Temporomandibular joint disc position and shape in patients submitted to two protocols of rapid maxillary expansion and face mask therapy: A randomized clinical trial.

OBJECTIVE: The objective of this prospective study was to assess possible changes in the position and shape of the temporomandibular joint (TMJ) articular disc in patients treated with two protocols of rapid maxillary expansion (RME) and face mask (FM) therapy. METHODS: A sample of 88 patients with Class III or Class III subdivision malocclusions, aged between 6 and 13 years, were consecutively selected and divided into three groups (G): G1-34 patients were treated with RME, followed by FM therapy; G2-34 patients were treated using RME according to modified alternate rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by FM therapy. These treated groups were randomly (1:1 allocation ratio) distributed according to the two treatment protocols. G3 - Control Group - 20 untreated patients were followed. Magnetic resonance imaging (MRI) TMJs were obtained before (T1) and after (T2) a treatment period or follow-up. McNemar test, Fisher's exact test and intra- and inter-observer concordance (K) were performed (p ≤ .05). RESULTS: There were no statistically significant differences in the baseline cephalometric variables at T1 between the groups. There were statistically significant differences between the groups (p < .001) in relation to the disc shape in T1, since G1 (8 TMJs -11.76%) presented higher occurrences of altered forms in comparison with G2 (no changes). No significant differences were observed in disc position CM and OM (G1 - p > .999; G2 - p = .063; G3 - p = .500) and shape (G1 - p > 0.999; G2 - p = .250; G3 - not calculable), between T1 × T2, in any of the groups studied. CONCLUSION: The two treatment protocols did not have adverse effects on the position and shape of the TMJ disc, in a short-term evaluation.

Associations between skeletal discrepancies, breathing pattern, and upper airway obstruction in Class III malocclusions.

OBJECTIVE: To verify the associations between sagittal and vertical skeletal discrepancies, changes in upper airways, and breathing pattern in children and adolescents with Angle Class III and Class III subdivision malocclusions. METHODS: Eighty-five children and adolescents with a mean age of 9.5 ± 1.74 years were selected. Cephalometry assessed the sagittal relationship (AO-BO measurement), facial types (Ricketts VERT index), nasopharynx, and oropharynx. An otorhinolaryngologist analyzed the breathing pattern and upper airway obstruction during anamnesis, physical examination, anterior rhinoscopy, and nasofibroscopy. Medical records were also reviewed. For statistical analysis, ordinary one-way ANOVA, Kruskal-Wallis (Tukey's post-hoc), unpaired t-test, Pearson's correlation, chi-square, and Fisher's exact tests (p < 0.05) were used. RESULTS: The nasopharyngeal cephalometric dimension and pharyngeal tonsil hypertrophy were associated, whereas the oropharyngeal cephalometric dimension and palatine tonsils hypertrophy were not. Sagittal discrepancies were associated with septum deviation, while facial type was associated with inferior turbinate and palatine tonsils hypertrophy. However, facial type was not associated with breathing pattern, septum deviation, and pharyngeal tonsils hypertrophy. CONCLUSIONS: Sagittal discrepancies and type of malocclusion were not associated with breathing pattern and changes in upper airways, except for the severity of septum deviation and Class III malocclusions, which were associated with large sagittal discrepancies. Although the facial types analyzed presented signs of airway obstruction, the highest prevalence of inferior turbinate and palatine tonsils hypertrophy were found in patients with dolichofacial type.

Temporomandibular joint articular disc position and shape in skeletal Class III.

OBJECTIVE: To compare the position and shape of the temporomandibular joint (TMJ) articular disc among the sagittal and vertical skeletal patterns in Angle Class III, Class III subdivision malocclusion and normal occlusion. The null hypothesis was that there was no difference in disc position and shape in different (1) malocclusions and (2) skeletal patterns. METHODS: This cross-sectional observational study evaluated 105 patients divided into 3 groups: Class III (33, 9.39 ± 1.96 years), Class III subdivision (45, 9.51 ± 1.59 years) and a normal occlusion (27, 10.24 ± 0.87 years) was included as healthy control. Severity of the maxilla-mandibular anteroposterior discrepancy and vertical facial pattern were determined using 2D cephalometry, and the position and shape of the articular discs were evaluated in magnetic resonance images. Statistical parametric and non-parametric tests and Kappa analysis for intra-observer and inter-observer assessment were used (p ≤ .05). RESULTS: Significant between-group differences were found in articular disc position. In the normal occlusion group, all the articular discs were well positioned. In Class III and Class III subdivision, the discs were displaced in 30.3% and 12.2% of the TMJs, respectively. Sagittal and vertical skeletal patterns did not affect the findings significantly. The Class III subdivision malocclusion group is probably different from the other groups, showing 97.7% of biconcave discs in both TMJs. CONCLUSION: The longitudinal follow-up of this sample becomes relevant as the two groups with malocclusion in the pre-peak phase of pubertal growth showed differences in the prevalence of displacement and form of the articular disc, with no association with their vertical facial characteristics.

