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1.
Angle Orthod ; 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33434282

RESUMO

OBJECTIVES: To compare the effects of a hybrid miniscrew-supported expander versus a conventional Hyrax (CH) expander in growing patients. MATERIALS AND METHODS: Forty patients were randomized into two groups: a hybrid Hyrax (HH) expander group using a Hyrax expander with two miniscrews and a CH expander group. The final sample had 18 subjects (8 female, 10 male; initial age of 10.8 years) in the HH group and 14 subjects (6 female, 8 male; initial age of 11.4 years) in the CH group. Cone-beam computed tomography examinations and digital dental models were obtained before expansion and 11 months postexpansion. The primary outcomes included the orthopedic transverse effects of expansion. Intergroup comparison was performed using analysis of covariance (P < .05). RESULTS: Significantly greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width were found for the HH group. No intergroup differences were observed for dental arch width or shape changes. CONCLUSIONS: The HH group showed greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width. No differences were observed for intermolar, interpremolar, or intercanine widths; arch length; or arch perimeter. Arch size and shape showed similar changes in both groups.

2.
Angle Orthod ; 90(5): 672-679, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378475

RESUMO

OBJECTIVES: To determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS: A retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed. RESULTS: No changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05). CONCLUSIONS: Following RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.


Assuntos
Fenda Labial , Fissura Palatina , Adolescente , Criança , Fenda Labial/diagnóstico por imagem , Fissura Palatina/diagnóstico por imagem , Fissura Palatina/cirurgia , Tomografia Computadorizada de Feixe Cônico , Humanos , Maxila/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Técnica de Expansão Palatina , Estudos Retrospectivos
4.
Am J Orthod Dentofacial Orthop ; 158(6): 834-839, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33097363

RESUMO

INTRODUCTION: Orthodontic miniscrews have become popular not only because they can provide an absolute form of anchorage, but also because they can reduce the required patient compliance when compared with traditional orthodontic anchorage. The objective of this study was to examine success rates of miniscrews placed by orthodontic residents and to evaluate which factors may affect insertion outcomes. METHODS: The sample consisted of 109 consecutive miniscrews placed in 60 patients (27 males and 33 females). Miniscrews were placed at 4 different insertion sites (anterior palate [n = 31], palatal alveolar process [n = 25], maxillary buccal alveolar process [n = 15], and mandibular buccal alveolar process [n = 38]). Analysis of variance tests were used to evaluate the influence of insertion sites and anchorage type (direct vs indirect) on the success rate. RESULTS: The overall success rate for miniscrews was 72.5%. The success rate was 83.9% in the anterior palate, 76% in the palatal alveolar process, 60% in the maxillary buccal alveolar process, and 65.8% in the mandibular buccal alveolar process. The success rate was significantly higher in indirect anchorage (84.2%) compared with direct anchorage (58.8%). CONCLUSIONS: Palatal miniscrews were more successful than buccal miniscrews. Indirect anchorage mechanics had a higher success rate than direct anchorage mechanics.


Assuntos
Internato e Residência , Procedimentos de Ancoragem Ortodôntica , Parafusos Ósseos , Feminino , Humanos , Masculino , Mandíbula , Desenho de Aparelho Ortodôntico
5.
Am J Orthod Dentofacial Orthop ; 158(4): 527-534, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32807630

