Comparison between clear aligners and 2 × 4 mechanics in the mixed dentition: a randomized clinical trial.

OBJECTIVES: To compare the efficacy and efficiency between clear aligners and 2 × 4 fixed appliances for correcting maxillary incisor position irregularities in the mixed dentition. MATERIALS AND METHODS: The sample comprised 32 patients from 7 to 11 years of age randomly allocated into two parallel treatment groups: the clear aligners group, 14 patients (6 girls, 8 boys) with a mean initial age of 9.33 years (standard deviation [SD] = 1.01) treated with clear aligners; and the fixed appliances group, 13 patients (9 girls, 4 boys) with a mean initial age of 9.65 years (SD = 0.80) treated with partial (2 × 4) fixed appliances. Digital models were acquired before treatment and after appliance removal. Primary outcomes were incisor irregularity index and treatment time. Secondary outcomes were arch width, perimeter, length, size and shape, incisor leveling, incisor mesiodistal angulation, plaque index, and white spot lesion formation (International Caries Detection and Assessment System index). Intergroup comparisons were evaluated using t-tests or Mann-Whitney U-tests with Holm-Bonferroni correction (P < .05). RESULTS: Treatment time was approximately 8 months in both groups. No intergroup differences were observed for changes in any of the variables. Similar posttreatment arch shapes were observed in both groups. CONCLUSIONS: Clear aligners and 2 × 4 mechanics displayed similar efficacy and efficiency for maxillary incisor position corrections in the mixed dentition. The choice of appliance should be guided by clinician and family preference.

Intercenter comparison of slow and rapid maxillary expansion in unilateral complete cleft lip and palate.

OBJECTIVE: The aim of this study was to compare the occlusal changes of rapid maxillary expansion (RME) and slow maxillary expansion (SME) in patients with unilateral complete cleft lip and palate (UCLP), by means of digital dental models. METHODS: Group RME was composed by 22 patients (13 males and 9 females), with mean age of 9.9 years, treated with rapid maxillary expansion with Hyrax appliance in Center 1. Group SME was composed by 29 patients (14 females and 15 males), with mean age of 10.7 years, treated with slow maxillary expansion with quad-helix appliance in Center 2. Digital dental models of the maxillary dental arch were obtained immediately pre-expansion (T1) and 6-month post-expansion (T2). Transversal distances, arch perimeter, arch length, palatal depth, palatal volume and posterior tooth inclination were digitally measured. Interphase and intergroup comparisons were performed with paired t-test and independent t-test, respectively. RESULTS: Intercanine expansion was 4 to 5mm in both groups, and increase in the intercanine distance was similar for both groups. RME group showed a greater increase in arch distances at the region of permanent premolar and molars, compared to SME group. Arch perimeter increase was greater for RME group, compared to SME. No differences were found for arch length, palatal depth, palatal volume and posterior tooth buccal tipping. CONCLUSION: RME and SME produced similar dentoalveolar outcomes, with greater amount of expansion on RME group.

Intercenter comparison of slow and rapid maxillary expansion in unilateral complete cleft lip and palate

ABSTRACT Objective: The aim of this study was to compare the occlusal changes of rapid maxillary expansion (RME) and slow maxillary expansion (SME) in patients with unilateral complete cleft lip and palate (UCLP), by means of digital dental models. Methods: Group RME was composed by 22 patients (13 males and 9 females), with mean age of 9.9 years, treated with rapid maxillary expansion with Hyrax appliance in Center 1. Group SME was composed by 29 patients (14 females and 15 males), with mean age of 10.7 years, treated with slow maxillary expansion with quad-helix appliance in Center 2. Digital dental models of the maxillary dental arch were obtained immediately pre-expansion (T1) and 6-month post-expansion (T2). Transversal distances, arch perimeter, arch length, palatal depth, palatal volume and posterior tooth inclination were digitally measured. Interphase and intergroup comparisons were performed with paired t-test and independent t-test, respectively. Results: Intercanine expansion was 4 to 5mm in both groups, and increase in the intercanine distance was similar for both groups. RME group showed a greater increase in arch distances at the region of permanent premolar and molars, compared to SME group. Arch perimeter increase was greater for RME group, compared to SME. No differences were found for arch length, palatal depth, palatal volume and posterior tooth buccal tipping. Conclusion: RME and SME produced similar dentoalveolar outcomes, with greater amount of expansion on RME group.

