Stability of early anterior open bite treatment: a 2-year follow-up randomized clinical trial.

This 2-year-follow up study compared and evaluated the stability of early anterior open bite (AOB) treatment based on different appliances. Children from 7 to 10 years with Angle Class I, AOB larger than 1.0 mm and fully erupted maxillary and mandibular permanent central incisors were eligible. The initial sample was 99 patients distributed, by simple randomization, into four groups: BS (bonded spurs), CC (chincup), FPC (fixed palatal crib) and RPC (removable palatal crib). Cephalometric analysis was performed at baseline (T1), final (T2) and 2-year post-treatment (T3) by taking the overbite measurements as the main outcome. Blinding was possible to cephalometric analysis. At T3, with dropouts, there were 63 individuals, being BS (n=15; overbite 0.19 mm; 11.54 years; 10 female (F)/5 male (M)); CC (n=11; overbite -0.19 mm; 11.41 years; 8 F/3 M); FPC (n=21; overbite 1.23 mm; 11.44 years; 15 F/6 M) and; RPC (n=16; overbite 0.73 mm; 11.67 years; 6 F/10 M). Changes in dentoskeletal variables and breaking deleterious oral habits during the follow up were statically analyzed with p<.05. Mandibular skeletal linear measurements and vertical dental components have gradually increased with age, manly at pubertal growth spurt and at the establishment of permanent dentition after treatment. Incisor teeth extrusion had impact on AOB correction and stability in 4 groups, which recorded a 1.15 mm-improvement of overbite after treatment (T3-T2). The experimental appliances were effective with stable results, being FPC the device recorded the highest AOB correction and the lowest patient withdrawal rate.

Clinical complications during early treatment of anterior open bite.

The object of this study was to compare the clinical complications of 4 different appliances used in the early treatment of anterior open bite (AOB), and to test the null hypothesis that there is no difference in the number of complications among the appliances. Records from 99 Class I malocclusion patients with AOB treated using bonded spurs, BS, n = 25; chin cup, CC, n = 25; fixed palatal crib, FPC, n = 25; and removable palatal crib, RPC, n = 24) were examined. The total number and frequency of clinical complications that occurred over 12 months were described and compared by using chi-square and Kruskal-Wallis tests (Dunn's post-test) (α = 5%, CI = 95%). The incidence of clinical complications was 66.7%, comprising: breakage, bond failure, maladjustment, allergy, soft-tissue lesion, loss of removable appliance and abandonment. Eighteen patients gave up treatment; this occurred more frequently in the groups with removable appliances. Regarding the total number of complications per patient, Group BS exhibited a significantly higher number than the other groups (p < 0.0001). A low frequency of complications (1 to 3) was found in the groups, except for Group BS, in which 8% of the patients presented moderate frequency (4 to 6). In terms of appliance types (fixed or removable), there was no difference in the incidence of complications (p > 0.094). The null hypothesis was rejected, since the BS group exhibited the highest total number and frequency of complications. There was no difference between fixed and removable appliances in terms of incidence of clinical complications, although more patients using removable appliances abandoned their treatment.

Stability of early anterior open bite treatment: a 2-year follow-up randomized clinical trial

Abstract This 2-year-follow up study compared and evaluated the stability of early anterior open bite (AOB) treatment based on different appliances. Children from 7 to 10 years with Angle Class I, AOB larger than 1.0 mm and fully erupted maxillary and mandibular permanent central incisors were eligible. The initial sample was 99 patients distributed, by simple randomization, into four groups: BS (bonded spurs), CC (chincup), FPC (fixed palatal crib) and RPC (removable palatal crib). Cephalometric analysis was performed at baseline (T1), final (T2) and 2-year post-treatment (T3) by taking the overbite measurements as the main outcome. Blinding was possible to cephalometric analysis. At T3, with dropouts, there were 63 individuals, being BS (n=15; overbite 0.19 mm; 11.54 years; 10 female (F)/5 male (M)); CC (n=11; overbite -0.19 mm; 11.41 years; 8 F/3 M); FPC (n=21; overbite 1.23 mm; 11.44 years; 15 F/6 M) and; RPC (n=16; overbite 0.73 mm; 11.67 years; 6 F/10 M). Changes in dentoskeletal variables and breaking deleterious oral habits during the follow up were statically analyzed with p<.05. Mandibular skeletal linear measurements and vertical dental components have gradually increased with age, manly at pubertal growth spurt and at the establishment of permanent dentition after treatment. Incisor teeth extrusion had impact on AOB correction and stability in 4 groups, which recorded a 1.15 mm-improvement of overbite after treatment (T3-T2). The experimental appliances were effective with stable results, being FPC the device recorded the highest AOB correction and the lowest patient withdrawal rate.

