Reanatomização de incisivos inferiores para a correção da discrepância de Bolton / Mandibular incisors reshaping to correct Bolton discrepancy

Resumo A agenesia de um incisivo inferior, além de causar um problema estético, pode gerar inclinações indesejáveis dos dentes, desvio da linha média inferior e aumento do overjet e overbite, além de uma discrepância de Bolton. O objetivo deste trabalho é apresentar uma abordagem de tratamento interdisciplinar realizado em um paciente jovem do sexo masculino com agenesia do incisivo central inferior esquerdo. Foi realizada abertura de pequenos espaços entre os incisivos inferiores com molas abertas. A distribuição dos espaços para reanatomização dos incisivos inferiores com resina composta corrigiu a discrepância de Bolton e proporcionou resultados estéticos e funcionais com overjet e overbite adequados.(AU)

Abstract Agenesis of a mandibular incisor, besides causing an esthetic problem, can generate undesirable teeth inclinations, lower midline deviation and increased overjet and overbite, in addition to a Bolton discrepancy. The objective of this paper is to present an interdisciplinary treatment approach performed in a young male patient with a mandibular left central incisor agenesis. The opening of small spaces between mandibular incisors was performed with coil springs. Space distribution for reshaping mandibular incisors with composite upturned the Bolton discrepancy and provided aesthetic and functional results with adequate overjet and overbite (AU)

Stress Distribution Evaluation of the Periodontal Ligament in the Maxillary Canine for Retraction by Different Alveolar Corticotomy Techniques: A Three-dimensional Finite Element Analysis.

AIM: By using the finite element method (FEM), this study aimed to evaluate the effect of different corticotomy formats on the distribution and magnitude of stress on the periodontal ligament (PDL) during retraction of the maxillary canine. MATERIALS AND METHODS: A geometric model of the left hemi-jaw was created from computed tomography scan images of a dry human skull and loads were administered during distalization movement of the canine. Three trials were performed: (1) without corticotomy, (2) box-shaped corticotomy and perforations in the cortical bone of the canine (CVC) and (3) CVC and circular-shaped corticotomy in the cortical bone of the edentulous space of the first premolar. RESULTS: There was no difference in stress distribution among the different corticotomy formats. CONCLUSION: Different corticotomy formats used to accelerate orthodontic tooth movement did not affect stress distribution in the PDL during canine retraction. CLINICAL SIGNIFICANCE: From a mechanical perspective, the present study showed that the stress distribution on the PDL during canine retraction was similar in all the corticotomy formats. When using the Andrews T2 bracket, the PDL presented the highest levels of stress in the middle third of the PDL, suggesting that the force was near the center of resistance. Also, as bone weakening by corticotomies did not influence stress distribution, the surgical procedure could be simplified to a less aggressive one, focusing more on inflammatory cellular stimulation than on bone resistance. A simpler surgical act could also be performed by most orthodontists in their practices, enhancing postoperative response and reducing patient costs.

Therapeutic approach to Class II, Division 1 malocclusion with maxillary functional orthopedics.

INTRODUCTION: Interceptive treatment of Class II, Division 1 malocclusion is a challenge orthodontists commonly face due to the different growth patterns they come across and the different treatment strategies they have available. OBJECTIVE: To report five cases of interceptive orthodontics performed with the aid of Klammt's elastic open activator (KEOA) to treat Class II, Division 1 malocclusion. METHODS: Treatment comprehends one or two phases; and the use of functional orthopedic appliances, whenever properly recommended, is able to minimize dentoskeletal discrepancies with consequent improvement in facial esthetics during the first stage of mixed dentition. The triad of diagnosis, correct appliance manufacture and patient's compliance is imperative to allow KEOA to contribute to Class II malocclusion treatment. RESULTS: Cases reported herein showed significant improvement in skeletal, dental and profile aspects, as evinced by cephalometric analysis and clinical photographs taken before, during and after interceptive orthodontics.

