Changes in behavioral and cognitive abilities after rapid maxillary expansion in children affected by persistent snoring after long-term adenotonsillectomy: A noncontrolled study.

INTRODUCTION: The objective of this study was to verify changes in behavioral abilities and cognitive functions after rapid maxillary expansion (RME) in children with refractory sleep-disordered breathing (SDB) in the long term after adenotonsillectomy. METHODS: A prospective clinical trial study using RME therapy was conducted. Participant inclusion criteria were children who had adenotonsillectomy with maxillary transverse deficiency and persistent SDB (obstructive apnea-hypopnea index ≥1). The study included 24 children aged 5-12 years, and of these 24 children, 13 had primary snoring and 11 had obstructive sleep apnea. The patients underwent laryngeal nasofibroscopy and a complete polysomnography. In addition, patients completed the Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life Questionnaire. Behavioral and neurocognitive tests were also completed before and after RME. RESULTS: The Obstructive Pediatric Sleep Questionnaire and Obstructive Sleep Apnea 18-Item Quality-of-Life scores showed a statistically significant decrease in both groups (P <0.001) after RME. The results showed that neurocognitive and behavioral parameters (Child Behavior Checklist scale) were similar in primary snoring and obstructive sleep apnea (OSA) groups before RME. In the OSA group, the mean scores of the "Somatic" and "Aggressiveness" domains decreased significantly (P <0.05). The cognitive functions did not register significant differences pre- and post-RME in any of the cognitive functions, except for visuospatial function in the OSA group. CONCLUSIONS: The noncontrolled design was a major limitation of our study. The need for treatment for SDB should consider the association of symptoms and behavioral disturbances with the child's obstructive apnea-hypopnea index. RME might prove to be an alternative treatment for children with SDB refractory to adenotonsillectomy, improving quality of life and behavioral aspects. However, a larger sample size with a control group is needed to substantiate these claims.

Preliminary short-term outcomes of rapid maxillary expansion on periodic limb movements during sleep in pediatric sleep-disordered breathing.

OBJECTIVE: To assess the short-term outcome of rapid maxillary expansion (RME) on periodic limb movement disorder (PLMD) in children with residual snoring after late adenotonsillectomy (AT). METHODS: This prospective clinical trial included 24 patients treated with rapid maxillary expansion (RME). Participants' inclusion criteria were children with maxillary constriction aged 5-12 years who had AT for more than two years and those whose parents/guardians reported that they still snored ≥4 nights per week. Of which 13 had primary snoring, and 11 had OSA. All patients underwent laryngeal nasofibroscopy evaluation and complete polysomnography. The Quality of life (QOL) Questionnaire (OSA-18), the Pediatric Sleep Questionnaire (PSQ), the Conners Abbreviated Scale (CAE), and the Epworth Sleep Scale (ESS) were applied before and after palatal expansion. RESULTS: The OSA 18 domain, PSQ total, CAE, and ESS scores were significantly reduced in both groups (p < 0.001). There was a decrease in PLMS indices. In the total sample, the mean decreased significantly from 4.15 to 1.08. In the Primary Snoring group, the mean decreased from 2.64 to 0.99; in the OSA group, the average decreased significantly from 5.95 to 1.19. CONCLUSION: This preliminary study suggests that the improvement of PLMS in the OSA group with maxillary constriction is correlated with a favorable neurological impact of the treatment. We suggest a multi-professional approach to the treatment of sleep disorders in children.

The effects of rapid maxillary expansion on persistent pediatric snoring post-tonsillectomy.

PURPOSE: To investigate the short-term effects of rapid maxillary expansion (RME) on the quality of life of children who had persistent snoring post-adenotonsillectomy (AT). METHODS: The study included children with maxillary constriction aged 5 to 12 years, two or more years after AT whose parents/guardians reported that they still snored ≥ 5 nights per week. We enrolled children with sleep-disordered breathing, including children with primary snoring and children with obstructive sleep apnea (OSA). All patients underwent laryngeal nasofibroscopy and complete polysomnography. Quality of Life (QOL) Questionnaire (OSA-18), the Pediatric Sleep Questionnaire (PSQ), Conners Abbreviated Scale (CAS), and the Epworth Sleepiness Scale (ESS) were administered before and after RME. RESULTS: Of 24 children enrolled, 13 had primary snoring and 11 had OSA. Overall OSA-18 scores were reduced in both groups (intragroup difference, p < 0.001). The PSQ total score, CAS, and ESS were significantly reduced in both groups (p < 0.001) In the evaluation of snoring, there was a reduction due to the treatment effect in both groups (p < 0.001). Daytime sleepiness and attention deficit hyperactivity disorders were also positively affected in both groups. CONCLUSIONS: Our study demonstrated the potential benefit of RME in treating children with persistent snoring and transverse maxillary deficiency (TMD). RME can improve snoring and the QOL of children with refractory SDB after AT. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: RBR-463byn.

