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1.
J Biol Regul Homeost Agents ; 33(3 Suppl. 1): 63-72, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31538451

RESUMEN

The open-bite treatment can be considered one of the most difficult malocclusions to treat in children as well as in adult patients. Several papers show that the traditional maxillary expander device contribute to increase the vertical face dimension and bite opening due to posterior rotation of the mandible, buccal tipping of lateral segments and cuspal interferences. Other more specific studies compared the effects of traditional maxillary expander to those of bonded acrylic expander and evidenced that the acrylic expander can better control the vertical effects of the maxillary expansion by the resin bite plane on which the heavy occlusal forces are exerted. We decided to use an acrylic expander in order to prevent worsening of anterior openbite after a careful assessment of nasal airflow by the otorhinolaryngologist.


Asunto(s)
Mordida Abierta/cirugía , Técnica de Expansión Palatina/instrumentación , Acrilatos/química , Cefalometría , Humanos , Mandíbula , Dimensión Vertical
2.
Am J Orthod Dentofacial Orthop ; 156(1): 94-103, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31256848

RESUMEN

INTRODUCTION: Self-ligating appliances are purposed to expand the arches, but evidence on stability of the result is lacking. We measured the width of maxillary and mandibular arches and torque changes after treatment with the use of passive self-ligating appliances and assessed stability at the 2-year follow-up. METHODS: Maxillary and mandibular 3-dimensional (3D) models from 32 subjects (mean initial age 14.9 ± 0.9 years), consecutively treated with the use of self-ligating appliances, were obtained before, immediately after, and 2 years after treatment. Dental arches were examined with the use of 3D software to evaluate differences in transverse arch dimensions and torque values. RESULTS: An incremental increase of arch widths was recorded, especially regarding maxillary and mandibular premolars. The increase in the transverse diameters was associated with a significant positive torque gain. No significant changes in arch perimeter and depth were recorded. In the retention period, slight significant changes in transverse diameters were recorded, and a transverse diameter constriction detected. Torque values remained almost unchanged in the follow-up period. CONCLUSIONS: Transverse arch dimensions, along with torque values, increased significantly after treatment with the use of a passive self-ligating appliance. In the 2 years following treatment, a tendency to transverse diameter restriction, especially for the maxillary and mandibular premolars, was observed.


Asunto(s)
Arco Dental/anatomía & histología , Maloclusión/terapia , Aparatos Ortodóncicos , Técnica de Expansión Palatina , Técnicas de Movimiento Dental/métodos , Torque , Adolescente , Adulto , Análisis de Varianza , Diente Premolar , Diseño Asistido por Computadora , Técnica de Colado Dental , Modelos Dentales , Femenino , Estudios de Seguimiento , Humanos , Imagenología Tridimensional/métodos , Masculino , Maloclusión/patología , Mandíbula , Maxilar , Níquel , Diseño de Aparato Ortodóncico , Técnica de Expansión Palatina/instrumentación , Programas Informáticos , Titanio , Corona del Diente/anatomía & histología , Técnicas de Movimiento Dental/instrumentación , Resultado del Tratamiento , Adulto Joven
3.
Comput Methods Programs Biomed ; 176: 195-209, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31200906

RESUMEN

BACKGROUND AND OBJECTIVE: The orthopedic Maxillary Expansion (ME) procedure is used for treating the transverse maxillary deficiency. This pathology consists in a smaller transverse dimension in the maxilla and leads to malocclusion. The treatment takes advantage of the existence of the midpalatal suture (MPS), which corresponds to the junction at the palatine bones of its horizontal portions. The technique employs a device, conventionally a palatal expander attached to the posterior teeth, to separate the two maxillary bones in the MPS. The objective of this study was to analyze, using the Finite Element Method, the biomechanical behavior of the MPS when an expansion is applied. METHODS: A Computer Tomography image of the maxilla was reconstructed, the suture geometry was modeled with different interdigitation levels and types of hyrax devices. A total of 12 geometric models (three levels for interdigitation and four types of hyrax devices) were prepared and analyzed taking into account the chewing forces and the expansion displacement. For each case, maximum principal stresses on the maxilla (bone), and equivalent stresses on the expander device (stainless steel) were observed. In the MPS, maximum principal stresses and directional displacement were evaluated. RESULTS: The results showed that the interdigitation does not have an important influence on the deformation behavior of the maxilla but it affects the stress distribution. In addition, the type of expander device and anchorage have a direct relationship with the treatment effectiveness; larger deformation in the expansion direction was obtained with skeletal when compared to dental anchorage. CONCLUSIONS: A study that allows a better understanding of the oral biomechanics during the application of ME was presented. To our knowledge, it is the first study based on computational simulations that takes into account bone structures, like maxilla and part of the skull, to analyze the interdigitation influence on the MPS behavior when exposed to a ME.


