Interception and early treatment with rapid maxillary expansion for the impacted maxillary permanent central incisor in children: Two cases report with 5-years follow-up.

INTRODUCTION: The maxillary central incisor impaction represents a complex challenge in paediatric dentistry practice and may result in aesthetic and functional disharmony. The causes of this condition include physical barriers associated or not with a lack of space making eruption not possible, idiopathic ectopic positioning of the teeth or by trauma, non-coordination in rhizalysis and rhizogenesis between deciduous and successor or tooth shape abnormalities. The incidence of this involvement is quite rare, around 1% of the population. Opening of space through disjunction of the palatal suture is the main treatment proposed to solve this situation and, when necessary, the orthodontic traction assisted by surgery. DESCRIPTION: Were presented two cases of maxillary central incisors impaction in children treated with rapid maxillary expansion, alignment and levelling, and a follow-up after 5 years of treatment. RESULTS AND CONCLUSIONS: The challenge of these treatments were based on the early treatment in mixed dentition with expansion. The treatment of permanent maxillary central incisor impaction in children enabled excellent periodontal response and post-treatment occlusal stability.

Different approaches to the treatment of skeletal Class II malocclusion during growth: Bionator versus extraoral appliance.

INTRODUCTION: Class II malocclusion, which has a significant incidence in the population, may compromise facial esthetics and the smile, as well as the masticatory and respiratory functions. Often associated with skeletal abnormalities, it severely affects and compromises quality of life. An accurate diagnosis is fundamental to prepare a treatment plan to correct dental and skeletal anomalies. OBJECTIVES: This study discusses treatment alternatives to the correction of Class II division 1 and 2 malocclusion in growing patients, using a Bionator and an extraoral appliance.

Different approaches to the treatment of skeletal Class II malocclusion during growth: Bionator versus extraoral appliance

ABSTRACT Introduction: Class II malocclusion, which has a significant incidence in the population, may compromise facial esthetics and the smile, as well as the masticatory and respiratory functions. Often associated with skeletal abnormalities, it severely affects and compromises quality of life. An accurate diagnosis is fundamental to prepare a treatment plan to correct dental and skeletal anomalies. Objectives: This study discusses treatment alternatives to the correction of Class II division 1 and 2 malocclusion in growing patients, using a Bionator and an extraoral appliance.

RESUMO Introdução: A má oclusão de Classe II apresenta uma incidência significativa na população, podendo comprometer a estética facial, o sorriso e as funções mastigatória e respiratória. Frequentemente está associada à alteração esquelética, o que aumenta a repercussão desse comprometimento, interferindo ainda mais na qualidade de vida das pessoas afetadas. O correto diagnóstico dessa condição é fundamental para a elaboração de um plano de tratamento que permita a correção dentária e esquelética. Objetivos: O objetivo do presente artigo é discutir as alternativas terapêuticas para correção da Classe II divisão 1 e 2 em pacientes em fase de crescimento, utilizando-se o Bionator de Balters ou o aparelho extrabucal.

Measurement of the bone height of mandibular incisors and canines on computed tomography-Limitations according to bone thickness.

AIM: To verify the correlation between cone beam CT (CBCT) and spiral CT (SCT) images and direct measurement of the bone height and to verify whether bone thickness (BT) influences the accuracy of bone height measurement on CT. SETTING AND SAMPLE: One hundred and fourteen measurements were obtained in 10 dry human mandibles. MATERIALS AND METHODS: The alveolar bone height was measured on volumetric and linear images. RESULTS: Negative, average and significant correlations (-0.622** to -0.489**) were verified between BT and the absolute error. When the alveolar bone thickness was at least 0.6 mm, the mean differences were 0.16 and 0.28 mm on linear images and 0.12 and 0.03 mm on volumetric images for CBCT and SCT. Additionally, these values ranged from -0.46 to 0.79 and -0.32 to 0.88 mm on linear images and from -0.64 to 0.67 and -0.57 to 0.62 mm on volumetric images for CBCT and SCT. When the alveolar bone thickness was less than 0.6 mm, the CT evaluation varied from -1.74 to 5.42 and -1.64 to 5.42 mm on linear images and from -3.70 to 4.28 mm and -3.49 to 4.25 mm on volumetric images for CBCT and SCT. CONCLUSIONS: Spiral CT and CBCT images demonstrate significant correlation with direct measurement for the alveolar bone height. Measurement of the alveolar bone labial and lingual to the mandibular incisors and canines presented higher accuracy when its thickness was greater than 0.6 mm. When the thickness was less than 0.6 mm, bone dehiscence can be diagnosed despite bone being clinically present.