RESUMO

INTRODUCTION: This study aimed to evaluate the follow-up observation of patients with obstructive sleep apnea treated with maxillomandibular advancement (MMA) procedure with or without genial tubercle advancement (GTA). METHODS: A total of 25 patients (mean age 37.1 ± 17.3 years) were included in the study. Cone-beam computed tomography scans were taken before treatment; after presurgical orthodontic treatment; immediately after MMA procedure; and follow-up visit. All Digital Imaging and Communications in Medicine files were analyzed using the Dolphin 3D Imaging software program (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to determine the total airway volume (TAV), airway area (AA), and minimal cross-sectional area (MCA). Dolphin 3D voxel-based superimposition was used to determine the amount of skeletal advancement with MMA and changes after surgery. RESULTS: Significant increase in TAV, AA, and MCA was found with MMA treatment (40.6%, 28.8%, and 56.4%, respectively, P <0.0001). Smaller but significant decrease in TAV, AA, and MCA was found during a follow-up visit (20.0%, 9.7%, and 26.8%, respectively, P <0.0001) giving a net increase of TAV, AA and MCA (35.8%, 27.1%, and 45.9%, respectively). No significant differences were found in any of the airway measurements with or without the GTA procedure. The average forward movements of the maxilla, mandible, and chin were 6.6 mm, 8.2 mm, and 11.4 mm, respectively. A relapse of less than 1 mm was found in each of the variables during the follow-up period. No correlation was found between the magnitudes of skeletal advancement and the change in oropharyngeal airway space (OPAS). CONCLUSIONS: Significant increase in OPAS can be expected with MMA surgery with or without GTA procedure in patients diagnosed with obstructive sleep apnea. A partial loss in OPAS was found during the follow-up visit. The surgical movements were found to be stable, with less than 1 mm of relapse during the follow-up period, which was not clinically significant.


Assuntos
Avanço Mandibular , Apneia Obstrutiva do Sono/diagnóstico por imagem , Apneia Obstrutiva do Sono/cirurgia , Apneia Obstrutiva do Sono/terapia , Adulto , Cefalometria , Seguimentos , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Pessoa de Meia-Idade , Osteotomia de Le Fort , Faringe/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
6.
Turk J Orthod ; 33(2): 123-132, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32637194

RESUMO

Gingival recession is a frequent mucogingival defect in the adult population. It affects the esthetics and is related to hypersensitivity and a high risk of periodontal attachment loss. The connection between orthodontic treatment and periodontal health has been debated for a long time. A healthy periodontium can be preserved during safe orthodontic tooth movement even in patients with poor mucogingival anatomy. This article aimed to review the strategies around managing the risks of mucogingival and apical root changes owing to maxillary canine impaction, with a special focus on gingival recession and impacted maxillary canine treatment. Maxillary canines are the second most frequently impacted teeth after the third molars. They can be located in the labial or buccal aspect of the alveolar bone. If interceptive procedures fail, the next step is the challenging and time-consuming comprehensive orthodontic-surgical treatment. Determining the exact impacted canine location, its relation to the adjacent teeth and structures, the least invasive surgical approach, and the best path for traction are all a part of the standard diagnostic process. It has also been suggested that orthodontists should evaluate periodontal risks to achieve the best possible results. Clinical examination and cone beam computed tomography provide valuable information for the treatment plan that yields good results with a healthy periodontium.

7.
Angle Orthod ; 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32213147

RESUMO

OBJECTIVES: To determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS: A retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed. RESULTS: No changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05). CONCLUSIONS: Following RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.

8.
Angle Orthod ; 90(2): 233-238, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31469593

RESUMO

OBJECTIVE: The objective of this study was to compare the effects on upper dental arch size and shape after maxillary expansion with Hyrax, Quad-helix, and a differential opening expander in bilateral cleft lip and palate (BCLP) patients. MATERIALS AND METHODS: Seventy-five BCLP patients were divided into three groups: Hyrax (H), Quad-helix (QH), and Expander with differential opening (EDO). Digital models were obtained before (T1) and after 6 months (T2) of maxillary expansion. Twelve landmarks were placed by one investigator on T1 and T2 dental models of each group, and x,y coordinates for each landmark were collected. For dental arch size analysis, centroid size of each dental arch at T1 and T2 was calculated from raw coordinates and was used as the measure of size. Procrustes Analysis was performed for dental arch shape analysis. Analysis of variance was used to compare the groups for size and shape differences (P < .05). RESULTS: There were no significant dental arch size differences among the expanders at T1 or T2. Differences in arch shape were found between all groups at T2. Intragroup arch shape showed a significant variation for the QH and EDO groups. while it remained stable in the H group. CONCLUSIONS: Both the QH and the EDO create dental arch shape changes with greater intercanine than intermolar increase. The H does not change the dental arch shape.


