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2.
Rev. ADM ; 77(5): 261-266, sept.-oct. 2020. ilus
Artículo en Español | LILACS | ID: biblio-1147137

RESUMEN

Una de las consecuencias de la desprogramación neuromuscular es la rotación mandibular en sentido horario, evidenciando el punto prematuro de contacto y aumentando la dimensión vertical del paciente. En pacientes clase II con componente vertical, es un problema realizar este tipo de tratamiento, ya que por lo general este efecto de posterorrotación mandibular hace el perfil más convexo, y en algunos casos genera mordida abierta anterior, la cual se debe corregir posteriormente con el tratamiento de ortodoncia, cirugía o prótesis, lo que alarga el tiempo total de tratamiento por la necesidad de control vertical. El presente caso se trata de una mujer de 45 años de edad, dolicofacial, con tendencia a mordida abierta, mordida dual, sobremordida vertical y horizontal disminuidas, motivo de consulta dolor articular, el cual no le permite continuar con sus labores diarias, el tratamiento realizado fue desprogramación neuromuscular con un guarda oclusal inferior con el propósito de aliviar sintomatología articular y control vertical con microtornillos palatinos previo a tratamiento ortodóncico (AU)


One of the effects of the neuromuscular deprogramming treatment is the mandibular clockwise rotation, making the light premature occlusal contact more evident and increasing the patient vertical dimension. In Class II patients with vertical component is difficult to treat them due to profile worsening as an effect of the clockwise rotation creating in some patient's anterior open bite, this has to be corrected later in treatment with orthodontic intrusion, surgery or prosthodontic treatment, increasing the total time of treatment with the vertical control necessity. This case report is a 45 years old patient, dolichofacial, with anterior open bite tendency, dual bite, decreased overjet and overbite, her chief complaint was temporomandibular joint dysfunction which dont allow her to do her daily duties, the treatment for her was neuromuscular deprogramming splint for the temporomandibular joint pain, and vertical control with temporary anchorage devices (miniscrews) before the orthodontic treatment (AU)


Asunto(s)
Humanos , Persona de Mediana Edad , Dimensión Vertical , Síndrome de la Disfunción de Articulación Temporomandibular/terapia , Implantes Dentales , Mordida Abierta/terapia , Rotación , Ferulas Oclusales , Manifestaciones Neuromusculares , Sobremordida/terapia , Mandíbula/fisiología , México
3.
Int. j. odontostomatol. (Print) ; 14(1): 101-108, mar. 2020. tab, graf
Artículo en Español | LILACS | ID: biblio-1056508

RESUMEN

RESUMEN: El apiñamiento en edades tempranas, se refleja cuando el tamaño dental no coincide con la longitud de arco. De este modo, resulta importante determinar si la expansión del maxilar podría solucionar por sí solo el problema de apiñamiento en el sector anterior, teniendo en cuenta que este tratamiento es uno de los más antiguos y que comúnmente se ha enfocado en la resolución de alteraciones transversales en dientes posteriores empleándose a edades tempranas. El objetivo fue determinar si la expansión maxilar es efectiva o no, en la corrección del apiñamiento en dentición mixta mediante el análisis de la evidencia disponible. Se realizó una revisión sistemática en español e inglés, para establecer la máxima evidencia posible, con las indicaciones de la guía PRISMA. Dos artículos cumplieron con la calidad de la revisión. En el primero se estableció que el apiñamiento mejoro despues del tratamiento de expansion maxilar, con una recidiva menor en la dentición permanente. En el segundo, se encontró que el apiñamiento en los incisivos permanentes superiores fue corregido cuando se retiró el aparato expansor. Se concluyó que la evidencia actual no tiene la suficiente calidad metodológica para llevar a una toma de decisión. Se recomienda hacer ensayos clínicos aleatorizados en este tema.


