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1.
Am J Orthod Dentofacial Orthop ; 156(3): 375-382, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474267

RESUMEN

INTRODUCTION: The aim of this work was to compare the skeletal and dental outcomes of 1- versus 2-phase treatment in Class II subjects with difficult-to-treat high-angle severe Class II malocclusions. METHODS: The sample of 120 cases was collected from the private offices of 3 experienced clinicians. The following selection criteria were used: (1) ANB ≥6°, (2) SN-GoGn ≥37° or mandibular plane to Frankfort horizontal plane ≥30°; and (3) overjet ≥6 mm. Patients were classified into either the early or the late treatment group according to dental age (early Tx: ≥5 primary teeth; late Tx: otherwise). Thirty-four angular, linear, and proportional measurements were determined for each patient. Statistical significance was assessed with the use of a 2-tailed t test, analysis of covariance test, and chi-square test. RESULTS: The results showed that early 2-phase treatment for severe Class II high-angle patients offered no skeletal anteroposterior advantages over late 1-phase treatment. Severe high-angle Class II patients also showed similar dental anteroposterior outcomes with the use of both approaches. Vertically there was a higher frequency of increased mandibular plane angles and extrusion of upper incisors and lower molars in the late treatment group. CONCLUSIONS: Early 2-phase treatment for severe Class II high-angle patients offered no skeletal or dental advantage over late 1-phase treatment.


Asunto(s)
Maloclusión de Angle Clase II/terapia , Ortodoncia Correctiva/métodos , Adolescente , Cefalometría/métodos , Niño , Femenino , Humanos , Incisivo , Masculino , Mandíbula , Maxilar , Diente Molar , Sobremordida/terapia , Factores de Tiempo , Resultado del Tratamiento
2.
Am J Orthod Dentofacial Orthop ; 156(3): 401-411, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31474270

RESUMEN

A 24-year-old man presented with a severe skeletal class III malocclusion, associated with an anterior and posterior crossbite in the left side, upper and lower lip eversion, skeletal asymmetry, midline discrepancy, diastemas in the maxillary and mandibular dental arches, and agenesis of maxillary lateral incisors and canines with retained deciduous teeth. Treatment was performed with the use of the Win Lingual System. When the 0.016 × 0.022-inch NiTi archiwire was applied, the deciduous teeth were extracted and replaced with temporary crowns connected to the appliance. After the aligning, leveling, and diastema closure phases, a modified Le Fort II osteotomy, a mandibular setback with a bilateral sagittal split osteotomy and a genioplasty were performed. Implants were placed in the canine site through a flapless guided surgery, and cantilevered temporary bridges were delivered. Final prosthetic rehabilitation included veneers for the central incisors and zirconia-ceramic cantilevered bridges for the canine and lateral incisors. After 36 months of active treatment, the patient showed an Angle Class I molar and canine relationship and an ideal overbite and overjet. His profile had improved, lips were competent, and gingival levels were acceptable. The lateral radiograph and cephalometric analysis showed a good balance of the skeletal pattern, a good profile of the soft tissue, and proper inclinations of the maxillary and mandibular incisors in relation to maxilla and mandible. After 2 years of follow-up, the patient had a pleasant smile and no relapse, or joint or muscular pain.


Asunto(s)
Anodoncia/complicaciones , Maloclusión de Angle Clase III/terapia , Diseño de Aparato Ortodóncico/instrumentación , Diseño de Aparato Ortodóncico/métodos , Aparatos Ortodóncicos , Adulto , Cefalometría , Diente Canino , Implantación Dental Endoósea , Implantes Dentales , Modelos Dentales , Diastema/cirugía , Diastema/terapia , Estética Dental , Humanos , Incisivo , Labio , Masculino , Maloclusión de Angle Clase I/complicaciones , Maloclusión de Angle Clase III/diagnóstico por imagen , Maloclusión de Angle Clase III/rehabilitación , Maloclusión de Angle Clase III/cirugía , Mandíbula/cirugía , Maxilar/cirugía , Diente Molar , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Soportes Ortodóncicos , Alambres para Ortodoncia , Osteotomía , Sobremordida/terapia , Radiografía Panorámica , Técnicas de Movimiento Dental/instrumentación , Técnicas de Movimiento Dental/métodos , Adulto Joven
3.
J Med Case Rep ; 13(1): 207, 2019 Jul 07.
Artículo en Inglés | MEDLINE | ID: mdl-31279335