Resumo Os objetivos do presente estudo foram comparar e avaliar a estabilidade do tratamento precoce da mordida aberta anterior (MAA) com diferentes dispositivos. A amostra inicial foi composta por 99 pacientes randomizados em quatro grupos experimentais: BS - esporões colados; CC - mentoneira; FPC - grade palatina fixa; RPC - grade palatina removível. Análise cefalométrica foi realizada para avaliar os dados do período inicial (T1), final do tratamento (T2) e 2 anos após tratamento (T3), sendo a variável overbite o desfecho principal. Em T3, após perdas de seguimento, haviam 63 indivíduos, sendo BS (n=15; overbite 0.19 mm; 11.54 anos; 10 Feminino (F)/5 Masculino (M)); CC (n=11; overbite -0.19 mm; 11.41 anos; 8 F/3 M); FPC (n=21; overbite 1.23 mm; 11.44 anos; 15 F/6 M) e; RPC (n=16; overbite 0.73 mm; 11.67 anos; 6 F/10 M). Comparações das alterações nas variáveis dentoesqueléticas e abandono de hábitos bucais deletérios durante o tempo de acompanhamento foram estatisticamente analisados com p<.05. Medidas esqueléticas lineares mandibulares e componentes verticais aumentaram gradualmente com a idade, principalmente com o surto de crescimento puberal e estabelecimento da dentição permanente no pós-tratamento. O overbite foi significantemente melhorado durante o tratamento, permanecendo estável com alterações positivas. A extrusão dos incisivos impactou na correção da MAA e estabilidade nos 4 grupos, que registraram uma melhora de 1.15 mm no pós-tratamento (T3-T2). Com suas limitações, todos dispositivos experimentais foram efetivos e mostraram resultados estáveis no tratamento precoce da MAA, sendo que a FPC apresentou a maior correção da MAA e o menor índice de desistência.

Clinical complications during early treatment of anterior open bite

Abstract The object of this study was to compare the clinical complications of 4 different appliances used in the early treatment of anterior open bite (AOB), and to test the null hypothesis that there is no difference in the number of complications among the appliances. Records from 99 Class I malocclusion patients with AOB treated using bonded spurs, BS, n = 25; chin cup, CC, n = 25; fixed palatal crib, FPC, n = 25; and removable palatal crib, RPC, n = 24) were examined. The total number and frequency of clinical complications that occurred over 12 months were described and compared by using chi-square and Kruskal-Wallis tests (Dunn's post-test) (α = 5%, CI = 95%). The incidence of clinical complications was 66.7%, comprising: breakage, bond failure, maladjustment, allergy, soft-tissue lesion, loss of removable appliance and abandonment. Eighteen patients gave up treatment; this occurred more frequently in the groups with removable appliances. Regarding the total number of complications per patient, Group BS exhibited a significantly higher number than the other groups (p < 0.0001). A low frequency of complications (1 to 3) was found in the groups, except for Group BS, in which 8% of the patients presented moderate frequency (4 to 6). In terms of appliance types (fixed or removable), there was no difference in the incidence of complications (p > 0.094). The null hypothesis was rejected, since the BS group exhibited the highest total number and frequency of complications. There was no difference between fixed and removable appliances in terms of incidence of clinical complications, although more patients using removable appliances abandoned their treatment.

Transverse stability of Class II malocclusion correction with the pendulum appliance.

INTRODUCTION: This study aimed to evaluate the stability of transverse changes after Class II malocclusion correction with the pendulum fixed distalizer, followed by preadjusted edgewise fixed orthodontic appliances. METHODS: This longitudinal study was conducted in the maxillary dental casts of 20 Class II malocclusion subjects (mean age, 12.5 years; 14 females and 6 males). Eighty 3-dimensional maxillary dental casts were analyzed; 20 at the beginning of treatment, 20 after distalization, 20 after edgewise appliance debonding, and 20 at 5 years posttreatment. Maxillary transverse distances between canines, first premolars, second premolars, first molars, and second molars were analyzed using Geomagic Studio 5 (3D Systems, Rock Hill, SC). RESULTS: There were no significant changes in intercanine distance during and after treatment. There were significant interfirst and intersecond premolar distance increases during treatment. There were significant interfirst and intersecond molar distance increases during the distalization phase. However, there were significant decreases in these distances at the end of treatment. There were no significant long-term posttreatment changes. CONCLUSIONS: The intercanine distance remains stable during and after treatment. The interfirst and intersecond premolar distances significantly increase during treatment and remain stable after treatment. The interfirst and intersecond molar distances increase during the distalization phase, decrease at the end of treatment, and remain stable after treatment.