ABSTRACT: Crowding at early ages is reflected when tooth size does not coincide with arch length. Thus, it is important to determine whether maxillary expansion alone could solve the problem of crowding in the anterior sector, bearing in mind that this treatment is one of the oldest and has commonly focused on solving transverse alterations in posterior teeth used at an early age. The objective was to determine whether or not maxillary expansion is effective in correcting crowding in the mixed dentition by analysing the available evidence. A systematic review was carried out in Spanish and English, to establish the maximum possible evidence, with the indications of the PRISMA guide. Two articles met the quality of the review. The first established that crowding improved after the treatment of maxillary expansion, with a minor recurrence in the permanent dentition. In the second, it was found that crowding in the upper permanent incisors was corrected when the expanding appliance was removed. The current evidence is not of sufficient methodological quality to lead to a decision. Randomized clinical trials are recommended in this area.


Asunto(s)
Humanos , Técnica de Expansión Palatina , Aparatos de Tracción Extraoral , Sobremordida/terapia , Maloclusión de Angle Clase III/terapia , Tamizaje Masivo , Diseño de Aparato Ortodóncico , Dentición Mixta
4.
Angle Orthod ; 90(2): 291-304, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31816252

RESUMEN

OBJECTIVES: To evaluate systematically the effectiveness of miniscrew-supported maxillary incisor intrusion compared with other nonsurgical intrusive mechanics for deep-bite correction. MATERIALS AND METHODS: Unrestricted electronic searches in Embase, Web of Science, MEDLINE, LILACS, and Cochrane's CENTRAL as well as manual searches were conducted up to August 2019. Only randomized clinical trials (RCTs) were included. Study selection, data extraction, and bias assessment were done by two independent reviewers. The Cochrane risk-of-bias tool was used, and the quality of evidence was graded using the GRADE approach. A random-effects meta-analysis of continuous data, with its 95% confidence intervals (CIs), was used. RESULTS: Seven RCTs were included in the quantitative synthesis, and the overall quality of evidence was very low to low. When compared with intrusion arches, miniscrews resulted in a more efficient deep-bite reduction with a standardized mean difference (SMD) of -0.48 (95% CI, -0.89 to -0.07). When miniscrews were used, a statistically significant difference was observed favoring less maxillary molar extrusion (SMD, -0.86; 95% CI, -1.46 to -0.27) and more incisor intrusion as measured from centroid to palatal plane (SMD, -0.95; 95% CI, -1.41 to -0.49). Results also showed a statistically nonsignificant difference regarding the amount of resultant root resorption between miniscrews and intrusion arches. CONCLUSIONS: There is weak evidence indicating efficient deep-bite correction using miniscrews. Root resorption seems to be an associated adverse effect that occurs regardless of the intrusive mechanics used. These conclusions should be viewed with great caution as further well-designed long-term research is recommended.


Asunto(s)
Tornillos Óseos , Métodos de Anclaje en Ortodoncia , Sobremordida , Humanos , Incisivo , Sobremordida/terapia , Técnicas de Movimiento Dental
5.
Int Orthod ; 17(4): 806-816, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31477527

RESUMEN

The treatment of skeletal deep bite does not remain stable. The patient was a Japanese woman aged 16 years and 10 months. Her chief complaint was maxillary protrusion. The degree of overjet was + 10.5 mm and overbite was + 5.0 mm; the intermolar relationship was Angle Class II. An excessive curve of Spee was observed in the mandibular arch. A hypodivergent skeletal pattern was indicated by a small mandibular plane angle and gonial angle. The maxillary incisors were proclined and the mandibular incisors were retroclined. Based on the above findings, the patient was diagnosed with Angle Class II maxillary protrusion and deep bite with hypodivergency. Both maxillary first premolars were extracted and orthodontic treatment was performed using multi-bracket appliances. A proper overbite was achieved by 5.0 mm intrusion of the mandibular incisors. The maxillary incisors were retracted by 11.2 mm and a proper overjet was achieved. Good treatment results were obtained without apical root resorption. After 2 years of retention, the occlusion has been well maintained. This report may constitute a remarkable suggestion for treatment of an unstable deep bite.