Asunto(s)
Maxilar/patología , Técnica de Expansión Palatina/instrumentación , Paladar (Hueso)/fisiología , Fenómenos Biomecánicos , Simulación por Computador , Análisis de Elementos Finitos , Humanos , Imagenología Tridimensional/métodos , Modelos Anatómicos , Estrés Mecánico , Diente
4.
Arch Oral Biol ; 99: 161-168, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30710837

RESUMEN

OBJECTIVES: The aim of this study was to investigate the effects of continuous parathyroid hormone (cPTH) and intermittent parathyroid hormone (iPTH) on bone formation and bone resorption in midpalatal suture during maxillary expansion. METHODS: Forty-eight male SD rats were randomly divided into four groups (n = 12 each), including the control, the expansion (E), the E + cPTH, and the E + iPTH. A thermosensitive controlled-release hydrogel was synthesized for cPTH administration. All animals were sacrificed after seven days. Microcomputed tomography, histochemical staining and real-time PCR were used to investigate the bone remodeling of midpalatal suture. Serum chemistry was adopted to evaluate the systemic condition of experimental animals. RESULTS: The suture width was increased by the expansion, and further elevated by cPTH and iPTH administration. Both regimes improved bone volume fraction and trabecular thickness of suture bone region. Moreover, both cPTH and iPTH decreased SOST expression and enhanced the expression of ß-catenin and Col-I. cPTH increased RANKL expression, inhibited OPG expression, and resulted in an increment of osteoclasts, while iPTH had no influence on osteoclastogenesis. The serum calcium concentration was enhanced by PTH administration. CONCLUSION: Both cPTH and iPTH promote midpalatal suture expansion by enhancing bone formation, probably via SOST downregulation and the resulting ß-catenin activation. Our results demonstrated that PTH administration may have potential to be an adjunctive approach for maxillary expansion treatment.


Asunto(s)
Suturas Craneales/efectos de los fármacos , Osteogénesis/efectos de los fármacos , Técnica de Expansión Palatina , Hormona Paratiroidea/administración & dosificación , Hormona Paratiroidea/farmacología , Animales , Remodelación Ósea/efectos de los fármacos , Resorción Ósea/metabolismo , Resorción Ósea/patología , Suturas Craneales/diagnóstico por imagen , Suturas Craneales/patología , Masculino , Modelos Animales , Aparatos Ortodóncicos , Osteoclastos/efectos de los fármacos , Técnica de Expansión Palatina/instrumentación , Ligando RANK/metabolismo , Ratas , Factores de Tiempo , Microtomografía por Rayos X , beta Catenina/metabolismo
5.
J Oral Rehabil ; 46(4): 377-387, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30664799

RESUMEN

BACKGROUND: Constricted maxilla is frequently associated with reduced nasal airway dimensions. Wheatear skeletal maxillary expansion (ME) is effective on the dimension of the upper airways is still a debated issue. OBJECTIVES: This overview aimed to report the evidence provided by systematic reviews (SRs) on the effect of ME on the upper airways and to assess the methodological quality of the included SRs. METHODS: Six electronic databases have been explored up to November 2017. After title and abstract screening, SRs addressing the effects of fixed palatal expanders on the dimension and function of the nasal airways were included. The methodological quality of the included SRs was assessed using the updated version of A Measurement Tool to Assess Systematic Review (AMSTAR-2). RESULTS: Eight SRs were included. The methodological quality of most of the included SRs ranged between low and critically low. One SR was rated of high quality. A significant increase in nasal linear dimensions was reported both in the short and long term, but supported by low-/critically low-quality SRs. The significant increase in nasal cavity volume was the only outcome supported by a high-quality SR Controversial results were found with regards to nasal function. CONCLUSION: Whenever a constricted maxilla is present general dentists, paediatricians and ENTs should be familiar with the potential improvement provided by ME. However, due to the low/critically low quality of SRs supporting these results, ME cannot be indicated only for upper airways enhancement, but should be supported by an orthodontic indication.


