Nonsurgical maxillary expansion in adults: report on clinical cases using the Hyrax expander.

BACKGROUND: Maxillary expansion in adults is object of intense controversy and is still considered an unreliable procedure within the orthodontic community. Therefore, the surgically assisted rapid maxillary expansion is still considered the elective treatment nowadays. The aim of this study is to evaluate the efficacy of a nonsurgical maxillary expansion treatment in adult patients with unilateral or bilateral crossbites and to assess the occurrence of related complications, such as pain and tissue swelling, tipping of the posterior teeth and gingival recessions. METHODS: Maxillary expansion using a Hyrax appliance on the upper first premolars and first molars was performed in 29 patients ranged between 18 and 32 years, mean age of 22±4 years. The sample included 13 patients with unilateral crossbite and 16 with bilateral crossbite. The statistical analysis was carried out using the SPSS Statistics version 23.0. An analysis of the paired data obtained on dental casts before and after treatment was performed using the Student's t-test. RESULTS: The posterior crossbite was fully corrected in all patients. The procedure was well tolerated, and pain, swelling or discomfort was not significant. Statistically significant differences were found between the interdental widths for all pairs, with a P<0.001 for all of them, except in the measurements of canines, in which P=0.001. Measurements of clinical crown height at the beginning (T0) and at the end (T1) of treatment were performed for the same teeth. An increase of the clinical crown height between 0.14 and 0.44 mm was found for premolars and molars. CONCLUSIONS: The results indicate that nonsurgical maxillary expansion in adult patients is an efficient method for correcting transverse deficiency in the maxillary arch. Similarly, the level of complications during treatment was not clinically significant, thus this procedure may be considered a safe treatment.

[The extraction-non extraction dilemma: a case in the border]. / Dilemme « traiter avec ou sans extraction ¼ : discussion à propos d'un cas limite.

INTRODUCTION: The extraction-non extraction dilemma is a classic one in the history of orthodontics [2, 19, 30]. In some cases the decision seems to be very clear whereas in some others discrepancies among clinicians can easily be found. Different authors propose different protocols in order to decide whether extractions are necessary in a particular clinical situation. In the last 25 years, the debate has been reframed with new non-extractionists trends based on new treatment philosophies or mechanics. In this new scenario, it seems pertinent to redefine the classic and new protocols with a critical perspective in order to find a potential consensus on the parameters that set up the indication for extractions in orthodontics. MATERIALS AND METHODS: The decision to extract is obviously different in Class I, Class II or Class III malocclusions. In Class II or Class III cases, extractions may be indicated in order to correct the Class II cuspid, the overjet or the anterior crossbite, for instance, independently of other factors. In this article, a borderline Class I case is presented, where parameters such as the crowding, craniofacial typology, facial esthetics, occlusal pattern and periodontal status are taken into consideration in order to make the decision to extract. RESULTS: The different treatment options are discussed and the potential advantages and disadvantages analyzed. The outcomes of the treatment option finally selected are critically described and debated. However, borderline cases allow for further reflection and, maybe, different proposals or strategies. So, the discussion is open: be my guest.

[Limiting factors in the class III camouflage treatment: a potential protocol]. / Proposition d'un protocole définissant les facteurs limites des traitements de compensation de la classe III.

The Class III skeletal malocclusion has been traditionally treated with a combined approach of orthodontics and orthognathic surgery or with a strategy of orthodontic camouflage. Some severe cases can be identified as ideal candidates for a surgical treatment whereas some others can be handled with orthodontics alone, with a reasonable expectation of an acceptable result. However, the problem remains for the borderline patient. In fact, limited information is available in the literature regarding the identification of the factors that can help in establishing the limits for one treatment modality or the other. Furthermore, the quantification of some of these factors, for practical purposes, is practically missing or very seldom suggested. Therefore, the decision making process remains a subjective reflection based on the "good clinical sense" of the orthodontist or just reduced to an "educated guess". In order to add some information, hopefully useful in deciding the most suitable treatment option for the individual patient, we propose a clinical protocol based on four different factors. Namely: the skeletal discrepancy, the occlusal discrepancy, the periodontal condition and facial aesthetics. For each one of these factors several parameters will be evaluated and, for some of them, an attempt to provide some reference numerical values will be made. Finally, clinical examples will be presented to illustrate the concepts discussed and the treatment alternatives, final treatment plan and treatment outcome will be analyzed for each one of them.

[The extraction of a lower incisor in orthodontics: indications, planning of the treatment and clinical handling in different malocclusions]. / Extraction d'une incisive mandibulaire en orthodontie : indication, plan de traitement et gestion clinique pour différentes malocclusions ∗

The extraction of a lower incisor has been a therapeutic approach considered controversial in orthodontics over the last decades and, therefore, supported by some authors and questioned by others. In recent years, different publications have attempted to provide with substantial and structured information that could help to perform this atypical form of therapy in selected cases with a prospective good result. The purpose of this article is to summarise the available information, providing an order and structure to the diagnostic features that could support the indication and use of this treatment alternative, including the quantification of those parameters that can be measured in the decision-making process. Finally, to set up a clear and meaningful clinical frame that could be used by the orthodontist as a reference line in daily practice. Four case reports will be used in order to illustrate the indication of this treatment modality in different malocclusions.