Correction of Anterior Open Bite Malocclusion with the Association of Removable Palatal Crib and Chincup / Correção da Mordida Aberta Anterior com Associação da Grade Palatina Removível e Mentoneira

Anterior open bite affects the child population by approximately 20%, with great aesthetic-functional impairment due to dental-skeletal changes, which may involve the presence of posterior crossbite. The objective was to present the anterior open bite correction associated with posterior crossbite with the use of a removable palatal crib. Patient during the mixed dentition phase presented an anterior open bite caused by a pacifier sucking habit and secondary lingual interposition. The treatment protocol consisted of the use of removable expander with palatal crib and nocturnal use of the chincup. The anterior open bite was corrected, and the best transverse relation of the arches was obtained. The precocious treatment using the palatal crib associated to the chincup allows to achieve favorable results in the resolution of the anterior open bite. (AU)

A mordida aberta anterior acomete a população infantil em aproximadamente 20%, com grande comprometimento estético-funcional em decorrência das alterações dentoesqueléticas, podendo envolver a presença de mordida cruzada posterior. O objetivo do estudo foi apresentara correção da mordida aberta anterior associada à mordida cruzada posterior com a utilização de grade palatina removível. Paciente em fasede dentadura mista, apresentava mordida aberta anterior ocasionada por um hábito de sucção de chupeta e interposição lingual secundária.O protocolo de tratamento consistiu na utilização de expansor removível com grade palatina e uso noturno da mentoneira. A mordida aberta anterior foi corrigida e melhor relação transversal dos arcos foi obtida. O tratamento precoce utilizando grade palatina associada à mentoneira permite alcançar resultados favoráveis na resolução da mordida aberta anterior. (AU)

Supernumerary: the Importance of Early Orthodontic Treatment / Supranumerário: a Importância do Tratamento Ortodôntico Precoce

The presence of supernumeraries may lead to irruptive problems, such as impacted teeth, functional and aesthetic disorders. The present study describes two clinical cases, with anterior teeth eruption disorders caused by additional dental elements, treated early. Patients presented with aesthetic involvement, with delay in the emergence of the upper incisors. The clinical and radiographic examinations detected the presence of obstacles to the teeth eruption. Early treatment with 2x4 appliance was realized, followed by final corrective orthodontics. After restoration of the dimension for retained teeth, there was spontaneous eruption in clinical case 1 and need of traction in clinical case 2. When patients reached the complete permanent dentition, a corrective phase was performed with the objective of detailing the dental occlusion and finishing the treatment. The early diagnosis of teeth impacted and supernumerary, provide the achievement of adequate occlusion and positive aesthetic of patients, with good prognosis, avoiding psychological and functional problems caused by absence of anterior teeth. (AU).

A presença de supranumerários pode ocasionar problemas irruptivos, como impacção de dentes, desordens funcionais e estéticas. O presente trabalho descreve dois casos clínicos abordados precocemente, com alterações na irrupção de dentes anteriores devido a presença de supranumerários. Os pacientes apresentavam queixas estéticas, com atraso no aparecimento dos incisivos superiores. Os exames clínico e radiográfico detectaram a presença de barreiras irruptivas. Realizou-se tratamento precoce com auxílio da mecânica 4x2, seguido pela ortodontia corretiva final. Após etapa de restabelecimento da dimensão para os dentes retidos, houve irrompimento espontâneo no caso clínico 1 e necessidade de tracionamento no caso clínico 2. Quando pacientes atingiram a dentição permanente completa, realizou-se uma fase corretiva com o objetivo de detalhamento da oclusão dentária e finalização do tratamento. O diagnóstico precoce de impacção dentária e detecção de supranumerários favoreceu a restituição de oclusão adequada e estética dos pacientes, com prognóstico muito favorável, evitando problemas psicológicos e funcionais provocados pela ausência de dentes anteriores. (AU).

Photoelastic analysis of stress generated by Connecticut Intrusion Arch (CIA).

OBJECTIVE: The present in vitro study evaluated, by means of the photoelastic technique, the effects generated by the Connecticut Intrusion Arch (CIA), with a 90o bend on the distal surface of molar tubes and using the 4 x 2 appliance on the anterior and posterior regions of the upper dental arch. METHODS: Five models were manufactured, in which two different clinical situations were correlated: 1) use of intrusion arch not cinched back and transpalatal bar for anchorage (Group 1); 2) use of intrusion arch cinched back and transpalatal bar for anchorage (Group 2). Stress generated in the apical and middle regions of tooth roots of maxillary anterior teeth and maxillary first molars was evaluated. RESULTS: Taking a reference value of 1.0 MPa = 100%, qualitative descriptive analysis was performed, which showed uniformity between stress values in the apical region of anterior teeth of both groups (G1 and G2). In the posterior region, for models with the arch cinched back (G2), stress remained within 100%. As for G1 models (with the arch not cinched back), variations in the mesial surface of first molars were observed, with an increase of 20% in the generated stress. The apical region did not undergo any changes, while in the distal region of molars there was a decrease of 20% in stress. CONCLUSION: Laboratory results revealed differences in stress between Groups 1 and 2 in the molar region, thereby indicating that there was a tendency towards mesial root tipping of first molars when the distal end of the CIA was not cinched back.