Asunto(s)
Maxilar/patología , Enfermedades Maxilares/terapia , Cavidad Nasal/patología , Técnica de Expansión Palatina/instrumentación , Oclusión Dental , Odontología Basada en la Evidencia , Humanos , Mandíbula/anatomía & histología , Mandíbula/patología , Maxilar/anatomía & histología , Enfermedades Maxilares/patología , Metaanálisis como Asunto , Cavidad Nasal/anatomía & histología , Respiración , Revisiones Sistemáticas como Asunto , Resultado del Tratamiento
6.
Acta Odontol Scand ; 77(2): 88-98, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30350741

RESUMEN

BACKGROUND: Anchorage in orthodontics can be provided through several extra- and intra-oral sources including headgear, teeth, cortical bone and soft tissue. OBJECTIVE: The aim of this review was to systematically review the effectiveness of miniscrews in reinforcing anchorage during en-masse retraction of anterior teeth in comparison to conventional anchorage appliances. Search method: Comprehensive searching of the electronic databases was undertaken up to March 2018 in the Cochrane Database of Systematic review, Cochrane Central Register of Controlled Trials, MEDLINE via PubMed and Scopus databases. Additional searching for on-going and unpublished data and hand search of relevant journals were also undertaken, authors were contacted, and reference lists screened. Eligibility criteria: Searches were restricted to randomized clinical trials (RCTs) published in English, which compared anchorage reinforcement using mechanically-retained miniscrews (diameter of 2 mm or less) to conventional anchorage appliances during en-masse retraction of anterior teeth in participants of any age treated with fixed appliances combined with extraction of maxillary premolars. DATA COLLECTION AND ANALYSIS: Blind and induplicate study selection, data extraction and risk of bias assessment were undertaken. The primary outcome was the amount of mesial movement of the upper first permanent molar (anchorage loss) while secondary outcomes included treatment duration, number of visits, adverse effects and patient-centered outcomes. The risk of bias was assessed using Cochrane risk of bias tool. A random-effects model with its corresponding 95% confidence interval (CI) were generated for comparable outcomes. Statistical heterogeneity across the studies were assessed using the I2 and Chi2 test. Additional sensitivity tests were implemented. RESULTS: Seven RCTs met the inclusion criteria, however, data of 241 participants from 6 RCTs (250 miniscrews and 134 conventional anchorage appliances) were meta-analyzed. Qualities of the included RCTs varied from low to high. The standardized mean difference (SMD) of the anchrage loss between the two intervention groups was 2.07 mm ((95% CI (-3.05) to (-1.08), p < .001, I2 = 88%, 6 RCTs)) in favour of miniscrews, which was also preserved after excluding the high risk of bias studies (SMD 1.94 mm, 95% CI (-2.46) to (-0.42) p < .001, I2 = 93%, 3 RCTs)). Information on overall treatment duration, space closure duration, quality of treatment, patient-reported outcomes, adverse effects and number of visit were limited. CONCLUSION: The result of the meta-analysis suggested that there is moderate quality of evidence that miniscrews are clinically and statistically more effective in preserving orthodontic anchorage than conventional appliances. However, this conclusion is supported by a small number of studies with variable qualities. High-quality RCTs would give a better understanding of miniscrews effectiveness in providing orthodontic anchorage.


Asunto(s)
Diseño de Prótesis Dental , Métodos de Anclaje en Ortodoncia/métodos , Técnicas de Movimiento Dental/métodos , Humanos , Métodos de Anclaje en Ortodoncia/instrumentación , Soportes Ortodóncicos , Alambres para Ortodoncia , Técnica de Expansión Palatina/instrumentación , Técnicas de Movimiento Dental/instrumentación
7.
Am J Orthod Dentofacial Orthop ; 155(1): 117-126, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30591155

RESUMEN

This case report describes the successful camouflage treatment to correct a moderate skeletal Class III malocclusion in a 19-year-old male cleft-palate patient. Early closure of the palate produced palatal scar tissue that inhibited midfacial growth, causing maxillary arch deficiency, severe maxillary crowding, and anterior and posterior crossbites. Combined surgical-orthodontic therapy would have been the preferred treatment of choice; however, the patient declined this option because of surgical risks and costs. Therefore, nonextraction camouflage treatment using a passive self-ligating bracket system was used. Treatment aims including expansion of the maxillary arch and correction of the anterior and posterior crossbites were achieved without the use of an additional maxillary arch expander or other auxiliary appliances. This treatment resulted in satisfying facial esthetics and a normal dental occlusion.