RESUMO Objetivo: O objetivo do presente estudo foi comparar, por meio de modelos digitais, as alterações oclusais após a expansão rápida da maxila (ERM) e após a expansão lenta da maxila (ELM) em pacientes com fissura labiopalatina completa unilateral (FLPU). Métodos: O grupo ERM foi composto por 22 pacientes (13 homens e 9 mulheres), com idade média de 9,9 anos, tratados com expansão rápida da maxila com aparelho Hyrax no Centro 1. O grupo ELM foi composto por 29 pacientes (14 mulheres e 15 homens), com idade média de 10,7 anos, tratados com expansão lenta da maxila com aparelho quadri-hélice no Centro 2. Modelos digitais da arcada dentária superior foram obtidos imediatamente pré-expansão (T1) e seis meses pós-expansão (T2). Distâncias transversais, perímetro da arcada, comprimento da arcada, profundidade do palato, volume do palato e inclinação dos dentes posteriores foram medidos digitalmente. As comparações interfases e intergrupos foram realizadas com teste t pareado e teste t independente, respectivamente. Resultados: A expansão da arcada na região dos caninos foi de 4 a 5 mm em ambos os grupos, e o aumento na distância intercaninos foi semelhante nos dois grupos. O grupo ERM apresentou maior aumento nas distâncias entre pré-molares e molares permanentes, em comparação ao grupo ELM. O aumento do perímetro da arcada foi maior para o grupo ERM, em relação ao ELM. Não foram encontradas diferenças para comprimento da arcada, profundidade do palato, volume do palato e inclinação vestibular dos dentes posteriores. Conclusão: ERM e ELM produziram resultados dentoalveolares semelhantes, com maior quantidade de expansão no grupo ERM.

As diferentes formas de ancoragem para o aparelho Herbst / Different forms of anchorage for Herbst appliance

Introdução: O aparelho ortopédico mecânico Herbst destaca-se entre os aparelhos que estimulam o avanço mandibular. Objetivo: Esse artigo demonstra diferentes formas de ancoragem para o aparelho Herbst. Método: Descrevem-se formas distintas de ancoragem, variando desde ancoragem com banda ortodôntica, com esplinte acrílico, com esplinte metálico, associadas ou não ao parafuso expansor. Conclusão: A escolha do tipo de ancoragem para o aparelho Herbst é dependente do plano de tratamento ortodôntico e definida de forma individual para cada paciente.

Introduction: Herbst mechanical orthopedic device stands out among the devices that stimulate the mandibular advancement. Objective: This paper describes different forms of Herbst appliance anchorage. Method: Distinct forms of Herbst appliance anchorage are described varying from orthodontic band, acrylic splint, metallic splint ancorage associated or not with expansion screw. Conclusions: The choice of Herbst appliance anchorage is dependent of orthodontic treatment planning and defined individually for each patient.

Analysis of the maxillary dental arch after rapid maxillary expansion in patients with unilateral complete cleft lip and palate.

INTRODUCTION: Although rapid maxillary expansion has been extensively studied in noncleft patients, scarce evidence of maxillary effects is found for patients with oral clefts. Our objective was to evaluate the dentoalveolar effects of rapid maxillary expansion in children with unilateral complete cleft lip and palate compared with noncleft patients. METHODS: The experimental group included 25 patients with unilateral complete cleft lip and palate and posterior crossbite (9 girls, 16 boys; mean age, 10.6 years). The control group comprised 27 noncleft patients with posterior crossbite (14 boys, 13 girls; mean age, 9.1 years). The experimental group had lip and palate repairs at 3 and 12 months of age, respectively, and maxillary expansion was indicated before a secondary alveolar bone graft. Digital dental models were obtained immediately before expansion and 6 months after expansion with a laser scanner. Canine and posterior tooth inclinations, transversal widths, arch perimeters, arch lengths, palatal depths, and palatal volumes were digitally measured. The paired t test was used for interphase comparisons, and the independent t test was used for intergroup comparisons (P <0.05). RESULTS: In the experimental group, expansion produced buccal tipping of the canines and posterior teeth and significant increases of all maxillary transverse measurements, arch perimeter, palatal volumes, and palatal depths; only arch lengths decreased. No differences were observed between the groups for any measurement, except for intermolar distance. CONCLUSIONS: Rapid maxillary expansion produced similar changes in the patients with unilateral complete cleft lip and palate compared with the noncleft patients except for arch length and palatal depth that decreased after expansion in the children with oral clefts.

