Three-dimensional evaluation of the effects of Bionator and Forsus appliances on oropharyngeal airway volume in patients with mandibular retrognathia.

OBJECTIVE: To evaluate whether there is a difference between the effects of Bionator and Forsus appliances on airway volume. METHODS: Forty patients with mandibular retrognathia were divided into two groups. The Bionator appliance was applied to Group 1, while the Forsus FRD EZ2 appliance was applied to Group 2. Three-dimensional images were captured before and after functional appliance use in both groups. Dolphin 3D software was used for airway measurements. RESULTS: No statistically significant difference was found between the groups in terms of volumetric and area measurements. There was a statistically significant difference between the minimum axial T and O-N border T measurements of the groups. CONCLUSION: The use of functional appliances may contribute to an increase in oropharyngeal airway dimensions, but there was no difference between the Bionator and Forsus groups in terms of volumetric measurements.

Long-term stability of Class II malocclusion treatment with the cantilever bite jumper.

INTRODUCTION: This study aimed to assess the long-term stability of Class II malocclusion treatment with the Cantilever Bite Jumper (CBJ) after 13 years of follow-up. METHODS: The treatment group comprised 10 Class II Division 1 malocclusion patients treated with the CBJ, followed by fixed appliances, analyzed at 3 stages: pretreatment (aged 11.56-14.32 years), posttreatment (aged 16.34-19.58 years), and long-term posttreatment (aged 29.04-32.33 years). The control group included 15 subjects with normal occlusion. Intragroup treatment changes comparison was performed with repeated measures and analysis of variance followed by Tukey tests. Intergroup comparisons regarding the long-term posttreatment changes were performed with t tests. RESULTS: No statistically significant relapse was observed during the follow-up period. Morever, the treated group presented a significantly smaller increase in lower anterior facial height and greater retrusion of the lower lip than the control group in the posttreatment period. CONCLUSIONS: Treatment with the CBJ, followed by fixed appliances, is a stable alternative for Class II Division 1 malocclusion correction. The dentoskeletal and soft-tissue changes obtained during treatment remained stable in the long-term posttreatment follow-up.

Efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares / Effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders

RESUMEN Fundamento: Existen modalidades de tratamiento para los trastornos temporomandibulares, una de ellas es la Ortopedia funcional de los maxilares. Objetivo: Evaluar la efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares. Metodología: Se realizó estudio experimental, abierto, controlado y aleatorizado en el servicio de Prótesis Estomatológica de la Clínica Estomatológica de Fomento en el período de septiembre de 2019 a septiembre de 2021. Se seleccionaron 60 pacientes con trastornos temporomandibulares que cumplieron los criterios de selección, mediante asignación aleatoria se establecieron los grupos: Estudio (tratado con Bionator de California) y control (tratado con férula neuromiorrelajante). Se utilizaron métodos del nivel teórico, empírico y estadístico. La variable de respuesta principal fue: Efectividad del Bionator de California en el grado de severidad del trastorno temporomandibular. Resultados: Al inicio del estudio predominó la severidad moderada de trastornos temporomandibulares en ambos grupos, pero a los 6 meses de tratamiento predominaron los asintomáticos (66.7 %) en el grupo estudio y 36.7 % en el grupo control, con diferencia estadísticamente significativa entre ambos grupos. Conclusiones: El tratamiento con el Bionator de California fue efectivo porque se logró disminuir el grado de severidad de los trastornos temporomandibulares.

ABSTRACT Background: There are treatment modalities for temporomandibular disorders, one of them is functional orthopedics of the jaws. Objective: To evaluate the effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders. Methodology: An experimental, open, controlled and randomized study was carried out in the Dental Prosthesis service at Fomento Dental Clinic from September 2019 to September 2021. 60 patients with temporomandibular disorders who met the selection criteria were selected. The groups were established by random assignment: Study (treated with Bionator from California) and control (treated with a neuromyorelaxant splint). Method theoretical, empirical and statistical levels were used. The main response variable was: Effectiveness of the California Bionator in the degree of severity of the temporomandibular disorder. Results: At the beginning of the study moderate severity of temporomandibular disorders prevailed in both groups, but after 6 months of treatment asymptomatic predominated (66.7%) in the study group and 36.7% in the control group, with a statistically significant difference between both groups. Conclusions: The treatment with the California Bionator was effective because the degree of severity of temporomandibular disorders was reduced.