Asunto(s)
Maloclusión de Angle Clase III/terapia , Aparatos Ortodóncicos Fijos , Técnica de Expansión Palatina/instrumentación , Cefalometría , Fisura del Paladar/complicaciones , Fisura del Paladar/cirugía , Estética Dental , Humanos , Masculino , Maloclusión de Angle Clase III/etiología , Diseño de Aparato Ortodóncico , Radiografía Panorámica , Adulto Joven
8.
J Craniomaxillofac Surg ; 46(12): 2069-2081, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30377029

RESUMEN

The most common problem in surgical and orthodontic treatment involves abnormal transverse dimension of the maxilla. Behaviour of the facial skeleton in its anterior-posterior dimension during treatment of maxillary narrowing using surgical assist is interesting to observe. Assessment of bone changes of the maxillary location assessed on lateral cephalograms and CBCT during surgically assisted maxillary expansion with bone-anchored appliances. The analysed material included documentation of 78 patients, the mean age of 16.86±2.65, treated with transverse maxillary distraction using a bone-anchored appliance. The software (Dolphin Imaging) was used to measure parameters on lateral cephalograms. Results obtained analysis of correlation between planes, angles and diameters between teeth before and after treatment. Simple Regression - SNA vs. SN-OCCL change of the anterior height with regard to changes in the occlusal angle refer to the opening and dropping of the maxilla in the anterior section. Simple Regression - SNA vs. S-PNS-ANS describe changes in the anterior section such as opening of the S-PNS-ANS angle, and in a correlation with the SNA angle opening it indicates maxillary dropping and protrusion. Dropping and protrusion of the maxilla can be observed during surgically assisted maxillary expansion with bone-anchored appliances. Maxillary anterior movement may depend on a surgical procedure.


Asunto(s)
Cefalometría , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Técnica de Expansión Palatina/instrumentación , Tomografía Computarizada de Haz Cónico Espiral , Adolescente , Puntos Anatómicos de Referencia , Niño , Femenino , Humanos , Masculino , Osteotomía Maxilar , Diseño de Aparato Ortodóncico , Osteotomía Le Fort , Interpretación de Imagen Radiográfica Asistida por Computador , Anclas para Sutura , Resultado del Tratamiento , Adulto Joven
9.
Dental Press J Orthod ; 23(5): 93-101, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30427498

RESUMEN

INTRODUCTION: Rapid maxillary expansion (RME) is the therapy of choice to correct skeletal transverse dimension in children and adolescents, associating orthopedic and dental effects. In an attempt to prevent the undesirable dentoalveolar effects and optimize the potential of skeletal expansion in individuals in advanced stages of skeletal maturation, the miniscrew-assisted rapid palatal expander (MARPE) was proposed by Lee et al. in 2010. OBJECTIVE: This paper presents a systematized protocol for selection of miniscrews indicated for MARPE, by the evaluation of cone-beam computed tomographies (CBCT). Variables related with the bone and soft tissue thicknesses at the palatal regions of interest, as well as in relation to the fixation rings of miniscrews of the palatal expander are analyzed and discussed to provide better performance in the clinical practice.


Asunto(s)
Tornillos Óseos , Maloclusión/terapia , Métodos de Anclaje en Ortodoncia/métodos , Técnica de Expansión Palatina , Protocolos Clínicos , Tomografía Computarizada de Haz Cónico , Técnica de Colado Dental , Implantación Dental/instrumentación , Implantación Dental/métodos , Humanos , Maloclusión/diagnóstico por imagen , Métodos de Anclaje en Ortodoncia/instrumentación , Técnica de Expansión Palatina/instrumentación
10.
Prog Orthod ; 19(1): 46, 2018 Nov 19.
Artículo en Inglés | MEDLINE | ID: mdl-30450504

RESUMEN

BACKGROUND: Skeletal maxillary expander (MSE) is one of the more recent expander designs being utilized for skeletal expansion by splitting the midpalatal sutures applying forces through palatal micro-implants. Its effects on the soft tissue remain a question asked by both patients and clinicians. The aim of this study was to analyze and quantify soft tissue facial changes induced by MSE. METHODS: 3D facial images (3dMD) were used to capture face scans of 25 patients generating 3D soft tissue meshes before expansion (T0), right after expansion (T1), and 1 year in retention (T2). MATLAB was then used, utilizing non-rigid iterative closest point algorithm, to align all samples in vertex correspondence and generate averages. Surface mapping of each average, along with its variance, allows for quantification of changes between the three pools of samples in 3D space. RESULTS: The generated 3D p-maps between T0 and T1 demonstrate that statistically significant changes (p < 0.05 and p < 0.01) are localized in the circummaxillary area (paranasal, lips, and both cheeks). Vector map shows a mean displacement of 1.5 mm in the paranasal area. The right cheek showing a mean displacement magnitude of 2.5 mm while the left cheek has a mean of 2.9 mm. Direction of vectors are latero-anterior with more dominant anterior direction. CONCLUSIONS: There are significant changes in paranasal, upper lip, and at both cheeks following expansion using MSE with greater magnitude at the cheeks area. Those changes do not relapse after 1 year (p < 0.05).