Uso de propulsor mandibular fixo Flex Developer como recurso no tratamento da Classe II em paciente não colaborador / Flex Developer as an alternative in Class II treatment in non-compliance patient

A má oclusão de Classe II apresenta alta incidência na população, podendo comprometer a estética do sorriso, função e estabilidade da oclusão, enquanto a Classe II esquelética pode resultar no comprometimento da estética facial e no volume da via aérea superior do indivíduo. A má oclusão de Classe II rotineiramente está associada à condição de Classe II esquelética, tendo como alternativas de tratamento o uso de Aparelho Extra Bucal (AEB) ou propulsores mandibulares removíveis ou fixos. Neste artigo é descrito relato de caso de paciente que não aceitou uso de AEB e foi então adaptado propulsor mandibular fixo do tipo Flex Developer, para correção da Classe II, e discutidas as vantagens e desvantagens das propostas terapêuticas para correção da Classe II. (AU)

Abstract Class II malocclusion has a high incidence in the population, which may compromise smile aesthetics, occlusion function and stability. Skeletal Class II may affect facial aesthetics and upper airway volume. Class II malocclusion is routinely associated with skeletal Class II condition, having as treatment alternatives the use of Extra Buccal Appliance (EBA) or removable or fixed propulsor appliance. This article describes a case of a patient who did not accept the use of EBA and so it was fitted a Flex Developer propulsor for Class II correction and discussed the advantages and disadvantages of therapeutic alternatives for Class II correction (AU)

Importance of Dental Clinic Recalls for Caries Prevention in Children: Practice-Based Research.

Objective: to investigate the association between caries incidence in children and the number of clinical preventive visits and follow-up period (intervals). Study Design: a 30-year cohort composed of the dental records of 600 children who were 12-23 months old at their first dental appointment and who were followed up to 12 years of age (200 followed since 1981, Group 1; 200 followed since 1991, Group 2; and 200 followed since 2001, Group 3) was analytically and quantitatively evaluated. Random sample calculation was performed with 95% confidence, a maximum error of 2.95% and a ratio of 50%. Results: association was found between caries incidence and the number of dental visits and consultation intervals. Children who attended a smaller number of preventive visits had a higher incidence of the disease. Children who had an interval between returns greater than 12 months had an 18.7-times greater caries risk compared to children who had intervals no longer than 8 months between return visits. Conclusions: preventive consultations with an average interval of up to 8 months seemed to increase family adherence to preventive procedures and acted as a protective factor against caries incidence in children.

A complex orthognathic surgical approach correcting a Class III malocclusion involving traumatic dental injuries and a maxilla fracture.

This case report describes a complex approach to orthodontic preparation for surgical treatment of a Class III facial skeletal deformity in a patient who suffered a unilateral maxilla fracture that also featured maxillary left central incisor avulsion, maxillary right central incisor extrusion, and maxillary right lateral luxation. A 12-mm negative overjet was formed by extraction of the maxillary right lateral incisor and closure of the residual space by retraction of the maxillary right central incisor, maxillary left lateral incisors, and maxillary right and left canines. Forward and impaction movement of the maxilla and retrusion and a counterclockwise turning movement of the mandible were then performed. Maxillary first premolars were reshaped to establish a maxillary canine shape, maxillary canines were reshaped to be maxillary lateral incisors, and a maxillary left lateral incisor received a central incisor crown, with a Class II molar relationship with good occlusion after 2 years of follow-up. This case was a great challenge that included complex multidisciplinary procedures, and the results indicated successful treatment of an orthodontic preparation for surgical treatment in a patient after maxillary fracture associated with dental trauma.

