RESUMO
Adult orthodontic treatment involving maxillary transverse deficiency is a challenge for an interdisciplinary team. Surgically assisted rapid palatal expansion to segment the maxilla was once the treatment of choice, but the invasiveness, bone deficiency, and gingival recession hindered its acceptance. Corticotomy-assisted rapid maxillary arch expansion with ridge augmentation has the advantage of augmenting alveolar bony housing to accommodate and facilitate tooth movement. This approach was used to correct a severely constricted maxilla with bilateral posterior crossbite and anterior crowding in a 46-year-old man. Treatment time was 14 months. The accelerated arch expansion overcame the crossbite in 7 months, increasing intercanine distance by 5.2 mm and intermolar distance by 9.8 mm. Subsequent implant prosthesis was able to be restored in a functional normal occlusion. Satisfactory and stable clinical outcome was followed for 7 years. Corticotomy-assisted rapid maxillary arch expansion with alveolar bone augmentation is a novel and effective interdisciplinary approach for correcting adult maxillary transverse deficiency. Well controlled prospective clinical trails are warranted for further investigation.
Assuntos
Aumento do Rebordo Alveolar/métodos , Má Oclusão/terapia , Técnica de Expansão Palatina , Técnicas de Movimentação Dentária/métodos , Cefalometria , Oclusão Dentária , Seguimentos , Humanos , Masculino , Má Oclusão/diagnóstico por imagem , Má Oclusão/patologia , Má Oclusão/cirurgia , Má Oclusão Classe II de Angle/diagnóstico por imagem , Má Oclusão Classe II de Angle/patologia , Má Oclusão Classe II de Angle/cirurgia , Má Oclusão Classe II de Angle/terapia , Má Oclusão Classe III de Angle/diagnóstico por imagem , Má Oclusão Classe III de Angle/patologia , Má Oclusão Classe III de Angle/cirurgia , Má Oclusão Classe III de Angle/terapia , Maxila/anormalidades , Maxila/patologia , Maxila/cirurgia , Pessoa de Meia-Idade , Modelos Dentários , Aparelhos Ortodônticos , Braquetes Ortodônticos , Fios Ortodônticos , Palato/cirurgia , Planejamento de Assistência ao Paciente , Estudos Prospectivos , Resultado do TratamentoRESUMO
Achieving ideal results when treating a difficult malocclusion is a challenge that orthodontists frequently encounter. Maintaining those results is sometimes more challenging than the correction itself. As specialists in orthodontics, we should be able to apply bone physiology concepts during the diagnosis and treatment planning process and predict how bone will react after biomechanical stimuli. Understanding bone physiology and the biology of tissue response during orthodontic tooth movement should allow us to develop the proper mechanical design and consequently the therapeutic procedures necessary to achieve the expected tooth position and bone architecture. Surgically facilitated orthodontic therapy uses basic bone biology and physiologic bone turnover procedures as well as basic orthodontic biomechanical principles to correct dental malocclusions in the shortest, safest, and most conservative manner. The correction of such malocclusions with this approach is expected to be functional and stable.