Asunto(s)
Implantes Dentales , Cara/anatomía & histología , Cara/diagnóstico por imagen , Imagenología Tridimensional , Técnica de Expansión Palatina/instrumentación , Fotogrametría/métodos , Adolescente , Adulto , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Adulto Joven
11.
Prog Orthod ; 19(1): 42, 2018 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-30345472

RESUMEN

BACKGROUND: Protraction of maxilla is usually the preferred and more commonly used treatment approach for skeletal Class III with a retrognathic maxilla. The aim of this study was the comparison of the skeletal and dental effects of two skeletally borne appliances for maxillary protraction: a) Hybrid-Hyrax in combination with facemask (FM), b) Hybrid-Hyrax in combination with Mentoplate (ME). METHODS: Thirty four Patients (17 facemask, 17 Mentoplate) were investigated by means of pre- and posttreatment cephalograms. The two groups matched with regard to treatment time, age gender and type of dentoskeletal deformity before treatment. RESULTS: Both groups showed a significant forward movement of A-point (FM GROUP: SNA + 2.23° ± 1.30°- p 0.000*; ME: 2.23° ± 1.43°- p 0.000*). B-Point showed a larger sagittal change in the FM Group (SNB 1.51° ± 1.1°- p 0.000*) compared to the ME group (SNB: - 0.30° ± 0.9°- p 0.070). The FM group showed a significant increase of the ML-NL + 1.86° ± 1.65° (p 0.000*) and NSL-ML + 1.17° ± 1.48 (p 0.006*). Upper Incisor inclination did not change significantly during treatment in both groups as well as the distance of the first upper Molar in relation to A-point. CONCLUSION: Both treatments achieve comparable rates of maxillary protraction, without dentoalveolar side effects. Skeletal anchorage with symphysial plates in the mandible provides greater vertical control and might be the treatment of choice in high angle patients.


Asunto(s)
Aparatos de Tracción Extraoral , Maloclusión de Angle Clase III/terapia , Diseño de Aparato Ortodóncico , Técnica de Expansión Palatina/instrumentación , Cefalometría , Niño , Humanos
12.
Prog Orthod ; 19(1): 41, 2018 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-30345476

RESUMEN

BACKGROUND: Miniscrew-assisted rapid palatal expansion (MARPE) has been adopted in recent years to expand the maxilla in late adolescence and adult patients. Maxillary Skeletal Expander (MSE) is a device that exploits the principles of skeletal anchorage to transmit the expansion force directly to the maxillary bony structures and is characterized by the miniscrews' engagement of the palatal and nasal cortical bone layers. In the literature, it has been reported that the zygomatic buttress is a major constraint that hampers the lateral movement of maxilla, since maxilla is located medially to the zygomatic arches. The objective of the present study is to analyze the changes in the zygomatic bone, maxillary bone, and zygomatic arches and to localize the center of rotation for the zygomaticomaxillary complex in the horizontal plane after treatment with MSE, using high-resolution cone-beam computed tomography (CBCT) images. METHODS: Fifteen subjects with a mean age of 17.2 (± 4.2) years were treated with MSE. CBCT records were taken before and after miniscrew-assisted maxillary expansion; three linear and four angular parameters were identified in the axial zygomatic section (AZS) and were compared from pre-treatment to post-treatment using the Wilcoxon signed rank test. RESULTS: Anterior inter-maxillary distance increased by 2.8 mm, posterior inter-zygomatic distance by 2.4 mm, angle of the zygomatic process of the temporal bone by 1.7° and 2.1° (right and left side) (P < 0.01). Changes in posterior inter-temporal distance and zygomaticotemporal angle were negligible (P > 0.05). CONCLUSIONS: In the horizontal plane, the maxillary and zygomatic bones and the whole zygomatic arch were significantly displaced in a lateral direction after treatment with MSE. The center of rotation for the zygomaticomaxillary complex was located near the proximal portion of the zygomatic process of the temporal bone, more posteriorly and more laterally than what has been reported in the literature for tooth-borne expanders. Bone bending takes place in the zygomatic process of the temporal bone during miniscrew-supported maxillary expansion.