Tratamento ortopédico e ortodôntico em paciente infantil portador de mandíbula hipoplásica ­ micrognatia com controle de 5 anos / Orthodontic and orthopedic approach to treat hypoplastic mandible (micrognathia) in a growing patient ­ 5 years-follow up

O tratamento da micrognatia em crianças representa um desafio ortopédico em razão da limitação da magnitude de alteração do padrão de crescimento facial versus o componente genético que, por vezes, requer o auxílio de tratamento com cirurgia ortognática. Todavia, entendemos necessária a abordagem ortopédica em crianças portadoras de mandíbula hipoplásica, seja para efetivamente eliminiar a necessidade cirúrgica, seja para reduzir a magnitude desta ou para permitir melhor qualidade de vida durante o desenvolvimento da criança até a fase adulta. Apresentamos nesse artigo um caso clínico de tratamento de micrognatia em criança com aumento da via aérea em orofarínge, oclusão ideal, acompanhamento de estabilidade de 5 anos e sem a necessidade de cirurgia ortognática na vida adulta (AU)

Abstract The treatment of micrognathia in children represents an orthopedic challenge due to the limitation of the magnitude of growth pattern orthopedic approach versus the genetic pattern, which sometimes requires orthognathic surgery treatment. However, we consider the need for an orthopedic approach in children with hypoplastic mandibles, either to eliminate the surgical need, to reduce the magnitude of this or to allow a better quality of life during the child's development until adulthood. This paper presents a treatment of micrognathia in children with increase of the airway in oropharyngeal, ideal occlusion, without the need of orthognathic surgery in adult life, with 5 years-follow up (AU)

Bruxismo na infância ­ aspectos contemporâneos no século 21 ­ revisão sistemática / Bruxism in children ­ contemporary aspects in 21st century ­ systematic review

O bruxismo é definido como uma atividade rítmica, repetitiva e involuntária dos músculos da mastigação caracterizado pelo ranger e/ou apertar dos dentes. Com alta prevalência em crianças, o bruxismo infantil é relatado na literatura recente, apresentando risco de danos aos tecidos dentários, demonstrando a relevância de se conhecer a etiologia, diagnóstico, epidemiologia, consequências e propostas terapêuticas para essa condição. Objetivou-se realizar revisão sistemática de literatura científica coletando dados relevantes e atuais para discutir as informações existentes. Foram realizadas buscas por livros-textos e artigos de texto completo nas bases de dados, selecionados ao todo 84 artigos e dois manuais. O bruxismo é uma manifestação de origem central, portanto, definir sua causa é um desafio, considerando seu aspecto multifatorial, comumente associado a fatores psicológicos/emocionais como estresse e ansiedade, fatores sistêmicos como distúrbios do sono e fatores locais como hiperplasias das amigdalas e adenoides, presença de vermes, dentre outros. A identificação e eliminação, quando possível, dos fatores causais podem eliminar a ocorrência do evento. Desgastes dentários podem ser sinais clínicos da ocorrência de bruxismo, todavia, podem ser sinais de eventos passados e não mais presentes desta condição, portanto, o diagnóstico deve considerar uma anamnese específica. O controle, seja por supervisão, seja por proteção, dos desgastes dentais, associado à investigação médica de fatores causais e adoção de práticas de "higiene do sono", parecem compor estratégia mais adequada para o tratamento desta condição (AU).

Bruxism is a widely studied alteration in Dentistry and other medical classes because of its multifactorial etiology. It is defined as a rhythmic, repetitive and involuntary activity of the chewing muscles characterized by teeth grinding and/or clenching. Having high prevalence in children, infant bruxism is reported in recent literature, presenting a risk of dental tissues damage, demonstrating the relevance of knowing the etiology, diagnosis, epidemiology, consequences, and therapeutic proposals for this condition. The aim of the present work is to perform a systematic review of the scientific literature collecting relevant and current data, in order to discuss existing information and disseminate it in the community of students and teachers. Thus, there were search for textbooks and full text articles in the databases, selecting altogether 84 articles and two manuals considered relevant to the study. There is no consensus in the literature on the etiology of bruxism, but psychological/emotional factors such as stress and anxiety, systemic factors such as sleep disturbances, and local factors such as tonsils and adenoids hyperplasia are the most described and at higher risk of development of bruxism. The involvement of a multidisciplinary team is fundamental for correct diagnosis and efficient treatment, reaching all causal aspect (AU).

