The Impact of Early Orthodontic Intervention on Dental and Skeletal Development in Children with Mixed Dentition.

Background: The mixed dentition stage in children is a critical period for orthodontic assessment and intervention. This study investigates the effects of interceptive orthodontics on dental and skeletal development in children with mixed dentition, aiming to evaluate the potential benefits of early orthodontic treatment. Materials and Methods: A retrospective analysis was conducted on a cohort of 150 children with mixed dentition (aged 7-11 years), who received interceptive orthodontic treatment. Dental and skeletal records, including cephalometric radiographs and dental cast models, were collected before and after treatment. A control group of 150 untreated children with mixed dentition was also assessed for comparison. Various dental and skeletal parameters, such as dental alignment, overjet (OJ), overbite (OB), and cephalometric measurements, were recorded and analyzed. Results: The results of this study indicate significant improvements in dental alignment and occlusion in the group of children who received interceptive orthodontic treatment. The average reduction in OJ was 3.5 mm, and the OB correction averaged 2.1 mm. Cephalometric analysis showed positive changes in skeletal relationships, with a mean reduction in the angle formed by point A, nasion (N) and point B. (ANB) angle of 2.8 degrees. These improvements were statistically significant compared to the control group (P < 0.05). Conclusion: Early orthodontic intervention, such as interceptive orthodontics, has a positive impact on dental and skeletal development in children with mixed dentition.

Early Interceptive Correction for Anterior Crossbite Using a Removable Appliance: A Pediatric Case Study.

Anterior crossbite is a malocclusion that occurs for a variety of reasons, causes significant issues, and may be corrected in a variety of ways. Early recognition and timely intervention are crucial in managing anterior dental crossbites during the mixed dentition stage. The purpose of this report is to assist general dentists and pediatric dentists in distinguishing between cases within their scope of practice and those requiring referral to orthodontists and treating this condition immediately to prevent future complex treatment and improve patient aesthetics and function. This case report highlights the treatment of an eight-year-old patient with class III incisors on a skeletal class I base, presenting with an anterior crossbite. The patient was treated successfully using an upper removable appliance, showcasing a non-invasive and effective approach to correcting dental malocclusions early. The rapid correction of the crossbite within six weeks underscores the importance of early intervention and the potential for general dentists and pediatric dentists to manage such conditions efficiently, improving patient outcomes in aesthetics and function.

Accuracy and Completeness of ChatGPT-Generated Information on Interceptive Orthodontics: A Multicenter Collaborative Study.

Background: this study aims to investigate the accuracy and completeness of ChatGPT in answering questions and solving clinical scenarios of interceptive orthodontics. Materials and Methods: ten specialized orthodontists from ten Italian postgraduate orthodontics schools developed 21 clinical open-ended questions encompassing all of the subspecialities of interceptive orthodontics and 7 comprehensive clinical cases. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using predefined accuracy (range 1-6) and completeness (range 1-3) Likert scales. Results: For the open-ended questions, the overall median score was 4.9/6 for the accuracy and 2.4/3 for completeness. In addition, the reviewers rated the accuracy of open-ended answers as entirely correct (score 6 on Likert scale) in 40.5% of cases and completeness as entirely correct (score 3 n Likert scale) in 50.5% of cases. As for the clinical cases, the overall median score was 4.9/6 for accuracy and 2.5/3 for completeness. Overall, the reviewers rated the accuracy of clinical case answers as entirely correct in 46% of cases and the completeness of clinical case answers as entirely correct in 54.3% of cases. Conclusions: The results showed a high level of accuracy and completeness in AI responses and a great ability to solve difficult clinical cases, but the answers were not 100% accurate and complete. ChatGPT is not yet sophisticated enough to replace the intellectual work of human beings.

Orthodontic Pain and Dietary Impact Considering Age Groups: A Comparative Study.

(1) Background: orthodontic treatment can frequently be associated with discomfort and pain, a significant factor contributing to treatment discontinuation. (2) Methods: This study, conducted on 160 orthodontic patients across different age groups, aimed to explore the influence of age on patients' responses to treatment, particularly regarding changes in dietary patterns and weight loss. The patients were categorized into three age groups and assessed through a questionnaire about pain perception, pain latency, dietary changes, and weight loss associated with orthodontic appliances. (3) Results: Younger patients (6-12 years) reported lower pain levels, shorter pain latency and fewer alterations in dietary habits compared to adults (over 18 years). Females over 18 represented a significant portion of the sample, suggesting a self-driven inclination towards orthodontic treatment for aesthetic reasons. Fixed orthodontic appliances induced more significant pain than removable ones. Adults experienced more changes in dietary habits and weight loss than younger individuals. (4) Conclusions: the results provide valuable insights for orthodontic practitioners aiming to mitigate adverse effects and improve overall patient experience during treatment.