Asunto(s)
Tornillos Óseos , Tomografía Computarizada de Haz Cónico , Maxilar/diagnóstico por imagen , Maxilar/fisiología , Técnica de Expansión Palatina/instrumentación , Cigoma/diagnóstico por imagen , Cigoma/fisiología , Adolescente , Femenino , Humanos , Imagenología Tridimensional , Masculino , Maloclusión/terapia , Mandíbula/diagnóstico por imagen , Diseño de Aparato Ortodóncico , Estudios Retrospectivos , Rotación , Adulto Joven
13.
Prog Orthod ; 19(1): 33, 2018 Oct 03.
Artículo en Inglés | MEDLINE | ID: mdl-30280257

RESUMEN

BACKGROUND: Maxillary skeletal expander (MSE) in combination with miniscrews was developed to overcome the drawbacks that may have resulted from the application of conventional rapid maxillary expander (RME). This research was conducted to analyze the difference of stress distribution of maxillary expansion using RME and MSE in the region of interests (ROIs): first molars (M1), palatal alveolar bones of M1, palatine sutures, zygomatic sutures, miniscrews, and their surrounding bones. METHODS: A dry skull was scanned using CBCT and rendered into a three-dimensional (3D) model of craniomaxillary structures. The data analysis was done both visually and numerically. RESULT: The stress distributions in RME group were located at the palatal side of M1, mesial side of palatal alveolar of M1, pulp chamber of M1, and inferior cortex of palatine sutures. The stress distributions in the MSE group were located at the distopalatal cusp of M1, palatal side of palatal alveolar of M1, and inferior and superior cortex of palatine sutures. The stress distributions in zygomatic sutures on both groups were located at the zygomaticotemporal sutures, whereas in the miniscrews, the stress were located at the anterior miniscrews and palatal side of surrounding bones. CONCLUSIONS: There were significant differences of stress distribution of maxillary expansion measured in the ROIs in the craniomaxillary 3D model using RME and MSE.


Asunto(s)
Análisis del Estrés Dental , Maxilar/fisiología , Técnica de Expansión Palatina/instrumentación , Proceso Alveolar/fisiología , Tornillos Óseos , Tomografía Computarizada de Haz Cónico , Suturas Craneales/fisiología , Análisis de Elementos Finitos , Humanos , Imagenología Tridimensional , Maxilar/diagnóstico por imagen , Modelos Anatómicos , Diente Molar/fisiología , Paladar Duro/fisiología , Estrés Mecánico , Cigoma/fisiología
14.
Am J Orthod Dentofacial Orthop ; 154(4): 504-516, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30268261

RESUMEN

INTRODUCTION: The objective of this research was to evaluate the buccal bone plate and root length of maxillary permanent first molars using cone-beam computed tomography after maxillary expansion with different activation protocols. METHODS: Cone-beam computed tomography images of growing patients were obtained from the orthodontic department of Pontifical Catholic University of Rio Grande do Sul in Brazil. The groups were Haas-type 2/4 turns, Haas-type 4/4 turns, hyrax-type 2/4 turns, and hyrax-type with alternate rapid maxillary expansions and constrictions (alt-RAMEC) 4/4 turns a day. Tooth length, periodontal insertion, alveolar bone thickness, and intermolar distances were evaluated. The data at the start of treatment and 6 months later were compared using generalized linear models. The intergroup differences were determined by univariate analysis of variance with the Bonferroni adjustment. RESULTS: Tooth length was significantly shortened after expansion in all groups (-0.28 to -0.51 mm), except for the alt-RAMEC group. Bone level variables (bone level and bone level at the tooth tip) changed statistically in all groups, except for the Haas 4/4 turns group. There was significant periodontal attachment loss after rapid maxillary expansion with the hyrax/alt-RAMEC (5.09 mm). The hyrax/alt-RAMEC and hyrax groups had more dehiscences, fenestrations, and exposures of the root. CONCLUSIONS: The consequence of rapid maxillary expansion using the hyrax was alveolar bone resorption, especially in the hyrax/alt-RAMEC group, whereas the Haas expander caused mild root resorption.


Asunto(s)
Placas Óseas/efectos adversos , Tomografía Computarizada de Haz Cónico/métodos , Maxilar/anatomía & histología , Maxilar/diagnóstico por imagen , Técnica de Expansión Palatina/efectos adversos , Raíz del Diente/anatomía & histología , Raíz del Diente/diagnóstico por imagen , Adolescente , Pérdida de Hueso Alveolar , Proceso Alveolar/diagnóstico por imagen , Análisis de Varianza , Brasil , Niño , Arco Dental/anatomía & histología , Arco Dental/diagnóstico por imagen , Femenino , Humanos , Imagenología Tridimensional , Masculino , Diente Molar/anatomía & histología , Diente Molar/diagnóstico por imagen , Métodos de Anclaje en Ortodoncia/efectos adversos , Métodos de Anclaje en Ortodoncia/instrumentación , Ortodoncia Correctiva/instrumentación , Ortodoncia Correctiva/métodos , Técnica de Expansión Palatina/instrumentación , Diente/anatomía & histología , Diente/diagnóstico por imagen , Raíz del Diente/patología
15.
J Indian Soc Pedod Prev Dent ; 36(3): 225-233, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30246741