Class II treatment effects with fixed functional appliances: Jasper jumper vs. Forsus fatigue resistant device.

OBJECTIVE: This study aimed to compare cephalometric changes of Class II malocclusion patients treated with Jasper Jumper and Forsus, associated with fixed appliances. METHODS: The sample consisted of 62 individuals divided into 3 groups: group 1 included 22 subjects with a mean initial age of 12.39 years, treated with Jasper Jumper associated with fixed appliances for a mean period of 2.43 years; group 2 included 19 subjects with a mean initial age of 12.43 years, treated with Forsus associated with fixed appliances for a mean period of 3.54 years; and group 3 included 22 Class II malocclusion untreated subjects at a mean age of 12.14 years, followed for a mean period of 1.78 years. Intergroup comparison was performed with one-way ANOVA, followed by Tukey test. RESULTS: Both treated groups had similar dentoskeletal changes: restrictive effect on the maxilla; clockwise rotation of the occlusal plane; mild increase in lower anterior facial height; limitation on the vertical development of the maxillary molars; labial tipping and intrusion of the mandibular incisors; extrusion of mandibular molars; improvements of the maxillomandibular relationship, overjet, overbite, molar relationship; and retrusion of the upper lip. The mandibular incisors exhibited greater protrusion in group 1 compared to the other groups. In addition, group 2 presented mild protrusion of the lower lip, and groups 1 and 3 showed mild retrusion. CONCLUSION: The Jasper Jumper and Forsus appliances were effective and showed similar changes in the treatment of Class II malocclusion.

Estudo exploratório dos efeitos das terapias com eletroestimulação neuromuscular e dispositivos biomecânicos intraoral na saliva em pacientes com síndrome de Down e apneia obstrutiva do sono / Exploratory study of the effects of therapies with neuromuscular electrostimulation and intraoral biomechanical devices on saliva in patients with Down syndrome and obstructive sleep apnea

Este estudo tem como objetivo avaliar os efeitos das terapias com eletroestimulação neuromuscular e dispositivos biomecânicos intraorais sobre as propriedades físicoquímica e microbiológica da saliva em pacientes com síndrome de Down (SD) e apneia obstrutiva do sono (AOS). Ainda investigamos a morfologia das glândulas salivares maiores: parótidas, submandibulares e sublinguais para verificar possíveis desordens estruturais nesses indivíduos. Vinte e três pacientes adultos com SD e AOS, com idade entre 18 e 31 anos, de ambos os gêneros, foram convidados para participar deste estudo. Dentre esses pacientes, 18 concluíram as terapias propostas e foram divididos em três grupos: EENMs (n=7; terapia com eletroestimulação neuromuscular de superfície), DMHB (n=4; terapia com dispositivo mastigatório com hiperboloide) e AIOm (n=7; terapia com aparelho intraoral de avanço mandibular). A EENMs foi aplicada sobre os músculos masseter (porção superficial) e temporal (porção anterior), em ambos os lados. O DMHB foi posicionado entre as faces oclusais dos dentes posteriores e o paciente mordeu suas pontas ativas com hiperboloide. O AIOm foi utilizado somente no período de sono. Esse aparelho foi ativado lentamente, de 0,5 mm a 1,0 mm a cada 1 ou 2 semanas, respeitando as limitações fisiológicas do paciente. Todas as terapias foram realizadas durante 2 meses consecutivos. Antes e após as terapias propostas, testes de saliva foram realizados, incluindo taxa de fluxo salivar (TFS), valor de pH, capacidade tampão (CT), cortisol salivar matinal (CSmatinal) e noturno (CSnoturno) e identificação de Pseudomonas aeruginosas (P. aeruginosas). A seguir, a morfologia das glândulas salivares maiores, foram investigadas através do exame de ultrassonografia. Na análise estatística, teste de Wilcoxon (signed-rank test) para análise de correlação e teste de Kruskal-Wallis com o teste de Dunn para comparações múltiplas não paramétricas foram feitos. O nível de significância foi de p < 0,05. Embora a TFS tenha permanecido reduzida, a produção de saliva aumentou em todas as terapias. A TFS mostrou diferença estatística apenas no AIOm (p<0,0225). Houve diferença estatística no valor de pH apenas no EENMs (p < 0,0346). Nenhuma diferença estatística no CT foi encontrada; entretanto, os valores de normalidade foram alcançados (valores de limítrofe para normal) em 50% para DMHB e em 29% para EENMs e AIOm. Os valores normais de CSn não foram afetados, embora os níveis de CSn tenham aumentado estatisticamente na EENM (p < 0,0360) e entre as terapias EENM e AIOm (p < 0,0058). Nenhuma espécie de P. aeruginosa foi identificada em nossos pacientes antes das terapias. Neste estudo, pudemos concluir que a redução de fluxo salivar permaneceu nos pacientes com SD e AOS após as terapias propostas; entretanto, o AIOm seguido do DMHB mitigaram a severidade dessa alteração. A EENMs teve melhor desempenho em relação a qualidade da saliva quando comparado com as demais terapias. Dentre as terapias, os pacientes tratados com AIOm mostraram alta susceptibilidade ao estresse no período noturno. Nenhum paciente tinha risco de pneumonia por aspiração, antes das terapias. Nenhuma anomalia congênita de glândulas salivares maiores foi evidenciada, todavia alterações adquiridas foram observadas em alguns pacientes com SD e AOS (AU).