A clinical trial on 3D CT scan and polysomnographyc changes after rapid maxillary expansion in children with snoring

Abstract Objective: The present prospective clinical study aimed to investigate the effects of rapid maxillary expansion on the airway, correlating airway volumes obtained on multi-slice computed tomography and polysomnography assessment of oxygen saturation and apnea/hypopnea index. Methods: Twenty-four patients (11 with obstructive sleep apnea and 13 with residual snoring, mean age 10.0 (1.8), were enrolled in the study. Each patient underwent multislice computed tomography and nocturnal polysomnography before rapid maxillary expansion and after removal of maxillary expansion after six months. Airway regions were segmented, and volumes were computed. Results: The increase in oropharyngeal volume was significant in both groups. Oxygen saturation and apnea/hypopnea index were not statistically significant. No correlation was found between total airway volume, oxygen saturation, and apnea/hypopnea index changes between the time points examined. Conclusions: This study showed that when rapid maxillary expansion is performed in individuals with sleep-disordered breathing, there were statistically significant differences in oropharyngeal volume between pre- and post-rapid maxillary expansion, but there was no correlation between oxygen saturation values and oropharyngeal volume increase. Level of evidence: The article is classified as Evidence Level 3 (Three).

A clinical trial on 3D CT scan and polysomnographyc changes after rapid maxillary expansion in children with snoring.

OBJECTIVE: The present prospective clinical study aimed to investigate the effects of rapid maxillary expansion on the airway, correlating airway volumes obtained on multi-slice computed tomography and polysomnography assessment of oxygen saturation and apnea/hypopnea index. METHODS: Twenty-four patients (11 with obstructive sleep apnea and 13 with residual snoring, mean age 10.0 (1.8), were enrolled in the study. Each patient underwent multislice computed tomography and nocturnal polysomnography before rapid maxillary expansion and after removal of maxillary expansion after six months. Airway regions were segmented, and volumes were computed. RESULTS: The increase in oropharyngeal volume was significant in both groups. Oxygen saturation and apnea/hypopnea index were not statistically significant. No correlation was found between total airway volume, oxygen saturation, and apnea/hypopnea index changes between the time points examined. CONCLUSIONS: This study showed that when rapid maxillary expansion is performed in individuals with sleep-disordered breathing, there were statistically significant differences in oropharyngeal volume between pre- and post-rapid maxillary expansion, but there was no correlation between oxygen saturation values and oropharyngeal volume increase. LEVEL OF EVIDENCE: The article is classified as Evidence Level 3 (Three).

Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review / Eficácia dos aparelhos ortodônticos funcionais no tratamento da apneia obstrutiva do sono em crianças: revisão da literatura

Abstract Introduction: Obstructive sleep apnea syndrome is a common condition in childhood and if left untreated can result in many health problems. An accurate diagnosis of the etiology is crucial for obstructive sleep apnea treatment success. Functional orthodontic appliances that stimulate mandibular growth by forward mandibular positioning are an alternative therapeutic option in growing patients. Objective: To perform a literature review about the effects of functional orthodontic appliances used to correct the mandibular deficiency in obstructive sleep apnea treatment. Methods: The literature search was conducted in June 2020 using Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS Ovid; SciELO Web of Science; EMBASE Bireme and BBO Bireme electronic databases. The search included papers published in English, until June 2020, whose methodology referred to the types and effects of functional orthopedic appliances on obstructive sleep apnea treatment in children. Results: The search strategy identified thirteen articles; only four articles were randomized clinical studies. All studies using the oral appliances or functional orthopedic appliances for obstructive sleep apnea in children resulted in improvements in the apnea-hypopnea index score. The cephalometric (2D) and tomographic (3D) evaluations revealed enlargement of the upper airway and increase in the upper airspace, improving the respiratory function in the short term. Conclusion: Functional appliances may bean alternative treatment for obstructive sleep apnea, but it cannot be concluded that they are effective in treating pediatric obstructive sleep apnea. There are significant deficiencies in the existing evidence, mainly due to absence of control groups, small sample sizes, lack of randomization and no long-term results.

Resumo Introdução: A síndrome da apneia obstrutiva do sono é uma condição comum na infância e, se não tratada, pode resultar em muitos problemas de saúde. Um diagnóstico preciso da etiologia é crucial para o sucesso do tratamento dessa condição clínica. Aparelhos ortodônticos funcionais que estimulam o crescimento mandibular através do anteroposicionamento mandibular são uma opção terapêutica para pacientes em crescimento. Objetivo: Fazer uma revisão da literatura sobre os efeitos do aparelho ortodôntico funcional usado para corrigir a deficiência mandibular no tratamento da apneia obstrutiva do sono. Método: A pesquisa bibliográfica foi feita em junho de 2020 nos os bancos de dados eletrônicos da Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), Lilacs Ovid; SciELO Web of Science; Embase Bireme e BBO Bireme. A busca incluiu artigos publicados em inglês, até junho de 2020, cuja metodologia referia-se aos tipos e efeitos dos aparelhos ortopédicos funcionais no tratamento da apneia obstrutiva do sono em crianças. Resultados: A estratégia de busca identificou 19 artigos; apenas quatro eram estudos clínicos randomizados. Todos os estudos que usaram aparelhos orais ou aparelhos ortopédicos funcionais para apneia obstrutiva do sono em crianças resultaram em melhorias no índice de apneia-hipopneia. As avaliações cefalométrica (2D) e tomográfica (3D) mostraram alargamento das vias aéreas superiores e aumento do espaço das vias aéreas superiores, que melhoraram a função respiratória em curto prazo. Conclusão: Os aparelhos funcionais podem ser um tratamento opcional para apneia obstrutiva do sono, mas não é possível concluir que sejam eficazes na população pediátrica. Existem deficiências significativas nas evidências existentes, principalmente devido à ausência de grupos de controle, tamanho pequeno das amostras, falta de randomização e ausência de resultados em longo prazo.

Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review.

INTRODUCTION: Obstructive sleep apnea syndrome is a common condition in childhood and if left untreated can result in many health problems. An accurate diagnosis of the etiology is crucial for obstructive sleep apnea treatment success. Functional orthodontic appliances that stimulate mandibular growth by forward mandibular positioning are an alternative therapeutic option in growing patients. OBJECTIVE: To perform a literature review about the effects of functional orthodontic appliances used to correct the mandibular deficiency in obstructive sleep apnea treatment. METHODS: The literature search was conducted in June 2020 using Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS Ovid; SciELO Web of Science; EMBASE Bireme and BBO Bireme electronic databases. The search included papers published in English, until June 2020, whose methodology referred to the types and effects of functional orthopedic appliances on obstructive sleep apnea treatment in children. RESULTS: The search strategy identified thirteen articles; only four articles were randomized clinical studies. All studies using the oral appliances or functional orthopedic appliances for obstructive sleep apnea in children resulted in improvements in the apnea-hypopnea index score. The cephalometric (2D) and tomographic (3D) evaluations revealed enlargement of the upper airway and increase in the upper airspace, improving the respiratory function in the short term. CONCLUSION: Functional appliances may be an alternative treatment for obstructive sleep apnea, but it cannot be concluded that they are effective in treating pediatric obstructive sleep apnea. There are significant deficiencies in the existing evidence, mainly due to absence of control groups, small sample sizes, lack of randomization and no long-term results.

Three-dimensional airway changes after adenotonsillectomy in children with obstructive apnea: Do expectations meet reality?

INTRODUCTION: The assessment of the volumetric changes of the airways after adenotonsillectomy has gained popularity among orthodontists, but the validity of such evaluation is not clear. METHODS: Thirty patients with obstructive sleep apnea diagnosed with the use of polysomnography (PSG) were evaluated according to the Apnea and Hypopnea Index (AHI), the obstructive apnea index (OAI), the oxygen desaturation index (ODI), the lowest oxygen saturation (LSpO2), and the average oxygen saturation (ASpO2). The volume and the minimal cross-section of lower (oropharynx and velopharynx) and upper (nasopharynx) spaces of the airways were calculated. Patients were adenotonsillectomized; posttreatment data were collected after 12 months. Thirty comparison patients also had the volume of airways evaluated. RESULTS: A statistically significant improvement (P < 0.05) of most PSG parameters was observed after adenotonsillectomy: AHI from 14.5 to 5.2, OAI from 9.4 to 5.5, ODI from 14.6 to 6.5, and LSpO2 from 77% to 94%). A significant increase in airway volume of the lower space (from 2571.5 mm3 to 5276.3 mm3) and the upper space (from 726 mm3 to 1056.9 mm3), as well as in the minimal cross-section of the airways (from 98.5 mm2 to 335.8 mm2) was found in adenotonsillectomy patients. No significant volumetric changes of the airways were observed in the comparison patients. No significant correlation was found between PSG parameters and the dimensions of the airways before adenotonsillectomy. No significant correlation was found between changes of the PSG parameters and changes of the dimensions of the airways 12 months after the adenotonsillectomy. CONCLUSIONS: Adenotonsillectomy contributed to the increase of the airway volume and minimal cross-section, and to the improvement of the PSG parameters, but there was no correlation between the magnitude of the anatomic changes and the improvement of the breathing mode.

