Dental changes induced by a modified Herbst appliance followed by fixed appliances: A digital dental model analysis.

BACKGROUND: Herbst therapy is an effective treatment for Class II malocclusions. However, the maintenance of the effects after fixed appliances treatment remains questionable. This retrospective study aimed to assess, using digital dental models, the sagittal and transverse dental arch changes in young patients during two Class II Division 1 treatment phases, first with modified Herbst appliance (HA) and then with fixed appliances. METHODS: The treated group (TG) comprised 32 patients (17 boys, 15 girls; mean age, 12.85 ± 1.16 years) treated with HA and fixed appliances. The control group comprised 28 patients (13 boys, 15 girls; mean age, 12.21 ± 1.35 years) with untreated Class II malocclusions. Digital models were obtained immediately before and after HA therapy and after fixed appliances. Data were statistically analyzed. RESULTS: Compared with the control group, the TG showed an increase in maxillary and mandibular arch perimeters and in intercanine and intermolar arch widths, a decrease in overjet and overbite, and an improvement in canine and molar relationships. In the time after HA therapy until the end of fixed appliances treatment, the TG showed a decrease in maxillary and mandibular arch perimeters, overjet, upper and lower intermolar widths; an increase in molar Class II relationship; and no changes in canine relationship, overbite, and upper and lower intercanine widths. CONCLUSIONS: In this sample of patients treated with HA, on average, there was an improvement in the Class II relationship, which seemed to remain after fixed appliances. The transverse dental changes achieved in HA phase relapsed after treatment with fixed appliances.

Three-Dimensional Evaluation of Dental Arches in Individuals with Syndromic Craniosynostosis.

Objective: Individuals with syndromic craniosynostosis present alterations in the dental arches due to anomalies caused by the early fusion of the craniomaxillary sutures. This study aimed to compare intradental and interdental dimensions between individuals with Apert and Crouzon syndromes and nonsyndromic controls. Materials and Methods: Digital models were obtained from the archive of a public tertiary care hospital. The sample consisted of 34 patients (Apert n = 18, Crouzon n = 16) and 34 nonsyndromic controls matched for gender and age. Measurements of perimeter, length, intercanine and intermolar distances (upper and lower), overjet, and molar ratio were performed. Statistical comparisons were performed using ANOVA and Tukey tests (p < 0.05). Results: Patients with Apert and Crouzon syndromes have severely reduced maxillary transverse dimensions, perimeter, and length of the upper arch compared to the control group (p < 0.001). The lower arch is less impacted. Patients with Apert syndrome had an anterior crossbite (p < 0.001), while patients with Crouzon syndrome had an edge-to-edge bite (p < 0.011). Patients with Apert and Crouzon syndromes do not have serious transverse proportion problems when comparing the upper and lower arches. Conclusions: In this sample, both the Apert and Crouzon groups have severely compromised upper arches compared to the control group. Mild dentoalveolar expansion in the maxilla should be sufficient for the transverse adaptation of the dental arches before frontofacial advancement.

Hyoid Bone Position and Head Posture in Patients With Richieri-Costa Pereira Syndrome (EIF4A3 Mutations).

Robin sequence with cleft mandible and limb anomalies, known as Richieri-Costa-Pereira syndrome (RCPS), is an autosomal recessive acrofacial dysostosis characterized by mandibular cleft and other craniofacial anomalies and respiratory complications. The aim of this cross-sectional study was to describe the hyoid and head posture of 9 individuals with RCPS using cephalometric measurements and provide a discussion about its implications in obstructive sleep apnea syndrome (OSAS). The study was conducted on lateral cephalograms of patients with RCPS and 9 selected age-matched controls in tertiary cleft center in Brazil. The cephalograms were digitized and analyzed on a software to obtain the vertical and horizontal hyoid position, its relationship with the mandible and the relation of the cranial base and postvertebral line. The t test was used for analysis of means and Levene's test for equality of variances.Cephalometric measurements H-S (vertical distance between hyoid bone and sella) (Supplemental Digital Content, Figure 1, http://links.lww.com/SCS/B247) and H-C4lp (horizontal position of the hyoid in relation to the post-pharyngeal space) showed statistically significant difference compared to controls (P < 0.05). Therefore, the hyoid bone was more inferiorly and posteriorly positioned in the study group compared with the control group. The vertebrae measurements did not present differences compared to controls. The described position of hyoid bone could be involved in the severe OSAS of RCPS patients.