Esthetic evaluation of the facial profile in rehabilitated adults with complete bilateral cleft lip and palate.

PURPOSE: To assess the facial esthetics of patients with complete bilateral cleft lip and palate, and to compare the judgment of raters related and unrelated to cleft care. MATERIALS AND METHODS: The sample comprised 23 adult patients (7 women and 16 men) with a mean age of 26.1 years, rehabilitated at a single center. Standardized photographs of the right and left facial profile were taken of each patient and subjectively evaluated by 25 examiners: 5 orthodontists and 5 plastic surgeons with expertise in oral cleft rehabilitation, 5 orthodontists and 5 plastic surgeons without expertise in oral cleft rehabilitation, and 5 laypersons. The facial profiles were classified into 3 categories: esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Intraexaminer and interexaminer agreements were evaluated with the Spearman correlation coefficient and Kendall coefficient of concordance. The differences between rater categories were analyzed using the Student-Newman-Keuls test (with P < .05 indicating a statistically significant difference). RESULTS: Most of the sample was classified as esthetically acceptable. Orthodontists and plastic surgeons related to oral cleft rehabilitation gave the best scores to the facial profiles, followed by layperson examiners and by orthodontists and plastic surgeons unrelated to oral cleft rehabilitation. The middle third of the face, the nose, and the upper lip were frequently pointed out as contributors to the esthetic impairment. CONCLUSIONS: The facial profile of rehabilitated adult patients with complete bilateral cleft lip and palate was considered esthetically acceptable because of morphologic limitations in the structures affected by the cleft. Laypersons and professionals unrelated to oral cleft rehabilitation seem to be more critical regarding facial esthetics than professionals involved with cleft rehabilitation.

Protocolo Compass´TA: novo método para avaliação tridimensional do torque e angulação dentária utilizando modelos digitais / Compass-TA protocol: a new method for the three-dimensional torque and angulation assessment using digital impressions

Introdução: as seis chaves de oclusão normal, descritas por Lawrence Andrews em meados da década de 60, descrevem os parâmetros de inclinação e angulação normais individuais de cada dente. Objetivo: diante dos avanços tecnológicos, esse artigo tem como objetivo descrever um novo método de mensuração tridimensional da inclinação e angulação de dentes, usando modelos digitais. Métodos: após escaneamento dos modelos....., os arquivos foram importados para o software VistaDent 3D (Dentsply - Nova York, EUA), onde uma análise denominada C-TA foi criada utilizando um módulo de cefalometria tridimensional para avaliar a inclinação e angulação de cada um dos elementos dentários... Para análise da reprodutibilidade de método, foram realizadas duas mensurações de 100 elementos dentários, por um mesmo examinador calibrado. Resultados: o novo método introduzido mostrou-se excelente replicabilidade, sem diferenças estatisticamente significativas entre as duas medições realizadas, com erro casual relativamente pequeno e alto índice de correlação, estatisticamente significativa. Conclusões: a metodologia inovadora mostrou-se apta a reproduzir, de maneira fiel, o mais importante estudo da Ortodontia referente à inclinação e angulação dentária. A excelente replicabilidade e simplicidade do método permite que seja empregado em pesquisas com modelos tridimensionais, descortinando os limites da movimentação e compensação dentária, bem como explicitando os valores da oclusão normal não tratada, em diferentes grupos étnicos e padrões faciais.