Redirection of palatally ectopic maxillary canines: Case report and proposition of an interceptive sequential guideline.

The eruptive deviation of the permanent maxillary canine must be identified early, at the beginning of the second transitional period of the mixed dentition. Acting at this moment is fundamental for its spontaneous redirection and eruption. The aim of the paper is to present a case where the extraction of the deciduous canines was the choice for redirecting the maxillary permanent canines with eruptive palatal deviation, as well as to suggest a sequence of procedures for diagnosis and choice of treatment. The success of deciduous canine extraction in redirecting the ectopic permanent canines is discussed in this case, as well as aspects that might lead to failure. Still, it highlights the importance of computed tomography for choosing conservative treatment or traction, including it in the sequential guideline for acting in these cases.

Validación y Comparación de un Nuevo Método para Predecir el Ancho Mesiodistal de Caninos y Premolares no Erupcionados en una Población Chilena de la Región de Valparaíso, Chile

Uno de los principales problemas durante la dentición mixta es la determinación de la futura discrepancia entre tamaño dentario y el espacio disponible. Para predecir el ancho mesiodistal de los dientes permanentes no erupcionados se han introducido diferentes métodos de análisis. Objetivo: El propósito de este estudio fue comparar el método Tanaka-Johnston con una nueva ecuación de regresión para predecir el ancho mesiodistal de caninos y premolares permanentes no erupcionados en una población de la región de Valparaíso, Chile. Material y método: Este estudio fue realizado en la Facultad de Odontología de la Universidad de Valparaíso, desde octubre de 2022 a junio de 2023 (8 meses), la muestra estuvo compuesta por 202 modelos de estudio del departamento de ortodoncia (91 hombres y 111 mujeres) en el rango de edad de 11 -20 años. Resultados: Se demostró que el método elaborado por Lara-Sandoval presenta mayor fiabilidad respecto a las medidas mesiodistales reales de los pacientes (ICC 0,773 para maxilar y 0,762 para mandíbula), en comparación con el método de Tanaka-Johnston (ICC 0,665 para maxilar y 0,623 para mandíbula). No existen diferencias significativas entre los valores reales y el método de Lara-Sandoval. Conclusión: El método de Lara-Sandoval es mejor que el propuesto por Tanaka-Johnston para determinar el ancho mesiodistal de caninos y premolares para esta muestra. Es necesario validar este método en otras regiones del país para ser utilizado con mayor seguridad que el ya existente como método estándar nacional.

One of the main orthodontic problems in mixed dentition is the determination of future tooth and size arch discrepancy. In order to predict the mesiodistal widths of unerupted permanent teeth different methods of analyses have been introduced. The aim of this study is to compare the Tanaka-Johnston analysis with a new regressive equation to predict the mesiodistal width of unerupted permanent canines and premolars in a Chilean population sample, from Valparaíso region. This study was conducted at the Universidad de Valparaíso Dental Faculty, from october 2022 to june 2023 (8 months), and the sample comprised historical dental casts from 202 patients (91 boys and 111 girls) in the age range of 11-20 from the orthodontics department. All the patients are from the Valparaíso region, Chile. The results show that the predictions of the new regressive equation method are closer to the actual mesiodistal measurements of the patients (ICC 0,773 for maxilla and 0,762 for mandible), compared to the Tanaka- Johnston method (ICC 0,665 for maxilla and 0,623 for mandible). There are no significant differences between the real values and the Lara-Sandoval method. Lara-Sandoval method is better than the one proposed by Tanaka-Johnston to determine the mesiodistal width of canines and premolars in this sample population. It is necessary to validate this method in other regions of the country to be used with greater security than the ones that already exists as a national standard method.

Primary Failure Eruption: Genetic Investigation, Diagnosis and Treatment: A Systematic Review.