Efeito da contaminação por saliva na resistência adesiva de braquetes cerâmicos utilizando uma resina ortodôntica hidrofílica / Saliva contamination effect on shear bond strength of ceramic brackets with an orthodontic hydrophilic resin

Introdução: Alguns fatores, como a presença de saliva, são capazes de influenciar a adesão do braquete ao dente durante o procedimento de colagem e podem causar falha da resistência adesiva. Objetivo: O objetivo deste estudo foi avaliar a resistência ao cisalhamento de braquetes cerâmicos ortodônticos colados com Transbond XT e Transbond Plus Color Change em esmalte de dentes bovinos, contaminado e não contaminado por saliva, além de analisar o local da falha adesiva. Material e método: Sessenta incisivos bovinos foram divididos aleatoriamente em quatro grupos (n=15), de acordo com o material de colagem e a presença de contaminação: Grupo 1 (G1): colagem com Transbond XT na ausência de contaminação; Grupo 2 (G2): colagem com Self Etching Pimer e Transbond Color Change na ausência de contaminação; Grupo 3 (G3): colagem com Transbond XT na presença de contaminação, e Grupo 4 (G4): colagem com Self Etching Primer e Transbond Color Change na presença de contaminação. Resultado: O teste não paramétrico de Kruskal-Wallis mostrou que G1 diferiu estatisticamente (p<0,05) de G2 e G3. Não houve diferença estatística significativa entre os demais grupos. O índice de adesivo remanescente (IAR) variou entre 2 e 3 no G1 e entre 0 e 1 nos outros grupos. Conclusão: A contaminação por saliva diminui a resistência adesiva ao cisalhamento de braquetes cerâmicos colados com a resina hidrofóbica Transbond XT convencional. Por outro lado, a utilização da resina hidrofílica Transbond Plus Color Change associada ao Self Etching Primer, em ambiente contaminado por saliva, confere resistência adesiva adequada para o seu uso clínico.

Introduction: Some fator, such as the presence of saliva, are able to influence the adhesion of the bracket to the tooth enamel during the orthodontic bonding procedure and may cause the adhesive failure. Objective: The aim of this study was to evaluate the shear strength of orthodontic ceramic brackets bonded with Transbond XT and Transbond Plus Color Change to bovine teeth, under saliva contamination and the adhesive failure mode. Material and method: Sixty bovine permanent incisors were randomly divided into 4 groups (n=15) according to bonding material and saliva contamination: Group 1 (G1) bonded with Transbond XT with no saliva contamination; Group 2 (G2) bonded with Self Etching Primer and Transbond Plus Color Change with no saliva contamination; Group 3 (G3) bonded with Transbond XT with saliva contamination and Group 4 (G4) bonded with Transbond Plus Color Change with saliva contamination. Result: The Kruskal-Wallis non-parametric test (p<0,05) was used and showed that G1 differed statistically from G2 and G3. There was no statistical difference between the other groups. The adhesive remnant index (ARI) ranged between 2 and 3 in G1 and between 0 and 1 score in the other groups. Conclusion: Saliva contamination decreases the shear bond strength of ceramic brackets bonded with conventional Transbond XT hydrophobic resin. On the other hand, the Transbond Plus Color Change hydrophilic resin associated with a Self Etching Primer, under saliva contamination, provide a sufficient shear bond strength, suitable for their clinical use.