Photoelastic analysis of stress generated by Connecticut Intrusion Arch (CIA)

ABSTRACT Objective: The present in vitro study evaluated, by means of the photoelastic technique, the effects generated by the Connecticut Intrusion Arch (CIA), with a 90o bend on the distal surface of molar tubes and using the 4 x 2 appliance on the anterior and posterior regions of the upper dental arch. Methods: Five models were manufactured, in which two different clinical situations were correlated: 1) use of intrusion arch not cinched back and transpalatal bar for anchorage (Group 1); 2) use of intrusion arch cinched back and transpalatal bar for anchorage (Group 2). Stress generated in the apical and middle regions of tooth roots of maxillary anterior teeth and maxillary first molars was evaluated. Results: Taking a reference value of 1.0 MPa = 100%, qualitative descriptive analysis was performed, which showed uniformity between stress values in the apical region of anterior teeth of both groups (G1 and G2). In the posterior region, for models with the arch cinched back (G2), stress remained within 100%. As for G1 models (with the arch not cinched back), variations in the mesial surface of first molars were observed, with an increase of 20% in the generated stress. The apical region did not undergo any changes, while in the distal region of molars there was a decrease of 20% in stress. Conclusion: Laboratory results revealed differences in stress between Groups 1 and 2 in the molar region, thereby indicating that there was a tendency towards mesial root tipping of first molars when the distal end of the CIA was not cinched back.

RESUMO Objetivo: o presente estudo in vitro avaliou, por meio da técnica de fotoelasticidade, os efeitos produzidos pelo Arco de Intrusão de Connecticut (CIA) com dobra de 90o na face distal dos tubos molares e usando um aparelho 4 x 2 nas regiões anterior e posterior da arcada dentária superior. Métodos: foram confeccionados cinco modelos, aos quais foram correlacionadas duas situações clínicas diferentes: 1) uso do arco de intrusão sem dobra distal, mas com barra transpalatina para ancoragem (G1); 2) uso do arco de intrusão com dobra distal e barra transpalatina para ancoragem (G2). Avaliou-se as tensões geradas nos terços apical e médio das raízes dos dentes anterossuperiores e primeiros molares superiores. Resultados: considerando-se um valor de referência de 1,0 MPa = 100%, foi realizada uma análise descritiva qualitativa, a qual demonstrou uniformidade entre os valores de tensão na região apical dos dentes anteriores nos dois grupos (G1 e G2). Na região posterior dos modelos com arcos com dobra distal (G2), a tensão foi mantida em 100%. Já nos modelos do G1 (arco sem dobra distal), foram observadas variações na face mesial dos primeiros molares, com um aumento de 20% na tensão gerada. A região apical não sofreu qualquer alteração, ao passo que, na região distal dos molares, houve uma diminuição de 20% na tensão. Conclusão: os resultados laboratoriais revelaram diferenças, entre os grupos 1 e 2, para a tensão gerada na região dos molares, indicando que houve uma tendência de mesialização da raiz dos primeiros molares quando não foi realizada a dobra na extremidade distal do CIA.

Comparação das alterações no arco inferior com braquetes autoligáveis e convencionais / Comparison of changes on the mandibular arch using self-ligating and conventional brackets

O objetivo do presente trabalho foi comparar as alterações dimensionais do arco inferior em pacientes tratados ortodonticamente sem extração, com braquetes autoligáveis e convencionais, através de tomografia computadorizada de feixe cônico (TCFC). Dois períodos foram avaliados: pré-tratamento (T0) e após os primeiros seis meses (T1) de alinhamento e nivelamento. A amostra foi composta por 25 pacientes classe I e II de Angle, de ambos os sexos, divididos em dois grupos: grupo 1 (G1), composto de 13 indivíduos tratados com aparelho autoligável EasyClip .022" (Aditek), com média de idade inicial de 18,58 anos; e grupo 2 (G2), constituído de 12 indivíduos tratados com aparelho pré-ajustado convencional .022" (Abzil-Unitek 3M), com média de idade inicial de 21,61 anos. A mesma sequência de fio recomendada pelo fabricante foi utilizada para ambos os grupos. A comparação entre as fases inicial e após seis meses intra e intergrupos foi realizada por meio do teste t de Student. Em todos os testes estatísticos foi adotado nível de significância de 5% (p < 0,05). O erro intraexaminador foi realizado por meio do teste t de Student e pela fórmula de Dahlberg. O erro interexaminadores foi avaliado pelo coeficiente de correlação intraclasse (CCI). Houve somente uma medida significante entre os dois grupos (nível vertical lingual). Concluiu-se que ambos os sistemas de braquetes investigados (autoligável e convencional) promoveram uma similar inclinação vestibular durante os primeiros seis meses de alinhamento e nivelamento. Não houve diferença estatisticamente significativa entre os sistemas de braquetes convencionais e autoligáveis quanto às alterações ósseas dimensionais do arco dentário inferior.