AIM: The aim of this systematic review is to explore the pathology, diagnosis, treatment, and genetic basis of Primary Failure of Eruption (PFE) in the field of pediatric dentistry and orthodontics. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. The databases PubMed, Science Direct, Scopus, and Web of Science were searched from 1 July 2013 to 1 July 2023, using keywords "primary failure of tooth eruption" OR "primary failure of eruption" OR "tooth eruption failure" OR "PFE" AND "orthodontics". The study selection process involved screening articles based on the inclusion and exclusion criteria. RESULTS: A total of 1151 results were obtained from the database search, with 14 papers meeting the inclusion criteria. The review covers various aspects of PFE, including its clinical features, diagnosis, treatment options, and genetic associations with mutations in the PTH1R gene. Differentiation between PFE and Mechanical Failure of Eruption (MFE) is crucial for accurate treatment planning. Orthodontic and surgical interventions, along with multidisciplinary approaches, have been employed to manage PFE cases. Genetic testing for PTH1R mutations plays a significant role in confirming the diagnosis and guiding treatment decisions, although some cases may not be linked to this mutation. CONCLUSIONS: This systematic review provides valuable insights into the diagnosis, treatment, and genetic basis of PFE. Early diagnosis and personalized treatment planning are crucial for successful management. Genetic testing for PTH1R mutations aids in accurate diagnosis and may influence treatment decisions. However, further research is needed to explore the complex genetic basis of PFE fully and improve treatment outcomes for affected individuals.

Challenges of a two-phase orthodontic treatment of a mandibular lateral incisor-canine transposition and a maxillary palatally displaced canine: A case report.

INTRODUCTION: The management of eruption disturbances in orthodontics may be challenging and requires a careful diagnosis and treatment planning. This case report discusses the challenges of a two-phase orthodontic treatment of a patient presenting with a dental eruption pattern anomaly. PATIENT CONCERNS: A 10-year-old boy was presented with no complaints for a routine orthodontic evaluation during mixed dentition. PRIMARY DIAGNOSES: The patient was diagnosed with a skeletal Class I malocclusion with unilateral posterior crossbite, incomplete mandibular lateral incisor-canine transposition and a unilateral maxillary ectopic canine. INTERVENTIONS: Phase 1 started with rapid maxillary expansion to correct maxillary constriction and the ectopic eruption of the right maxillary canine. In the mandibular arch, phase 1 included the extraction of the left primary lateral incisor and canine, alignment of the left permanent lateral incisor and orthodontic traction of the left permanent canine. The duration of phase 1 was 14 months. Phase 2 involved a comprehensive course of orthodontic treatment and started when the patient was aged 13 years. This phase lasted 18 months. RESULTS: An adequate dental occlusion was obtained, and the treatment results were stable after an 18-month follow-up. CONCLUSION: In this case, the early diagnosis of the dental anomalies was valuable as it allowed an early intervention to be undertaken, which resulted in overall treatment simplification and potentially minimised the adverse effects. This case report reinforces the importance of a careful follow-up during mixed dentition.

Comparative Analysis of Skeletal Changes, Occlusal Changes, and Palatal Morphology in Children with Mild Class III Malocclusion Treated with Elastodontic Appliances and Bimaxillary Plates.

BACKGROUND: The aim of the present study was to compare the changes observed in children after the early treatment of mild class III malocclusion using bimaxillary removable plates supported by class III elastics and elastodontic devices. METHODS: Twenty children (mean age 7.6 ± 1.1 years) with signs of class III malocclusion were treated using by-maxillary plates (PG group) with class III elastics (10 subjects = mean age 7.9 ± 1.3 years) or using class III elastodontic devices (EG group) (10 subjects = mean age 7.4 ± 0.8 years). Digital models and lateral cephalograms were obtained before treatment (T0) and at the end of treatment (T1). The digital models were analyzed to assess occlusal changes and maxillary morphology using the surface-to-surface matching technique. Changes in cephalometric parameters were also analyzed. The data outcomes were statistically analyzed using the paired Student's t test for inter-timing assessments and the independent Student's t test for inter-group assessments. RESULTS: Both groups showed correction of class III malocclusions, with a significant increase in the ANB angle and the overjet (p < 0.05). Subjects in the PG group exhibited a greater reduction in the inter-incisal angle compared to the EG group (p < 0.05). The children in the EG group had a significantly lower percentage of palatal morphology matching between T0 and T1 compared to the PG group (p < 0.05), suggesting greater morphological changes in the palate. CONCLUSIONS: Elastodontic appliances (EAs) and bi-maxillary plates successfully correct class III malocclusions in children. However, elastodontic devices significantly improved the morphology of the palate, both in the transverse and anteroposterior directions.

