Is There Still Time to Orthodontics in Elderly Patients? / Ainda há Tempo para a Ortodontia na Melhor Idade?

Life expectancy rate has increased in the past decades and a crescent number of elderly patients are searching for dental treatment aiming for aesthetic and functional rehabilitation. Geriatric Dentistry is a dental specialty which focuses on the elderly population dental care, specially aiming at preventive and healing care of patients with diseases or systemic and chronic conditions, associated to physiological, physical or psychological deficiencies. Other specialties in Dentistry, such as Orthodontics, have become important allies in this new challenge of the Dental profession. This study aimed at analyzing characteristics involved in orthodontic treatment when associated with gerontologic needs, considering relevant factors to an adequate application based on a case report. The treatment was planned integrating Periodontics, Orthodontics, Prosthodontics and Operative Dentistry practice, allowing the reestablishment of function and aesthetics harmonically. Orthodontic treatment represents a feasible procedure in Geriatric Dentistry, as long as applying light forces and respecting both the characteristics and limitations of these areas of treatment.(AU)

Com o aumento considerável da expectativa de vida da população, um crescente número de pacientes idosos tem procurado tratamento odontológico para reabilitação estética e/ou funcional. A Odontogeriatria, é a especialidade odontológica que enfatiza o cuidado bucal da população idosa, especificamente do atendimento preventivo e curativo de pacientes com doenças ou condições de caráter sistêmico e crônico, associadas a problemas fisiológicos, físicos ou psicológicos. Diversas especialidades odontológicas, dentre elas a Ortodontia, vêm se integrando com esta área odontológica. Este trabalho objetiva abordar as características do tratamento ortodôntico associado a uma atuação odontogeriátrica, considerando os fatores relevantes para a execução do tratamento ortodôntico nesses pacientes a partir do relato de um caso clínico. Planejou-se este caso de forma integrada, envolvendo Periodontia, Ortodontia, Prótese e Dentística Restauradora, que foram capazes de devolver à paciente função e estética. O tratamento ortodôntico representa uma intervenção viável na atuação odontogeriátrica, desde que realizado com forças suaves, considerando as limitações e respeitando as características inerentes a esta atuação. (AU)

Differential Diagnosis of Skeletal Class II: Orthodontic-Surgical Approach with Surgery First / Diagnóstico Diferencial da Classe II esquelética: Abordagem Ortodôntico-Cirúrgica com Benefício Antecipado

Abstract Orthodontic-surgical treatment with the "Surgery First Approach" provides immediate facial aesthetic improvements and significantly reduces the patient's orthodontic treatment time, avoiding the transient worsening of the facial profile due to dental decompensation that occurs in surgical cases. Thus, this clinical case describes the retreatment of a 22-year-old female leukoderma patient, whose main complaint was related to the proclination of upper and lower incisors. The patient used a mio-relaxing plate for 30 days, which evidenced the skeletal mandibular deficiency and the ½ bilateral Class II malocclusion. Orthognathic surgery first approach associated with the extraction of the 4 premolars was chosen considering the patient's aesthetic demand. The use of a mio-relaxing plate in the diagnostic stage was essential for the real diagnosis of mandibular deficiency and the technique employed made it possible to conclude the treatment avoiding aesthetic commitment, with excellent results. (AU)

Resumo O tratamento ortodôntico-cirúrgico por meio do benefício antecipado proporciona melhorias estéticas faciais imediatas e reduz de maneira significativa o tempo de tratamento ortodôntico do paciente, evitando a piora transitória do perfil facial devido à descompensação dentária que ocorre em casos cirúrgicos. Assim, este caso clínico descreve o retratamento de uma paciente com 22 anos de idade, leucoderma, sexo feminino, que apresentava queixa principal relacionada à inclinação vestibular dos dentes anteriores. Após uso de placa miorrelaxante por 30 dias, verificou-se a presença de Classe II esquelética com deficiência mandibular e ½ Classe II dentária bilateral. Considerando a demanda estética da paciente, optou-se pela abordagem ortodôntico-cirúrgica com Benefício Antecipado associada à extração de 4 pré-molares para correção da inclinação dentária anterior. O uso da placa miorrelaxante foi fundamental para o diagnóstico real da deficiência mandibular e a técnica empregada possibilitou concluir o tratamento evitando o comprometimento estético pré-cirúrgico, com obtenção de excelentes resultados. (AU)

Interdisciplinary Orthodontic Treatment to Reestablishment Smile Function and Aesthetics / Tratamento Ortodôntico Interdisciplinar Para o Reestabelecimento da Função e Estética do Sorriso