Verticalização do segundo molar inferior com mini-implante em paciente adulto - relato de caso clínico / Lower second molar uprighting using mini-implants in adult patients - a case report

Muitos pacientes adultos procuram tratamento ortodôntico atualmente por motivos estéticos, funcionais e também por indicação de protesistas para possibilitar a reabilitação oral. Objetivo: o presente trabalho se propõe a relatar um caso clínico de paciente do gênero feminino, com perda de primeiro molar inferior e consequente inclinação mesial e perda de espaço protético. Relato de caso: foi realizado movimento de verticalização do segundo molar inferior em paciente adulto com auxílio de mini-implante para ancoragem para possibilitar posterior reabilitação. Conclusão: o tratamento beneficiou a paciente, pois teve a correção do segundo molar inferior inclinado em apenas três meses, além da visível neoformação de tecido ósseo na região mesial do mesmo dente após seis meses, resultando em uma melhor condição parainstalação de um futuro implante na região do dente ausente.

Many adult patients seeking orthodontic treatment currently for aesthetic reasons, functional and also prosthetic indication to enable oral rehabilitation. Objective: This study aims to report a case of female patient with absence of the first molar, mesial inclination of the second molar and consequent loss of prosthetic space. Case report: the second molar in an adult patient was uprigthed using miniscrew as anchorage system to enable subsequent rehabilitation. Conclusion: It can be concluded that the patient was benefited with this type of treatment, as the uprigthing of the second inclined molar occurred in just three months, beyond the visible formation of new bone tissue in the mesial region of the same tooth after six months, resulting in a better condition for installing a future implant in the missing tooth region.

Orthopedic treatment of Class III malocclusion with rapid maxillary expansion combined with a face mask: a cephalometric assessment of craniofacial growth patterns

OBJECTIVE: The aim of this prospective study was to assess potential changes in the cephalometric craniofacial growth pattern of 17 children presenting Angle Class III malocclusion treated with a Haas-type expander combined with a face mask. METHODS: Lateral cephalometric radiographs were taken at beginning (T1) and immediately after removal of the appliances (T2), average of 11 months of treatment. Linear and angular measurements were used to evaluate the cranial base, dentoskeletal changes and facial growth pattern. RESULTS: The length of the anterior cranial base experienced a reduction while the posterior cranial base assumed a more vertical position at T1. Some maxillary movement occurred, there was no rotation of the palatal plane, there was a slight clockwise rotation of the mandible, although not significant. The ANB angle increased, thereby improving the relationship between the jaws; dentoalveolar compensation was more evident in the lower incisors. Five out of 12 cases (29.41%) showed the following changes: In one case the pattern became more horizontal and in four cases more vertical. CONCLUSIONS: It was concluded after a short-term assessment that treatment with rapid maxillary expansion (RME) associated with a face mask was effective in the correction of Class III malocclusion despite the changes in facial growth pattern observed in a few cases.

Intervenção precoce na mordida aberta anterior / Early intervention in anterior open bite

A mordida aberta anterior é uma anomalia complexa cujas características próprias envolvem a função, a estética, além das alterações dentárias e esqueléticas. Sua principal característica é a presença de um trespasse vertical negativo, existente entre as bordas incisais dos dentes anteriores superiores e inferiores, quando a mandíbula está em posição cêntrica. O objetivo deste trabalho é apresentar, por meio de um relato clínico, a intervenção precoce de uma mordida aberta anterior funcional associada ao hábito de sucção da chupeta, que foi tratada com grade palatina na fase de dentição decídua. Os resultados clínicos demonstraram a viabilidade e a eficiência da realização de uma terapia, mesmo em crianças de pouca idade, em curto prazo de tempo.

The anterior open bite is a complex anomaly, with its own characteristics, such as aesthetic, function, as well as dental and skeletal changes. Its main characteristic is the presence of a negative vertical crossing existing between the incisor borders of the upper anterior and lower anterior teeth, when the jaw is in centric position. The objective of this study is to present, through a clinical case analysis, the precocious intervention of one anterior open bite case associated with the habit of the pacifier, that was dealt with palatal crib in the phase of primary dentition. The clinical results demonstrated the viability and efficiency of the therapy in young children in short term.