A Modified Tongue Crib Appliance for Correction of Tongue Thrusting.

Digit sucking and tongue thrusting are parafunctional habits that are commonly observed and are recognized as major etiological factors in the development of dental malocclusion. Treatment for these oral habits typically involves removal of the etiology, retraining exercises, and use of mechanical restraining appliances. A 13-year-old male patient reported a complaint of forwardly placed upper front teeth. The extraoral examination of the patient showed a convex profile, good facial symmetry, acute nasolabial angle, incompetent lips at rest, and a shallow mentolabial sulcus. Intraoral examination showed class I molar and canine relations on either side, a mild open bite tendency, a midline diastema, proclined upper and lower anteriors, an increased overjet, and tongue thrusting habit. A modification to the tongue crib was made by adding an acrylic bead in the center of the crib. The patient was trained to roll the bead posteriorly with the aim of retraining the tongue to posture away from the front teeth. Harmful forces of the tongue can result in excessive posterior teeth eruption, open bite, and increased overjet. Duration of appliance wear and type of appliance used are important considerations in treating patients with tongue thrust or open bite. A modified tongue crib was used for six months resulting in significant improvement in maxillary anterior dentition position, lip competence, arch forms, overbite, and midline diastema closure. A tongue crib is a useful tool for addressing tongue thrusting and digit-sucking behaviors by retraining the related muscles, providing physical restraint, and serving as a reminder to break the habit. It can be used in conjunction with a fixed appliance to improve its effectiveness.

Interdisciplinary Treatment of a Case With Unilateral Cleft Lip and Palate in the Mixed Dentition.

A 10-year-old girl had reported to Sharad Pawar Dental College. Her parents had chief complaints of lip and palate deformity. On examination, it was found that the patient had unilateral cleft lip and palate on the right side. The aim was to expand the maxilla with alveolar bone grafting in the cleft region to facilitate the eruption of permanent canine and further reduce the deformity to prepare the patient for face mask therapy, reduce morbidity in the permanent dentition, and avoid Le Fort one surgery in the future. She had been previously operated on for cleft lip repair and palatal fistula closure eight years back. The present condition in the mixed dentition needed arch expansion, bone in the cleft region for the eruption of permanent canine, and further arch alignment for facemask therapy. This would reduce the severity of skeletal deformity and later on avoid the surgical advancement of the maxilla.

Non-extraction Orthodontic Treatment Protocol of Moderate Crowding.

Dental crowding is referred to as the swarming of teeth, mainly due to the discrepancy between the size of the jaw bases and that of the teeth. When the amount of space required for the teeth is more than that in the jaws, it leads to crowding. The prevalence of crowding has now increased to almost 30-60%. It can be classified into mild, moderate, and severe according to the amount of overlap. Depending on the severity of the crowding, the decision of extraction is made. The given case presents a non-extraction protocol for treating moderate crowding. The present case report explains the non-extraction treatment of moderate crowding using inter-proximal stripping.

Simple approach for correcting an entrapped ectopic permanent mandibular first molar caused by poor marginal adaptation of a preformed metal crown on an adjacent primary second molar: a case report with a 5-year follow-up.

Ectopic eruption of the permanent first molar can lead to malocclusion if left untreated. Despite several reported etiologic factors and treatment options, ectopic eruption caused by an improper restoration on an adjacent tooth and a simple solution have never been documented. Case report: An 8-year-old boy presented with an entrapped ectopic permanent mandibular first molar under the poorly adapted margin of a preformed metal crown (PMC) on the adjacent primary second molar. Replacement with a PMC that had well-contoured margins followed by inserting a separating module between the proximal contact of the two teeth resulted in successful management of this situation in 1 month. Conclusion: This simple approach with good interdisciplinary communication is practical for correcting eruption problems due to a poorly adapted PMC, with long-term satisfactory results. To avoid subsequent malocclusion and unnecessary treatments, dental practitioners must be vigilant when manipulating PMCs and assessing the marginal adaptation prior to their cementation.