Existe justificativa para o uso do xilitol na prevenção da cárie? Uma revisão de literatura / Is the xylitol useful in caries prevention? A literature review

A ingestão de açúcares e sua fermentação pelos microrganismos cariogênicos desempenham relevante papel no desenvolvimento da cárie dental. O xilitol, um poliol com baixo teor calórico, tem se mostrado um importante substituto da sacarose. O presente estudo teve como objetivo levantar informações sobre o uso do xilitol na Odontologia, abordando suas formas de administração mais eficientes na prevenção da cárie dental. Foi realizada uma busca por artigos de texto completos nas bases de dados PubMed, Medline, Scielo e BBO. A literatura é convergente em afirmar que o xilitol não consegue ser metabolizado pelos Streptococcus mutans. Por consequência, observa-se redução destas bactérias na superfície dental quando do uso contínuo desta substância. Todavia, existem controvérsias acerca da real redução da incidência de cárie, visto a redução dessas bactérias ser parcial e temporária, além da impossibilidade de uma dieta restrita ao uso de outros açúcares. O consumo de xilitol é promissor na prevenção da cárie dental. Os custos da produção ainda são altos, não justificando seus benefícios, porém, formas de produção mais viáveis estão sendo desenvolvidas, o que pode tornar a relação custo­benefício do xilitol satisfatória. Concluiu-se que o efeito do xilitol na prevenção da cárie é controverso. Apesar dessa substância dulcificante não ser fermentada por bactérias, e conseguir reduzir temporariamente a quantidade de Streptococcus mutans na cavidade bucal, essa redução é parcial e temporária, e não está relacionada diretamente à redução da cárie, sendo esta uma ação auxiliar e não determinante (AU).

The ingestion of sugars and their fermentation by cariogenic microorganisms play an important role in the development of dental caries. Xylitol, a low-calorie polyol, has been shown to be an important sucrose substitute. The objective of this study was to obtain information on the use of xylitol in Dentistry, addressing its more efficient forms of administration in the prevention of dental caries disease. A search for full text articles was performed in PubMed, Medline, Scielo, and BBO databases. The literature is convergent in affirming that xylitol can not be metabolized by Streptococcus mutans. Consequently, it is observed a reduction of these bacteria in the dental surface when the substance is used continuously. However, there is controversy about the real reduction of the incidence of caries, since the reduction of these bacteria is partial and temporary, besides the impossibility of a diet restricted to the use of other sugars. The consumption of xylitol is promising in the prevention of dental caries. Production costs are still high, not justifying their benefits, but more viable forms of production are being developed, which may make the cost-benefit ratio of xylitol satisfactory. It was concluded that the effect of xylitol on caries prevention is controversial. Although this sweetness substance is not fermented by bacteria, and is able to temporarily reduce the amount of Streptococcus mutans in the oral cavity, this reduction is partial and temporary, and is not directly related to the reduction of caries (AU).

Hypodontia of mandibular incisors: considerations on the orthodontic treatment.

Hypodontia is the most prevalent craniofacial malformation in mankind. It may present a wide variety of manifestations and, depending on the number and location of missing teeth, it may affect the esthetics, mastication, speech and occlusal balance. This paper discusses the therapeutic approaches to solve this condition, describing a case report with hypodontia of one mandibular lateral incisor, which treatment option included space closure at the region of hypodontia associated with composite resin restorations in the mandibular central incisors. The three-year follow-up after treatment revealed occlusal stability, adequate intercuspation in Class I relationship and excellent micro and macroesthetics.

Hypodontia of mandibular incisors: considerations on the orthodontic treatment

ABSTRACT Hypodontia is the most prevalent craniofacial malformation in mankind. It may present a wide variety of manifestations and, depending on the number and location of missing teeth, it may affect the esthetics, mastication, speech and occlusal balance. This paper discusses the therapeutic approaches to solve this condition, describing a case report with hypodontia of one mandibular lateral incisor, which treatment option included space closure at the region of hypodontia associated with composite resin restorations in the mandibular central incisors. The three-year follow-up after treatment revealed occlusal stability, adequate intercuspation in Class I relationship and excellent micro and macroesthetics.

Resumo A agenesia dentária é a malformação craniofacial mais prevalente em humanos. Pode apresentar uma grande variedade de manifestações e, dependendo do número e localização dos dentes ausentes, pode afetar a estética, a mastigação, a fala e o equilíbrio da oclusão. Neste artigo, serão discutidas as propostas terapêuticas para resolução dessa condição e será descrito um caso clínico com agenesia de um incisivo lateral inferior, cuja opção de tratamento foi o fechamento do espaço remanescente da agenesia, associado ao incremento de resina composta nos incisivos centrais inferiores. No acompanhamento por três anos após o tratamento, verificou-se estabilidade oclusal, adequada intercuspidação em Classe I e excelente micro e macroestética.