Shear bond strength of three different bonding systems for orthodontic brackets

Aim: The objective of this study was to compare the efficiencies of different adhesive systems used to bond orthodontic brackets as well as the fracture pattern during debonding on bovine teeth. Methods: The sample included 45 specimens assigned to 3 groups according to the adhesive system applied: Group I: Transbond XT (3M Unitek®, Monrovia/CA -USA), Group II: Orthocem (FGM® Joinville/SC-BR), and Group III: Orthobond (Morelli®, Sorocaba/SP-BR). For this purpose, metal brackets were bonded to bovine teeth following the instructions from each manufacturer. The specimens were subjected to a shear test to assess bond strength (BS). Finally, after debonding, the adhesive remnant index (ARI) was estimated. Results: The average shear strength for a tooth bonded using the adhesive system Transbond XT was 16.39 MPa, while it was 18.08 Mpa for Orthocem and 7.28 Mpa for Orthobond; The Tukey test revealed no statistically significant differences between groups I and II (p < 0.01) and group III differed statistically from groups I and II. Conclusion: In conclusion, both adhesive systems Transbond XT and Orthocem attained higher bond strength values than Orthobond; the fracture pattern was similar for all adhesive systems applied

Influence of the cranial base flexion on Class I, II and III malocclusions: a systematic review.

OBJECTIVE: The aim of this study was to perform a systematic review on the morphological characteristics of the skull base (flexion, anterior length and posterior length) and the concomitant development of malocclusions, by comparing differences in dimorphism, ethnicity and age. METHODS: The articles were selected by means of electronic search on BBO, MEDLINE and LILACS databases from 1966 to 2016. A qualitative evaluation of the methodologies used on the articles was also performed. RESULTS: Although the literature on this topic is abundant, only 16 articles were selected for the present systematic review. The cranial base angle itself does not seem to play a significant role in the development of malocclusions. In fact, the cranial base angle is relatively stable at the ages of 5 to 15 years. CONCLUSIONS: A more obtuse angle at the skull base, in association or not with a greater anterior length of the cranial base, can contribute to the development of Class II division 1 malocclusions. On the other hand, a more acute angle at the skull base can contribute to a more anterior positioning of the mandible and to the development of Class III malocclusions.

Molar Uprighting: A Considerable and Safe Decision to Avoid Prosthetic Treatment.

BACKGROUND: Tipped lower molar over edentulous space is very common in orthodontics practice when adults seek treatment. The segmented arch technique features a predictable force system that provides a controlled release of force that can produce light and continuous tooth movement. CASE DESCRIPTION: A female adult patient, who lost a permanent lower first molar, needed correction of the position of her permanent first molar place. Instead of making space for rehabilitation, it was closed after second molar uprighting and a balanced interdigitation was created without prosthetics. The patient was successfully treated with segmented arch technique using root correction spring activated with geometry VI to promote uprighting of a tipped molar and Niti spring coil to promote space closure. PRACTICAL IMPLICATIONS: Segmented arch technique is known to provide predictable light and continuous forces, which is very much indicated in adult treatment. There are several things to consider when orthodontically treating adult patients. Their periodontal conditions might not be ideal, less bone apposition may occur, and side effects of orthodontic tooth movement are expected. Thus, a predictable and controlled orthodontic treatment is needed.

Influence of the cranial base flexion on Class I, II and III malocclusions: a systematic review

ABSTRACT Objective: The aim of this study was to perform a systematic review on the morphological characteristics of the skull base (flexion, anterior length and posterior length) and the concomitant development of malocclusions, by comparing differences in dimorphism, ethnicity and age. Methods: The articles were selected by means of electronic search on BBO, MEDLINE and LILACS databases from 1966 to 2016. A qualitative evaluation of the methodologies used on the articles was also performed. Results: Although the literature on this topic is abundant, only 16 articles were selected for the present systematic review. The cranial base angle itself does not seem to play a significant role in the development of malocclusions. In fact, the cranial base angle is relatively stable at the ages of 5 to 15 years. Conclusions: A more obtuse angle at the skull base, in association or not with a greater anterior length of the cranial base, can contribute to the development of Class II division 1 malocclusions. On the other hand, a more acute angle at the skull base can contribute to a more anterior positioning of the mandible and to the development of Class III malocclusions.