RESUMEN

Objective: The present review was conducted to compare the effectiveness of Quad Helix (QH) appliance with other slow maxillary expanders in children with posterior crossbite. Materials and Methods: Randomized controlled clinical trials and retrospective studies published between January 1, 1995, and December 31, 2016, were identified from MEDLINE, the Cochrane Central Register of Controlled Trials, the National Institutes of Health Trials, Clinical Trials Registry India, Google Scholar and major journals. After a comprehensive search, the articles were independently screened for eligibility by two reviewers. All cross-reference lists of the selected studies were screened for any additional papers. Results: The preliminary screening consisted of 608 articles, of which 33 articles were selected. A final total of only 9 articles were included as they met the inclusion and exclusion criteria. Of the nine papers, four articles clearly state that QH appliance was a more effective appliance, while the remaining five studies suggest that the maxillary expansion caused by QH is comparable to other slow maxillary expansion appliances. Of the nine included articles, four articles also describe the complications of QH in comparison to other slow maxillary expansion devices. Conclusion: The QH appliance is a viable alternative for the correction of posterior crossbite. The QH appliance is comparable to or even better than other slow maxillary expanders in terms of maxillary expansion while being cost-effective with very few complications.


Asunto(s)
Maloclusión/terapia , Aparatos Ortodóncicos , Técnica de Expansión Palatina/instrumentación , Niño , Análisis Costo-Beneficio , Humanos , Aparatos Ortodóncicos/efectos adversos , Aparatos Ortodóncicos/economía , Técnica de Expansión Palatina/efectos adversos , Técnica de Expansión Palatina/economía
17.
Head Face Med ; 14(1): 16, 2018 Sep 19.
Artículo en Inglés | MEDLINE | ID: mdl-30231897

RESUMEN

BACKGROUND: Surgically assisted rapid maxillary expansion (SARME) is primarily used in adult orthodontics. In many cases it is followed by further surgery to address further anteroposterior and/or vertical discrepancies. Treatment times in such cases are often long with adult patients usually requesting invisible appliances. Lingual appliances can provide the mechanical control required as well as fulfil the aesthetic demands in such cases. However lingual appliances are usually custom made and indirectly bonded. Due to tooth movement following surgery there is usually a long delay before impressions can be made for customized lingual appliances. This results in a long delay before alignement and leveling can be commenced post-surgery. CASE PRESENTATIONS: Three cases are presented here demonstrating the simultaneous placement of bone anchored expansion devices for surgically assisted rapid maxillary expansion with customized lingual appliances. CONCLUSIONS: The combination of the two procedures allows the alignement and leveling to commence very soon after surgery significantly reducing treatment times. The design of the appliances and the clinical procedures are described and discussed.


Asunto(s)
Estética Dental , Maxilar/anomalías , Maxilar/cirugía , Aparatos Ortodóncicos , Técnica de Expansión Palatina/instrumentación , Adulto , Prótesis Anclada al Hueso , Terapia Combinada , Congresos como Asunto , Femenino , Humanos , Masculino , Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Diseño de Aparato Ortodóncico , Soportes Ortodóncicos , Diseño de Prótesis , Muestreo , Resultado del Tratamiento
18.
Angle Orthod ; 88(6): 702-709, 2018 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-30102085

RESUMEN

OBJECTIVES:: To evaluate and compare the dental and skeletal changes with conventional and miniscrew-supported maxillary expansion appliances in adolescents. MATERIALS AND METHODS:: Forty patients were divided into two groups, with one group receiving a tooth-borne expander and the other group receiving an expander supported by four miniscrews (bone-borne). Multiplanar coronal and axial slices obtained from cone-beam computed tomography images were used to measure the changes in transverse skeletal widths, buccal bone thickness, tooth inclination, and root length. Paired t-tests and independent-sample t-tests were used to compare the two expansion methods. RESULTS:: Bone-borne expansion increased the maxillary suture opening more than 2.5 times than tooth-borne expansion both anteriorly and posteriorly. Between the maxillary first premolars, sutural expansion accounted for 28% and 70% of the total transverse width increase in the tooth-borne and bone-borne expander groups, respectively. Similarly, 26% and 68% of the total expansion was of skeletal nature in the tooth-borne and bone-borne expander groups between the maxillary first molars. The pattern of expansion was variable, with most of the patients in both groups demonstrating a triangular-shaped sutural opening that was wider anteriorly. Subjects in the conventional group experienced significantly more buccal bone reduction and greater buccal inclination of the teeth. No significant differences were observed for root length measurements between the two groups. CONCLUSION:: Use of bone-borne expansion in the adolescent population increased the extent of skeletal changes in the range of 1.5 to 2.8 times that of tooth-borne expansion and did not result in any dental side effects.