This study aims to evaluate the effects of neuromuscular electrostimulation therapies and intraoral biomechanical devices on the physicochemical and microbiological properties of saliva in patients with Down syndrome (DS) and obstructive sleep apnea (OSA). In addition, we investigated the major salivary glands' morphology: the glands of parotid, submandibular and sublingual to verify possible structural disorders in these individuals. Twenty-three adult patients with DS and OSA, with age range from 18 to 31 years old, of both genders, were invited to participate in this study. Among these patients, 18 patients completed the proposed therapies, and they were divided into three groups of therapy: sNME (n=7; therapy with surface neuromuscular electrostimulation), MDHB (n=4; therapy with masticatory device with hyperboloid) and mIOA (n= 7; therapy with mandibular advancement intraoral appliance). The sNME was applied on the masseter (superficial portion) and temporal (anterior portion) muscles on both the sides. The MDHB was positioned between the occlusal surfaces of the posterior teeth and the patient bit the active tips with hyperboloid. The mIOA was used only during the sleep. This appliance was activated slowly, from 0.5 mm to 1.0 mm per 1 to 2 weeks, respecting the patient's physiological limitations. All therapies were performed for 2 consecutive months. Before and after the proposed therapies, saliva tests were done, including salivary flow rate (SFR), pH value, buffering capacity (BC), morning (morningSC) and night (nightSC) salivary cortisol, and identification of Pseudomonas aeruginosa (P. aeruginosa). Furthermore, the major salivary glands' morphology, were investigated by means of ultrasound examination. For statistical analysis, Wilcoxon signed-rank test for correlation analysis and Kruskal-Wallis test with Dunn's test for nonparametric multiple comparisons were done. The level of significance was p < 0.05. Although SFR remained reduced, the saliva production increased in all therapies. The SFR showed a statistical difference only in the mIOA (p<0.0225). Despite the few variations in the pH value, there was a statistical difference only in the sNME (p<0.0346). No statistical difference was found in BC; however, the normality values were reached (borderline to normal values) in 50% for MDHB and in 29% for sNME and mIOA. The normal values of nSC were not affected, even though the nSC levels have increased statistically in NMES (p < 0.0360) and between the NMES and mIOA therapies (p <0.0058). No P. aeruginosa species was identified in our patients before the therapies. In this study, we concluded that the reduction in salivary flow remained in DS patients with DS and OSA after the proposed therapies; however, mIOA followed by MDHB mitigated the severity of this alteration. sNME showed better performance in relation to saliva quality when compared to other therapies. Among the therapies, patients treated with mIOA showed high susceptibility to stress, particularly at night. No patient had risk of aspiration pneumonia before the therapies. No congenital anomalies of major salivary glands were evidenced, but acquired alterations were observed in some patients with DS and OSA. (AU)

Efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares / Effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders

