[Application of semi-buried curvilinear distraction devices in complex management of lower micrognathia in children].

The aim of the study was to apply an effective treatment protocol with low morbidity for children with syndromic and nonsyndromic micrognathia using curvilinear distractors, intraoral approach and early orthodontic treatment. We report 7 patients aged from 3 to 13 years with bilateral mandibular hypoplasia. These patients were characterized by severe malocclusion, esthetic facial deformation and respiratory disorders. In 3 patients mandibular hypoplasia was combined with anterior open bite. The intraoral surgical approach was used in all cases. Good functional and esthetic results were achieved during treatment. The less traumatic intraoral approach, curvilinear distractors, ultrasound callus formation control and early orthodontic treatment assure the good functional and esthetic results in severe cases facilitating the continuinty in complex rehabilitation of the growing child.

[Primary failure of eruption: diagnostics, treatment, casus and review of literature]. / Primair falen van eruptie: diagnostiek, behandeling, casuïstiek en literatuuroverzicht.

Primary failure of eruption is a rare eruption disorder of above all, the permanent second and sometimes the first molars. It is characterized by infra occlusion of the molars resulting in a severe lateral open bite. Primary failure of eruption is a disorders which affects all molars distal to the most mesial involved tooth. Diagnosis is possible both clinically and with radiographs. A panoramic radiograph combined with clinical findings of impaction or infra occlusion can confirm the suspicion of primary failure of eruption. Primary failure of eruption cannot be treated as other eruption disturbances are. The teeth do not respond to orthodontic force. Exposure of the molar and orthodontic traction of a molar affected by primary failure of eruption is discouraged. Observation and extraction, in case the primary failure of eruption poses a risk to the healthy dentition, are the only two treatment options for young patients. Additional treatment of this eruption disorder should be carried out at an adult age and consists of prosthetic closure of the open bite.

O aparelho quad-helix modificado na reeducação da língua em casos de mordida aberta anterior / The modified quad-helix appliance in tongue rehabilitation of anterior open bite cases

O tratamento da mordida aberta é sempre um grande desafio para o clínico, principalmente quando o fator estabilidade em longo prazo é levado em consideração, pois, na maioria das vezes, os indivíduos que apresentam este tipo de maloclusão estão acometidos de disfunção lingual, a qual, se não for corrigida satisfatoriamente, será o fator da recidiva da mordida aberta anterior. Tendo isso em vista, este trabalho tem como objetivo apresentar uma variação introduzida no desenho original do aparelho quadrihélice de Ricketts, o qual, além de permitir obter excelentes resultados na reeducação da língua durante os seus movimentos peristálticos, serve também como guia para a sua posição de repouso.

The open bite treatment is always a great challenge for the clinician, especially when the long-term stability factor is taken into consideration, because in most cases, individuais who present this type of malocclusion are affected lingual dysfunction, which, if not corrected satisfactorily, will be the factor of anterior open bite relapse. Thus, this paper aims to present a variation introduced in the original design of the Ricketts Quad-Helix appliance, which allows obtaining excellent results in the rehabilitation of the tongue during his peristaltic movements as well as serving as a guide to its rest position.

Two-phase orthodontic treatment of a complex malocclusion: giving up efficiency in favor of effectiveness, quality of life, and functional rehabilitation?

The interceptive orthodontic treatment of patients with complex dentofacial abnormalities is frequently inefficient and produces less than ideal outcomes. Therefore, postponing therapy to a single-phase surgical-orthodontic approach might be considered a reasonable option. However, other relevant aspects of the patient's quality of life, such as possible psychosocial problems and functional impairments, should also be considered before deciding whether to intercept a severe dentofacial malocclusion while the patient is still growing, or wait and treat later. This case report describes the nonsurgical treatment of a young patient with a severe Class III open-bite malocclusion associated with a cervical cystic lymphangioma. Despite the poor interceptive therapy prognosis, a 2-phase approach was effective. A reflection about giving up efficiency in favor of effectiveness, functional rehabilitation, and the patient's quality of life is included.

Myofunctional and speech rehabilitation after orthodontic-surgical treatment of dento-maxillofacial dysgnathia.

