations of the dentoalveolar apparatus during the period of the transition occlusion. The creation of new orthodontic appliances or the modification of existing appliances is actual today. The aim is to create easy-to-use therapeutical-prophilaxis orthodontic appliances that can be used to treat open bite and anomalies of the individual teeth position. The mechanism of action of the proposed appliance by P. Flis - V. Filonenko for the treatment of open bite (Ukraine's declarative patent No. 69548 for the utility model A61C7 / 00) is to expand the dentition; stimulation of growth of the apical bases of the jaws by moving the upper frontal teeth orally; correction of the tooth-alveolar height; normalization of the position of tongue. The clinical experience of the use of the orthodontic apparatus by P. Flis - V. Filonenko pointed to the drawbacks of its use in the case of retrusion or normal torque of upper frontal teeth. This goal is achieved by introducing into the design a lingual arc and lip bumper (Ukraine's declarative patent No. 115089 for the utility model A61C7 / 00). Orthodontic appliances of P. Flis - V. Filonenko and P. Flis - O.Tsyzh - V. Filonenko are advisable to use for the treatment and prevention of dentoalveolar anomalies and deformations, in particular, open bite and anomalies of individual teeth position. Conducted clinical studies indicate the feasibility of widespread introduction of appliances in orthodontic practice.


Asunto(s)
Aparatos Activadores , Oclusión Dental , Mordida Abierta/terapia , Diseño de Aparato Ortodóncico , Ortodoncia Correctiva/instrumentación , Humanos , Mordida Abierta/diagnóstico , Ucrania
12.
Niger J Clin Pract ; 21(12): 1678-1684, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30560836

RESUMEN

This case report presents the treatment and long-term follow-up of a patient with severe skeletal hyperdivergent open bite, Class II malocclusion, and a severely retruded chin. After failure of early treatment using high-pull headgear with a bite block during the early permanent dentition stage due to an unfavorable growth pattern, orthognathic surgery was proposed but rejected by the patient. Then, temporary anchorage devices were used to correct the occlusion and establish an acceptable overbite and overjet. The overall observation time was 8.5 years; the treatment time using fixed appliances was 3 years and 4 months. The achieved tooth position and occlusal relationship remained stable 2.5 years later without recurrence of the open bite.


Asunto(s)
Maloclusión de Angle Clase II/terapia , Mordida Abierta/terapia , Métodos de Anclaje en Ortodoncia/métodos , Aparatos Ortodóncicos , Procedimientos Quirúrgicos Ortognáticos/métodos , Cefalometría , Femenino , Estudios de Seguimiento , Humanos , Métodos de Anclaje en Ortodoncia/instrumentación , Resultado del Tratamiento
13.
Am J Orthod Dentofacial Orthop ; 154(5): 693-701, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30384940

RESUMEN

INTRODUCTION: One nonsurgical treatment method for a patient with open bite is to use curved nickel-titanium arches and anterior elastics. The aim of this study was to investigate the effects of this technique with cone-beam computed tomography. METHODS: Eighteen open-bite patients' treatment records were used for this retrospective study. The treatment methods were identical for all patients, beginning with the levelling and alignment of the teeth and the placement of maxillary accentuated and mandibular reverse curved archwires with anterior elastics. Cone-beam tomography images were taken and analyzed 3 dimensionally. The paired-samples t test statistical analysis was performed. RESULTS: A-point moved anteriorly (0.33 mm) and the SN-MP angle increased slightly (1.17°). Maxillary and mandibular incisors were extruded by 2.16 and 1.49 mm, respectively. Overbite increased (4.38 mm). There were no significant changes in the vertical parameters of the premolars and molars. CONCLUSIONS: The open bite was eliminated by retraction and extrusion of the anterior teeth while maintaining the vertical positions of the molars.