The aim of this study was to compare the dimensional changes of the lower arch in patients orthodontically treated without extraction using self-ligating and conventional brackets through cone beam computed tomography (CBCT). Pre-treatment (T0) and 6 months of alignment and leveling (T1) were investigated. The sample was comprised of 25 patients with Angle class I and II malocclusions of both genders, randomly divided into two groups: group 1 (G1) consisting of 13 subjects were treated with self-ligating brackets (EasyClip .022 ", Aditek) with an average initial age of 18,58 years old; group 2 (G2) consisted of 12 subjects treated with conventional pre-adjusted brackets (.022" Abzil-Unitek, 3M) with an average initial age of 21,61 years old. The same sequence of wire recommended by the manufacturer was used in both groups. The comparison between the initial and 6 months within and between each group was performed by Student t test. In all statistical tests it was adopted a significance level of 5% (p < 0.05). The intra-examiner error was analyzed with the Student's t test and Dahlberg's formula. The intra-examiner error was assessed by intraclass correlation coefficient (ICC). The lower incisors area showed similar dimensional changes (bone changes) in both groups during the alignment and leveling phase. There was only one significant variable between the groups (vertical lingual bone level). In conclusion, both bracket systems (self-ligating and conventional) provided a similar proclination during the first 6 months of leveling and alignment phase. No significant differences between conventional and self-ligating brackets systems regarding the dimensional bone changes of the anterior region of the mandible arch were found.

Evaluation of long-term stability of mesiodistal axial inclinations of maxillary molars through panoramic radiographs in subjects treated with Pendulum appliance.

OBJECTIVE: To evaluate the stability of mesiodistal inclination of maxillary molars produced by a pendulum appliance, five years after completion of orthodontic treatment. Angulation changes were compared to an untreated sample. METHODS: The sample consisted of 20 patients (14 females and 6 males) with Class II, Division 1 malocclusion that was treated through molar distalization with a pendulum appliance followed by cervical headgear and full fixed appliances. Maxillary molar inclination was evaluated through panoramic radiograph. The mean age at pretreatment was 14.3 ± 1.6 years, whereas at immediate post-treatment it was 18.6 ± 1.8 years, and at long-term post-treatment it was 23.8 ± 2.0 years. A control group of 16 untreated individuals with untreated normocclusion ranging in age from 12 to 17 years old were used as comparison group. Data were statistically analyzed with independent t-tests and ANOVA test followed by Tukey post-hoc tests. RESULTS: Statistically significant differences were found between T1(94.50) and T2 (98.80) as well as between T2 and T3 (94.70) for maxillary first molars. Maxillary second molars did not show any statistically significant positional changes during the evaluated time periods T1 (107.50), T2 (109.30) and T3 (106.90). CONCLUSION: Although maxillary first molars underwent distal crown inclination immediately after treatment, approximately five years thereafter their roots tended to upright close to the pretreatment positions.

Estudo fotoelástico das tensões geradas na unidade de ancoragem utilizando arco de intrusão / Photoelastic study of generated tensions on the anchorage unit using the intrusion archwire

O objetivo primário deste estudo foi avaliar e quantificar, pelo método da fotoelasticidade, a tensão gerada no primeiro molar superior durante o movimento de intrusão dos incisivos superiores com arco de intrusão. Secundariamente, objetivou-se analisar o tipo de movimento dentário ocorrido sobre os primeiros molares, seguido da mecânica de intrusão. Foram utilizados dez modelos fotoelásticos, divididos em dois grupos. No grupo 1 (G1), utilizou-se um arco de intrusão de nitinol pré-fabricado (CIA – Connecticut Intrusion Arch, Ortho Organizers, CA, EUA) de .017” x .025”, enquanto que no grupo 2 (G2), utilizou-se um arco de intrusão de .017” x .025" confeccionado com a liga de titânio-molibdênio (TMA, Morelli, São Paulo, Brasil). A leitura da tensão foi realizada em pontos pré-determinados ao redor do dente 16, por meio de um polariscópio de reflexão. Os resultados foram analisados estatisticamente por meio da análise de variância (Anova) seguido do teste de Tukey, com um nível de significância de 5%. Os resultados revelaram que ambos os arcos de intrusão geraram maior concentração de tensão no terço cervical do primeiro molar superior, apresentando diferença significante entre os pontos de medição da tensão. Apesar de utilizar uma força de ativação inicial similar, comparando-se os dois sistemas de arcos, houve maior liberação de tensão com o arco de intrusão construído em TMA. Na região do terço apical, houve diferença significante entre os pontos de tensão e entre os arcos de intrusão. Concluiu-se que, durante a intrusão dos incisivos superiores, a quantidade de força sobre a unidade de ancoragem liberada pelo arco de intrusão de NiTi foi menor, em comparação ao arco de intrusão confeccionado com a liga de TMA. Além disso, um movimento de tip-back parece ocorrer sobre os primeiros molares superiores com o uso de ambos os arcos de intrusão...