Improvement in the transverse dimension of dental arches in mixed dentition patients with posterior crossbite treated with functional therapy.

OBJECTIVES: To evaluate the effects of treatment of posterior crossbite (PXB) in the mixed dentition with the Function Generating Bite (FGB) appliance on the transverse dimension of the dental arches. MATERIALS AND METHODS: This study included 84 PXB patients (female = 46; male = 38; mean age, 8.2 ± 1.8 years) and 69 control (C) patients (female = 31; male = 38; mean age, 8.9 ± 1.4 years). Measurements were taken with digital calipers on maxillary and mandibular study casts before (T0) and after (T1) treatment for the following measures: intermolar (IMD), intermolar gingival (IMGD), intercanine (ICD), and intercanine gingival distances (ICGD). RESULTS: At T0, there was a significant difference in all maxillary measurements between the PXB and C groups (P < .001), reflecting maxillary hypoplasia in PXB patients. At T1, there was no difference between the groups. In PXB patients, the mean increase between T0 and T1 for IMD was 4.34 ± 2.42 mm; this difference measured 3.51 ± 2.19 mm for IMGD, 2.78 ± 2.37 mm for ICS, and 1.89 ± 1.7 mm for ICGD. There was no significant difference in mandibular measurements between groups at T0 and T1. CONCLUSIONS: Functional therapy with FGB is effective in significantly increasing the transverse dimension of the maxillary dental arch in PXB patients. Considering its efficacy in treating masticatory dysfunction, FGB may be considered a good treatment option for the correction of PXB in growing children.

Comparison between clear aligners and 2 × 4 mechanics in the mixed dentition: a randomized clinical trial.

OBJECTIVES: To compare the efficacy and efficiency between clear aligners and 2 × 4 fixed appliances for correcting maxillary incisor position irregularities in the mixed dentition. MATERIALS AND METHODS: The sample comprised 32 patients from 7 to 11 years of age randomly allocated into two parallel treatment groups: the clear aligners group, 14 patients (6 girls, 8 boys) with a mean initial age of 9.33 years (standard deviation [SD] = 1.01) treated with clear aligners; and the fixed appliances group, 13 patients (9 girls, 4 boys) with a mean initial age of 9.65 years (SD = 0.80) treated with partial (2 × 4) fixed appliances. Digital models were acquired before treatment and after appliance removal. Primary outcomes were incisor irregularity index and treatment time. Secondary outcomes were arch width, perimeter, length, size and shape, incisor leveling, incisor mesiodistal angulation, plaque index, and white spot lesion formation (International Caries Detection and Assessment System index). Intergroup comparisons were evaluated using t-tests or Mann-Whitney U-tests with Holm-Bonferroni correction (P < .05). RESULTS: Treatment time was approximately 8 months in both groups. No intergroup differences were observed for changes in any of the variables. Similar posttreatment arch shapes were observed in both groups. CONCLUSIONS: Clear aligners and 2 × 4 mechanics displayed similar efficacy and efficiency for maxillary incisor position corrections in the mixed dentition. The choice of appliance should be guided by clinician and family preference.

Effect of orthopedic and functional orthodontic treatment in children with obstructive sleep apnea: A systematic review and meta-analysis.

Orthodontic treatment is suggested in growing individuals to correct transverse maxillary deficiency and mandibular retrusion. Since, as a secondary effect, these orthodontic procedures may improve pediatric obstructive sleep apnea (OSA), this systematic review assessed their effects on apnea-hypopnea index (AHI) and oxygen saturation (SaO2). Twenty-five (25) manuscripts were included for qualitative synthesis, 19 were selected for quantitative synthesis. Five interventions were analyzed: rapid maxillary expansion (RME, 15 studies), mandibular advancement (MAA, five studies), myofunctional therapy (MT, four studies), and RME combined with MAA (one study). RME produced a significant AHI reduction and minimum SaO2 increase immediately after active treatment, at six and 12 months from baseline. A significant AHI reduction was also observed six and 12 months after the beginning of MAA treatment. MT showed positive effects, with different protocols. In this systematic review and meta-analysis of data from mainly uncontrolled studies, interceptive orthodontic treatments showed overall favorable effects on respiratory outcomes in pediatric OSA. However, due to the low to very low level of the body evidence, this treatment cannot be suggested as elective for OSA treatment. An orthodontic indication is needed to support this therapy and a careful monitoring is required to ensure positive improvement in OSA parameters.