RESUMEN

BACKGROUND: Little information is available on the treatment of open bite with temporomandibular joint disorder by intrusion of molars using miniscrews. CASE PRESENTATION: This case report describes a 42-year-old Japanese woman with a skeletal class II severe anterior open bite and temporomandibular joint disorder. The pretreatment magnetic resonance imaging of both temporomandibular joints revealed osteoarthritis and anterior disc displacement without reduction in both temporomandibular joints. A stabilization splint was used before orthodontic treatment and bilateral upper and lower premolars were extracted. Miniscrews were inserted into the palatal region to intrude the maxillary molars and avoid loss of anchorage. The maxillary left first molar was also extracted to improve the molar relationship and the dental midline. Normal overjet and overbite with Angle class I molar relationship were achieved, and the upper and lower midlines coincided. Our patient's teeth continued to be stable and her temporomandibular joint was asymptomatic after a retention period of 2 years. CONCLUSIONS: Intrusion of molars by miniscrews is available for skeletal class II severe open bite.


Asunto(s)
Sobremordida/terapia , Trastornos de la Articulación Temporomandibular/terapia , Técnicas de Movimiento Dental/métodos , Adulto , Tornillos Óseos , Femenino , Humanos , Imagen por Resonancia Magnética , Diente Molar/cirugía , Sobremordida/complicaciones , Sobremordida/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/complicaciones , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Extracción Dental
4.
Am J Orthod Dentofacial Orthop ; 156(1): 137-147, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31256827

RESUMEN

A 16-year-old patient sought orthodontic correction for profile improvement and labially inclined maxillary incisors. She had Class II malocclusion, protrusive maxillary and mandibular incisors, and increased overjet and overbite with an American Board of Orthodontics discrepancy index value of 25. She was treated with maxillary premolar extractions and miniscrew-supported en masse retraction assisted with piezoincisions. Extraction spaces (7.5 mm per side) were closed with maximum anchorage in 10 months. Total treatment time was 23 months. Twenty-seven months after debonding, a pink spot was noted at the buccocervial region of the left central incisor. Radiographic evaluation on cone-beam computed tomographic scans revealed a severe case of invasive cervical resorption on both central incisors, around which the piezosurgical cuts had been made. Treatment proceeded with a nonintervention approach and the affected teeth were reinforced with a lingual retainer.


Asunto(s)
Maloclusión de Angle Clase II/terapia , Ortodoncia Correctiva/métodos , Sobremordida/terapia , Piezocirugía/efectos adversos , Adolescente , Diente Premolar/cirugía , Tornillos Óseos , Cefalometría , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Incisivo/diagnóstico por imagen , Incisivo/patología , Incisivo/cirugía , Maloclusión de Angle Clase II/diagnóstico por imagen , Maloclusión de Angle Clase II/cirugía , Mandíbula , Maxilar/diagnóstico por imagen , Maxilar/patología , Maxilar/cirugía , Métodos de Anclaje en Ortodoncia/instrumentación , Métodos de Anclaje en Ortodoncia/métodos , Diseño de Aparato Ortodóncico , Aparatos Ortodóncicos , Soportes Ortodóncicos , Alambres para Ortodoncia , Sobremordida/diagnóstico por imagen , Sobremordida/cirugía , Radiografía Panorámica , Resorción Radicular/etiología , Técnicas de Movimiento Dental/métodos , Resultado del Tratamiento , Dimensión Vertical
5.
Orthod Fr ; 90(1): 13-27, 2019 Mar.
Artículo en Francés | MEDLINE | ID: mdl-30994446

RESUMEN

INTRODUCTION: Skeletal class II, frequently associated with retromandibular and overjet > 2 mm, lead to functional and aesthetic damage, that orthodontic treatment has to correct. The aim of this article is to describe a treatment protocol by aligners for class II growing patients according to the value of the class II and the maturity state of cervical vertebrae. MATERIALS AND METHODS: Through clinical cases, this article will present three different therapeutic approaches depending on the growth state. RESULTS: The study of the auxologic potential and determination of the bone age (radiological analysis of the maturation of the cervical vertebrae) will allow to determine the best moment to treat class II and the most appropriate therapeutic attitude according to growing state. DISCUSSION: This study before treatment is essential to adapt an individualized clinical protocol to each patient. In this way, aligners are devices that respond well to this imperative because they are customizable in view of the strategy and the treatment plan considered by the practitioner. We must keep in mind, however, that with any therapy, it is essential to ensure good patient compliance.


