Maxillary dental midline deviation in the patient perspective

Objective: This study aimed to determine aesthetic perceptions of midline deviations by orthodontic patients; influence of adjacent structures to smile in the perception of deviations; and difference between patients treated in University and in private practice. Methods: In this observational comparative cross-sectional study a smiling woman photograph was digitally modified, producing left maxillary dental midline deviations relative to facial midline. Twelve photographs were cropped in Group LCN including lips, chin and 2/3 of the nose; and group L including the lips. Non-parametric Friedman test ( = 0.05), followed by Wilcoxon test corrected by Bonferroni test ( = 0.0033) were used for multiple comparisons. Pearson correlation coefficient was used to study of the correlation and regression of the degree of smile esthetics on the midline deviations, adopting a significance level of 5%. Results: Patients were able to identify deviations from 2 mm. Among the groups of photos there was statistically significant difference in deviations of 2 and 3 mm. Comparing patients from University and private there was significant difference when comparing the photos in group LCN, without deviation and deviation of 2, 4 and 5 mm. Conclusions: Orthodontic patients are able to detect maxillary dental midline deviation from 2 mm. There was influence of viewing structures adjacent to smile in the perception of deviation for the private patients. University patients were more critical than private patients.

Objetivo: O objetivo foi avaliar a percepção estética do desvio da linha média dentária por pacientes ortodônticos; influência de estruturas adjacentes ao sorriso na percepção de desvios; e diferença de percepção entre pacientes tratados em Universidade e consultório particular. Métodos: Neste estudo comparativo observacional transversal uma fotografia de mulher sorrindo foi modificada digitalmente com desvios da linha média para a esquerda em relação à face. Doze fotografias foram recortadas para obter o grupo LCN incluindo lábios, queixo e 2/3 nariz; e grupo L incluindo lábios. O teste não paramétrico de Friedman ( = 0.05), seguido pelo de Wilcoxon, corrigido pelo teste de Bonferroni ( = 0.0033) foram utilizados para comparações múltiplas. O teste de Mann-Whitney foi aplicado para comparar grupos LCN e L, verificando a influência das estruturas adjacentes ao sorriso. O coeficiente de Pearson foi usado para correlação e regressão dos desvios sobre a estética do sorriso, adotando nível de significância de 5%.Resultados: Desvios de 2 mm foram identificados. Comparando grupos LCN e L houve diferença estatisticamente significante nos desvios de 2 e 3 mm. Entre pacientes da universidade e do consultório houve diferença significativa ao comparar fotografias no grupo LCN, sem desvio e desvios de 2, 4 e 5 mm. Conclusões: pacientes ortodônticos são capazes de detectar desvio da linha média dentária maxilar de 2 mm. Estruturas adjacentes ao sorriso influenciaram na percepção do desvio para os pacientes privados. Os pacientes da Universidade foram mais críticos do que os de consultório particular.

Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review.

OBJECTIVE:: The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability. METHODS:: Search strategies were executed for electronic databases Cochrane Library, Web of Science, PubMed and Scopus, which were completed on January 15, 2016. The inclusion criteria included randomized, prospective or retrospective controlled trials in growing subjects with posterior crossbite; treated with maxillary expanders; retention phase after expansion; post-retention phase of at least 6 months. The exclusion criteria were anterior crossbite, craniofacial anomalies, surgery or another orthodontic intervention; case reports; author's opinions articles, thesis, literature reviews and systematic reviews. The risk of bias of selected articles was assessed with Cochrane risk of bias tool for RCTs and Downs and Black checklist for non-RCTs. RESULTS:: A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality. The retention period after maxillary expansion ranged between 4 weeks and 16 months. Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention. CONCLUSIONS:: Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.

Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review

ABSTRACT OBJECTIVE: The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability. METHODS: Search strategies were executed for electronic databases Cochrane Library, Web of Science, PubMed and Scopus, which were completed on January 15, 2016. The inclusion criteria included randomized, prospective or retrospective controlled trials in growing subjects with posterior crossbite; treated with maxillary expanders; retention phase after expansion; post-retention phase of at least 6 months. The exclusion criteria were anterior crossbite, craniofacial anomalies, surgery or another orthodontic intervention; case reports; author’s opinions articles, thesis, literature reviews and systematic reviews. The risk of bias of selected articles was assessed with Cochrane risk of bias tool for RCTs and Downs and Black checklist for non-RCTs. RESULTS: A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality. The retention period after maxillary expansion ranged between 4 weeks and 16 months. Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention. CONCLUSIONS: Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.

RESUMO OBJETIVO: o objetivo da presente revisão sistemática foi avaliar a duração do período de contenção e a estabilidade do tratamento ortodôntico com expansão maxilar em pacientes em crescimento com mordida cruzada posterior. MÉTODOS: foram realizadas buscas estratégicas nas bases eletrônicas: Cochrane Library, Web of Science, PubMed e Scopus, até 15 de janeiro de 2016. Os critérios de inclusão foram: estudos clínicos controlados e randomizados, prospectivos ou retrospectivos, de pacientes em crescimento com mordida cruzada; tratados com aparelhos expansores maxilares, com fase de contenção pós-expansão e no mínimo seis meses de fase de pós-contenção. Os critérios de exclusão foram: mordida cruzada anterior, anomalias craniofaciais, cirurgia ou outro tratamento ortodôntico; relato de casos; artigos de opinião; teses; revisões de literatura e revisões sistemáticas. O risco de viés dos artigos selecionados foi avaliado a partir do Cochrane risk of bias tool para ensaios clínicos randomizados e Downs and Black checklist para ensaios clínicos não randomizados. RESULTADOS: a busca resultou em 156 títulos/resumos, sendo 44 textos examinados na íntegra. Foram selecionados 6 artigos para o acesso à qualidade metodológica. A duração do período de contenção ocorreu entre 4 semanas e 6 meses. Aparelhos fixos (aparelho em acrílico, Haas, Hyrax e quad-helix) ou removíveis (Hawley e Hawley com expansor) foram utilizados na fase de contenção. CONCLUSÃO: parece que seis meses de contenção com aparelhos fixos ou removíveis são suficientes para evitar a recidiva ou garantir mudanças mínimas em um curto período de acompanhamento pós-contenção.