Fundamento: Existen modalidades de tratamiento para los trastornos temporomandibulares, una de ellas es la Ortopediafuncional de los maxilares.Objetivo: Evaluar la efectividad del Bionator de California en la disminución del grado de severidad de los trastornostemporomandibulares.Metodología: Se realizó estudio experimental, abierto, controlado y aleatorizado en el servicio de Prótesis Estomatológicade la Clínica Estomatológica de Fomento en el período de septiembre de 2019 a septiembre de 2021. Se seleccionaron60 pacientes con trastornos temporomandibulares que cumplieron los criterios de selección, mediante asignación aleatoriase establecieron los grupos: Estudio (tratado con Bionator de California) y control (tratado con férula neuromiorrelajante).Se utilizaron métodos del nivel teórico, empírico y estadístico. La variable de respuesta principal fue: Efectividad delBionator de California en el grado de severidad del trastorno temporomandibular.Resultados: Al inicio del estudio predominó la severidad moderada de trastornos temporomandibulares en ambos grupos,pero a los 6 meses de tratamiento predominaron los asintomáticos (66.7 %) en el grupo estudio y 36.7 % en el grupocontrol, con diferencia estadísticamente significativa entre ambos grupos.Conclusiones: El tratamiento con el Bionator de California fue efectivo porque se logró disminuir el grado de severidadde los trastornos temporomandibulares [AU]

Mandibular incisor inclination and gingival recession after treatment with the Jasper Jumper: a 10-year follow-up.

OBJECTIVE: To evaluate the long-term outcomes of Class II treatment with the Jasper Jumper appliance and comprehensive orthodontic treatment concerning inclination of the mandibular incisors and gingival recession. METHODS: Sixteen patients with Class II malocclusion at a mean age of 12.54y (SD = 1.17) were treated with the Jasper Jumper appliance and comprehensive orthodontic treatment. The mean treatment time was 2.05y (SD = 0.21). Dental records were taken before (T1), after treatment (T2) and 11.90y (SD = 0.48) after debonding (T3). The frequency of gingival recession, clinical crown height and mandibular incisor position were evaluated using intraoral photographs, digital models and lateral cephalograms. Interphase changes were evaluated using dependent t and McNemar's tests. Correlation between clinical crown height and final position of the mandibular incisors was evaluated using Pearson correlation test (P < 0.05). RESULTS: The frequency of gingival recessions increased over time and was observed in 6 (9.4%), 12 (18.8%) and 24 (37.5%) of the mandibular incisors at T1, T2 and T3, respectively. A significant increase in labial inclination and protrusion of the mandibular incisors was observed between T1 and T2 interval. The clinical crown height significantly increased in the follow-up period (T3-T2) and in the complete observation time (T3-T1). There was no correlation between the amount of labial inclination and protrusion of the mandibular incisors and clinical crown height for all time intervals. CONCLUSION: No significant correlation between the amount of labial movement of the mandibular incisor and clinical crown height increase was found.

Nuevas opciones de aparatos funcionales para tratar pacientes con retrognatismo mandibular / New functional appliance options for treating patients with mandibular retrognathia

RESUMEN Fundamento: El estudio sobre los aparatos actuales de la ortopedia funcional de los maxilares puede aportar nuevos conocimientos para el perfeccionamiento del tratamiento de pacientes con retrognatismo mandibular. Objetivo: Profundizar en los nuevos aparatos de la ortopedia funcional de los maxilares para el tratamiento de pacientes con retrognatismo mandibular. Desarrollo: Se realizó una revisión bibliográfica en las bases de datos SciELO, PubMed, Ebsco, Cumed y Lilacs. En la búsqueda se revisaron 37 artículos, de ellos más del 80 % son de los últimos cinco años. Se identificaron bases teóricas de la ortopedia funcional de los maxilares en el tratamiento de pacientes con retrognatismo mandibular y los aparatos que se utilizan en la actualidad. Conclusiones: Existen nuevas opciones de aparatos funcionales, en su mayoría fijos y clasificados como dentosoportados pasivos, para el tratamiento de pacientes con retrognatismo mandibular.

ABSTRACT Background: The study of the current jaw functional orthopedic appliances can provide new knowledge for the improvement of the patients' treatment with mandibular retrognathia. Objective: To study deeply the current jaw functional orthopedic appliances for the patients' treatment with mandibular retrognathia. Development: A bibliographic review was conducted in the SciELO, PubMed, Ebsco, Cumed and Lilacs databases. A total of 37 articles were reviewed, more than 80 % from the last five years. Theoretical bases on the jaw functional orthopedics in the patients' treatment with mandibular retrognathia and current appliances in use were identified. Conclusions: New functional appliance options, mostly fixed and classified as passive dent supportive, are available for the patients' treatment with mandibular retrognathia.

Evaluation of the open-bite Bionator versus the removable posterior bite plane with a tongue crib in the early treatment of skeletal anterior open bite: A randomized controlled trial.