Asunto(s)
Mordida Abierta/diagnóstico por imagen , Mordida Abierta/terapia , Aparatos Ortodóncicos , Alambres para Ortodoncia , Técnicas de Movimiento Dental/instrumentación , Técnicas de Movimiento Dental/métodos , Adolescente , Aleaciones , Cefalometría , Tomografía Computarizada de Haz Cónico , Humanos , Imagenología Tridimensional , Masculino , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Estudios Retrospectivos , Dimensión Vertical
14.
Am J Orthod Dentofacial Orthop ; 154(6): 848-859, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30477783

RESUMEN

Skeletal Class II high-angle open bite is often accompanied by osteoarthrosis of the temporomandibular joint (TMJ-OA). This type of malocclusion is challenging to correct, and it has been reported that patients with TMJ-OA treated with orthognathic surgery often experience skeletal relapse and a poor prognosis. This case report describes the treatment of a 25-year-old woman with retrognathia and TMJ-OA, whose masseter and temporal muscle activities were weak. Temporary anchorage devices were placed in the maxilla and the mandible, and the first molars were intruded. We used improved superelastic nickel-titanium alloy wires with tip-back bends for both arches, and intermaxillary elastics were used to upright the molars. After treatment, intrusion of the maxillary and mandibular first molars, counterclockwise rotation of the mandible, and improvement of occlusion and profile had been achieved. The patient's condyles were repositioned into ideal positions, and masticatory muscle activity was augmented and balanced. After 2 years of retention, the mandibular and condylar positions were stable, and acceptable occlusion was maintained without recurrence of TMJ symptoms; harmonious activity of the masticatory muscles was retained. The findings of this case report suggest that molar intrusion using temporary anchorage devices for a patient with severe anterior open bite and TMJ-OA may be useful for improving stomatognathic function, occlusion, and facial esthetics.


Asunto(s)
Maloclusión de Angle Clase II/terapia , Músculo Masetero/fisiopatología , Mordida Abierta/etiología , Mordida Abierta/terapia , Métodos de Anclaje en Ortodoncia/instrumentación , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/terapia , Adulto , Cefalometría , Electromiografía , Femenino , Humanos , Imagen por Resonancia Magnética , Mordida Abierta/fisiopatología , Radiografía Panorámica , Trastornos de la Articulación Temporomandibular/fisiopatología
15.
Am J Orthod Dentofacial Orthop ; 154(4): 554-569, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30268266

RESUMEN

A 33-year-old woman had a chief complaint of difficulty chewing, caused by a constricted mandibular arch and a unilateral full buccal crossbite (scissors-bite or Brodie bite). She requested minimally invasive treatment but agreed to anchorage with extra-alveolar temporary anchorage devices as needed. Her facial form was convex with protrusive but competent lips. Skeletally, the maxilla was protrusive (SNA, 86°) with an ANB angle of 5°. Amounts of crowding were 5 mm in the mandibular arch and 3 mm in the maxillary arch. The mandibular midline was deviated to the left about 2 mm, which was consistent with a medially and inferiorly displaced mandibular right condyle. Ectopic eruption of the maxillary right permanent first molar to the buccal side of the mandibular first molar cusps resulted in a 2-mm functional shift of the mandible to the left, which subsequently developed into a full buccal crossbite on the right side. Treatment was a conservative nonextraction approach with passive self-ligating brackets. Glass ionomer bite turbos were bonded on the occlusal surfaces of the maxillary left molars at 1 month into treatment. An extra-alveolar temporary anchorage device, a 2 × 12-mm OrthoBoneScrew (Newton A, HsinChu City, Taiwan), was inserted in the right mandibular buccal shelf. Elastomeric chains, anchored by the OrthoBoneScrew, extended to lingual buttons bonded on the lingually inclined mandibular right molars. Cross elastics were added as secondary uprighting mechanics. The maxillary right bite turbos were reduced at 4 months and removed 1 month later. At 11 months, bite turbos were bonded on the lingual surfaces of the maxillary central incisors, and an OrthoBoneScrew was inserted in each infrazygomatic crest. The Class II relationship was resolved with bimaxillary retraction of the maxillary arch with infrazygomatic crest anchorage and intermaxillary elastics. Interproximal reduction was performed to correct the black interdental spaces and the anterior flaring of the incisors. The scissors-bite and lingually inclined mandibular right posterior segment were sufficiently corrected after 3 months of treatment to establish adequate intermaxillary occlusion in the right posterior segments to intrude the maxillary right molars. The anterior bite turbos opened space for extrusion of the posterior teeth to level the mandibular arch, and the infrazygomatic crest bone screws anchored the retraction of the maxillary arch. In 27 months, this difficult malocclusion, with a Discrepancy Index score of 25, was treated to a Cast-Radiograph Evaluation score of 22 and a pink and white esthetic score of 3.