The primary objective of this study was to evaluate and quantify the tension generated in the first molar during the intrusion movement of the upper incisors with an intrusion arch by means of a photoelastic method. Secondly, the objective was to analyze the type of tooth movement occurred on the first molars followed by mechanical intrusion. Ten photoelastic models were divided into two groups. In group 1 (G1), we used a prefabricated Nitinol intrusion arch (CIA – Connecticut intrusion arch, Ortho-Organizers, CA) .017"x .025", while in group 2 (G2), we used an intrusion arch (.017"x .025") made with beta-Titanium Alloy (TMA, Morelli, SP, Brazil). The tension reading was performed at predetermined points around the tooth 16, by means of a reflection polariscope. The results were statistically analyzed by Anova and Tukey tests with a 5% significance level. The results revealed that both intrusion arches generated a greater tension concentration at the cervical third of the first molar, with significant difference between points, but not between the intrusion systems. In the apical third region, there was a significant difference between points and between intrusion arches. It was concluded that during the intrusion of the upper incisors, the amount of force on the anchorage unit released by NiTi intrusion arch was lower compared to the intrusion arch made with TMA alloy. It seems that a tip-back movement of the upper first molars occurred during the use of an intrusion arch...

Evaluation of long-term stability of mesiodistal axial inclinations of maxillary molars through panoramic radiographs in subjects treated with Pendulum appliance

Objective: To evaluate the stability of mesiodistal inclination of maxillary molars produced by a pendulum appliance, five years after completion of orthodontic treatment. Angulation changes were compared to an untreated sample. Methods: The sample consisted of 20 patients (14 females and 6 males) with Class II, Division 1 malocclusion that was treated through molar distalization with a pendulum appliance followed by cervical headgear and full fixed appliances. Maxillary molar inclination was evaluated through panoramic radiograph. The mean age at pretreatment was 14.3 ± 1.6 years, whereas at immediate post-treatment it was 18.6 ± 1.8 years, and at long-term post-treatment it was 23.8 ± 2.0 years. A control group of 16 untreated individuals with untreated normocclusion ranging in age from 12 to 17 years old were used as comparison group. Data were statistically analyzed with independent t-tests and ANOVA test followed by Tukey post-hoc tests. Results: Statistically significant differences were found between T1(94.50) and T2 (98.80) as well as between T2 and T3 (94.70) for maxillary first molars. Maxillary second molars did not show any statistically significant positional changes during the evaluated time periods T1 (107.50), T2 (109.30) and T3 (106.90). Conclusion: Although maxillary first molars underwent distal crown inclination immediately after treatment, approximately five years thereafter their roots tended to upright close to the pretreatment positions.

Objetivo: avaliar a estabilidade da inclinação mesiodistal dos molares superiores cinco anos após o tratamento realizado com o aparelho Pendulum seguido de aparelho ortodôntico fixo. As mudanças na angulação foram comparadas com uma amostra não tratada. Métodos: a amostra consistiu de 20 pacientes (14 do sexo feminino e 6 do masculino) com má oclusão de Classe II, divisão 1 tratados por meio da distalização dos molares com o aparelho Pendulum seguido de ancoragem extrabucal cervical e aparelho fixo. A inclinação dos molares superiores foi avaliada por meio de radiografias panorâmicas. A média da idade ao início do tratamento foi de 14,3 ± 1,6 anos; ao final do tratamento, de 18,6 ± 1,8 anos e, no longo tempo pós-tratamento, de 23,8 ± 2,0 anos. Para comparação, foi usado um grupo controle com 16 indivíduos não tratados e com oclusão normal, apresentando idades entre 12 e 17 anos. Os dados foram analisados estatisticamente pelo teste t independente e ANOVA, seguido do teste de Tukey. Resultados: os primeiros molares superiores apresentaram diferenças estatisticamente significativas entre T1 (94,5o) e T2(98,8o), bem como entre T2 e T3(94,7o). Os segundos molares superiores não apresentaram alterações estatisticamente significativas no seu posicionamento durante os períodos avaliados, T1 (107,5o), T2(109,3o) e T3 (106,9o). Conclusões: apesar de os primeiros molares superiores apresentarem inclinação distal da coroa imediatamente após o tratamento, aproximadamente cinco anos depois suas raízes tendem a ocupar posições próximas às do início do tratamento.

Management of the Class III malocclusion treated with maxillary expansion, facemask therapy and corrective orthodontic. A 15-year follow-up.