BACKGROUND: Several treatment approaches can be found in the literature about early treatment of open bite. However, no studies have addressed the use of a removable posterior bite plane with a tongue crib (RPBP/C), compared with functional appliances, for treating open-bite cases. The objectives of this trial was to compare the effectiveness of the open-bite Bionator (OBB) and the RPBP/C as an early intervention to correct skeletal open-bite cases in children, in terms of limiting excessive vertical growth of the craniofacial skeletal components and normalizing the developement of the anterior dentoalveolar region. MATERIALS AND METHODS: Two-arm, parallel-group randomized controlled trial was conducted. Forty patients with a skeletal anterior open bite (age range: 7.5-10.5 years) were treated at the University of xxxx School of Dentistry in xxxx, xxxx. They were distributed randomly into 2 equal groups: the OBB group (20 patients; mean age: 8.8 ± 1.5 years) and the RPBP/C group (20 patients; mean age: 8.6 ± 1.1 years). Randomization was based on a computer-generated sequence of random numbers. Primary outcome measures were the skeletal and dentoalveolar variables, whereas the secondary outcome measures were the soft-tissue parameters assessed on standardized lateral cephalograms collected before and after 12 months of treatment. Mann-Whitney U tests were used to detect significant differences between the 2 groups. RESULTS: Both the OBB and the RPBP/C appliances induced favorable dental effects. A statistically significant difference was found between the 2 groups in the overbite (P = 0.003). Open bite in the OBB group showed a mean closure of 4.91 mm (SD 0.4 mm), and a mean closure of 3.43 mm (SD 0.3 mm) was observed in the RPBP/C group. Dentoalveolar changes at the anterior region were evident, with statistically significant extrusion, and lingual tipping of the maxillary and mandibular incisors (P ≤ 0.05). The results showed no significant differences in the skeletal changes between the 2 groups. CONCLUSIONS: The OBB and the upper posterior bite plane with crib were both effective in the early treatment of the skeletal anterior open bite. However, closure of the anterior open bite was mainly due to the dentoalveolar changes at the anterior region of the dental arches.

Tratamento de dentes inclusos em proximidade a cavidade nasal e seio maxilar: relato de caso / Treatment of teeth included with proximity to the nasal cavity and maxillary sinus: case report

Durante a formação dentária, distúrbios de desenvolvimento podem acontecer, causando anomalias de número, forma, tamanho, estrutura e posição, além de apresentarem anormalidade no padrão sequencial de irrupção. Uma boa anamnese, associada a palpação e exames de imagens são indispensáveis para um diagnóstico precoce e favorável destas alterações. Os exames de imagem determinarão a relação espacial destes dentes com as estruturas nobres adjacentes. O objetivo deste trabalho é relatar a presença de supranumerário unilateral e impactação bilateral de caninos permanentes, ambas anomalias com proximidade da cavidade nasal e seio maxilar, ressaltando a importância do diagnóstico preciso através de exames clínico e de imagens, que direcionam o planejamento terapêutico específico para cada caso, bem como a associação multidisciplinar para obtenção de um resultado satisfatório do quadro e melhora da qualidade de vida do paciente(AU)

During dental formation, developmental disorders can occur, causing anomalies of number, shape, size and position, in addition to presenting abnormality in the sequential pattern of irruption. Anamnesis associated with palpation are indispensable for an early diagnosis of these alterations. Imaging exams will determine the spatial relationship between these teeth and the adjacent noble structures. The aim of this study was to report the presence of unilateral supernumerary and bilaterally impacted canines, both anomalies with proximity of nasal cavity and maxillary sinus, emphasizing the importance of accurate diagnosis through clinical and imaging exams, that direct the specific therapeutic planning for each case, as well as the multidisciplinary association to obtain satisfactory results and improve the life quality of patients(AU)

Pharyngeal airway and hyoid bone position changes of skeletal anchored Forsus Fatigue Resistant Device and activator appliances.