Asunto(s)
Conducta de Elección , Estética Dental , Maloclusión de Angle Clase II/terapia , Aparatos Ortodóncicos Removibles , Sobremordida/terapia , Adolescente , Niño , Toma de Decisiones/fisiología , Femenino , Humanos , Maloclusión de Angle Clase II/clasificación , Aparatos Ortodóncicos Funcionales , Retenedores Ortodóncicos , Sobremordida/clasificación
6.
J Ayub Med Coll Abbottabad ; 31(1): 26-31, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30868778

RESUMEN

BACKGROUND: Most of the orthodontic cases require a long period of retention which is usually carried out with the help of fixed retainers (FR). One of the downsides of FR is that these are prone to breakages. The aim of the present study was to identify the frequency and factors associated with failure of fixed spiral wire retainers.. METHODS: A retrospective crosssectional study was conducted using orthodontic files and dental casts of 126 patients from dental clinics of a tertiary care hospital. Descriptive statistics were applied to calculate the frequency and most common site of breakages. Chi-square test was applied to compare the frequency of breakages among age groups and different retainer spans. Independent sample ttest was used to compare the mean overbite in retainer breakage and retainer intact groups. A p-value ≤0.05 was considered as statistically significant. RESULTS: The frequency of retainer breakage was found to be 53.1%. Maxillary retainer breakages were found in 41.3% subjects whereas mandibular retainer failed in 22.2% subjects. The mean survival time of retainer was 8.91±4.57 months. The detachment of the retainer from the tooth surface was the most common occurrence (86%). The most common site of retainer breakage was maxillary canine (32.5%) and mandibular central incisor (12.7%). All the subjects who had retainers extending till maxillary molars encountered breakages.. CONCLUSIONS: A longer retainer span is associated with a greater risk of breakage. Failure rate in the maxillary arch was higher than the mandibular arch. The most common sites were the maxillary canine and mandibular central incisor. The most common pattern was wire detachment.


Asunto(s)
Retenedores Ortodóncicos , Falla de Prótesis , Adolescente , Niño , Análisis de Falla de Equipo , Femenino , Humanos , Masculino , Mandíbula , Maxilar , Sobremordida/terapia , Estudios Retrospectivos , Factores de Tiempo , Adulto Joven
7.
Am J Orthod Dentofacial Orthop ; 155(3): 411-420, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30826044

RESUMEN

Patients with Class II malocclusion and severe overjet are often dissatisfied with their facial disharmony. Although temporary skeletal anchorage devices (TSADs) are now widely used in orthodontic treatment, traditional anchorage devices should not be overlooked as a treatment option. Proper design of traditional anchorage can achieve 3-dimensional control of incisors and molars as efficiently as TSADs in some patients with severe malocclusion. We used traditional anchorage devices, including a transpalatal arch and a Nance palatal arch, combined with a utility arch to treat an 11-year-old Chinese girl with a skeletal Class II malocclusion and severe overjet. The space was closed in 2 steps to protect molar anchorage. Facial improvement, especially smile esthetics, and Class I molar relationship and overjet correction were achieved in 17 months of treatment. Follow-up records 22 months after treatment show that the results remained stable.


Asunto(s)
Maloclusión de Angle Clase II/terapia , Métodos de Anclaje en Ortodoncia , Ortodoncia Correctiva/métodos , Sobremordida/terapia , Cefalometría , Niño , Terapia Combinada , Femenino , Humanos , Maloclusión de Angle Clase II/diagnóstico por imagen , Sobremordida/diagnóstico por imagen , Radiografía Panorámica
8.
J Craniomaxillofac Surg ; 47(1): 66-72, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30497948