Assuntos
Fenda Labial , Fissura Palatina , Arco Dental , Técnica de Expansão Palatina , Arco Dental/anatomia & histologia , Humanos , Maxila
9.
Angle Orthod ; 90(2): 269-277, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31549857

RESUMO

OBJECTIVES: To evaluate the effect of changing kVp, mA, and voxel size on the accuracy of voxel-based superimposition on the anterior cranial base. MATERIALS AND METHODS: Cone beam computed tomography (CBCT) scans were taken on a phantom skull using different kVp, mA, and voxel size combinations. CBCT scans were superimposed using commercially available software. Two separate open-source software programs were used to generate a three-dimensional (3D) color map objective assessment of the differences in seven different regions: Nasion, Point A, Zygomatic (right and left), Point B, and Gonial (right and left). Each region had around 200 points that were used to calculate the mean differences between the superimpositions. RESULTS: Intraclass correlation showed excellent reliability (0.95). Lowering the kVp made the biggest difference, showing an average discrepancy of 0.7 ± 0.3 mm, and a high mean of 1.4 ± 0.3 in the Right Gonial region. Lowering the mA showed less of a discrepancy, with an average of 0.373 ± 0.2 mm, and the highest discrepancy, also on the Right Gonial Area, of 0.7 ± 0.1 mm. The voxel size had the least impact on the accuracy of registered volumes, with mean discrepancy values of less than 0.2 mm. CONCLUSIONS: Using different CBCT settings can affect the accuracy of the voxel-based superimposition method. This is particularly the case when using low kVp values, while changes in mA or voxel sizes did not significantly interfere with the superimposition outcome.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Imageamento Tridimensional , Dente , Humanos , Reprodutibilidade dos Testes , Base do Crânio
10.
Am J Orthod Dentofacial Orthop ; 156(1): 13-28.e1, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256826

RESUMO

The Board of Trustees of the American Association of Orthodontists asked a panel of medical and dental experts in sleep medicine and dental sleep medicine to create a document designed to offer guidance to practicing orthodontists on the suggested role of the specialty of orthodontics in the management of obstructive sleep apnea. This White Paper presents a summary of the Task Force's findings and recommendations.


Assuntos
Ortodontia/métodos , Ortodontia/normas , Ortodontistas , Apneia Obstrutiva do Sono/terapia , Academias e Institutos , Humanos , Aparelhos Ortodônticos , Médicos , Polissonografia/métodos , Prevalência , Radiografia Dentária , Fatores de Risco , Índice de Gravidade de Doença , Apneia Obstrutiva do Sono/diagnóstico , Apneia Obstrutiva do Sono/epidemiologia , Apneia Obstrutiva do Sono/etiologia , Cirurgiões , Resultado do Tratamento , Estados Unidos
12.
Healthcare (Basel) ; 6(4)2018 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-30477095

RESUMO

Sclerostin modulation is a novel therapeutic bone regulation strategy. The anti-sclerostin drugs, proposed in medicine for skeletal bone loss may be developed for jaw bone indications in dentistry. Alveolar bone responsible for housing dentition share common bone remodeling mechanisms with skeletal bone. Manipulating alveolar bone turnover can be used as a strategy to treat diseases such as periodontitis, where large bone defects from disease are a surgical treatment challenge and to control tooth position in orthodontic treatment, where moving teeth through bone in the treatment goal. Developing such therapeutics for dentistry is a future line for research and therapy. Furthermore, it underscores the interprofessional relationship that is the future of healthcare.