RESUMO Objetivo: o objetivo desse estudo foi realizar uma revisão sistemática sobre as características morfológicas da base do crânio (flexão, comprimento anterior e comprimento posterior) e o desenvolvimento concomitante da má oclusão, comparando as diferenças do dimorfismo, etnia e idade. Métodos: os artigos foram selecionados por meio de busca eletrônica nas bases de dados BBO, MEDLINE e LILACS, de 1966 a 2016. Uma avaliação qualitativa da metodologia dos artigos também foi executada. Resultados: ainda que a literatura seja abundante nesse assunto, somente 16 artigos foram selecionados para a presente revisão sistemática. O ângulo da base do crânio, por si só, não parece desempenhar papel significativo no desenvolvimento das más oclusões. De fato, o ângulo da base do crânio é relativamente estável dos 5 aos 15 anos. Conclusões: um ângulo mais obtuso na base do crânio, associado ou não a um comprimento maior, pode contribuir para o desenvolvimento da má oclusão de Classe II, divisão 1. Por outro lado, um ângulo mais agudo na base do crânio pode contribuir para um posicionamento mais anterior da mandíbula e para o desenvolvimento da má oclusão de Classe III.

Orthodontic Replacement of Lost Permanent Molar with Neighbor Molar: A Six-Year Follow-Up.

Extraction is very frequent indication in orthodontic planning, especially when there are crowding, biprotrusion, and aesthetically unpleasant profiles. Next to extraction comes space closure, which represents a challenge for orthodontists because of extended treatment time, discomfort created for the patient, tissue tolerance, and stability concerns. When it comes to what mechanics to choose for space closure, loops present two major advantages in relation to sliding mechanics: absence of abrasion and possibility to reach pure dental translation. A case is presented where an adult female patient with early loss of the first lower permanent molars, minor lower crowding, and tooth biprotrusion was treated with upper first bicuspids extraction along with upper and lower space closure done with T-loops to promote best space closure control in order to correct the malocclusion and enhance facial aesthetics.

Orthodontic Traction of Impacted Canine Using Cantilever.

The impaction of the maxillary canines causes relevant aesthetic and functional problems. The multidisciplinary approach to the proper planning and execution of orthodontic traction of the element in question is essential. Many strategies are cited in the literature; among them is the good biomechanical control in order to avoid possible side effects. The aim of this paper is to present a case report in which a superior canine impacted by palatine was pulled out with the aid of the cantilever on the Segmented Arch Technique (SAT) concept. A 14.7-year-old female patient appeared at clinic complaining about the absence of the upper right permanent canine. The proposed treatment prioritized the traction of the upper right canine without changing the occlusion and aesthetics. For this, it only installed the upper fixed appliance (Roth with slot 0.018), opting for SAT in order to minimize unwanted side effects. The use of cantilever to the traction of the upper right canine has enabled an efficient and predictable outcome, because it is of statically determined mechanics.

Two-Step Extraction of the Lower First Molar for Class III Treatment in Adult Patient.

The aim of this article is to describe a case report of Class III malocclusion treatment with lower first molar extraction. The 27-year-old Caucasian male patient presented a symmetric face with a straight profile, hyperdivergent growth pattern, molar and cuspid Class III relation, and an anterior crossbite as well as a mild crowding on cuspids area, in both upper and lower arches and a tendency to posterior crossbite. The treatment was performed by the use of Haas expansion appliance followed by an initial alignment and leveling of the upper and lower arches with a fixed edgewise appliance, extraction of lower teeth aiming the correction of the incisors proclination and end the treatment with a Class I molar relationship. It resulted in a significant change in the patient's profile, dentoalveolar Class III correction, upper arch expansion, leveling and alignment of the upper and lower arches, and improvement of tipping of the upper and lowers incisors. In cases of a dentoalveolar compensation in well positioned bone bases the treatment with fixed appliances is an alternative and extraction of lower teeth is considered.