RESUMEN

PURPOSE: To evaluate the effect of temporomandibular joint (TMJ) disc repositioning and post-operative functional splint for the treatment of anterior disc displacement (ADD) in juvenile patients with Class II malocclusion. MATERIALS AND METHODS: Juvenile patients (≤20 years) who had bilateral TMJ ADD with and Class II malocclusion treated by disc repositioning and functional splints were included in the study. Magnetic resonance imaging (MRI) and cephalometric radiographs before surgery (T0), immediately after surgery (T1) and more than 3 months after surgery (T3) were obtained in all patients. Cephalometric values including condylar height, overjet, SNA, SNB and pogonion position etc. were measured and compared before and after disc repositioning by statistical analysis. Fourteen patients (13 female, 1 male) were included in this study. Their average age was 16.7 years (range, 12-20 years). RESULTS: Seven patients with 14 joints had an MRI at least 6 months (6-24 months, mean 14.3) prior to disc repositioning. When compared to the MRI taken just prior to surgery, of those 14 joints, 9 condyles (64.3%) had evidence of bone resorption, 5 condyles (35.7%) had new bone formation mostly at the posterior part of the condyle (21.4%). These MRIs showed the condylar height was reduced 0.81 mm ± 0.61 (P = 0.013). Pre-operative cephalometric radiographs showed increased overjet (P = 0.039). The mean post-operative follow-up was 9.4 months (range, 4-13 months). Postoperative MRI showed the condylar height increased 1.74 ± 0.98 mm after disc repositioning (P < 0.001). Newly generated bone was observed on all condyles. 84.6% of the new bone was formed on the superior and posterior-anterior surfaces. Postoperative cephalometric radiographs showed the SNB angle increased 1.83 ± 1.56°(P < 0.001), pogonion position (pg'-G') moved anteriorly 2.18 ± 3.13 mm (P = 0.028) and incisor overjet decreased 3.55 ± 1.86 mm (P < 0.001), whereas significant changes were not found in SNA, Sn - G Vert, Y-Axis, U1 SN, IMPA (L1-MP) and U1-L1 (P > 0.05). CONCLUSION: Conservative treatment for ADD with Class II malocclusion in juvenile patients may cause condyle resorption and aggravate the dentofacial deformity. Disc repositioning combined with post-operative functional splints can effectively promote condylar growth and help correct the dentofacial deformity.


Asunto(s)
Luxaciones Articulares/cirugía , Maloclusión de Angle Clase II/cirugía , Procedimientos Quirúrgicos Ortognáticos/métodos , Férulas (Fijadores) , Disco de la Articulación Temporomandibular/cirugía , Trastornos de la Articulación Temporomandibular/cirugía , Adolescente , Puntos Anatómicos de Referencia , Huesos/diagnóstico por imagen , Huesos/cirugía , Cefalometría , Niño , Femenino , Humanos , Luxaciones Articulares/patología , Luxaciones Articulares/terapia , Imagen por Resonancia Magnética/métodos , Masculino , Maloclusión de Angle Clase II/diagnóstico por imagen , Maloclusión de Angle Clase II/terapia , Sobremordida/cirugía , Sobremordida/terapia , Periodo Posoperatorio , Articulación Temporomandibular/diagnóstico por imagen , Articulación Temporomandibular/patología , Articulación Temporomandibular/cirugía , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Disco de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/patología , Trastornos de la Articulación Temporomandibular/terapia , Adulto Joven
9.
Equine Vet J ; 51(3): 316-322, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30267592

RESUMEN

OBJECTIVE: To describe a symphyseal osteotomy stabilised with two short locking compression plates (LCPs) for treatment of class 2 malocclusions. STUDY DESIGN: Case series. METHODS: Five horses (age range 8 months to 5¾ years) with overjets and/or overbites ranging from 6 to 32 mm and from 0 to 60 mm, respectively, were treated by osteotomy through the caudal third of the mandibular symphysis, cranial to the interdental space. After cranial distraction and ventral rotation of the rostral part of the mandible, two short (5/6 hole), bent 3.5 mm LCPs were applied ventro-laterally and secured with two or three locking screws on each side of the osteotomy. In one case, the osteotomy gap was filled with bone marrow. RESULTS: Final outcome was good to excellent. Two cases needed a second corrective surgery, one because of non-occlusion of the cheek teeth and another because of abaxial deviation of the rostral portion of the mandible. In three cases with a persistent fistula, LCPs were removed after bridging; drainage resolved and wounds healed. The time to bridging of the osteotomy gap ranged from 2 to 6.5 months. The procedure is technically challenging. It is important that the incisors are well aligned, which proved to be difficult when there was an abnormal maxillary incisor arcade. Incisors should not make contact when LCPs are fixed. The cheek teeth, however, should have good occlusion after positioning and fixation of the LCPs. Endodontic treatment of open incisor pulp cavities may be helpful. MAIN LIMITATIONS: The study population was small and relatively heterogeneous in severity. A larger population with more severe cases might have allowed for a more definitive assessment of the value of the technique for clinical practice. CONCLUSIONS: This technique can be used to achieve a good correction for class 2 malocclusions. The approach provides adequate stability with smaller implants than other published techniques that require transection of both rami. The technique is less invasive and preserves the roots of the incisors and cheek teeth, as well as the mandibular canal.