Banded Helical Space Regainer-an Innovative Approach for Management of Space Loss: A Case Report.

The transitory phase of the mixed dentition to a permanent one is seldom accurate, the hurdles being space loss, tooth size arch length discrepancy, early exfoliation of primary teeth, or premature eruption of permanent teeth. Space regainers are appliances used to regain and maintain space, so as to guide the unerupted tooth into the proper position in the arch. It not only maintains function and preserves arch length, but also maintains esthetics, prevents the development of deleterious oral habits, and eliminates any potential psychological damage a child could face. This case report aims to describe an effective, easy-to-fabricated, and innovatively designed space regainer that showed excellent patient compliance and was superior to the present space regainer designs/appliances. How to cite this article: Tatiya N, Kesri R, Pattanshetti K, et al. Banded Helical Space Regainer-an Innovative Approach for Management of Space Loss: A Case Report. Int J Clin Pediatr Dent 2023;16(6):868-870.

Can lingual spurs alter the oral health-related quality of life during anterior open bite interceptive treatment? A systematic review

ABSTRACT Introduction: The use of lingual spurs has been described as one efficient option, with great stability of results, but with scarce information of toleration for use in the mixed and permanent dentition phases. Objective: The purpose of this study was to assess the impact of lingual spurs on the oral health-related quality of life of children and/or adolescents during anterior open bite treatment. Methods: The review was recorded in the PROSPERO database. Eight electronic databases and partial gray literature were searched, without restrictions until march 2022. A manual search was also performed in the references of the included articles. Studies assessing the impact of lingual spurs on the oral health-related quality of life were included. Risk of bias was assessed using JBI or ROBINS-I tool, according to the study design. The level of evidence was assessed through GRADE. Results: Five studies met the eligibility criteria. Two non-randomized clinical trials had a serious risk of bias. Of the case-series studies, two had a low risk of bias and the other, a moderate risk of bias. The certainty of the evidence was classified as very low for all the evaluated results. In general, the studies reported an initial negative impact with the use of lingual spurs, however this was transitory in nature. A quantitative analysis was not performed due to the great heterogeneity between the studies. Conclusion: Current evidence, although limited, suggests that lingual spurs have an initial transient negative impact during interceptive treatment. Additional well-conducted randomized clinical trials are needed.

RESUMO Introdução: O uso de esporões linguais tem sido descrito como uma opção eficiente, com grande estabilidade de resultados, mas com poucas informações quanto à tolerância de seu uso nas fases de dentição mista e permanente. Objetivo: O objetivo deste estudo foi avaliar o impacto dos esporões linguais na qualidade de vida relacionada à saúde bucal de crianças e/ou adolescentes durante o tratamento da mordida aberta anterior. Métodos: Essa revisão foi registrada no banco de dados PROSPERO. Oito bases de dados eletrônicas e parte da literatura cinzenta foram pesquisadas, sem restrições, até março de 2022. Uma busca manual também foi realizada nas referências dos artigos incluídos. Estudos avaliando o impacto dos esporões linguais na qualidade de vida relacionada à saúde bucal foram incluídos. O risco de viés foi avaliado usando a ferramenta JBI ou ROBINS-I, de acordo com o desenho do estudo. O nível de evidência foi avaliado por meio do GRADE. Resultados: Cinco estudos preencheram os critérios de elegibilidade. Dois ensaios clínicos não randomizados apresentaram sério risco de viés. Dos estudos de série de casos, dois tiveram baixo risco de viés e o outro, risco moderado de viés. A certeza da evidência foi classificada como muito baixa para todos os resultados avaliados. Em geral, os estudos relataram um impacto negativo inicial com o uso dos esporões linguais; porém, de caráter transitório. Não foi realizada análise quantitativa, devido à grande heterogeneidade entre os estudos. Conclusão: As evidências atuais, embora limitadas, sugerem que os esporões linguais têm um impacto negativo transitório inicial durante o tratamento interceptativo. São necessários mais ensaios clínicos randomizados bem conduzidos.