Estudo comparativo do tratamento da mordida profunda com o uso do Bite Turbo® ­ estudo piloto / Comparative study of the treatment of deep bite with the use of Bite Turbo® ­ pilot study

O objetivo desse estudo piloto foi avaliar os efeitos induzidos pelo uso do Bite Turbo® como um mecanismo auxiliar no tratamento ortodôntico de pacientes com mordida profunda. A amostra consistiu de 14 pacientes com média de idade de 11 anos. Sete pacientes foram tratados exclusivamente com aparelho fixo (grupo controle) e sete pacientes com aparelho fixo e o Bite Turbo® colado nos incisivos centrais superiores. O período médio de avaliação (T0-T1) nos dois grupos foi de 9 meses. O erro do desvio padrão para cada variável usada no estudo foi calculado por meio de dupla avaliação usando a fórmula Dahlberg e para avaliação das mudanças cefalométricas entre os grupos foi utilizado o teste não paramétrico de Wilcoxon a 5%. O grupo tratado com Bite Turbo® mostrou significante melhora da mordida profunda, com aumento na altura facial total e extrusão dos primeiros molares, o que levou a um aumento na profundidade facial. Concluiu-se que o uso do Bite Turbo® levou a uma melhora significante na mordida profunda, mas a rotação mandibular deve ser considerada quando planejamos o tratamento ortodôntico nos diferentes tipos faciais. (AU)

The aim of this pilot study was to evaluate the effects induced by Bite Turbo® (Ormco Corp. Glendora, Ca, USA) as an auxiliary mechanism to orthodontic treatment of patients with deep overbite. The sample consisted of 14 patients with mean age of 11 years. Seven patients were treated with fixed appliances exclusively (control group) and 7 patients with fixed appliances and Bite Turbo® bonded to the upper central incisors. The average time of the evaluation period (T0 and T1) in both groups was 9 months. The standard error deviation for each variable used in the study was calculated from the double determinations using Dahlberg's formula and the cephalometric changes between groups were evaluated by the Wilcoxon nonparametric test at 5%. The Bite Turbo® group showed significant improvement of deep overbite, with an increase in total facial height (TFH) and extrusion of the first molars which led to an increase in facial depth (FD). It was concluded that the use of Turbo Bite® led to a significant improvement in deep overbite, but the mandibular rotation should be taken into account when considering the orthodontic treatment plan in different facial types. (AU)

Custo benefício do ionômero de vidro encapsulado usado como material restaurador para Tratamento Restaurador Atraumático (ART): relato de caso / Cost-effective of the glass ionomer cement encapsulated used as filling material for Atraumatic Restorative Treatment (ART): case report

Objetivo ­ Relatar o caso clínico de uma criança submetido ao Tratamento Restaurador Atraumático (ART) utilizando como material restaurador o CIV nas duas versões (pó-líquido e encapsulado). Além disso, promover uma discussão a respeito das vantagens e desvantagens relacionadas a manipulação manual e mecânica do material restaurador. Paciente de 7 anos de idade portador de cárie dentária foi tratado de acordo com ART e recebeu uma restauração com CIV de alta viscosidade do tipo pó-líquido e um selante com CIV encapsulado. O material encapsulado apresenta custo inicial mais elevado entretanto, as propriedades físicas e mecânicas ficam asseguradas e esperase um reflexo positivo na longevidade clínica das restaurações. Desta maneira, os reparos podem ser menos frequentes diminuindo o custo a longo prazo. O Cimento de Ionômero de Vidro encapsulado facilita o processo restaurador e minimiza os erros de dosagem e manipulação. Entretanto, o custo é elevado quando comparado ao mesmo material do tipo pó-líquido. Estudos clínicos randomizados longitudinais são necessários para esclarecer se a diferença inicial de custo da versão encapsulada é compensada a longo prazo.

Objective ­ Report a case of a child submitted to ART using GIC as restorative material in both versions (powder-liquid and encapsulated). Moreover, promote a discussion of the advantages and disadvantages related to manual and mechanical manipulation of the restorative treatment. Patient 7-year-old with dental caries was treated according to ART and received a restoration with CIV high viscosity powderliquid type and a sealant with encapsulated CIV. The encapsulated material has higher initial cost however, the physical and mechanical properties are guaranteed and a positive reflection on the clinical performance of restorations is expected. Thus, repairs can be less frequent reducing the long term cost. The glass ionomer cement encapsulated facilitates the restorative process and minimizes the dosage and manipulation mistakes. However, the cost is high when compared to the same material as the powder-liquid type. Longitudinal randomized clinical studies are expected to clarify whether the initial cost difference of the encapsulated version is compensated over time.

Morphometric analysis of three normal facial types in mixed dentition using posteroanterior cephalometric radiographs: preliminary results / Análise morfométrica dos três tipos faciais normais na dentição mista utilizando radiografias cefalométricas póstero-anteriores: resultados preliminares

The aim of the present investigation was to evaluate the craniofacial features of subjects with normal occlusion with different vertical patterns in the mixed dentition using morphometric analysis (Thin-Plate Spline analysis - TPS) applied to posteroanterior (PA) films. The sample comprised 39 individuals (18 females and 21 males), all in mixed dentition, aged from 8.4 to 10 years with satisfactory occlusion and balanced profile and with no history of orthodontic or facial orthopedic treatment. The sample was divided into three groups (mesofacial, brachyfacial and dolichofacial) according to the facial types proposed by Ricketts (1989). The average craniofacial configurations of each study group were obtained by orthogonal superimposition of Procrustes, thereby eliminating size differences and allowing only shape differences between groups to be analyzed by viewing the TPS deformation grid. Significant differences were found among the three facial types but were more remarkable between mesofacials and dolichofacials than between mesofacials and brachyfacials. TPS morphometric analysis proved efficient for accurate visualization of transverse and vertical differences among facial types even before pubertal growth spurt. These differences cannot be easily detected by traditional posteroanterior cephalometry.