Skeletal and dental changes induced by bionator in early treatment of class II / Alterações esqueléticas e dentárias induzidas pelo bionator no tratamento precoce da classe II

The purpose was to investigate the amount of skeletal and dentoalveolar changes after early treatment of Class II, Division 1 malocclusion with bionator appliance in prepubertal growing patients. Forty Class II patients were divided in two groups. Treated group consisted of 20 subjects treated consecutively with bionator. Mean age at the start of treatment (T0) was 9.1 years, while it was 10.6 years at the end of treatment (T1). Mean treatment time was 17.7 months. Pretreatment and post-treatment cephalometric records of treated group were evaluated and compared with a control group consisted of 20 patients with untreated Class II malocclusion. Intergroup comparisons were performed using Student's t-tests and chi-square test with Yates' correction at a significance level of 5 per cent. Bionator appliance was effective in generating differential growth between the jaws. Cephalometric skeletal measurements ANB, WITS, Lafh, Co-A and dental L6-Mp, U1.Pp, IsIi, OB, OJ showed statistically significantly different from the control. Bionator induced more dentoalveolar changes than skeletal during treatment in prepubertal stage.

Este estudo quantificou as alterações esqueléticas e dentoalveolares no período pré-puberal de crescimento após o tratamento da má oclusão de classe II, divisão 1 com bionator. Quarenta pacientes classe II foram divididos em dois grupos. Um grupo com 20 pacientes tratados consecutivamente com bionator. A média de idade no início do tratamento (T0) foi de 9,1 anos, enquanto ao final (T1) foi de 10,6 anos. O tempo médio de tratamento foi de 17,7 meses. Os dados cefalométricos antes e após o tratamento foram avaliados e comparados com um grupo controle de 20 pacientes com má oclusão de classe II, divisão 1 não tratada. A comparação intergrupo foi realizada pelo teste t de Student e teste qui-quadrado com correção de Yates para um nível de significância de 5 por cento. O aparelho foi efetivo em gerar diferencial de crescimento entre os arcos dentários. As medidas cefalométricas esqueléticas ANB, WITS, Lafh, Co-A e as dentárias L6-Mp, U1.Pp, IsIi, OB, OJ demonstraram diferença estatística significante entre os grupos. O bionator induziu maiores alterações dentoalveolares que esqueléticas no tratamento da classe II, divisão 1 durante o período pré-puberal.

Changes in alveolar bone support induced by the Herbst appliance: a tomographic evaluation.

OBJECTIVE: This study evaluated alveolar bone loss around mandibular incisors, induced by the Herbst appliance. METHODS: The sample consisted of 23 patients (11 men, 12 women; mean age of 15.76 ± 1.75 years), Class II, Division 1 malocclusion, treated with the Herbst appliance. CBCT scans were obtained before treatment (T0) and after Herbst treatment (T1). Vertical alveolar bone level and alveolar bone thickness of mandibular incisors were assessed. Buccal (B), lingual (L) and total (T) bone thicknesses were assessed at crestal (1), midroot (2) and apical (3) levels of mandibular incisors. Student's t-test and Wilcoxon t-test were used to compare dependent samples in parametric and nonparametric cases, respectively. Pearson's and Spearman's rank correlation analyses were performed to determine the relationship of changes in alveolar bone thickness. Results were considered at a significance level of 5%. RESULTS: Mandibular incisors showed no statistical significance for vertical alveolar bone level. Alveolar bone thickness of mandibular incisors significantly reduced after treatment at B1, B2, B3, T1 and significantly increased at L2. The magnitude of the statistically significant changes was less than 0.2 mm. The changes in alveolar bone thickness showed no statistical significance with incisor inclination degree. CONCLUSIONS: CBCT scans showed an association between the Herbst appliance and alveolar bone loss on the buccal surface of mandibular incisors; however, without clinical significance.

Changes in alveolar bone support induced by the Herbst appliance: a tomographic evaluation

ABSTRACT Objective: This study evaluated alveolar bone loss around mandibular incisors, induced by the Herbst appliance. Methods: The sample consisted of 23 patients (11 men, 12 women; mean age of 15.76 ± 1.75 years), Class II, Division 1 malocclusion, treated with the Herbst appliance. CBCT scans were obtained before treatment (T0) and after Herbst treatment (T1). Vertical alveolar bone level and alveolar bone thickness of mandibular incisors were assessed. Buccal (B), lingual (L) and total (T) bone thicknesses were assessed at crestal (1), midroot (2) and apical (3) levels of mandibular incisors. Student's t-test and Wilcoxon t-test were used to compare dependent samples in parametric and nonparametric cases, respectively. Pearson's and Spearman's rank correlation analyses were performed to determine the relationship of changes in alveolar bone thickness. Results were considered at a significance level of 5%. Results: Mandibular incisors showed no statistical significance for vertical alveolar bone level. Alveolar bone thickness of mandibular incisors significantly reduced after treatment at B1, B2, B3, T1 and significantly increased at L2. The magnitude of the statistically significant changes was less than 0.2 mm. The changes in alveolar bone thickness showed no statistical significance with incisor inclination degree. Conclusions: CBCT scans showed an association between the Herbst appliance and alveolar bone loss on the buccal surface of mandibular incisors; however, without clinical significance.