Expansor de Williams: passo a passo / Williams expander: step-by-step procedures

Resumo Os apinhamentos suaves a moderados na dentição mista podem ser tratados com expansão rápida da maxila (ERM) associada à expansão lenta do arco dentário inferior. A expansão lenta no arco inferior pode ser conduzida com uma alternativa de aparelho fixo e com parafuso. O objetivo deste artigo consiste em apresentar o protocolo laboratorial e clínico do expansor de Williams. Apresentou-se um caso clínico de uma paciente do sexo feminino, 9 anos de idade, com a face simétrica do Padrão I na dentadura mista, com apinhamento moderado dos incisivos inferiores e apinhamento suave no arco superior. O tratamento foi realizado com expansão superior e inferior. No arco superior, a ERM mediante o aparelho Hyrax foi realizada. No arco inferior, procedeu-se à expansão lenta com expansor de Williams. Obteve-se uma adequada oclusão com o alinhamento dos incisivos permanentes e uma melhora do corredor bucal no sorriso. O expansor de Williams representa uma alternativa para os casos que necessitam expansão lenta do arco dentário inferior, independendo da colaboração do paciente. Quando adequadamente construído, o expansor mostra-se confortável e efetivo. (AU)

Abstract Mild to moderate crowding in the mixed dentition can be treated with rapid maxillary expansion (RME) associated with dentoalveolar expansion of the mandibular arch. Dentoalveolar expansion of the mandibular arch can be conducted with an alternative fixed and screw appliance. The aim of this study is to present the laboratory and clinical protocol of the Williams expander. A clinical report of a female patient, 9 years old, with the symmetrical face in the mixed dentition, with moderate crowding of the lower incisors and mild crowding of the upper arch, was presented. The treatment was carried out with maxillary and mandibular expansion. In the maxillary arch, RME was performed using the Hyrax device. In the mandibular arch, dentoalveolar expansion was performed with a Williams expander. Adequate occlusion was obtained with the alignment of the permanent incisors and an improvement in the buccal corridor in the smile. The Williams expander represents an alternative for cases that require dentoalveolar mandibular expansion, regardless of patient cooperation. When properly constructed, the expander is comfortable and effective.(AU)

Tracionamento ortodôntico de incisivo central superior impactado associado a odontoma ­ relato de caso / Orthodontic traction of impacted upper central incisor associated with odontoma ­ case report

Resumo A impacção dental, distúrbio irruptivo caraterizado pelo impedimento de erupção espontânea do dente, apresenta baixíssima prevalência para incisivos centrais superiores. Os fatores etiológicos mais comumente envolvidos são a presença de dentes supranumerários, tumores odontogênicos e trauma na dentição decídua. A impacção do incisivo central superior provoca grande comprometimento estético e psicossocial. O sucesso da intervenção ortodôntica depende de diagnóstico precoce, localização do dente e relação deste com dentes adjacentes. Sendo assim, o cuidadoso diagnóstico, planejamento individualizado e criterioso acompanhamento radiográfico são imprescindíveis. O objetivo deste estudo foi relatar o caso clínico de um paciente em fase de dentadura mista com incisivo central impactado pela presença de um odontoma. Foi realizado o tracionamento ortodôntico pela técnica de erupção fechada com ancoragem em dentes posteriores. Foi mantida a integridade radicular do dente tracionado, bem como a dos dentes adjacentes. Além disso, foi obtida adequada margem gengival. Concluiu-se que o tracionamento de incisivos centrais superiores impactados, quando executado de maneira criteriosa, promove estética e função satisfatórias com consequente melhora na autoestima e interação psicossocial do paciente. (AU)

Abstract Dental impaction, an irruptive disorder characterized by the impediment of spontaneous tooth eruption, presents a very low prevalence for maxillary central incisors. The etiological factors are the presence of supernumerary teeth, odontogenic tumor, and primary dentition injuries. The impaction of the upper central incisor causes great aesthetic and psychosocial impairment. The orthodontic intervention success depends on early diagnosis, tooth location, and relationship with adjacent teeth. Therefore, careful diagnosis, individualized treatment planning, and careful radiographic follow-up are essential. This study aimed to report the clinical case of a patient with a central incisor impacted by the presence of an odontoma. Orthodontic traction was performed by the closed eruption technique with anchorage in posterior teeth. Tooth root integrity was maintained, as well as that of adjacent teeth. In addition, adequate gingival margin was obtained. It was concluded that an accurate traction of impacted upper central incisors promotes satisfactory aesthetics and function, with consequent improvement in the patients self-esteem and psychosocial interaction.(AU)