Extrusive tooth movements are an important resource in orthodontic treatment and allow the manipulation of teeth and periodontal tissues. They can be performed quickly or slowly, depending on the patient's need. Rapid extrusion is indicated for cases in need of prosthetic preparation or restoration, where the bone and gingival tissues are intact, such as horizontal and oblique fractures, coronary or external root resorption, iatrogenic perforations (trepanations) and the presence of subgingival caries. The aim of this study is to describe the treatment of a patient who had a coronary fracture of the right upper central incisor, with a limit located 1 mm above the level of the bone crest. Rapid orthodontic extrusion was performed, to restore biologic distances and allow the preparation for prosthesis. It started with partial differentiated bonding of a fixed orthodontic appliance to the upper arch, to allow for a 3mm orthodontic extrusion. At the end of the extrusion, periodontal surgery was performed to increase the clinical crown and endodontic treatment. After these procedures, the case was concluded with the fixed prosthesis installation. The realization of an integrated planning allowed the restoration of aesthetics, with preservation of the functional periodontal limits for the patient.(Au)

Os movimentos dentários extrusivos constituem um recurso importante no tratamento ortodôntico e permitem a manipulação dos dentes e dos tecidos periodontais. Eles podem ser realizados de forma rápida ou lenta, dependendo da necessidade do paciente. A extrusão rápida está indicada para casos com necessidade de preparo protético ou restauração, onde os tecidos ósseo e gengival encontram-se íntegros, tais como fraturas horizontais e oblíquas, reabsorções coronárias ou radiculares externas, perfurações iatrogências (trepanações) e presença de cárie subgengival. O objetivo deste trabalho é descrever o tratamento de uma paciente que apresentava fratura coronária do incisivo central superior direito, com limite localizado 1mm acima do nível da crista óssea. Realizou se extrusão ortodôntica rápida, com a finalidade de restabelecer as distâncias biológicas e permitir o preparo para prótese. Iniciou-se com colagem diferenciada parcial de aparelho ortodôntico fixo no arco superior, para permitir a extrusão ortodôntica de 3mm. Ao término da extrusão, realizou-se cirurgia periodontal para aumento da coroa clínica e tratamento endodôntico. Após esses procedimentos, o caso foi finalizado com a instalação da prótese fixa. A realização de um planejamento integrado permitiu o restabelecimento da estética, com preservação dos limites periodontais funcionais para a paciente. (Au)

Effects of orthodontic treatment with aligners and fixed appliances on speech.

OBJECTIVES: To evaluate effects of orthodontic treatment with aligners and conventional fixed appliances on production of speech. MATERIALS AND METHODS: This was a parallel, randomized clinical trial. Patients with Angle Class I malocclusion, moderate crowding, and no speech impairment were randomly allocated to two groups: patients with orthodontic aligners (OAs; n = 20; mean age = 23.60 ± 5.65 years) and those with conventional fixed appliances (n = 20; mean age = 20.56 ± 4.51 years) and treated at the University of North Parana's clinic in Londrina, Brazil. Evaluation of speech production was performed semiobjectively by a speech therapist (myofunctional orofacial examination) and subjectively (self-assessment) at five time points: baseline, immediately after insertion of appliances, and subsequently at 3, 30, and 180 days after insertion. For intergroup comparison, independent t, χ2, Fisher exact, and Mann-Whitney tests were used; for intragroup comparison, the Friedman test was applied (α = 5%). RESULTS: In the semiobjective evaluation, patients with OAs exhibited a change in production of speech production, compared with patients with fixed appliances, immediately and 3 days after insertion of appliances (P < .001). Thirty days after insertion, the groups were similar (P = .487), an outcome that was unchanged at 180 days. However, in the self-assessments, patients in both groups reported significant speech difficulties immediately and 3 days after insertion of appliances, but such impairment was no longer perceived at 30 days or 180 days. CONCLUSIONS: Although the speech therapist identified changes in speech production at the start of treatment in the OA group only, patient self-assessments demonstrated that orthodontic treatment, regardless of the type of appliance used, interfered with their perception of speech.

Interdisciplinary Approach of Amelogenesis Imperfecta: 10 Years of Clinical Follow-Up / Abordagem Interdisciplinar da Amelogênese Imperfeita: 10 Anos de Acompanhamento Clínico

Amelogenesis imperfecta (AI) is an inherited disease that expresses a disorder in the development of enamel structure. In its mildest form, it promotes tooth color change; and in more severe cases, it presents a loss of enamel structure initiated during the eruption phase. Different AI manifestations can coexist in the same patient or in the same tooth, both in the primary and permanent dentures. In addition, several subtypes are described, characterized according to the variety of phenotype and genotype. Successful treatment requires early diagnosis and therapeutic solutions involving different dental specialties. Although some professionals prefer to postpone permanent rehabilitation until the development of complete permanent dentures, the aesthetic and functional impact of this disease in childhood and adolescence requires that restorative treatment be started as soon as possible. The proposed therapies demonstrate numerous challenges such as extreme dentinal sensitivity, difficulties installing and maintaining the orthodontic appliance and the need for restorative and prosthetic intervention in malformed teeth. This work aims to demonstrate the interaction between Orthodontics, Restorative Dentistry and Prosthesis in the treatment of a patient with AI, reporting the success of treatment involving aesthetics, function and well-being and the long-term benefit of this interdisciplinary approach for patients with this disease. (AU)