Asunto(s)
Placas Óseas/veterinaria , Enfermedades de los Caballos/congénito , Osteotomía/veterinaria , Sobremordida/veterinaria , Animales , Femenino , Enfermedades de los Caballos/cirugía , Caballos , Masculino , Osteotomía/instrumentación , Osteotomía/métodos , Sobremordida/terapia
10.
Angle Orthod ; 89(2): 333-349, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30080111

RESUMEN

This report illustrates successful nonsurgical orthodontic treatment of a hypodivergent adult patient with bilateral posterior scissors bite (Brodie bite) and excessive overjet. A 26-year-old woman primarily reported maxillary incisor protrusion. She was diagnosed with Class ll division 1 malocclusion with skeletal Class I, short face, low mandibular plane angle and bilateral posterior scissors bite. A lingual arch with anterior bite block and posterior miniscrews with preadjusted edgewise appliances were used to improve the bilateral scissors bite. After achieving molar occlusion, the maxillary first premolars were extracted, and six miniscrews were used to improve the anterior-posterior and vertical discrepancies. After active treatment for 56 months, the convex facial profile with excessively protruded lips was improved and good interdigitation with ideal incisor relationship was achieved. Additionally, the irregular movements of the incisal path and the bilateral condyles during lateral excursion were improved. At 13 months of retention, a satisfactory facial profile, occlusion, and jaw movements were maintained. The treatment results suggest that miniscrews and fixed bite blocks were effective and efficient to facilitate correction of the bilateral scissors bite, excessive overjet, and vertical relationship correction in this nonsurgical orthodontic treatment.


Asunto(s)
Maloclusión de Angle Clase III , Maloclusión de Angle Clase II , Mordida Abierta , Métodos de Anclaje en Ortodoncia , Sobremordida , Técnicas de Movimiento Dental , Adulto , Cefalometría , Oclusión Dental , Femenino , Humanos , Sobremordida/terapia
11.
J Prosthodont ; 28(2): e830-e836, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28422345

RESUMEN

PURPOSE: To compare the efficacy of twin-block (i.e., allows mouth opening) and fixed (i.e., maintains mouth closure) mandibular advancement splints (MASs) for the treatment of obstructive sleep apnea-hypopnea syndrome (OSA). MATERIALS AND METHODS: From 2011 to 2013, 23 patients with OSA in the twin-block group, and from 2013 to 2015, 29 patients in the fixed MAS group were included. All patients underwent polysomnography before and after 3 months of treatment. The two sets of polysomnographic and cephalometric variables were compared. RESULTS: A significant difference (p < 0.001) was observed in the apnea-hypopnea index before and after MAS treatment in both groups (twin-block group: 20.6 ± 11.5 vs. 14.7 ± 9.4; fixed group: 21.4 ± 15.2 vs. 11.2 ± 9.7). In the twin-block group, 5 patients (21.7%) were complete responders, 9 (39.1%) were fair responders, and 9 (39.1%) were nonresponders; the corresponding figures for the fixed group were 14 (48.3%), 9 (31.0%), and 6 (20.7%) patients. A significant between-group difference was observed in the distribution of responders (p = 0.046). The fixed group showed a significant improvement in the snoring index (p = 0.003), arousal index (p = 0.036), and desaturation rate (p = 0.012). Finally, the change in incisal overjet was larger in the fixed group than in the twin-block group (p < 0.001). CONCLUSIONS: These results suggest that fixed oral appliances are superior in treating OSA, based on their ability to prevent mouth opening and reduce incisal overjet.


Asunto(s)
Avance Mandibular/instrumentación , Aparatos Ortodóncicos Fijos , Apnea Obstructiva del Sueño/terapia , Cefalometría , Femenino , Humanos , Masculino , Avance Mandibular/métodos , Persona de Mediana Edad , Sobremordida/terapia , Polisomnografía , Ronquido/terapia , Resultado del Tratamiento
12.
Eur J Orthod ; 41(1): 21-28, 2019 01 23.
Artículo en Inglés | MEDLINE | ID: mdl-29617755