O objetivo da presente investigação foi avaliar as características craniofaciais de indivíduos com oclusão normal e diferentes padrões verticais na dentição mista, utilizando a análise morfométrica (análise Thin-Plate Spline - TPS) aplicada em radiografias póstero-anteriores. A amostra foi composta de 39 indivíduos (18 meninas e 21 meninos), todos com dentição mista, com idades variando entre 8, 4 e 10 anos, com oclusão satisfatória e perfil balanceado e sem histórico de tratamento ortodôntico ou ortopédico. A amostra foi dividida em três grupos (mesofacial, braquifacial e dolicofacial) de acordo com os tipos faciais propostos por Ricketts (1989). As configurações craniofaciais médias de cada grupo em estudo foram obtidas pela sobreposição ortogonal de Procrustes, eliminando, dessa maneira, diferenças de tamanho e permitindo analisar separadamente as diferenças de forma pela visualização das grades de deformação da análise de TPS. Diferenças significativas foram encontradas entre os três tipos faciais, mas foram mais marcantes entre os dolicofaciais e os mesofaciais do que entre os mesofaciais e os braquifaciais. A análise morfométrica TPS provou ser eficiente para a acurada visualização das diferenças transversais e verticais entre os tipos faciais, mesmo antes do pico de crescimento puberal. Essas diferenças não podem ser facilmente detectáveis pela cefalometria póstero-anterior tradicional.

Hábitos bucais como fatores de risco para a mordida aberta anterior: uma revisão de literatura / Oral habits as risk factors for anterior open bite: a literature revision

A mordida aberta anterior (MAA) pode ser definida como a presença de um trespasse vertical negativo existente entre as bordas incisais dos dentes anteriores superiores e inferiores. É uma má oclusão que acomete tanto o gênero masculino quanto o feminino, principalmente na infância e durante a troca de dentição. A proposta deste estudo foi realizar uma revisão narrativa sobre os hábitos bucais deletérios que causam a MAA. Para a realização deste trabalho foram utilizadas as bases de dados PUBMED, SciELO e LILACS, além de acervo bibliográfico presente na biblioteca da Universidade Camilo Castelo Branco – Campus Fernandópolis/SP, utilizando-se as palavras-chave: Mordida aberta, Etiologia e Hábitos, entre o período de 2004 a 2015. Os ortodontistas precisam conhecer os hábitos bucais deletérios, pois o conceito de prevenção resulta na melhor qualidade de vida através do estabelecimento de condições adequadas de alimentação, respiração e fala, favorecendo a harmonia e o equilíbrio entre esqueleto, tecidos moles, morfologia e volume dentário, os quais têm interferência direta sobre a oclusão. Esta má oclusão quando diagnosticada e interceptada precocemente, aumenta a probabilidade de sucesso da terapêutica ortodôntica

The anterior open bite (AOB) can be defined as the presence of an existing ‘no vertical overlap’ of incisors edges of the upper, lower and front teeth. It is a malocclusion that affects both the male and the female, especially in childhood and during the changing of teeth. The aim of this study was to perform a narrative review of the deleterious oral habits that cause AOB. To carry out this research we used PUBMED, SciELO and LILACS databases, plus bibliographic presented in the library of Universidade Camilo Castelo Branco - Campus Fernandópolis / SP. Using the keywords Open bite; Etiology and Habits, from 2004 to 2015. It is important for orthodontists get to know the deleterious oral habits, since it is known that any previous interventions to prevent them result in improved quality of life through the establishment of appropriate supply conditions, breathing and speaking, that support harmony and the balance of skeleton, soft tissues, morphology and dental volume, which have a direct interference in occlusion. It concluded that this type of malocclusion when diagnosed and early intercepted increases the likelihood

Aplicações clínicas dos mini-implantes ortodônticos no tratamento ortodôntico / Clinical applications of orthodontic mini-implants in orthodontic treatment

A ancoragem esquelética revolucionou os conceitos dos tratamentos ortodônticos no que diz respeito à ancoragem. Os micro-parafusos ortodônticos de titânio se destacam devido a sua grande aplicabilidade clínica á simplicidade cirúrgica, baixo custo, praticidade, boa aceitação por parte do paciente, tornando os tratamentos mais eficientes e previsíveis. O objetivo deste trabalho é expor, baseado na literatura recente, a utilização dos mini-implantes nos tratamentos ortodônticos proporcionando movimentações dentárias e minimizando os efeitos indesejados nas unidades de reação

The skeletal anchorage revolutionized the concepts of orthodontic treatments with respect to the anchorage. Orthodontic titanium micro-screws stand out due to their great clinical applicability will surgical simplicity, low cost, practicality, good acceptance by the patient, making them more efficient and predictable treatment. The aim of this study is to expose, based on recent literature, the use of mini-implants in orthodontic treatments providing dental movements and minimizing unwanted effects on reaction units

Morphometric analysis of long-term dentoskeletal effects induced by treatment with Balters bionator.