13.
Am J Orthod Dentofacial Orthop ; 154(1): 65-71, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29957322

RESUMO

INTRODUCTION: Our objective was to evaluate the prevalence of high-risk factors for sleep disordered breathing (SDB) in an orthodontic population of children. SDB is a spectrum of breathing disorders ranging from primary snoring to obstructive sleep apnea. METHODS: The sample included 303 healthy children between the ages of 9 and 17. High risk of SDB was assessed using the Pediatric Sleep Questionnaire, a validated instrument that consists of 22 questions, and high risk is defined as positive answers to 33% or more of the questions answered. Sixteen randomly selected patients repeated the questionnaire 1 month after the initial survey for reliability. RESULTS: In this sample, high-risk status on the Pediatric Sleep Questionnaire was not associated with sex, age, or race. The percentage of patients who were screened as high risk was 7.3% (95% confidence interval, 4.7%-10.6%). CONCLUSIONS: The results of this study suggest that approximately 7% of adolescent orthodontic patients may be at a significant risk for some form of SDB.


Assuntos
Síndromes da Apneia do Sono/epidemiologia , Adolescente , Criança , Feminino , Humanos , Masculino , Ortodontia Corretiva , Prevalência , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários
14.
Am J Orthod Dentofacial Orthop ; 153(4): 505-511, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29602342

RESUMO

INTRODUCTION: Cortical bone thickness, bone width, insertion depth, and proximity to nerves are important factors when planning and placing orthodontic miniscrews. The objective of this study was to anatomically assess the mandibular buccal shelf in a white patient population as the insertion site for orthodontic miniscrews by investigating these 4 variables. METHODS: Measurements were made on cone-beam computed tomography scans of 30 white patients (18 girls, 12 boys; mean age, 14.5 ± 2 years). All measurements were taken adjacent to the distobuccal cusp of the first molar, and the mesiobuccal and distobuccal cusps of the second molar. Additionally, bone depth was measured at 2 height levels, 4 and 8 mm from the cementoenamel junction. Stereolithographic models of patients were superimposed on the cone-beam computed tomography volumes to virtually create an outline of the soft tissue on the cone-beam computed tomography image to allow identification of the purchase point height (mucogingival junction). The inferior alveolar nerve was digitally traced. Miniscrews (1.6 × 10 mm) were virtually placed at the buccal shelf, and their insertion depths and relationships to the nerve were assessed. Analysis of variance with post hoc analysis was used for data analysis. RESULTS: Insertion sites and measurement levels had significant impacts on both cortical bone thickness and bone width. Cortical bone thickness was typically greatest at the distobuccal cusp of the second molar. Bone width was also greatest at the distobuccal cusp of the second molar 8 mm from the cementoenamel junction. The greatest insertion depth was found again at the distobuccal cusp to the second molar, whereas the miniscrews had the greatest proximity to the nerve at this site also. CONCLUSIONS: The distobuccal cusp level of the mandibular second molar is the most appropriate site for miniscrew insertion at the buccal shelf in white patients.


Assuntos
Parafusos Ósseos , Osso Cortical/anatomia & histologia , Mandíbula/anatomia & histologia , Maxila/anatomia & histologia , Procedimentos de Ancoragem Ortodôntica/instrumentação , Adolescente , Análise de Variância , Densidade Óssea , Criança , Tomografia Computadorizada de Feixe Cônico/métodos , Osso Cortical/diagnóstico por imagem , Feminino , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Masculino , Mandíbula/diagnóstico por imagem , Mandíbula/cirurgia , Nervo Mandibular/anatomia & histologia , Nervo Mandibular/diagnóstico por imagem , Maxila/diagnóstico por imagem , Maxila/cirurgia , Dente Molar/diagnóstico por imagem , Procedimentos de Ancoragem Ortodôntica/métodos , Estereolitografia , Colo do Dente/diagnóstico por imagem , Colo do Dente/cirurgia , Raiz Dentária/anatomia & histologia , Raiz Dentária/diagnóstico por imagem
15.
J Clin Orthod ; 51(9): 622-624, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29130928
16.
Angle Orthod ; 87(6): 847-854, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28862492