OBJECTIVES: To evaluate the effects of miniplate anchored Forsus Fatigue Resistant Device (MAF) and activator treatments in the pharyngeal airway dimensions and hyoid bone position. MATERIALS AND METHODS: Thirty-eight patients with mandibular retrusion who were treated with either MAF or activator were selected retrospectively and compared with an untreated control group. The data of 114 lateral cephalograms, comprising those taken before treatment (T1) and at the end of functional treatment (T2), were evaluated with regard to their linear, angular, and area measurements. RESULTS: The mandibular length increased and the hyoid bone moved forward with both treatments (P < 0.05). The horizontal change in the hyoid bone position with MAF treatment was correlated with changes in the point B and ANB angle. Increases of 1.8 mm, 1.4 mm, and 1.8 mm in the pharyngeal airway dimensions were obtained at the levels of the second, third, and fourth cervical vertebra, respectively, with the MAF treatment. On the other hand, an increase of 1.9 mm was found at the level of the fourth cervical vertebra with the activator treatment. The greatest vertical movement in the Menton and the highest increase in the oropharyngeal area were observed in the MAF group (P < 0.05). CONCLUSION: Both the MAF and activator treatments caused favorable maxillomandibular changes; however, the MAF treatment provided a greater increase in the oropharyngeal area according to both the increase in mandibular length and the change in the vertical position of the mandible. CLINICAL RELEVANCE: Functional appliances were found to be useful in increasing the pharyngeal airway dimensions in the short-term. The skeletal anchored fixed functional appliance caused a greater increase in the oropharyngeal airway area that may be beneficial for Class II patients who carry a risk of having respiratory problems.

Effects of orthodontic treatment with activator appliance on patients with skeletal Class II malocclusion: a systematic review and meta-analysis.

BACKGROUND: This systematic review aimed to evaluate and compare the treatment effects of activator appliances on untreated class II skeletal malocclusion patients in terms of skeletal, dental, and soft tissue changes. METHODS: We searched 11 databases from January 1966 to May 2021 for randomized and clinical controlled trials that compared the treatment effects of activator appliances on untreated Class II skeletal malocclusion patients. All data were analyzed using RevMan 5.3 software. RESULTS: According to the inclusion/exclusion criteria, 16 articles qualified for the final analysis. Thirteen outcome indicators of teeth, bone tissue, and soft tissue were compared and analyzed: SNA°, SNB°, ANB°, SN-MP°, ANS-Me, Co-Gn, Go-Me, overjet, overbite, U1-SN°, L1-MP°, UL-E, and LL-E. Five randomized controlled trials (RCTs) evaluations were of medium quality, and 11 controlled clinical trials (CCTs) evaluations were of B grade. Bone tissue changes: compared with the untreated group, the SNA and ANB decreased, and the SNB, SN-MP, ANS-Me, Co-Gn, and Go-Me increased after activator appliance treatment, and the differences were statistically significant (P<0.001). Dental changes: compared with the untreated group, the overjet, overbite and U1-SN in the treated group decreased significantly, while the L1-MP increased significantly (P<0.0001). Soft tissue changes: compared with untreated patients, the UL-E of patients treated with an activator appliance decreased significantly (P<0.0001); however, there was no significant difference in the LL-E between the two groups (P=0.09). DISCUSSION: Since the imprecision and high level of heterogeneity of the articles, further large-sample and high-quality clinical trials are necessary to evaluate effects of orthodontic treatment with activator appliance on patients with skeletal Class II malocclusion. In addition, this study failed to explore the long-term stability of activator treatment, so long-term studies are needed to assess the stability of its effect on the skeletal, dental, and soft tissue changes.

Treatment efficiency of activator and skeletal anchored Forsus Fatigue Resistant Device appliances.

OBJECTIVES: The aim of the study was to investigate the treatment efficiency of miniplate anchored Forsus Fatigue Resistant Device (MAF) as compared with the activator appliance. MATERIALS AND METHODS: Mandibular retrognathia was treated with two methods, the MAF group (8 girls, 11 boys, mean age 13.03 ± 0.69 years) and the activator group (7 girls, 12 boys, mean age 12.68 ± 0.73 years). An untreated control group (9 girls, 10 boys, mean age 12.95 ± 0.73 years) was constructed to eliminate growth-related changes through the American Association of Orthodontists Foundation Legacy Collection. Data of 114 lateral cephalograms were analyzed. RESULTS: The inhibition of the maxillary growth was greater in the MAF group, whereas forward displacement of the mandible was higher in the activator group (P < 0.05). Sagittal maxillomandibular relation was improved similarly in both treatment groups (P < 0.05). Mandibular length was increased in both treatment groups with the highest increase in the activator group (P < 0.05). Retroclination of the incisors was observed in the MAF group (P < 0.05). The upper lip was retruded in the MAF group and lower lip was protruded in the activator group (P < 0.05). CONCLUSION: The activator created greater mandibular changes, whereas the MAF provides somewhat smaller mandibular changes due to the restriction caused by retroclined maxillary incisors. CLINICAL RELEVANCE: Although both MAF and activator treatments caused favorable maxillomandibular changes, new treatment alternatives that reduce dentoalveolar side effects and eliminate patient cooperation are still required to achieve skeletal correction in class II malocclusion treatment in growing patients.