RESUMO Introdução: este estudo avaliou a perda óssea alveolar ao redor dos incisivos inferiores induzida pelo aparelho de Herbst. Métodos: a amostra foi composta por 23 pacientes (11 homens e 12 mulheres; média de idade 15,76 ± 1,75 anos), má oclusão de Classe II, divisão 1, tratados com aparelho de Herbst. TCFCs foram realizadas antes do tratamento (T0) e após o tratamento (T1) com o Herbst. A altura e a espessura óssea alveolar dos incisivos inferiores foram avaliadas. As espessuras ósseas vestibular (V), lingual (L) e total (T) foram mensuradas nos terços cervical (1), médio (2) e apical (3) dos incisivos inferiores. O teste t de Student e o teste t de Wilcoxon compararam as amostras dependentes nos casos paramétricos e não paramétricos, respectivamente. As análises de Pearson e Spearman determinaram a correlação entre as alterações na espessura do osso alveolar. Os resultados foram considerados para um nível de significância de 5%. Resultados: os incisivos inferiores não apresentaram significância estatística para a altura óssea alveolar. Após o tratamento, a espessura óssea alveolar dos incisivos inferiores reduziu-se significativamente em V1, V2, V3 e T1 e aumentou significativamente em L2. A quantidade da alteração óssea significativa foi menor que 0,2mm. As alterações na espessura óssea alveolar não apresentam correlação estatisticamente significativa com o grau de inclinação do incisivo. Conclusões: as imagens de TCFC demonstram associação entre o uso do aparelho de Herbst e a perda óssea alveolar no lado vestibular dos incisivos inferiores; entretanto, sem significância clínica.

Cone beam computed tomography study of apical root resorption induced by Herbst appliance.

OBJECTIVE: This study evaluated the frequency of root resorption during the orthodontic treatment with Herbst appliance by Cone Beam Computed Tomography (CBCT). MATERIAL AND METHODS: The sample comprised 23 patients (11 men, 12 women; mean ages 15.76±1.75 years) with Class II division 1 malocclusion, treated with Herbst appliance. CBCT was obtained before treatment (T0) and after Herbst treatment (T1). All the dental roots, except third molars, were evaluated, and apical root resorption was determined using the axial guided navigation method. Paired t-tests and Wilcoxon T Test were used to compare the dependent samples in parametric and nonparametric cases, respectively. Chi-Square Test with Yates' correction was used to evaluate the relationship between apical root resorption and gender. Results were considered at a significance level of 5%. RESULTS: Apical resorption was detected by CBCT in 57.96% of 980 roots that underwent Herbst appliance treatment. All patients had minimal resorption and there was no statistical significance between the genders. CONCLUSION: CBCT three-dimensional evaluation showed association between Herbst appliance and minimal apical root resorption, mostly in the anchoring teeth, without clinical significance.

Cone beam computed tomography study of apical root resorption induced by Herbst appliance

Objective This study evaluated the frequency of root resorption during the orthodontic treatment with Herbst appliance by Cone Beam Computed Tomography (CBCT).Material and Methods The sample comprised 23 patients (11 men, 12 women; mean ages 15.76±1.75 years) with Class II division 1 malocclusion, treated with Herbst appliance. CBCT was obtained before treatment (T0) and after Herbst treatment (T1). All the dental roots, except third molars, were evaluated, and apical root resorption was determined using the axial guided navigation method. Paired t-tests and Wilcoxon T Test were used to compare the dependent samples in parametric and nonparametric cases, respectively. Chi-Square Test with Yates’ correction was used to evaluate the relationship between apical root resorption and gender. Results were considered at a significance level of 5%.Results Apical resorption was detected by CBCT in 57.96% of 980 roots that underwent Herbst appliance treatment. All patients had minimal resorption and there was no statistical significance between the genders.Conclusion CBCT three-dimensional evaluation showed association between Herbst appliance and minimal apical root resorption, mostly in the anchoring teeth, without clinical significance.