A amelogênese imperfeita (AI) é uma doença hereditária que expressa uma desordem no desenvolvimento da estrutura do esmalte. Na sua forma mais branda, promove alteração na cor dos dentes; e em casos mais severos, apresenta perda de estrutura do esmalte iniciada durante a fase de irrupção. Diferentes manifestações da AI podem coexistir no mesmo paciente ou no mesmo dente, tanto na dentadura decídua quanto na permanente. Além disso, são descritos diversos subtipos, caracterizados de acordo com a variedade do fenótipo e genótipo. O sucesso do tratamento requer diagnóstico precoce e soluções terapêuticas que envolvam diversas especialidades odontológicas. Embora alguns profissionais prefiram adiar a reabilitação definitiva até o desenvolvimento da dentadura permanente completa, o impacto estético e funcional desta doença na infância e adolescência exige que o tratamento restaurador seja iniciado o mais cedo possível. As terapias propostas demonstram inúmeros desafios como a sensibilidade dentinária extrema, as dificuldades para instalação e manutenção do aparelho ortodôntico e a necessidade de intervenção restauradora e protética em dentes com má formação. O presente trabalho tem como finalidade demonstrar a interação entre a Ortodontia, a Dentística Restauradora e a Prótese no tratamento de um paciente com AI, relatando o sucesso do tratamento envolvendo estética, função, bem estar e o benefício em longo prazo desta abordagem interdisciplinar para os portadores desta doença. (AU)

Perceived pain during rapid maxillary expansion in children with different expanders.

OBJECTIVES: To evaluate and compare the intensity of pain caused by rapid maxillary expansion (RME) with two expanders: Hyrax and Haas type, in growing patients. MATERIALS AND METHODS: Thirty-nine patients (23 girls and 16 boys) with an average age of 9.3 years (SD = 1.39 years) were randomized into two groups and treated with Hyrax- and Haas-type expanders. In both groups, initial activation of the expander screw was one full turn on the first day followed by 2/4 of a turn two times a day (morning and night) for 7 days. Inclusion criteria were patients presenting with a posterior crossbite or maxillary atresia between 7 and 12 years old. To evaluate the intensity of pain during the active phase of the treatment, a combination of the Numerical Rating Scale and Wong-Baker Faces Pain Scale was used. Mann-Whitney test was used to compare the two treatment groups. RESULTS: There was significant inverse correlation between days following insertion and pain. During the expansion period, 100% of the children reported some pain. Hyrax expander subjects reported greater pain than those treated with the Haas-type expander only on the first day. The level of pain remained greater in girls throughout treatment. CONCLUSIONS: Pain was reported regardless of the type of expander and was higher in the Hyrax group only on the first day of activation.

Tomographic evaluation of dentoskeletal effects of rapid maxillary expansion using Haas and Hyrax palatal expanders in children: A randomized clinical trial.

BACKGROUND: Rapid maxillary expansion (RME) is a usual procedure for correcting the transversal maxillary deficiency. Among the most used appliances are the Haas type (tooth-tissue-borne) and Hyrax (tooth-borne) whose main difference is the design. This study aimed to evaluate the dentoskeletal effects of RME using two different expanders in children. MATERIAL AND METHODS: The sample was composed of 42 children of both gender presenting unilateral or bilateral posterior crossbite with mean age 9.49 (SD± 1.35). Patients were randomized into two groups according to the type of expander: Hyrax (n= 21, 9 boys and 12 girls) and Haas (n= 21, 11 boys and 10 girls). Multiplanar coronal and axial slices obtained from cone-beam computed tomography images (i-Cat, Hartsfield, PA, USA) were used at pretreatment (T1) and after 6 months when the expander was removed (T2). Measurements were performed on Dolphin Imaging Systems 11.7 software (Chatsworth, California, USA). The following variables were evaluated: inclinations of the posterior teeth, transverse skeletal widths, length of maxillary dental arch, buccal bone thickness and level of buccal alveolar crest. Statistical analysis performed using chi-squared test to compare the sex ratios between groups and independent t test with the Bonferroni correction for multiple tests. RESULTS: RME increased all maxillary transverse dimensions, regardless of the type of expanders used. Subjects in the Hyrax group experienced significantly increase in the lingual bone thickness (0.94 mm) compare to Haas group (0.21 mm). CONCLUSIONS: The Hyrax-type expander produced greater increase in the lingual bone thickness than did the Haas-type expander, but this effect might not be clinically significant. Both appliances presented similar transversal gain and tended to produce similar orthopedic and orthodontic effects. Key words:Cone-beam computed tomography, palatal expansion technique, palate.