The facial growth of Class III malocclusion worsens with age, in this case, the early orthopedic treatment, providing facial balance, modifying the maxillofacial growth and development. A 7.6-year old boy presented with Class III malocclusion associated with anterior crossbite; the mandible was shifted to the right and the maxilla had a transversal deficiency. Rapid maxillary expansion followed by facemask therapy was performed, to correct the anteroposterior relationship and improve the facial profile. The patient was followed for a 15-year period, after completion of the treatment, and stability was observed. Growing patients should be monitored following their treatment, so as to prevent malocclusion relapse.

Management of the Class III malocclusion treated with maxillary expansion, facemask therapy and corrective orthodontic. A 15-year follow-up

The facial growth of Class III malocclusion worsens with age, in this case, the early orthopedic treatment, providing facial balance, modifying the maxillofacial growth and development. A 7.6-year old boy presented with Class III malocclusion associated with anterior crossbite; the mandible was shifted to the right and the maxilla had a transversal deficiency. Rapid maxillary expansion followed by facemask therapy was performed, to correct the anteroposterior relationship and improve the facial profile. The patient was followed for a 15-year period, after completion of the treatment, and stability was observed. Growing patients should be monitored following their treatment, so as to prevent malocclusion relapse.

A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report.

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, posttreatment, and long-term follow-up records for the patient are presented.

Avaliação fotoelástica da tensão gerada durante a retração de caninos e mini-implantes para ancoragem / Photoelastic evaluation of tension generated during canine retraction and mini-implant anchorage

O objetivo deste estudo foi avaliar e quantificar, in vitro, a tensão resultante nas estruturas de suporte durante a retração de um canino superior com, o uso do método mini-implante e power arm, por meio da fotoelasticidade. Foram utilizados 15 modelos em resina fotoelástica representando um hemiarco superior direito com a ausência do primeiro pré-molar. Nos referidos dentes, foram colados braquetes convencionais (3M-Unitek, prescrição MBT .022”) e tubos nos molares (3M-Unitek, prescrição MBT .022”), os quais receberam um fio de NiTi (Orthometric, .016” x .022”). Foram adaptados dispositivos power arm nos braquetes dos caninos, nos tamanhos: curto, médio e longo, passando abaixo, na altura e acima do centro de resistência do canino, respectivamente. Na região vestibular, entre as raízes do segundo pré-molar e primeiro molar, foi posicionado um mini-implante. Uma mola de retração de 150 g (GAC, NiTi) foi conectada do mini-implante ao dispositivo power arm. A tensão gerada foi analisada ao longo da raiz do canino por meio de um polariscópio de reflexão, o qual quantificou as tensões (Mpa) por meio de um software (OS CALC 2.0). A análise estatística foi realizada pelo teste Anova seguido do teste de Tukey a 0,05% de significância. Os resultados obtidos revelaram que o power arm médio foi o mais eficiente para a realização do movimento de translação durante a retração do canino, quando comparado aos de tamanho curto e longo. Concluiu-se que para a retração de caninos, quando a finalidade é um movimento de corpo, o tamanho do power arm deve coincidir com a altura do centro de resistência do mesmo.

The aim of this study was to evaluate and quantify in vitro, the resulting tension in the supporting structures during retraction of a maxillary canine using the mini-implant and method power arm through photoelasticity. A total of 15 models in photoelastic resin representing a hemi-arch top right with the absence of the first premolar, and the presence of incisors, canine, second premolar, first and second molar. In those teeth were glued conventional brackets (3M-Unitek, prescription MBT .022 ") and tubes in the first and second molar (3M-Unitek, prescription MBT .022"), which received a wire NiTi (Orthometric, .016" x .022"). We adapted devices power arm in canine brackets in sizes: short, medium and long, going below the center of resistance, the height of the center of resistance and above the center of resistance of the tooth, respectively. For each device size power arm to be adopted, 5 models were manufactured in photoelastic resin. In the vestibular region, between the roots of the second premolar and first molar was positioned a mini implant to 5 mm apical to the cervical third. A spring retraction 150 g (GAC, NiTi) was connected to the mini-implant device power arm. The voltage generated was analyzed along the root of the canine by means of a polariscope using the reflection method, which quantified the stresses (MPa) through a software (OS CALC 2.0). Statistical analysis was performed by Anova followed by Tukey test at 0,05% significance. The results revealed that the average power arm was more efficient to perform the translation movement during retraction of the canine when compared to short and long size. It is concluded that for canine retraction when the purpose is a motion of body, size of the power arm must match the height of its center of resistance thereof then being the average size of choice.