RESUMEN

Background: Increased awareness on the role of oral functions in the aetiology of Class II deformities has led to the wide spread of myofunctional training appliances as easy and possibly effective treatment for children with Class II malocclusion but their efficacy is yet to be proven. Objectives: To evaluate soft- and hard-tissue changes following 12 months of Class II division 1 treatment in growing patients with a conventional functional appliance (a modified Activator) versus a myofunctional Trainer system (T4K®). Setting and sample population: Department of Orthodontics, Dental School. Participants, study design, and methods: Sixty Class II division 1 children (8-12 years old) were recruited from primary schools and were distributed randomly into two equal groups. Randomization was based on a computer-generated sequence of random numbers. Data analysis included: the Activator group (28 patients, mean age = 10.6 ± 1.3 years); the T4K® group (26 patients, mean age = 10.3 ± 1.4 years). Skeletal, dentoalveolar, and soft tissues changes were assessed using standardized lateral cephalograms collected before and after 12 months of treatment. No blinding was applied in this trial. Results: Improvement in the Class II skeletal and dentofacial characteristics were significantly greater in the Activator group when compared with the T4K® group. The improvement was evident in a significant decrease in the skeletal angle ANB with Activator (x¯ = -1.89 ± 1.12) compared to T4K® (x¯ = -0.9 ± 1.01) (P = 0.01), a significant greater increase in the facial convexity angle with Activator (x¯ = 2.61 ± 3.71) more than T4K® (x¯ = 0.2 ± 2.51) (P = 0.04), and a significant reduction in the overjet (x¯ = -3.0 ± 2.3 mm) compared to (x¯ = -1.5 ± 1.9 mm; P = 0.01) with Activator versus T4k®, respectively (P = 0.001). Limitations: This study was a short-term study (12-month follow-up). Conclusions: The results of the current study indicated that the Activator was more effective than the T4K® in treating Class II division 1 growing patients. Registration: The trial was not registered in any major database of clinical trials. Protocol: The protocol was not published before the commencement of the trial but can be given upon request.


Asunto(s)
Aparatos Activadores , Maloclusión de Angle Clase II/terapia , Terapia Miofuncional/métodos , Ortodoncia Correctiva/instrumentación , Cefalometría/métodos , Niño , Cara/patología , Femenino , Humanos , Masculino , Maloclusión de Angle Clase II/patología , Ortodoncia Correctiva/métodos , Sobremordida/terapia , Resultado del Tratamiento
13.
Am J Orthod Dentofacial Orthop ; 154(5): 718-732, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30384943

RESUMEN

Prader-Willi syndrome (PWS) is a complex disorder that affects multiple systems and may cause craniofacial and dentofacial abnormalities. However, there is still a lack of evidence in the literature regarding the progress of orthodontic treatment in patients with PWS. This case report describes the successful orthodontic treatment of a patient with PWS. A girl, 9 years 0 months of age, who had been diagnosed with PWS had protruding maxillary incisors and a convex profile. Her malocclusion was due to the posteriorly positioned mandible. Screening tests for sleep apnea syndrome showed that she had sleep-disordered breathing, including obstructive sleep apnea and bruxism. We also observed an excessive overjet of 10.0 mm, a deep overbite of 6.8 mm, and the congenital absence of the mandibular second premolars. The patient was diagnosed with an Angle Class II malocclusion and a skeletal Class II jaw-base relationship with a deep overbite. Functional appliance therapy with mandibular advancement, which can enlarge the upper airway and increase the upper airspace, was performed to prevent further deterioration of the patient's obstructive sleep apnea. An acceptable occlusion with a proper facial profile and functional excursion were achieved without interference after comprehensive 2-stage treatment that incorporated orthodontic therapy for the patient's excessive overjet and deep overbite. The resulting occlusion was stable, and the occlusal force and the contact area gradually increased over a 2-year retention period. These results suggest that orthodontic treatment offers the opportunity to greatly improve the health and quality of life of people with PWS.


Asunto(s)
Aparatos Ortodóncicos Funcionales , Sobremordida/etiología , Sobremordida/terapia , Síndrome de Prader-Willi/complicaciones , Anodoncia/complicaciones , Diente Premolar , Niño , Femenino , Humanos , Avance Mandibular , Sobremordida/diagnóstico , Calidad de Vida , Apnea Obstructiva del Sueño/etiología , Bruxismo del Sueño/etiología , Resultado del Tratamiento
14.
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
15.
Bull Tokyo Dent Coll ; 59(4): 285-290, 2018 Nov 30.
Artículo en Inglés | MEDLINE | ID: mdl-30333374