OBJECTIVE: To evaluate the long-term effects of the standard (Class II) Balters bionator in growing patients with Class II malocclusion with mandibular retrusion by using morphometrics (thin-plate spline [TPS] analysis). MATERIALS AND METHODS: Twenty-three Class II patients (8 male, 15 female) were treated consecutively with the Balters bionator (bionator group). The sample was evaluated at T0, start of treatment; T1, end of bionator therapy; and T2, long-term observation (including fixed appliances). Mean age at the start of treatment was 10 years 2 months (T0); at posttreatment, 12 years 3 months (T1); and at long-term follow-up, 18 years 2 months (T2). The control group consisted of 22 subjects (11 male, 11 female) with untreated Class II malocclusion. Lateral cephalograms were analyzed at the three time points for all groups. TPS analysis evaluated statistical differences (permutation tests) in the craniofacial shape and size between the bionator and control groups. RESULTS: TPS analysis showed that treatment with the bionator is able to produce favorable mandibular shape changes (forward and downward displacement) that contribute significantly to the correction of the Class II dentoskeletal imbalance. These results are maintained at a long-term observation after completion of growth. The control group showed no statistically significant differences in the correction of Class II malocclusion. CONCLUSIONS: This study suggests that bionator treatment of Class II malocclusion produces favorable results over the long term with a combination of skeletal and dentoalveolar shape changes.

Ocorrência de reabsorção radicular no tratamento ortodôntico: revisão crítica da literatura / Occurrence of root resorption during the orthodontic treatment: critical literature review

A reabsorção radicular é uma das possíveis sequelas de maior complexidade para o ortodontista, pela dificuldade de detecção e por ser assintomática. Sua presença está ligada a uma origem multifatorial, uma complexa combinação das atividades biológicas, variáveis anatômicas, fisiológicas, genéticas e as forças mecânicas. Dessa forma, o objetivo deste estudo foi realizar uma revisão crítica da literatura referente à reabsorção radicular frente à movimentação ortodôntica. Foram incluídos artigos publicados entre 2004 a 2014, indexados na base de dados PUBMED. Os descritores utilizados continham no DeCs, sendo adotados como critérios de inclusão: ensaios clínicos em humanos, apenas artigos que apresentavam ideias claras e objetivas, artigos que apresentavam idioma Inglês. A estratégia de busca utilizada resultou em 24 artigos e depois de aplicados os critérios de inclusão e exclusão, restaram 11 artigos, com base nos resultados, concluiu-se que forças pesadas, de intrusão, inclinação e torque levam a um maior grau de reabsorção radicular; sua etiologia é multifatorial, o controle radiográfico periódico durante o tratamento é necessário e mais estudos são sugeridos para identificar mais especificamente as causas e os fatores de risco para a reabsorção radicular

The root resorption is one of the possible sequels of greater complexity to the orthodontist, the difficulty of detection and be asymptomatic. The presence, during the orthodontic treatment, is linked to a multifactorial origin, a complex combination of biological activities, anatomical, physiological, genetic variables and mechanical forces. Thus, the aim of this study was perform to critical literature review related to root resorption in orthodontic movement. Were included articles published between 2004 to 2014, indexed in the PUBMED database. Used descriptors contained in the Mesh, being adopted as inclusion criteria: clinical trials in humans, only articles that had clear ideas and objective, articles with English language. The search strategy used resulted in 24 articles and after applied the inclusion and exclusion criteria, 11 articles remained. Based on the results of this study it was concluded that heavy forces of intrusion, inclination and torque leads to a greater degree of root resorption; its etiology is multifactorial, the periodic radiographic control during treatment is needed and further studies are suggested to identify more specifically the causes and risk factors for root resorption

Atendimento e protocolo indicados na odontologia à gestante: revisão da literatura / Service and protocol indicated in dentistry to pregnant women: literatura review

O objetivo deste artigo consiste em discorrer sobre o de atendimento e protocolo indicados na Odontologia à Gestante. Trata-se de uma revisão de literatura, realizada na Biblioteca Virtual de Saúde (BVS), nas seguintes bases de dados: Scientific Eletronic Library Online (SCIELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). Os critérios de inclusão dos artigos foram: idioma em português acerca da temática citada acima e artigos na íntegra indexados no período de 2003 a 2013. Os descritores utilizados foram os seguintes: Protocolo. Gestante. Odontologia. Os resultados mostram que a gestação é um período peculiar na vida da mulher, no entanto a mesma muitas vezes tem dificuldades em realizar um tratamento odontológico pelo motivo de a grande parte dos cirurgiões-dentistas tem algum receio. Concluiu-se que embora as dúvidas que pairam entre os profissionais, desde que os procedimentos odontológicos, sejam corretamente realizados não geram males ao feto, sobretudo quando executados no período gestacional. Além disso, o cirurgiãodentista deve ser criterioso na indicação das intervenções odontológicas na gravidez