OBJECTIVES: The lingual dysfunctions play a considerable role in the pathogenesis of dentoskeletal dysmorphisms. The treatment of dento-maxillofacial dysgnathia implies a functional rehabilitation to re-harmonize the stomatognathic system. This study aims to demonstrate the importance of a rehabilitation protocol of functional orofacial parameters at the end of a surgical-orthodontic treatment in order to achieve long-term success. MATERIALS AND METHODS: After orthognathic surgery, facial expression exercises and jaw exercises are prescribed to promote the recovery of neuromuscular function. At the end of treatment, a sample of 30 dysgnathic patients underwent a functional evaluation of the orofacial district to identify any lingual or articulatory dysfunctions. The information gathered led to an individual re-education program that consisted of an active myofunctional-logopedic approach integrated with appliances used as retention. RESULTS: 19 patients needed myofunctional therapy to re-educate deglutition and tongue posture. Articulatory disorders were found in 7 patients originally suffering from Class III and/or open-bite skeletal disharmony; 5 of these completed rehabilitation with speech therapy. After rehabilitation the functional parameters were completely normalized in 12 patients; in 5 cases, partial improvements were obtained, while in 2 cases the therapy was ineffective. CONCLUSIONS: In a patient undergoing post-surgical reconsolidation of his/her functional equilibrium even an uncontrolled speech defect may lead to an instable result. Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia.

Prosthodontic treatment of a class IV ACP PDI patient, with Langerhans cell histiocytosis (LCH).

Langerhans cell histiocytosis (LCH) is a disease of unknown etiology with a frustrating and unpredictable course. Surviving adult patients suffering from the multisystem type of the disease present with problems in most organs. This article presents the oral rehabilitation of a 28-year-old patient, with multisystem sequelae that included the oral cavity, classifying him as a Class IV American College of Prosthodontists Prosthodontic Diagnostic Index patient. A 5-year course of treatment is analyzed, starting from merely replacing missing teeth with a removable partial denture. The second stage of prosthetic rehabilitation included replacement of the removable prosthesis with fixed partial dentures. The final and most important aspect of treatment was the 2-year follow-up, when the patient presented with no problems or adverse effects. The purpose of this presentation is to offer an insight to prosthodontic treatment possibilities for patients suffering from multisystem LCH and to show the value of a "team approach" to achieving a positive outcome.

Intervenção precoce na mordida aberta anterior / Early intervention in anterior open bite

A mordida aberta anterior é uma anomalia complexa cujas características próprias envolvem a função, a estética, além das alterações dentárias e esqueléticas. Sua principal característica é a presença de um trespasse vertical negativo, existente entre as bordas incisais dos dentes anteriores superiores e inferiores, quando a mandíbula está em posição cêntrica. O objetivo deste trabalho é apresentar, por meio de um relato clínico, a intervenção precoce de uma mordida aberta anterior funcional associada ao hábito de sucção da chupeta, que foi tratada com grade palatina na fase de dentição decídua. Os resultados clínicos demonstraram a viabilidade e a eficiência da realização de uma terapia, mesmo em crianças de pouca idade, em curto prazo de tempo.

The anterior open bite is a complex anomaly, with its own characteristics, such as aesthetic, function, as well as dental and skeletal changes. Its main characteristic is the presence of a negative vertical crossing existing between the incisor borders of the upper anterior and lower anterior teeth, when the jaw is in centric position. The objective of this study is to present, through a clinical case analysis, the precocious intervention of one anterior open bite case associated with the habit of the pacifier, that was dealt with palatal crib in the phase of primary dentition. The clinical results demonstrated the viability and efficiency of the therapy in young children in short term.

Heightened telescopic copings in cleft palate rehabilitation: a case report.

OBJECTIVE: To increase retention of overdentures in cleft palate patients by means of heightened telescopic copings with a newly designed attachment. In this study, a "precision attachment" is described to develop the stability and retention of telescopic overdentures. CASE: A cleft palate patient was treated with a newly designed overdenture. Intraoral examination revealed poor tooth structure and retention. Therefore, a new semiprecision attachment was designed in order to increase retention and stabilization. CONCLUSION: The patient's tolerance was increased with the new overdenture.

Rehabilitation of a hemophiliac with implants: a medical perspective and case report.

A patient suffering from classical hemophilia had previous surgery for ankylosis of the right temporomandibular joint. This was replaced by a costochondral graft and an overlay of temporalis muscle. A bilateral sagittal split was performed for a micrognathic mandible and a sleep apnea problem. That procedure solved the sleep apnea; however, it resulted in a prognathic mandible and an anterior open bite. The lower anterior teeth were periodontally involved with impaired alveolar support. The restricted opening of the oral cavity of 18 mm between maxillary and mandibular centrals and the potential danger of bleeding complicated the surgical and restorative procedures. The patient was prepared medically on each of 4 occasions with factor VIII replacement concentrate, and oral antifibrinolytic therapy (tranexamic acid). The treatment of choice was the extraction of the remaining lower incisors and their replacement with an implant-supported temporarily cemented retrievable fixed prosthesis. Serial extractions and chairside temporization provided the surgeon with precise guides for implant placement, and enabled the patient to enjoy unimpaired function through periods of healing and osseointegration.