Alterações cefalométricas dentárias induzidas pelo aparelho de Herbst com dois tipos de ancoragem para maxila / Cephalometric changes induced by the Herbst appliance with two types of maxillary Anchorage

O presente estudo avaliou se o tipo de ancoragem maxilar utilizada no aparelho de Herbst tem influência nos efeitos dentários induzidos pelo seu uso no tratamento da Classe II. Neste estudo retrospectivo, foram avaliadas telerradiografias de 44 pacientes em fase de crescimento com má oclusão Classe II Divisão 1ª e deficiência mandibular, submetidos ao tratamento com aparelho de Herbst. A amostra foi dividida em dois grupos de acordo com a ancoragem maxilar utilizada: dentossuportada (Grupo 1) e dentomucossuportada (Grupo 2). Em ambos os grupos, para cada indivíduo, foram obtidas duas telerradiografias: T1 ao início do tratamento e T2 ao final da fase ortopédica de tratamento. Para avaliação dos resultados foram usadas as abordagens descritiva e dedutiva. A análise exploratória dos dados foi feita através do cálculo de medidas e a análise inferencial através do teste não paramétrico de Mann-Whitney com nível de significância de 5%. Os resultados evidenciaram diferenças estatisticamente significantes para as medidas 1.NB, 1-NB, 1/.Pp, IMPA, linha vertical de referência – molar superior (LVR-M6s), linha horizontal de referência – molar superior (LHR-M6s) e linha vertical de referência – incisal do incisivo inferior (LVR-Iii). O Grupo 1, com ancoragem maxilar reduzida, apresentou distalização e intrusão dos molares superiores, menor efeito de verticalização dos incisivos superiores e menor efeito de vestibularização dos incisivos inferiores, enquanto que o Grupo 2, com ancoragem maxilar total, apresentou extrusão do molar superior, maior verticalização dos incisivos superiores e maior vestibularização dos incisivos inferiores. Os dois grupos apresentaram efeito similar de mesialização dos molares inferiores...

This study aimed at verifying if the type of jaw anchorage used in Herbst appliance interferes over dental effects induced by the use of the device in the treatment of Class II. The presennt retrospective study analyzed lateral cephalograms of 44 prepubertal Caucasian patients, both genders, with Class II division 1 and mandibular deficiency, submitted to orthodontic treatment using Herbst appliance. The sample was divided into two groups according to the type of jaw anchorage: tooth-supported (Group 1) and tooth-tissue-supported (Group 2). In both groups, for each subject, two lateral cephalograms at maximum intercuspation were obtained: T1 at the beginning of treatment and T2 at the end of treatment. To evaluate the results descriptive and deductive approaches were utilized. Exploratory analysis of data was performed by calculating summary statistics and inferential analysis using the nonparametric Mann-Whitney test with significance level of 5%. The results showed statistically significant differences for measures 1.NB, 1-NB, 1/.Pp, IMPA, vertical reference line – upper-molar (LVR-M6s), horizontal reference line – upper-molar (LHR-M6s), and vertical reference line – lower incisor incisal (LVR - Iii). Group 1, with low jaw anchorage, presented distalization and intrusion of upper molars, lower effect of verticalization of the upper incisors and lower effect of proclination of the lower incisors. The second group, with total jaw anchorage, presented extrusion of upper molars, and showed higher verticalization of the upper incisors and higher proclination of the lower incisors. Both groups showed similar effect of mesial movement of mandibular molars...