Síndrome da apneia obstrutiva do sono em crianças (SAOS) associada aos dispositivos ortopédicos orais hyrax e bionator de balters sobre respostas miofuncionais / Obstructive sleep apnea syndrome in children (OSAS) associated with Hyrax and Balters' Bionator oral orthopedic devices on myofunctional responses

O objetivo deste estudo foi avaliar a influência terapêutica dos dispositivos orais Hyrax e Bionator de Balters no tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS), sobre a melhora da SAOS observado pela polissonografia, atividade elétrica dos músculos masseter e temporal, força máxima de mordida, qualidade de vida, e diâmetro dos pontos cefalométricos. Foram selecionados 11 participantes de ambos os sexos, diagnosticados com SAOS através do exame polissonográfico tipo III e com necessidade de tratamento ortopédico facial. Foi feita a coleta dos dados, os responsáveis preencheram os questionários (Escala de Distúrbios do Sono em Crianças e OSA-18-PV), termo de consentimento livre e esclarecido aos responsáveis e para as crianças, documentação ortodôntica (incluindo a análise do diâmetro dos pontos cefalométricos - espaço nasofaríngeo anterior e posterior (NFA-NFP), assim como espaço bucofaríngeo anterior e posterior (BFA-BFP)), análises iniciais da eletromiografia dos músculos masseter e temporal e força máxima de mordida. Estas informações foram coletadas no início do tratamento e após 11 meses, assim como o exame polissonográfico tipo III. Os dados foram normalizados pelo apertamento com Parafilm M e submetidos à análise normalidade pelo teste de Kolmogorov-Smirnov, sendo observado os dados: valor de polissonografia; eletromiografia de masséter direito e esquerdo; eletromiografia de temporal direito e esquerdo; força de mordida em região de incisivo e molar esquerdo/direito, os questionários foram avaliados através de score e nota (0-10), e cefalometria (análise das distâncias NFA-NFP e BFABFP). Para estes dados, foi realizado o teste t de Student. Para os dados com distribuição não normal, foi realizado o teste de Wilcoxon. Todas as análises foram realizadas com nível de significância de 5%. Em relação ao exame polissonográfico e os questionários, houve diferença estatística evidenciando melhora na qualidade do sono dos indivíduos. A eletromiografia demonstrou que houve diferença estatística em repouso no músculo temporal direito, e na mastigação de uva passas, nos músculos masseter e temporal do lado direito. Na cefalometria, foi observada diferença estatística na distância entre os pontos NFA-NFP. Conclui-se que o uso dos dispositivos Hyrax e Bionator de Balters em crianças classe II e portadoras da SAOS é uma alternativa de tratamento segura e eficaz(AU)

The aim of the study was to evaluate the influence of oral devices Hyrax and Balters Bionator in the treatment of Obstructive Sleep Apnea Syndrome (OSAS), on the improvement of OSAS observed by polysomnography, electrical activity of the masseter and temporal muscles, maximum bite force, quality of life, and diameter of cephalometric points. Eleven participants of both genders, diagnosed with OSAS through type III polysomnographic examination and in need of facial orthopedic treatment, were selected. Data collection was performed, the guardians filled out the questionnaires (Sleep Disorders Scale in Children and OSA-18-PV), informed consent form to guardians and for children, cephalometric orthodontic documents - nasopharyngeal space anterior and posterior (NFA-NFP), as well as anterior and posterior buccopharyngeal space (BFA-BFP)), initial analysis of the electromyography of the masseter and temporal muscles and maximum bite force. This information was collected at the beginning of treatment and after 11 months, as well as the type III polysomnographic exam. Data were normalized by tightening with Parafilm M and analysis of normality using the Kolmogorov-Smirnov test, observing the following data: polysomnography value; right and left masseter electromyography; right and left temporal electromyography; bite force in the left/right incisor and molar region, the questionnaires were obtained through score and grade (0-10), and cephalometry (analysis of the NFA-NFP and BFA-BFP distances). For these data, the Student test was performed. For data with non-normal distribution, the Wilcoxon test was performed. All analyzes were performed with a significance level of 5%. Regarding the polysomnographic exam and the questionnaires, there was a statistical difference showing an improvement in the sleep quality of the respondents. The electromyography required that there was a statistical difference at rest in the right muscle, and when chewing raisins, in the masseter and temporal muscles on the right side. In cephalometry, a statistical difference was observed in the distance between the NFA-NFP points. It can be concluded that the use of the Balters Hyrax and Bionator devices in class II children and children with OSAS is a safe and effective treatment alternative(AU)