Nonsurgical treatment for a severe anterior and lateral open bite and multiple congenitally missing teeth: a case report with 4-year follow-up

ABSTRACT This case report describes the treatment of a severe anterior and lateral open bite combined with multiple congenitally missing teeth. A 10-year-old girl presented with an open gonial angle, absence of lip sealing, and soft tissue pogonion retrusion. She had an open bite of 8.5 mm, agenesis of the upper right and left lateral incisors and the upper left first premolar, and transverse maxillary deficiency. Nonsurgical treatment was planned aiming at controlling the vertical pattern, establishing the correct overbite, and closing the spaces on the upper arch, to provide satisfactory occlusion and facial and dental esthetics.

RESUMO O presente caso clínico descreve o tratamento de uma mordida aberta anterior e lateral associada à ausência congênita de dentes permanentes. Paciente com 10 anos de idade, apresentava ângulo goníaco aberto, ausência de selamento labial passivo e retrusão do pogônio mole. Além disso, foi diagnosticada uma mordida aberta de 8,5 mm, agenesia de incisivos laterais superiores direito e esquerdo e de primeiro pré-molar superior esquerdo, além de deficiência transversa da maxila. O planejamento do caso envolveu um tratamento não cirúrgico, com controle vertical do crescimento, obtenção de correta sobremordida e fechamento dos espaços superiores. O caso foi finalizado com uma boa intercuspidação, contemplando a estética facial e dentária.

Nonsurgical treatment for a severe anterior and lateral open bite and multiple congenitally missing teeth: a case report with 4-year follow-up.

This case report describes the treatment of a severe anterior and lateral open bite combined with multiple congenitally missing teeth. A 10-year-old girl presented with an open gonial angle, absence of lip sealing, and soft tissue pogonion retrusion. She had an open bite of 8.5 mm, agenesis of the upper right and left lateral incisors and the upper left first premolar, and transverse maxillary deficiency. Nonsurgical treatment was planned aiming at controlling the vertical pattern, establishing the correct overbite, and closing the spaces on the upper arch, to provide satisfactory occlusion and facial and dental esthetics.

Orthodontic approach to treat complex hypodontia using miniscrews in a growing patient.

This article reports orthodontic treatment of a case of hypodontia of five premolars in an 11-year-old female patient with a positive tooth size-arch length discrepancy in both dental arches. The patient had a straight profile with balanced facial growth. Setup manufacture revealed the possibility of achieving ideal occlusion by mesializing permanent molars up to 15 mm, in addition to keeping a primary molar in the dental arch. With the aid of absolute anchorage, the proposed mechanics was performed and the occlusion predicted in the setup was achieved, while profile and facial growth pattern were maintained. The use of miniscrews for extensive orthodontic movements was successful. Furthermore, one primary molar was extensively mesialized. The indication of gingivoplasty to correct gingival smile proved effective. This is considered a useful technique for orthodontists.

Orthodontic approach to treat complex hypodontia using miniscrews in a growing patient

This article reports orthodontic treatment of a case of hypodontia of five premolars in an 11-year-old female patient with a positive tooth size-arch length discrepancy in both dental arches. The patient had a straight profile with balanced facial growth. Setup manufacture revealed the possibility of achieving ideal occlusion by mesializing permanent molars up to 15 mm, in addition to keeping a primary molar in the dental arch. With the aid of absolute anchorage, the proposed mechanics was performed and the occlusion predicted in the setup was achieved, while profile and facial growth pattern were maintained. The use of miniscrews for extensive orthodontic movements was successful. Furthermore, one primary molar was extensively mesialized. The indication of gingivoplasty to correct gingival smile proved effective. This is considered a useful technique for orthodontists.

Este artigo apresenta o tratamento ortodôntico de um caso com hipodontia de cinco pré-molares, em uma paciente, de 11 anos de idade, com discrepância positiva de modelo em ambas as arcadas. A paciente apresentava perfil reto, com crescimento facial equilibrado. Por meio da confecção de set-up, verificou-se a possibilidade de se estabelecer uma oclusão ideal por meio da mesialização, de até 15mm, dos molares permanentes e manutenção de um molar decíduo no arco. Com o auxílio de ancoragem absoluta, foi realizada a mecânica proposta, alcançando-se a oclusão prevista em set-up, além da manutenção do perfil e do padrão de crescimento facial. A utilização de mini-implantes para grandes movimentos ortodônticos foi favorável, incluindo a extensa mesialização de um molar decíduo. A indicação da gengivoplastia para correção do sorriso gengival se mostrou acertada, sendo essa uma técnica de grande auxílio à Ortodontia.