RESUMO

OBJECTIVES: To test the null hypotheses that the positions of the glenoid fossae and mandibular condyles are identical on the Class I and Class II sides of patients with Class II subdivision malocclusion. MATERIALS AND METHODS: Retrospective three-dimensional (3D) assessments of the positions of the glenoid fossae and mandibular condyles were made in patients with Class II malocclusion. Relative to a fiducial reference at the anterior cranial base, distances from the glenoid fossae and condyles were calculated in pretreatment cone beam computed tomographic scans of 82 patients: 41 with Class II and 41 with Class II subdivision malocclusions. The 3D distances from glenoid fossae to sella turcica in the X (right-left), Y (anterior-posterior), Z (inferior-superior) projections were calculated. RESULTS: Patients with Class II malocclusion displayed a symmetric position of the glenoid fossae and condyles with no statistically significant differences between sides (P > .05), whereas patients with Class II subdivision showed asymmetry in the distance between the glenoid fossae and anterior cranial base or sella turcica (P < .05), with distally and laterally positioned glenoid fossae on the Class II side. (P < .05). Male patients had greater distances between glenoid fossae and anterior cranial fossae (P < .05). The condylar position relative to the glenoid fossae did not differ between the two malocclusion groups nor between males and females (P > .05). CONCLUSIONS: The null hypotheses were rejected. Patients with Class II subdivision malocclusion displayed asymmetrically positioned right- and left-side glenoid fossae, with a distally and laterally positioned Class II side, although the condyles were symmetrically positioned within the glenoid fossae.


Assuntos
Tomografia Computadorizada de Feixe Cônico , Imageamento Tridimensional , Má Oclusão de Angle Classe II/diagnóstico por imagem , Côndilo Mandibular/diagnóstico por imagem , Osso Temporal/diagnóstico por imagem , Adolescente , Criança , Feminino , Humanos , Masculino , Côndilo Mandibular/anatomia & histologia , Estudos Retrospectivos , Osso Temporal/anatomia & histologia
17.
Am J Orthod Dentofacial Orthop ; 152(2): 178-192, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28760280

RESUMO

INTRODUCTION: The purpose of this study was to evaluate the effect of using the transverse analysis developed at Case Western Reserve University (CWRU) in Cleveland, Ohio. The hypotheses were based on the following: (1) Does following CWRU's transverse analysis improve the orthodontic results? (2) Does following CWRU's transverse analysis minimize the active treatment duration? METHODS: A retrospective cohort research study was conducted on a randomly selected sample of 100 subjects. The sample had CWRU's analysis performed retrospectively, and the sample was divided according to whether the subjects followed what CWRU's transverse analysis would have suggested. The American Board of Orthodontics discrepancy index was used to assess the pretreatment records, and quality of the result was evaluated using the American Board of Orthodontics cast/radiograph evaluation. The Mann-Whitney test was used for the comparison. RESULTS: CWRU's transverse analysis significantly improved the total cast/radiograph evaluation scores (P = 0.041), especially the buccolingual inclination component (P = 0.001). However, it did not significantly affect treatment duration (P = 0.106). CONCLUSIONS: CWRU's transverse analysis significantly improves the orthodontic results but does not have significant effects on treatment duration.


Assuntos
Ortodontia Corretiva/métodos , Ortodontia/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Criança , Feminino , Humanos , Masculino , Má Oclusão/terapia , Ohio , Ortodontia/métodos , Ortodontia/estatística & dados numéricos , Ortodontia Corretiva/normas , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Estudos Retrospectivos , Fatores de Tempo
19.
Angle Orthod ; 87(1): 25-32, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27463699