The purpose of this article is to discuss the service and indicated protocol in dentistry to the pregnant women. This is a literature review conducted in Virtual Health Library (VHL) on the following databases: Scientific Electronic Library Online (SCIELO), Latin American literature and Caribbean Health Sciences (LILACS).The inclusion criteria of the articles were: language in Portuguese on the theme mentioned above and full articles indexed from 2003 to 2013. The descriptors used were as follows: Protocol. Pregnant woman. Dentistry. The results showed that gestation is a peculiar period in a woman’s life, however it often have difficulties to perform a dental treatment by reason of the large number of dentists have some fear. It was concluded that although the doubts among traders, since dental procedures are properly carried out not generate evils to the fetus, particularly when performed during pregnancy. Furthermore, the dentist should exercise caution in indication of dental interventions in pregnancy

Comparative study on direct and indirect bracket bonding techniques regarding time length and bracket detachment.

OBJECTIVE: The aim of this study was to assess the time spent for direct (DBB - direct bracket bonding) and indirect (IBB - indirect bracket bonding) bracket bonding techniques. The time length of laboratorial (IBB) and clinical steps (DBB and IBB) as well as the prevalence of loose bracket after a 24-week follow-up were evaluated. METHODS: Seventeen patients (7 men and 10 women) with a mean age of 21 years, requiring orthodontic treatment were selected for this study. A total of 304 brackets was used (151 DBB and 153 IBB). The same bracket type and bonding material were used in both groups. Data were submitted to statistical analysis by Wilcoxon non-parametric test at 5% level of significance. RESULTS: Considering the total time length, the IBB technique was more time-consuming than the DBB (p < 0.001). However, considering only the clinical phase, the IBB took less time than the DBB (p < 0.001). There was no significant difference (p = 0.910) for the time spent during laboratorial positioning of the brackets and clinical session for IBB in comparison to the clinical procedure for DBB. Additionally, no difference was found as for the prevalence of loose bracket between both groups. CONCLUSIONS: The IBB can be suggested as a valid clinical procedure since the clinical session was faster and the total time spent for laboratorial positioning of the brackets and clinical procedure was similar to that of DBB. In addition, both approaches resulted in similar frequency of loose brackets.

Comparative study on direct and indirect bracket bonding techniques regarding time length and bracket detachment

OBJECTIVE: The aim of this study was to assess the time spent for direct (DBB - direct bracket bonding) and indirect (IBB - indirect bracket bonding) bracket bonding techniques. The time length of laboratorial (IBB) and clinical steps (DBB and IBB) as well as the prevalence of loose bracket after a 24-week follow-up were evaluated. METHODS: Seventeen patients (7 men and 10 women) with a mean age of 21 years, requiring orthodontic treatment were selected for this study. A total of 304 brackets were used (151 DBB and 153 IBB). The same bracket type and bonding material were used in both groups. Data were submitted to statistical analysis by Wilcoxon non-parametric test at 5% level of significance. RESULTS: Considering the total time length, the IBB technique was more time-consuming than the DBB (p < 0.001). However, considering only the clinical phase, the IBB took less time than the DBB (p < 0.001). There was no significant difference (p = 0.910) for the time spent during laboratorial positioning of the brackets and clinical session for IBB in comparison to the clinical procedure for DBB. Additionally, no difference was found as for the prevalence of loose bracket between both groups. CONCLUSION: the IBB can be suggested as a valid clinical procedure since the clinical session was faster and the total time spent for laboratorial positioning of the brackets and clinical procedure was similar to that of DBB. In addition, both approaches resulted in similar frequency of loose bracket.

OBJETIVO: avaliar o tempo necessário para realização da colagem de braquetes pelas técnicas direta (CDB) e indireta (CIB), mensurando o tempo despendido entre a parte laboratorial (CIB) e a parte clínica (CDB e CIB), e a prevalência de descolamentos durante o período de observação de 24 semanas. MÉTODOS: dezessete pacientes (7 homens e 10 mulheres), com idade média de 21 anos, com necessidade de tratamento ortodôntico, foram selecionados para participar desse estudo. Foram utilizados um total de 304 braquetes, sendo que 151 foram colados pela técnica de CDB e 153 pela CIB, com o mesmo tipo de braquete e material de colagem. Os dados foram submetidos ao teste não paramétrico de Wilcoxon, com significância de 5%. RESULTADOS: o tempo total para realização da CIB foi maior em relação à CDB (p < 0,001). Levando em consideração apenas a fase clínica, foi observado que o tempo para CIB foi menor em relação a CDB (p < 0,001). A comparação entre o tempo despendido para o posicionamento dos braquetes em laboratório mais o tempo em clínica para CIB com o tempo em clínica para a CDB revelou que não houve diferença significativa (p = 0,910), nem tampouco quanto à prevalência de descolamento dos braquetes. CONCLUSÃO: a CIB apresenta-se como uma utilidade clínica singular, pois o tempo em clínica foi menor que o da CDB. O tempo despendido no posicionamento dos braquetes no laboratório e de execução clínica da CIB foi semelhante ao tempo gasto pela CDB, a quantidade de descolamentos foi semelhante entre as técnicas.