Asunto(s)
Tornillos Óseos , Técnica de Expansión Palatina , Adolescente , Tomografía Computarizada de Haz Cónico , Femenino , Humanos , Masculino , Maloclusión/diagnóstico por imagen , Maloclusión/terapia , Métodos de Anclaje en Ortodoncia , Técnica de Expansión Palatina/instrumentación
19.
Eur J Paediatr Dent ; 19(3): 199-204, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30063151

RESUMEN

AIM: The aim of this study is to compare the dental and orthopaedic effects of the Leaf Expander with rapid and slow maxillary expanders. MATERIALS AND METHODS: The sample comprised 30 patients with a posterior crossbite divided into three groups: the rapid maxillary expander (RME) group (3 m, 7 f), average age 8.9 years; the slow maxillary expander (SME) group (7 m, 3 f) average age 12.2 years; the Leaf Expander (LE) group (7 m, 3 f), average age 7.9 years. Postero-anterior cephalometric studies have been obtained at the beginning of the therapy (T1) and after 9 months (T2). Nasal width, maxillary width, mandibular width, upper permanent molars width have been measured by a calibrated examiner. RESULTS: All the measurements increased significantly after the treatment (paired t-test P=0.05). Maxillary average width increased of 4.2 mm (SD 3.6 mm) in RME; + 2.8 mm (SD 2.8 mm) in RSE and +3.6 mm (SD 2.2 mm) in LE group. Upper permanent molars width increased: + 5.4 mm (SD 3.31 mm) in RME; + 5.4 mm (SD 3.3 mm) in SME and + 3.8 mm (SD 2.1 mm) in LE group. No statistical differencesbetween the groups have been found (t-student test P=.05). CONCLUSIONS: The effectiveness of the LE in transversal deficiency correction has been confirmed.


Asunto(s)
Cefalometría , Técnica de Expansión Palatina/instrumentación , Adolescente , Puntos Anatómicos de Referencia , Niño , Dentición Mixta , Femenino , Humanos , Masculino , Diseño de Aparato Ortodóncico , Estudios Retrospectivos
20.
J Craniomaxillofac Surg ; 46(9): 1408-1420, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30001885

RESUMEN

OBJECTIVE: SARME is often considered to be the only available treatment for significant or severe maxillary transverse palatal deficiencies (MTD) in skeletally-mature patients. Despite this observation, the aim of our study was to assess a new type of maxilla distraction osteogenesis. Using two innovative tools, we performed selective expansion: the site to be widened and the amount of increase were both pre-selected. Patients were treated in a single maxillomandibular procedure. Our study focuses primarily on the extent of osseous widening. STUDY DESIGN: Post-expansion computed tomography data from 55 non-syndromic patients were included in a prospective study and analyzed in two planes for transverse skeletal widening. Of the 55 patients, 16 underwent isolated posterior distraction for severe posterior endognathia (group I), and 39 were treated in both segments (group II). Diastemas and anterior spaces permitted resolution of crowding and patients with a small, narrow, tapering arch were given a more rounded form. All patients underwent a complete Le Fort I with down fracture. Two novel devices were used: first, an adjustable distractor to achieve an angular opening; and secondly, in group II, new modular plates interlocked for osteosynthesis to provide stability and anterior expansion. RESULTS: In group I, analysis of the width of the gain showed significant posterior values decreasing from back to front, a result never achieved with the SARME procedure. The mean osseous gain at first molars was 7.1 mm. When anterior space was required in group II, it was created as wide as needed (mean 4.2 mm, at canine level) with good preservation of the 1st molar space gain (mean 6.8 mm). CONCLUSION: Total Le Fort I osteotomy associated with two innovative devices provides a new, segmental and adaptable approach for transverse distraction osteogenesis. We demonstrate a good match with the dental enlargement required. All patients were managed in a single orthognathic procedure for all the anomalies to be treated. Long-term results show good stability.


Asunto(s)
Maloclusión/terapia , Procedimientos Quirúrgicos Ortognáticos , Técnica de Expansión Palatina/instrumentación , Adolescente , Terapia Combinada , Diseño de Equipo , Femenino , Humanos , Masculino , Osteogénesis por Distracción , Osteotomía Le Fort , Estudios Prospectivos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto Joven
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