Avanços na reconstrução cirúrgica da articulação temporomandibular / Advances in TMJ surgical reconstruction

As reconstruções totais da articulação temporomandibular(ATM)têm como finalidade restaurar a função e a forma, minimizar ador, assim como previnir o avanço das patologias e das más-oclusões envolvidas. As principais indicações para a intervenção incluem anquilose, reabsorções condilares, osteoartroses severas, artritereumatoide, doenças neoplásicas, disfunções ocasionadas por trauma e doenças congênitas. Considerando que a literatura científica é extremamente heterogênea em relação às técnicas de reconstrução da ATM, buscou-se organizar neste trabalho as diferentes possibilidades e os materiais empregados para tal reconstrução, assim como comparar as diferentes alternativas a longo prazo. Por uma questão didática, nestre trabalho, as possibilidades de reconstrução da ATM foram divididas em duas categorias: uma que preconizava enxertos autógenos, principalmente o costocontral, e a outra que utilizava próteses alógenas, compostas por material aloplástico e titânio. Após revisão da literatura observou-se prognóstico favorável a longo prazo com relação a estabilidade e o restabelecimento da função das próteses alógenas. Contudo, estudos com acompanhamento a longo prazo de reconstruções com enxertos autógenos demonstraram que o número de complicações foi consideravelmente maior, assim como a necessidade de novos procedimentos cirúrgicos, relatando uma estabilidade questionável da técnica. Embora exista vasta amplitude de opiniões relacionadas à reconstrução total da ATM, a evolução tecnológica dos materiais utilizados e os estudos com acompanhamentos de sua estabilidade a longo prazo levam a crer em um prognóstico favorável desta intervenção.

The TMJ rec onstruction aims to restore function and form, minimize pain and prevent the advancement of the disease and malocclusion involved. The main indications for intervention include ankylosis, condylar resorption, severe osteoarthrosis, rheumatoid arthritis,neoplastic diseases, disorders caused by trauma and congenital diseases. Since the scientific literature is extremely heterogeneous about reconstruction techniques, this paper aims to organize the different possibilities and materiais used for TMJ reconstruction, as well as compare the different alternatives in the long termo TMJ reconstruction was divided into two categories: one which advocates autogenous bone grafts, especially costochondral, and another that uses halogen prostheses composed by allo plastic material and titanium. The literature review demonstrates a favorable long-term prognosis with respect tostability and restoring function of halogen prostheses. However, studies with long-term monitoring of reconstruction with autogenous bone grafts showed greater number of complications, as well as the need for new surgical procedures, reporting a questionable stability of the technique. Although there is wide range of opinions related to TMJ reconstruction,technological evolution of materiais and follow-up study of its stability in the long-term lead to believe in a favorable outcome of this intervention.

A influência da espessura óssea na medição da altura da borda alveolar em imagens de tomografia computadorizada de feixe cônico e espiral / The influence of bone thickness in alveolar bone height measure in CBCT and MSCT

Imagens de tomografia computadorizada (TC) permitem a visualização, sem distorções ou sobreposições, do complexo maxilo-facial, principalmente do osso alveolar. Estudos demonstraram boa reprodutibilidade e precisão da mensuração da altura da borda alveolar, todavia a influência da espessura óssea ainda é pouco descrita. Através da comparação com a mensuração direta, o objetivo deste estudo foi avaliar a precisão, reprodutibilidade e a influência da espessura óssea, na mensuração da altura da borda alveolar em imagens volumétricas e imagens bidimensionais multiplanares em TC de feixe cônico (TCFC) e em TC espiral (TCE). Utilizando 10 mandíbulas secas de humanos, 57 dentes anteriores foram tomografados em equipamentos iCAT (Imaging Science International, Hatfield, PA, EUA) e Brilliance 64 canais (Philips Eletronics, Eindhoven, Holanda), ambos utilizando voxels de 0,25 mm. Através de imagens volumétricas (3D) e imagens bidimensionais (2D) de cortes multiplanares, foi comparada a mensuração da altura da borda alveolar dessas imagens com a mensuração direta nas mandíbulas, feita por vestibular e lingual, por três avaliadores, com o auxílio de um paquímetro, totalizando 114 bordas alveolares medidas. Alta reprodutibilidade intra-avaliador (0,999 a 0,902) e interavaliador (0,998 e 0,868) foi observada através do índice de correlação intraclasse (ICC). Observou-se alta correlação entre a mensuração direta e indireta da altura da borda alveolar em imagens 2D, sendo r=0,923** e 0,916**, e em imagens 3D, com r=0,929** e 0,954*, em TCFC e TCE, respectivamente. Imagens 2D superestimam a altura da borda alveolar em 0,32 e 0,49 mm e imagens 3D em 0,34 e 0,30 mm, em TCFC e TCE respectivamente. Quando o osso alveolar apresenta espessura de no mínimo 0,6 mm a média da diferença entre medidas diretas e indiretas é de 0,16 e 0,28 mm em imagens 2D e de 0,12 e 0,03 mm em imagens 3D para TCFC e TCE respectivamente, sendo que 95% do limite de concordância ...