RESUMO

OBJECTIVES: To evaluate the maxillary sinus volumes in unilaterally impacted canine patients and to compare the volumetric changes that occur after the eruption of canines to the dental arch using cone beam computed tomography (CBCT). MATERIALS AND METHODS: Pre- (T0) and posttreatment (T1) CBCT records of 30 patients were used to calculate maxillary sinus volumes between the impacted and erupted canine sides. The InVivoDental 5.0 program was used to measure the volume of the maxillary sinuses. The distance from impacted canine cusp tip to the target point on the palatal plane was also measured. RESULTS: Right maxillary sinus volume was statistically significantly smaller compared to that of the left maxillary sinus when the canine was impacted on the right side at T0. According to the T1 measurements there was no significant difference between the mean volumes of the impaction side and the contralateral side. The distance from the canine tip to its target point on the palatal plane were 17.17 mm, and the distance from the tip to the target point was 15.14 mm for the left- and right-side impacted canines, respectively, and there was a significant difference between the mean amount of change of both sides of maxillary sinuses after treatment of impacted canines. CONCLUSIONS: Orthodontic treatment of impacted canines created a significant increase in maxillary sinus volume when the impacted canines were closer with respect to the maxillary sinus.


Assuntos
Dente Canino/anatomia & histologia , Arco Dental/anatomia & histologia , Seio Maxilar/anatomia & histologia , Dente Impactado/patologia , Adolescente , Tomografia Computadorizada de Feixe Cônico/métodos , Dente Canino/diagnóstico por imagem , Arco Dental/diagnóstico por imagem , Feminino , Humanos , Imageamento Tridimensional/métodos , Masculino , Maxila/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Erupção Dentária , Dente Impactado/diagnóstico por imagem , Turquia
20.
Dental press j. orthod. (Impr.) ; 21(6): 82-90, Sept.-Oct. 2016. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-840191

RESUMO

ABSTRACT Objective: The aim of this study was to evaluate the skeletal and dental effects of rapid maxillary expansion (RME) in cleft patients using two types of expanders. Methods: Twenty unilateral cleft lip and palate patients were randomly divided into two groups, according to the type of expander used: (I) modified Hyrax and (II) inverted Mini-Hyrax. A pretreatment cone-beam computed tomographic image (T0) was taken as part of the initial orthodontic records and three months after RME, for bone graft planning (T1). Results: In general, there was no significant difference among groups (p > 0.05). Both showed a significant transverse maxillary expansion (p < 0.05) and no significant forward and/or downward movement of the maxilla (p > 0.05). There was greater dental crown than apical expansion. Maxillary posterior expansion tended to be larger than anterior opening (p < 0.05). Cleft and non-cleft sides were symmetrically expanded and there was no difference in dental tipping between both sides (p > 0.05). Conclusions: The appliances tested are effective in the transverse expansion of the maxilla. However, these appliances should be better indicated to cleft cases also presenting posterior transverse discrepancy, since there was greater expansion in the posterior maxillary region than in the anterior one.


RESUMO Objetivo: o objetivo deste estudo foi avaliar os efeitos esqueléticos e dentários da expansão rápida da maxila (ERM) em pacientes fissurados, utilizando dois tipos de disjuntores. Métodos: vinte pacientes com fissura labiopalatal unilateral foram aleatoriamente divididos em dois grupos, de acordo com o tipo de aparelho utilizado: (1) Hyrax modificado e (2) Mini-Hyrax invertido. Tomografias computadorizadas de feixe cônico foram obtidas antes do tratamento (T0), como parte da documentação ortodôntica inicial, e três meses após a ERM, para o planejamento de enxertia óssea (T1). Resultados: não houve diferença significativa entre os grupos (p>0,05). Ambos apresentaram significativa expansão transversal da maxila (p<0,05), sem significativa movimentação anterior e/ou inferior da maxila (p>0,05). Houve uma maior expansão transversal das coroas em relação à expansão nos ápices. A tendência observada foi uma maior expansão na região posterior da maxila, em comparação à anterior (p<0,05). Avaliando o deslocamento dos lados fissurado e não fissurado, a expansão ocorreu de maneira simétrica e não houve diferença na inclinação dentária entre os lados (p>0,05). Conclusões: os aparelhos testados são eficazes na expansão transversal da maxila em pacientes fissurados. Porém, esses aparelhos seriam melhor indicados para casos de fissura labiopalatal com atresia transversal posterior, uma vez que a expansão foi maior na região posterior da maxila do que na região anterior.

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