Morphometric analysis of treatment effects of the Balters bionator in growing Class II patients.

OBJECTIVE: To investigate the effects of the standard (Class II) Balters bionator in growing patients with Class II malocclusion with mandibular retrusion by using morphometrics (thin-plate spline [TPS] analysis). MATERIALS AND METHODS: Thirty-one Class II patients (17 male and 14 female) were treated with the Balters bionator (bionator group). Mean age at the start of treatment (T0) was 10.3 years, while it was 13 years at the end of treatment (T1). Mean treatment time was 2 years and 2 months. The control group consisted of 22 subjects (14 male and 8 female) with untreated Class II malocclusion. Mean age at T0 was 10.2 years, while it was 12.2 years at T1. The observation period lasted 2 years on average. TPS analysis evaluated statistical (permutation tests) differences in the craniofacial shape and size between the bionator and control groups. RESULTS: Through TPS analysis (deformation grids) the bionator group showed significant shape changes in the mandible that could be described as a mandibular forward and downward displacement. The control group showed no statistically significant differences in the correction of Class II malocclusion. CONCLUSIONS: Bionator appliance is able to induce significant mandibular shape changes that lead to the correction of Class II dentoskeletal disharmony.

Estudo longitudinal das alterações dentoesqueléticas à longo prazo da má oclusão de classe II, divisão 1ª tratada com o Bionator de Balters utilizando-se a cefalometria radiográfica e a morfometria geométrica / Morphometric analysis of long-term dentoskeletal effects induced by Balters Bionator Therapy

Avaliar os efeitos à longo prazo do tratamento com o bionator base (Classe II) de Balters de pacientes com maloclusão de Classe II e retrusão mandibular em crescimento usando-se a morfometria (análise de thin-plate spline [TPS]). Materiais e Métodos: Vinte e três pacientes (8 meninos e 15 meninas) foram consecutivamente tratados com o bionator de Balters (grupo bionator). A amostra foi avaliada em T0, início do tratamento; em T1, final da terapia com o Bionator; e em T2, na observação à longo prazo (incluindo uma fase com aparelhos fixos). A idade média ao início do tratamento foi de 10 anos e 2 meses (T0); no pós-tratamento foi de 12 anos e 3 meses; e no acompanhamento à longo prazo de 18 anos e 2 meses (CVM 6). O grupo controle constou de 22 indivíduos (11 meninos e 11 meninas) sem tratamento da maloclusão de Classe II. As radiografias cefalométricas foram analisadas nos três tempos de observação para todos os grupos. A análise TPS avaliou estatisticamente (testes de permutação) as diferenças na forma e tamanho craniofacial entre os grupos bionator e controle. Resultados: A análise TPS mostrou que o tratamento com o bionator foi capaz de produzir alterações favoráveis na forma mandibular (deslocamento para frente e para baixo) que contribuiu significantemente para a correção da desarmonia dentoesquelética de classe II, e esses resultados observados à longo prazo são mantidos após cessar o crescimento. O grupo controle não apresentou diferenças estatisticamente significantes no sentido da correção da Classe II. Conclusões: Este estudo sugere que o tratamento com o bionator na Classe II mantém resultados favoráveis à longo prazo na forma craniofacial com a combinação de alterações dentoalveolares e esqueléticas

Objective: To evaluate the long-term effects of the standard (Class II) Balters bionator in growing patients with Class II malocclusion with mandibular retrusion by using morphometrics (thin-plate spline [TPS] analysis). Material and Methods: Twenty-tree Class II patients (8 male and 15 female) were treated consecutively with the Balters bionator (bionator group). The sample was evaluated at T0, start of treatment; T1, end of bionator therapy; and T2, long-term observation (including fixed appliances). Mean age at the start of treatment was 10 years 2 months (T0); at posttreatment, 12 years 3 months (T1); and at long-term follow-up, 18 years 2 months (CS 6). The control group consisted of 22 subjects (11 males and 11 females) with untreated Class II malocclusions. Lateral cephalograms were analyzed at the three time points for all groups. TPS analysis evaluated statistical (permutation tests) differences in the craniofacial shape and size between the bionator and control groups. Results: TPS analysis showed that treatment with the bionator is able to produce favorable mandibular shape changes (forward and downward displacement) that contribute significantly to the correction of the Class II dentoskeletal imbalance and these results are maintained at long-term observation after completion of growth. The control group showed no statistically significant differences in the correction of Class II malocclusion. Conclusions: This study suggests that bionator treatment of Class II malocclusion maintains shape favorable results over the long-term with a combination of skeletal and dentoalveolar changes