Computerized tomogoraphy (CT) images allow for visualization, with no distortions or superimpostions, of the maxillo-facial complex, especially of the alveolar margins. Studies have demonstrated good reproducibility and precision of the alveolar bone height, however the influence of bone thickness is still scarcely described. The purpose of this study was, by comparing the direct measurement of alveolar bone height, to evaluate the precision, reproducibility and the influence of bone thickness on the same measurement in cone beam CT (CBCT) and spiral CT (SCT) volumetric and biplane images. Ten dry human mandibles, with a total of 57 anterior teeth were tomographed with an iCAT (Imaging Science International, Hatfield, PA, EUA) and a 64 channels Brilliance 64 tomograph (Philips Eletronics, Eindhoven, Holland), both using voxels of 0.25 mm. Alveolar bone height was measured on volumetric (3D) and bidimensional (2D) images of tomograms and compared with direct caliper measurements performed on the dry mandibles, on the buccal and lingual sides, by three raters in a total of 114 measurements. High intra-rater (0.999 a 0.902) and inter-rater (0.998 e 0.868) reproducibility was observed using the intraclass correlation coefficient (ICC). A high correlation was also observed between the direct and indirect measurements of alveolar bone height in 2D (r=0.923** e 0.916**), and 3D images (r=0.929** e 0.954*), for CBCT and SCT, respectively. Two-dimensional images overestimate alveolar bone height in 0.32 and 0.49 mm and 3D images in 0.34 and 0.30 mm, for CBCT and SCT, respectively. When alveolar bone thickness is at least 0.6 mm the mean difference is of 0.16 and 0.28 mm in 2D images and of 0.12 and 0.03 mm in 3D images for CBCT and SCT, respectively, with 95% limits of agreement ranging from -0.46 to 0.79 mm and -0.32 to 0.88 mm in 2D images, and of -0.64 to 0.67 mm and -0.57 to 0.62 mm in 3D images, for CBCT and SCT, respectively. When alveolar bone ...

Tracionamento de incisivo central superior impactado / Traction of impacted maxillary central incisor

A impacção dentária representa um desafio ao cirurgião-dentista, especialmente quando essa envolve dentes anteriores, devido à grande preocupação estética por parte dos pacientes. Os dentes podem se encontrar impactados por uma série de fatores etiológicos, incluindo a falta de espaço na arcada dentária; a presença de elementos supranumerários, cistos ou tumores; o posicionamento ectópico do germe dentário, entre outros; o que pode levar a uma má-oclusão dentária. Este artigo descreve o tracionamento ortodôntico-cirúrgico de um incisivo central superior impactado em um indivíduo do sexo masculino de 11 anos de idade. A sequência do tratamento, desde a abertura de espaço na arcada dentária superior à exposição cirúrgica da coroa e ao tracionamento do elemento impactado mostrou a importância do correto diagnóstico e planejamento e – sobretudo – de uma abordagem multidisciplinar, o que levou a um resultado bastante satisfatório, com excelente resposta à mecânica utilizada.

Dental impaction represents a challenge to the general dentist, especially when it involves anterior teeth, due to the great esthetic concern of the patients. Teeth may be impacted due to númerous etiological factors, including lack of space in the dental arch, the presence of supranumerary teeth and ectopic positioning of the dental germ, which can lead to malocclusion. This article describes the surgical-orthodontic traction of an impacted maxillary central incisor in a male patient aged 11 years. The sequence of treatment, since the opening of space in the upper dental arch to the surgical exposure of the crown and the traction of the impacted teeth showed the importance of correct diagnosis and planning and of a multidisciplinary approach, which led to a very satisfactory result with excellent response to the mechanics.