Padrão cefalométrico de Ricketts em brasileiros leucodermas, xantodermas e mestiços / Ricketts cephalometric analyses in brazilians youth: whites, xanthoderms and japanese-brazilians

Introdução: a cefalometria constitui um dos elementos auxiliares de grande importância no diagnóstico e no planejamento ortodôntico. Diversos estudos já demonstraram que diferentes etnias apresentam algumas variáveis cefalométricas distintas. Realizar o tratamento ortodôntico tendo como guia outra raça ou etnia requer cuidado. As características próprias do indivíduo e seu padrão de miscigenação devem ser respeitados para suportar o diagnóstico e facilitar o plano de tratamento. Objetivo: determinar os valores médios de normalidade das grandezas cefalométricas relacionadas à análise de Ricketts para jovens brasileiros leucodermas, xantodermas e nipo-brasileiros, com oclusão normal e com bom perfil facial, e compará-los entre si. Material e métodos: foram utilizadas 40 telerradiografias laterais de jovens leucodermas (com idade média de 13,64 anos), 31 de xantodermas (com idade média de 15,63 anos) e 32 de nipo-brasileiros (com idade média de 13,96 anos), provenientes do arquivo da Disciplina de Ortodontia da Faculdade de Odontologia de Bauru, Universidade de São Paulo. Os dados obtidos foram avaliados estatisticamente pela análise de variância a dois critérios (Anova a 2 critérios) e análise de covariância (Ancova), seguidos do teste Tukey. Resultados: encontrou-se diferença estatística significante (p < 0,05) entre as etnias em seis das variáveis estudadas: Is-APog, Is.APog, Ii-APog, 6-Ptv, profundidade facial e protrusão labial inferior. Não foi observado dimorfismo entre os gêneros. Conclusão: a amostra de xantodermas apresentou características bem demarcadas de maior protrusão dos incisivos e protrusão labial, e um mento mais retruído, quando comparada com leucodermas e nipo-brasileiros.

Introduction: cephalometry is one of the auxiliary elements with great importance in diagnosis and orthodontic planning. Several studies have shown that different ethnic groups have some distinct cephalometric variables. Do an orthodontic treatment having other race or ethnicity as a guide needs some care. The individual characteristics and miscegenation must be respected to support the diagnosis and facilitate treatment plan. Objective: determine the mean normal values and compare Ricketts cephalometric analysis in whites, xanthoderms and japanese-brazilians with normal occlusion and well-balanced faces. Material and methods: the sample is composed by 105 lateral cephalograms of young brazilians from Orthodontics Department of Bauru Dental Scholl, University of São Paulo, divided into three groups of both genders: group I: 40 whites; group II: 31 xanthoderms; group III: 32 japanese-brazilians. The data were statistically evaluated by analysis of variance 2 criteria and analysis of covariance, followed by Tukey test. Results: we found statistically significant difference (p < 0.05) between ethnic groups in 6 variables: Ui-APOG, Ui.APog, Li-APOG, 6-PTV, facial depth and lower lip protrusion. There wasn’t sexual dimorphism. Conclusions: xanthoderms presented a more retruded chin, incisivemore protruded combining with a larger biprotrusion lip, compared with whites and japanese-brazilians.

A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, posttreatment, and long-term follow-up records for the patient are presented.

Comparison of frictional resistance between self-ligating and conventional brackets tied with elastomeric and metal ligature in orthodontic archwires.

OBJECTIVE: To compare the frictional resistance between self-ligating and conventional brackets tied to different types of wire. MATERIAL AND METHODS: Abzil Kirium Capelozza (Pattern I) and Easy Clip (Roth prescription) incisor brackets were used. An elastomeric ligature or a 0.10-in ligating wire was used to ligate the wire to the Abzil bracket. Three types of orthodontic archwire alloys were assessed: 0.016-in NiTi wire, 0.016 x 0.021-in NiTi wire and 0.019 x 0.025-in steel wire. Ten observations were carried out for each bracket-archwire angulation combination. Brackets were mounted in a special appliance, positioned at 90 degrees in relation to the wire and tested in two angulations. Frictional test was performed in a Universal Testing Machine at 5 mm/min and 10 mm of displacement. The means (MPa) were submitted to ANOVA and Tukey's test set at 5% of significance. The surfaces of wires and brackets were observed at SEM. RESULTS: Steel-tied brackets (16.48 ± 8.31) showed higher means of frictional resistance than elastomeric-tied brackets (4.29 ± 2.16 ) and self-ligating brackets (1.66 ± 1.57) (P < 0.05), which also differed from each other (P < 0.05). As for the type of wire, 0.019 x 0.025-in steel wire (5.67 ± 3.97) showed lower means (P < 0.05) than 0.16-in NiTi wire (8.26 ± 10.92) and 0.016 x 0.021-in NiTi wire (8.51 ± 7.95), which did not differ from each other (P > 0.05). No statistical differences (P > 0.05) were found between zero (7.76 ± 8.46) and five-degree (7.19 ± 7.93) angulations. CONCLUSIONS: Friction was influenced not only by the type of bracket, but also by the ligating systems. Different morphological aspects were observed for the brackets and wires studied.