Extração seriada: considerações clínicas / Serial extraction: clinical considerations

O tratamento “precoce” das más-oclusões tem despertado interesse crescente da comunidade ortodôntica. Dentre estes, destaca-se a extração seriada que visa conciliar as diferenças entre a quantidade conhecida do material dentário e a deficiência permanente do osso de suporte. A técnica é aplicada na dentadura mista, por meio de uma sequência pré-determinada de exodontias entre dentes decíduos e permanentes, na busca do alinhamento imediato, de preferência espontâneo, dos dentes permanentes remanescentes com uma terapia ortodôntica mecânica mínima. Será relatado um caso clínico no qual foi realizada a extração seriada em um paciente com má-oclusão de Classe I, em crescimento, com apinhamento severo e biprotruso. Todos os objetivos estéticos e funcionais foram alcançados...

The early malocclusion treatment has increased interest of orthodontic community. Among these is the serial extraction that harmonizes the differences between the amount of dental material and permanent deficiency of supporting bone. The technique is applied in mixed dentition through a predetermined sequence of extractions between deciduous and permanent teeth, in order to reach spontaneous immediately alignment of remaining permanent teeth with a minimum orthodontic mechanics. It will be reported a case where the serial extraction was performed in a growing patient with biprotrusion, Class I malocclusion and severe crowding. All functional and aesthetics goals were reached...

Infra-oclusão de molares decíduos - diagnóstico e tratamento / Infraoccluded deciduos molars - diagnosis and treatment

A infra-oclusão dos molares decíduos é definida pela ausência total ou parcial do ligamento periodontal e caracteriza-se pela fusão anatômica do cemento e/ou dentina com o osso alveolar. Este trabalho tem o objetivo de relatar as implicações clínicas e opções de conduta do tratamento da anquilose em dentes decíduos por meio da apresentação de um caso clínico.

Infraocclusion of deciduous molars is defined by total or partial periodontal ligament absence and characterized by the cementum or dentin anatomical fusion with alveolar bone. This study aims to report an ankylosis clinical case, the implications and treatments management options in the deciduos dentition.

Estudo em telerradiografia em norma de 45° no tratamento da Classe II com aparelho de Herbst / Oblique 45-degree radiograph study on the treatment of Class II with Herbst appliance

O objetivo deste estudo cefalométrico retrospectivo foi avaliar alterações mandibulares e maxilares induzidas pelo uso do aparelho de Herbst decorrentes do crescimento natural por meio de telerradiografias cefalométricas em norma de 45° de indivíduos com má oclusão de Classe II divisão 1 de Angle com retrusão mandibular. Uma amostra de 49 indivíduos com idade entre 8 a 10 anos, ou seja, antes do pico de crescimento pubertário com má oclusão Classe II divisão 1 foi utilizada, sendo dividida em 2 grupos: grupo tratado com o aparelho de Herbst (n=24) e grupo controle (n=25). O grupo controle foi pareado ao grupo tratado quanto ao gênero e idades ósseas e cronológicas. A análise estatística foi realizada por meio do teste t de Student. O aparelho de Herbst promoveu a correção da má oclusão em um período de 7 meses, por meio de mesialização dos primeiros molares permanentes inferiores e distalização dos primeiros molares permanentes superiores. O aparelho de Herbst não foi influente na estrutura mandibular, como também no comprimento efetivo da mandíbula. Concluiu-se que o tratamento precoce da Classe II utilizando o aparelho de Herbst corrigiu a relação anteroposterior predominantemente por modificações dentoalveolares.

The aim of this retrospective study was to evaluate mandibular and maxillary changes induced by the use of Herbst applianceand by natural growth through oblique cephalometric radiographs in children with Class II division 1 malocclusion with mandibular retrusion. A sample of 49 individuals with age ranging from 8 to 10 years old (before growth peak) with Class II division 1, were into two groups: Herbst treated group (n=24) and control group (n=25). Both groups were paired for gender and chronological age. Statistical analysis was performed through Student’s t test. The Herbst appliance promoted the Class II correction in a 7 months period by mesialization of lower permanent first molars and distalization of upper permanent first molars. The Herbst appliance had no influence over the mandibular structure or the mandibular length. It was concluded that early treatment with Herbst appliance corrected the Class II malocclusion by means of dentoalveolar changes.