Asunto(s)
Incisivo , Maloclusión de Angle Clase II/terapia , Maxilar , Métodos de Anclaje en Ortodoncia/métodos , Sobremordida/terapia , Técnicas de Movimiento Dental/métodos , Adolescente , Diente Premolar , Cefalometría , Modelos Dentales , Oclusión Dental , Femenino , Humanos , Maloclusión de Angle Clase II/diagnóstico por imagen , Mandíbula , Métodos de Anclaje en Ortodoncia/instrumentación , Soportes Ortodóncicos , Alambres para Ortodoncia , Sobremordida/diagnóstico por imagen , Técnicas de Movimiento Dental/instrumentación , Resultado del Tratamiento
6.
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
7.
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
8.
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
9.
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
10.
Clin Exp Dent Res ; 5(3): 199-204, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31249699

RESUMEN

This study aims to evaluate the prevalence of occlusal traits and to assess parents'/caregivers' satisfaction with child's dental appearance and perception of orthodontic treatment need in 4-5-year-old Estonians. Clinical records and plaster casts of 390 children (190 girls and 200 boys, mean age 4.7 years, range 4 - 5 years) were analyzed. Assessed occlusal traits included deciduous canine and second molar sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite, and scissor bite. Parents'/caregivers' opinions regarding their child's teeth were determined with a questionnaire. The most prevalent occlusal traits were symmetrical sagittal relationship in deciduous canines (78.2%) and molars (75.1%), Class I sagittal relationship in deciduous canines (69.7%) and midline diastema (67.7%). Asymmetrical sagittal canine relationship was registered in 21.8% deciduous canines and in 24.9% second deciduous molars. Parents'/caregivers' perceived orthodontic treatment need was related to Class III sagittal relationship in canines, increased overjet and overbite, negative overbite, and crossbite. Prevalence of most occlusal traits in Estonian children were in line with those reported in neighboring countries. Parents/caregivers were well able to observe occlusal traits that deviated from acceptable occlusion.


Asunto(s)
Maloclusión/fisiopatología , Ortodoncia Correctiva , Padres , Satisfacción Personal , Apariencia Física , Preescolar , Estonia , Femenino , Humanos , Indice de Necesidad de Tratamiento Ortodóncico , Masculino , Maloclusión/terapia , Maloclusión de Angle Clase I/fisiopatología , Maloclusión de Angle Clase I/terapia , Maloclusión de Angle Clase II/fisiopatología , Maloclusión de Angle Clase II/terapia , Maloclusión de Angle Clase III/fisiopatología , Maloclusión de Angle Clase III/terapia , Evaluación de Necesidades , Sobremordida/fisiopatología , Sobremordida/terapia
11.
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
12.
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
13.
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
14.
Int Orthod ; 17(1): 3-11, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30770329

RESUMEN

OBJECTIVE: This systematic review aimed to clarify whether there are any significant long-term sequelae to wearing mandibular advancement devices focusing on dental and skeletal effects in adults with OSA. MATERIALS AND METHODS: Databases, including PubMed, Medline, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and SAGE Journals. Hand searches and grey literature were also used. A piloted data collection form was used to extract the appropriate data. RESULTS: Twenty-three reports of 19 studies were included. Five had serious risk of bias while 18 had moderate risk of bias. Meta-analysis revealed a significant change in overbite and overjet. I-squared analysis showed a high level of statistical heterogeneity. A moderate correlation was found between wear time and amount of change. CONCLUSION: Mandibular advancement devices will cause a small but statistically significant change in the dentition of long-term wearers. Skeletal changes are generally secondary to dental changes.


Asunto(s)
Avance Mandibular/instrumentación , Ferulas Oclusales , Apnea Obstructiva del Sueño/terapia , Adulto , Bases de Datos Factuales , Humanos , Avance Mandibular/efectos adversos , Avance Mandibular/métodos , Ferulas Oclusales/efectos adversos , Sobremordida/complicaciones , Sobremordida/terapia , Apnea Obstructiva del Sueño/etiología , Apnea Obstructiva del Sueño/patología
15.
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
16.
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
17.
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
18.
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
19.
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
20.
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
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