RESUMEN

An abnormal maxillomandibular ridge relationship frequently hinders oral implant treatment in patients with jaw deformities. Here, we describe a patient who was experiencing difficulty using dentures due to multiple maxillary tooth loss and mandibular prognathism. Treatment comprising sagittal splitting ramus osteotomy and alveolar ridge augmentation using bone grafts harvested from the mandibular ramus followed by implant treatment yielded good outcomes. The patient was a 47-year-old woman presenting with an unstable upper partial denture. Although prior prosthetic treatment for mandibular prognathism had resulted in normal overbite, she had since lost an increasing number of teeth due to advanced periodontal disease, impairing support for the denture. She was referred to the Department of Oral Implantology at the Tokyo Dental College Chiba Hospital in October 2008. Subsequent treatment comprised implant treatment following maxillary alveolar ridge augmentation and sagittal splitting ramus osteotomy to correct the maxillary-mandibular relationship. In January 2010, sagittal splitting ramus osteotomy and alveolar bone augmentation using a bone graft from the mandibular ramus were performed under general anesthesia. In July and August 2010, a total of 7 implants were placed in the maxilla and implant superstructure preparation started after 3 months. Taking both the patient's wishes and ease of maintenance into account, retrievable superstructures made of Auro Galvano Crown were fitted in April 2011. The jaw-to-jaw alveolar ridge relationship was improved by sagittal splitting ramus osteotomy, rendering subsequent treatment, from implant placement to superstructure preparation, feasible by conventional methods. The use of surplus bone generated during sagittal splitting ramus osteotomy for bone augmentation avoided the need to harvest bone from another area.


Asunto(s)
Aumento de la Cresta Alveolar/métodos , Implantes Dentales , Arcada Parcialmente Edéntula/cirugía , Maxilar/cirugía , Osteotomía Sagital de Rama Mandibular/métodos , Prognatismo/cirugía , Prognatismo/terapia , Pérdida de Hueso Alveolar/cirugía , Tornillos Óseos , Trasplante Óseo/métodos , Pilares Dentales , Implantación Dental Endoósea , Prótesis Dental de Soporte Implantado , Dentadura Completa Superior , Femenino , Humanos , Arcada Parcialmente Edéntula/rehabilitación , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Traumatismos Maxilofaciales/rehabilitación , Persona de Mediana Edad , Sobremordida/cirugía , Sobremordida/terapia , Prognatismo/diagnóstico por imagen , Tokio , Resultado del Tratamiento
18.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 53(9): 599-603, 2018 Sep 09.
Artículo en Chino | MEDLINE | ID: mdl-30196619

RESUMEN

Objective: To analyze factors affecting stability after fixed orthodontic treatment. Methods: Five hundred and forty-four patients who had finished fixed orthodontic treatment more than two years in First Department of Orthodontics, China Medical University from January, 2000 to December, 2017 were investigated and the rate of regular revisit was counted. The data of 288 patients were successfully collected by calling or sending text messages and the rate of standard use of retainers as prescribed (patients wore retainers for 24 months or longer) was counted. According to the variation of peer assessment rating (PAR) index at the start of retention and the time the data collected, the patients were divided into relapse group (variation of PAR index >5) and non-relapse group (variation of PAR index ≤5). Difference significance analysis and multiple-factor logistic regression analysis were used. Sixty patients wearing retainers well were collected and the curative effects of Hawley retainer and vacuum formed retainer (VFR) were compared, which included overbite, overjet, maxillary irregularity index, mandibular irregularity index, width betwenn canine and width between first molar. Results: The rate of regular revisit was 41.0% (223/544). Two hundred and one of 288 patients (69.8%) who were visited successfully had regular revisit, and 60.4%(174/288) of the patients wore retainers well; 30.2% (87/288) of the patients who were visited successfully didn't have regular revisit, and 10.4% (30/288) of the patients wore retainers well. Difference significance analysis showed that there was highly significant difference between relapse group and non-relapse group in the type of retainer and duration of retention (P<0.01). One hundred and forty of 224 patients (62.5%) in non-relapse group and 37.5% (24/64) of the patients in relapse group used VFR, and the duration of retention in non-relapse group was significantly longer than that in relapse group (P<0.01). Multiple-factor Logistic regression analysis showed that wearing Hawley retainers (OR=3.067, P<0.05) was the risk factor influencing relapse. The duration of retention (OR=0.832, P<0.01) was the protective factor influencing relapse. Independent-sample t test indicated that the variations of maxillary [(0.82±0.36) mm] and mandibular [(1.05±0.22) mm] irregularity index in Hawley retainer group were larger than maxillary [(0.64±0.29) mm] and mandibular [(0.72±0.35) mm)] irregularity index in VFR group, respectively. The differences between the two groups were significant (P<0.05). Conclusions: Duration of retention was implicated in stability after orthodontic treatment. VFR had better effect in the aspects of irregularity index than Hawley retainer.