Prevalência de dentes supranumerários na região dos pré-molares e sua associação com a presença dos terceiros molares / Prevalence of supranumerary teeth on pre-molars region and their association with third molars

O objetivo do presente estudo foi determinar a prevalência de supranumerários na região dos pré-molares nos estágios de dentadura decídua, mista e permanente, além de verificar sua associação com a presença de terceiros molares. Foram avaliadas radiografias panorâmicas de 1.976 pacientes matriculados no curso de Ortodontia Preventiva e Interceptiva da Profis (Sociedade de Promoção Social do Fissurado Lábio-Palatal), em Bauru-SP. As radiografias foram analisadas em negatoscópio, em ambiente escurecido, por um único examinador que determinou a presença de supranumerários na região dos pré-molares, bem como a presença de terceiros molares. A associação entre o aparecimento de supranumerários e a presença de terceiros molares foi verificada pelo Teste de McNemar. O Teste exato de Fisher foi aplicado para verificar o dimorfismo sexual. Constatou-se uma prevalência de 0,45% de supranumerários na região dos pré-molares na amostra estudada, sendo 11% na maxila e 89% na mandíbula, e não foi observado dimorfismo sexual em relação ao aparecimento dos supranumerários (p=0,32). Nas radiografias avaliadas, foi observado que os quatro terceiros molares estavam presentes sempre que verificada a presença dos supranumerários, detectando uma associação estatisticamente significante (p < 0,01) entre o aparecimento dos pré-molares supranumerários e a presença dos terceiros molares. Concluiu-se que a incidência de pré-molares supranumerários foi baixa na população estudada, e que existe associação entre o aparecimento destes supranumerários com a presença dos terceiros molares.

The purpose of the present study was to determine the prevalence of supranumerary teeth on the pre-molars region during the deciduous, mixed and permanent dentition and also verify their association with the presence of third molars. 1.976 panoramic radiographic from patients of the Preventive and Interceptive Orthodontic Course from Profis (Sociedade de Promoção Social do Fissurado Lábio-Palatal), in Bauru-SP were evaluated. The radiographies were analyzed in viewing box in a dark room by one unique examiner who determined the presence of supranumerary teeth on pre-molars region and also the presence of third molars. The association between the supranumerary and the third molars was verified by the McNemar test. The Fisher’s exact test was used to verify the sexual dimorphism. A prevalence of 0,45% of supranumerary teeth on the pre-molars region was found on the sample, 11% on the maxilla and 89% on the mandible. No sexual dimorphism was found (p=0,32). A statistically significant difference (p < 0,01) association between supranumerary pre-molars and the presence of third molar was found. The conclusion is that the incidence of supranumerary pre-molars is low on the examined sample and there is an association between the supranumerary pre-molars and the presence of third molars.

Photographic assessment of nasal morphology following rapid maxillary expansion in children.

OBJECTIVE: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. MATERIAL AND METHODS: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. RESULTS: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64% of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92% of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56% of the patients between the pre-expansion period and one year following expansion. CONCLUSIONS: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.

Photographic assessment of nasal morphology following rapid maxillary expansion in children

OBJECTIVE: The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite. MATERIAL AND METHODS: Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one year following rapid maxillary expansion with a Haas appliance were evaluated on 2 occasions by 3 experienced orthodontists independently, with a 2-week interval between evaluations. The examiners were instructed to assess nasal morphology and had no knowledge regarding the content of the study. Intraexaminer and interexaminer agreement (assessed using the Kappa statistic) was acceptable. RESULTS: From the analysis of the mode of the examiners' findings, no alterations in nasal morphology occurred regarding the following aspects: dorsum of nose, alar base, nasal width of middle third and nasal base. Alterations were only detected in the nasolabial angle in 1.64 percent of the patients between the pre-expansion and immediate post-expansion photographs. In 4.92 percent of the patients between the immediate post-expansion period and 1 year following expansion; and in 6.56 percent of the patients between the pre-expansion period and one year following expansion. CONCLUSIONS: RME performed on children in stages of primary and mixed dentition did not have any impact on nasal morphology, as assessed using facial analysis.