Asunto(s)
Tornillos Óseos , Oclusión Dental , Maloclusión de Angle Clase II/diagnóstico , Maloclusión de Angle Clase I/terapia , Mandíbula/cirugía , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Sobremordida/terapia , Adulto , Cefalometría , Modelos Dentales , Femenino , Humanos , Incisivo/patología , Maloclusión de Angle Clase I/diagnóstico , Maloclusión de Angle Clase II/terapia , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Diente Molar/patología , Mordida Abierta/terapia , Diseño de Aparato Ortodóncico , Aparatos Ortodóncicos , Aparatos Ortodóncicos Removibles , Soportes Ortodóncicos , Alambres para Ortodoncia , Ortodoncia Correctiva , Sobremordida/complicaciones , Sobremordida/diagnóstico , Sobremordida/diagnóstico por imagen , Planificación de Atención al Paciente , Radiografía Panorámica , Técnicas de Movimiento Dental/instrumentación , Resultado del Tratamiento , Dimensión Vertical
16.
Curr Med Sci ; 38(5): 914-919, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30341529

RESUMEN

This study aims to evaluate the long-term stability of vertical control in hyperdivergent patients treated with temporary anchorage devices. The sample included 20 hyperdivergent patients without anterior open bite. The temporary anchorage devices were used to intrude the upper incisor and molars for vertical control. Lateral cephalograms were established prior to treatment, immediately after treatment, and during retention. The upper molars and incisors were intruded by 1.33 mm and 1.41 mm after treatment (P<0.05). U6-PP increased by 0.11 mm and 0.23 mm during the first and second stages of retention (P>0.05). U1-PP was found to possess a significant extrusion of 1.2 mm during the first stage (P<0.05), which increased by 0.68 mm during the second stage (P>0.05). The mandibular plane angle (MP-SN) decreased by 2.58 degrees following treatment, and underwent a relapse of 0.51 degree and 0.42 degree during the first and second stages of retention respectively (P>0.05). No significant soft tissue changes occurred, with the exception of increased upper lip length during the second stage (P<0.05). Maxillary anterior and posterior intrusions, counter clockwise rotation of the mandibular plane, and improved profiles can be successfully achieved following treatment with vertical control. During the first stage of retention (less than three years), intruded molars and incisors both exhibited some extrusion, and molars had better long-term stability than incisors. During the second stage of retention (three to six years), the therapeutic effects appeared stable, with the exception of some increase in upper lip length. Rotated mandibular plane remained stable during the entire retention period.


Asunto(s)
Retención de Dentadura/métodos , Mordida Abierta/terapia , Métodos de Anclaje en Ortodoncia/métodos , Cefalometría , Femenino , Humanos , Incisivo/fisiopatología , Masculino , Mandíbula/diagnóstico por imagen , Mandíbula/fisiopatología , Maxilar/diagnóstico por imagen , Maxilar/fisiopatología , Persona de Mediana Edad , Diente Molar/fisiopatología , Mordida Abierta/diagnóstico por imagen , Mordida Abierta/fisiopatología , Diseño de Aparato Ortodóncico/métodos , Técnicas de Movimiento Dental/métodos
17.
Int Orthod ; 16(4): 744-760, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-30343061

RESUMEN

Acquired open bite mainly occurs after adolescence and is caused by a pathological or biological process. We herein report the case of an 18-year and 10-month-old Japanese woman. Her chief complaint was difficulty with mastication. Only distal cusps of first molars and second molars had contact. An angle class II molar relationship and extreme mesially inclined mandibular first molars were observed. The degree of overjet was +6.1mm and overbite was -2.0mm. There were no symptoms or abnormal findings in temporomandibular joints by radiography and magnetic resonance imaging. A skeletal class II jaw relationship was indicated. Therefore, the patient was diagnosed with a skeletal class II acquired open bite malocclusion accompanied with extreme mesial inclination of mandibular first molars. Orthodontic treatment with extraction of maxillary first premolars was performed. After stabilizing the maxillary dental arch, mandibular molars were uprighted and intruded by class III elastics. After treatment, overjet was +3.0mm and overbite was +2.3mm. Occlusal cusp-fossa relationships were established and canine relationships were class I. The lower occlusal plane and mandible were rotated counterclockwise, which helped to achieve proper overbite. After 2 years of retention, occlusion was well maintained.