Asunto(s)
Maloclusión de Angle Clase II/terapia , Retenedores Ortodóncicos/estadística & datos numéricos , Ortodoncia Correctiva , Citas y Horarios , Humanos , Mandíbula , Maxilar , Diente Molar , Sobremordida/terapia , Recurrencia , Factores de Riesgo , Resultado del Tratamiento
19.
Int Orthod ; 16(3): 586-601, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-30037507

RESUMEN

DATE OF BIRTH: 14/04/2000; sex: female. A. PRETREATMENT RECORDS: 12 y and 2m; 7/6/2012. DIAGNOSIS: The patient presents a left subdivision Angle's class II malocclusion associated with an incisor deep bite of 5mm and a deviation of the mandibular incisor midline to the left (of the patient). On a frontal view, we also note a slight asymmetry of the lower part of the face, the tip of the chin is slightly deviated to the left (of the patient). However, the patient presents a good labial occlusion at rest, a normal divergence and a harmonious face. TREATMENT PLAN: Bimaxillary multibracket appliance using Roth technique .022×.028'' with placement of the appliance in the maxillary before the mandible to allow the unlocking of the mandibular occlusion, then implementation of a class II appliance with intermaxillary traction elastics. B. POSTTREATMENT RECORDS: 13 y and 8m; 10/12/2013. DURATION OF ACTIVE TREATMENT: 18 months, good stability of the occlusion, preservation of the incisor midlines and of the deep bite. RETENTION: Maxillary: palatal wire bonded from teeth 12 to 22 and thermoformed splint; mandibular: lingual wire bonded from teeth 33 to 43 and thermoformed splint. C. POSTRETENTION RECORDS: (Minimum of 1 year): 15 years old; 3/4/2015.


Asunto(s)
Asimetría Facial/terapia , Maloclusión de Angle Clase II/terapia , Ortodoncia/métodos , Sobremordida/terapia , Adolescente , Cefalometría/métodos , Niño , Modelos Dentales , Cara/anatomía & histología , Cara/diagnóstico por imagen , Asimetría Facial/diagnóstico por imagen , Femenino , Humanos , Incisivo/diagnóstico por imagen , Maloclusión de Angle Clase II/diagnóstico por imagen , Mandíbula/anatomía & histología , Mandíbula/diagnóstico por imagen , Maxilar/anatomía & histología , Maxilar/diagnóstico por imagen , Soportes Ortodóncicos , Alambres para Ortodoncia , Ortodoncia/instrumentación , Planificación de Atención al Paciente , Radiografía Panorámica , Resultado del Tratamiento
20.
Angle Orthod ; 88(6): 771-778, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30035613

RESUMEN

OBJECTIVES:: To investigate the relationships among different intrusion patterns of clear overlay aligners and the corresponding orthodontic forces and to provide guidance for clinical treatment. MATERIALS AND METHODS:: Five sets of removable thermoplastic-formed aligners with the same thickness, designed for different intrusion procedures (G0 aligners as a control group, with no activation; G1 aligners for intruding canines; G2 aligners for intruding incisors; G3 aligners for intruding canines and incisors with the same activations; G4 aligners for intruding canines and incisors with different activation), were manufactured, and the corresponding intrusion forces were measured with a multiaxis force/torque transducer measurement system in real time. RESULTS:: With the same activation (0.2-mm intrusion) and rectangular attachments placed on the premolars and first molars, the canines experienced the largest intrusive force when intruded alone using G1 aligners. The canines received a larger intrusive force than incisors in G3. The incisors received similar forces in G2 and G3. First premolars endured the largest extrusive forces when all anterior teeth were intruded with G3 aligners. Extrusion forces were exerted on canines and lateral incisors when using G4 aligners. CONCLUSIONS:: Aligners with different intrusion patterns exert different forces on incisors, canines, and premolars, and the forces were closely related to the designed activation, shape and position of the attachment and relative movement of the adjacent teeth.


Asunto(s)
Aparatos Ortodóncicos Removibles , Sobremordida/terapia , Técnicas de Movimiento Dental/instrumentación , Diente Premolar , Diente Canino , Humanos , Técnicas In Vitro , Incisivo , Diente Molar , Diseño de Aparato Ortodóncico , Estrés Mecánico , Técnicas de Movimiento Dental/métodos , Torque
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