Therapeutic approach to Class II, Division 1 malocclusion with maxillary functional orthopedics

INTRODUCTION: Interceptive treatment of Class II, Division 1 malocclusion is a challenge orthodontists commonly face due to the different growth patterns they come across and the different treatment strategies they have available.OBJECTIVE: To report five cases of interceptive orthodontics performed with the aid of Klammt's elastic open activator (KEOA) to treat Class II, Division 1 malocclusion.METHODS: Treatment comprehends one or two phases; and the use of functional orthopedic appliances, whenever properly recommended, is able to minimize dentoskeletal discrepancies with consequent improvement in facial esthetics during the first stage of mixed dentition. The triad of diagnosis, correct appliance manufacture and patient's compliance is imperative to allow KEOA to contribute to Class II malocclusion treatment.RESULTS: Cases reported herein showed significant improvement in skeletal, dental and profile aspects, as evinced by cephalometric analysis and clinical photographs taken before, during and after interceptive orthodontics.

INTRODUÇÃO: o tratamento interceptor da má oclusão de Classe II primeira divisão é um desafio comum para os ortodontistas, em função dos diferentes padrões de crescimento que podem ser encontrados e das estratégias de tratamento disponíveis.OBJETIVO:apresentar cinco casos de interceptação da má oclusão de Classe II primeira divisão usando o ativador aberto elástico de Klammt (AAEK).MÉTODOS: o tratamento dessa má oclusão pode ser realizado em uma ou duas fases; e a utilização dos aparelhos ortopédicos funcionais, de acordo com suas indicações, pode minimizar as discrepâncias dentoesqueléticas, melhorando, consequentemente, a estética facial na primeira fase da dentição mista. O diagnóstico, a correta confecção do aparelho e a cooperação do paciente são a tríade indispensável para que o AAEK seja um coadjuvante no tratamento dessa má oclusão.RESULTADOS: os casos clínicos apresentaram melhora significativa nos aspectos esquelético, dentário e de perfil, evidenciada pelas análises cefalométricas e, no aspecto clínico, pelas fotografias pré- e trans-tratamento e após a interceptação.

O fechamento de diastemas interincisivos centrais superiores / Maxillary midline diastema closure

Em Ortodontia, o desafio é tratar a má oclusão e obter o melhor resultado estético e funcional. Isso depende das características específicas de cada caso e da interação com as especialidades afins que devem ser consideradas na elaboração do diagnóstico e na execução do plano de tratamento. A ausência de proporcionalidade dimensional entre os dentes superiores e inferiores impossibilita a intercuspidação, overjet e overbite adequados e pode interferir diretamente na qualidade do resultado estético. Nos casos de discrepância ósseo-dentária, discrepância de tamanho dos dentes ou Bolton com excesso inferior, estão indicados stripping inferior ou acréscimo e abertura ou fechamento de espaço na arcada oposta. No presente caso clínico, o diastema foi fechado com aparelho ortodôntico fixo, elásticos em cadeia, retração dos dentes anteriores e controle biomecânico para manutenção da linha mediana correta e contenção fixa colada nos dois incisivos centrais. O resultado estético foi atingido e a queixa da paciente em relação ao diastema solucionada.

In Orthodontics, achieving good function and aesthetic results on the treatment of malocclusion can be considered a challenge. This success depends on specific characteristics of each case and on the interaction among different specialists along the diagnosis and treatment planning. Lack of proportionality on the dimension of maxillary and mandibular teeth make it difficult to obtain proper interscupation, overjet and overbite, and may compromise the aesthetic result. In cases of tooth-bone discrepancy; tooth size discrepancy or Bolton discrepancy with mandibular excess; stripping or restoration and opening or closure of space in opposite arch are indicated. In the present clinical case midline diastema was closed using orthodontic fixed appliance, power chain retraction of anterior teeth and biomechanic control for proper midline and fixed retention on central incisors. Good aesthetic result was achieved and the patient was satisfied.

Four impacted canines in an adult patient: a challenge in orthodontics.

This case report illustrates the management of four impacted canines in an adult patient associated with prolonged retention of the four deciduous teeth. The treatment plan was formulated to extract the lower deciduous teeth, application of the forced eruption with the permanent canines, and extract the upper permanent canines and maintenance of the maxillary deciduous canines. No reshaping of the maxillary deciduous teeth was performed because the patient was satisfied with the results.