Asunto(s)
Maloclusión de Angle Clase II/terapia , Diente Molar , Mordida Abierta/terapia , Ortodoncia Correctiva/métodos , Adolescente , Cefalometría , Femenino , Humanos , Imagen por Resonancia Magnética , Mandíbula , Masticación , Mordida Abierta/diagnóstico por imagen , Métodos de Anclaje en Ortodoncia , Radiografía , Radiografía Panorámica , Extracción Dental , Técnicas de Movimiento Dental/métodos
19.
Angle Orthod ; 88(6): 675-683, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30207487

RESUMEN

OBJECTIVES:: To describe the demographic and practice characteristics of the clinicians enrolled in a large, prospective cohort study examining recommendations and treatment for adult anterior open bite (AOB) and the relationship between these characteristics and practitioners' self-reported treatment preferences. The characteristics of the AOB patients recruited were also described. MATERIALS AND METHODS:: Practitioners were recruited from the National Dental Practice-Based Research Network. Participants in the study consisted of practitioners and their adult AOB patients in active treatment. Upon enrollment, practitioners completed questionnaires enquiring about demographics, treatment preferences for adult AOB patients, and treatment recommendations for each patient. Patients completed questionnaires on demographics and factors related to treatment. RESULTS:: Ninety-one practitioners and 347 patients were recruited. Demographic characteristics of recruited orthodontists were similar to those of American Association of Orthodontists members. The great majority of practitioners reported using fixed appliances and elastics frequently for adult AOB patients. Only a third of practitioners reported using aligners frequently for adult AOB patients, and 10% to 13% frequently recommended temporary anchorage devices (TADs) or orthognathic surgery. Seventy-four percent of the patients were female, and the mean age was 31.4 years. The mean pretreatment overbite was -2.4 mm, and the mean mandibular plane angle was 38.8°. Almost 40% of patients had undergone orthodontic treatment previously. CONCLUSIONS:: This article presents the demographic data for 91 doctors and 347 adult AOB patients, as well as the practitioners' self-reported treatment preferences.


Asunto(s)
Mordida Abierta/terapia , Ortodoncistas/estadística & datos numéricos , Pautas de la Práctica en Odontología/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mordida Abierta/epidemiología , Estados Unidos/epidemiología , Adulto Joven
20.
Orthod Craniofac Res ; 21(4): 202-215, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30152171

RESUMEN

The aim of this review was to evaluate available evidence on the effect of early orthodontic management and myofunctional treatment in the developing dentition children, on anterior open bite correction, as well as on normalization of patterns of mouth breathing, swallowing and tongue resting position and pressure. Electronic searches in MEDLINE, Cochrane and LILACS, without language restrictions were conducted. Additionally, unpublished literature was identified. Randomized controlled trials, or controlled clinical trials, comparing interventions applied to manage anterior open bite and other muscle functions such as breathing/swallowing pattern and tongue resting position and pressure, were considered. Quality assessment was based on the Cochrane Risk of Bias tool. Random effects meta-analyses were conducted to assess treatment effects. From the 265 initial search results, 15 articles were included in the review. Eight were randomized controlled trials (RCTs) and 7 were controlled clinical trials. Treatment outcomes comprised skeletal and dentoalveolar changes recorded cephalometrically, mouth posture and lip closure normalization, improvement of tongue resting position/pressure and modification of swallowing pattern. Quantitative synthesis was possible for only 2 of the included RCTs. There was no evidence to support bonded lingual spurs over banded fixed appliances for the correction of anterior open bite in mixed dentition children presenting nonnutritive oral habits at the onset of treatment (SMD: -0.03; 95%CI: -.81, 0.74; P = 0.94). Although early orthodontic management and myofunctional treatment in the deciduous and mixed dentition children appears to be a promising approach, the quality of the existing evidence is questionable.


Asunto(s)
Dentición Mixta , Músculos Faciales/fisiopatología , Maloclusión/terapia , Terapia Miofuncional/métodos , Mordida Abierta/terapia , Cefalometría , Ensayos Clínicos Controlados como Asunto , Bases de Datos Factuales , Deglución , Humanos , Respiración por la Boca , Aparatos Ortodóncicos Fijos , Aparatos Ortodóncicos Funcionales , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como Asunto , Lengua/fisiopatología , Diente Primario , Resultado del Tratamiento
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