Tratamento do micrognatismo transversal com o ativador elástico de Klammt / Tratamiento del micrognatismo transversal con el activador abierto elástico de Klammt

Introdução: o micrognatismo transverso é uma anomalia dentomaxilofacial caracterizada por relações precárias entre as arcadas dentárias, geralmente devido à presença de anormalidades nos dentes, na maxila e nas articulações temporomandibulares, para as quais o ativador elástico aberto de Klammt torna-se uma opção terapêutica. Objetivo:avaliar o tratamento do micrognatismo transverso com o ativador elástico aberto Klammt. Métodos: foi realizado um estudo de intervenção do tipo quase experimental, antes e depois da modalidade sem grupo de controlo, em alunos do 2.º ano da Escola Ciro Redondo do município de Bayamo no período de 2017 a 2018. O universo foi constituído por 31 alunos da 2ª série, todos com diagnóstico de micrognatismo transverso. As variáveis estudadas foram: micrognatismo transverso, alterações clínicas, modificações esqueléticas e tempo de correção. Para a obtenção das informações foram utilizados métodos teóricos, empíricos e estatísticos e para o seo processamento utilizou-se o número (Não), a percentagem (%) e o teste de Wilcoxon. Resultados: a mordida cruzada posterior foi eliminada em 100,0 por cento dos casos e a largura maxilar atingiu valores dentro da norma em 74,19 por cento dos pacientes, a anomalia foi corrigida em 77,42 por cento dos alunos do primeiro ano de tratamento. Conclusões: demonstrou-se que, se o tratamento fosse aplicado a toda a população da área acometida pelo micrognatismo transverso, seriam obtidos resultados favoráveis com uma faixa que poderia oscilar entre 61,09 e 93,75 por cento de eficácia, o que tornou significativa a intervenção(AU)

Introducción: el micrognatismo transversal es una anomalía dentomaxilofacial que se caracteriza por presentar deficientes relaciones entre los arcos dentarios, generalmente debida a la presencia de anomalías de los dientes, maxilar y articulaciones temporomandibulares, para lo cual el activador abierto elástico de Klammt se convierte en una opción terapéutica. Objetivo: evaluar el tratamiento del micrognatismo transversal con el activador abierto elástico de Klammt. Métodos: se realizó un estudio de intervención de tipo cuasi-experimental, modalidad antes y después sin grupo control en alumnos de 2do grado de la Escuela Ciro Redondo del municipio Bayamo en el periodo 2017-2018. El universo estuvo constituido por 31 estudiantes de 2do grado, todos con el diagnóstico de micrognatismo transversal. Las variables estudiadas fueron: micrognatismo transversal, cambios clínicos, modificaciones esqueléticas y tiempo de corrección. Para obtener la información se emplearon métodos teóricos, empíricos y estadísticos y para su procesamiento se utilizaron número (No), porciento (%) y la prueba de Wilcoxon. Resultados: se eliminó la mordida cruzada posterior en el 100,0 por ciento de los casos y la anchura maxilar alcanzó valores dentro de la norma en el 74,19 por ciento de los pacientes, se corrigió la anomalía en el 77,42 por ciento de los estudiantes en el primer año de tratamiento. Conclusiones: se demostró que, si se aplicase el tratamiento a toda la población del área afectada por el micrognatismo transversal, se obtendrían resultados favorables con un rango que pudiera oscilar entre el 61,09 y el 93,75 por ciento de efectividad, lo cual hizo significativa la intervención(EU)

Tratamiento exitoso con activador funcional removible en paciente clase II esqueletal con mordida en tijera, después del peak de crecimiento puberal: caso y revisión de la literatura / Successful treatment with removable functional activator in a skeletal class II patient with scissor bite, after pubertal growth peak: clinical case and literature review

INTRODUCCIÓN: En pacientes con crecimiento esqueletal clase II, el tratamiento ideal es etiológico modificando la cantidad y dirección de crecimiento mandibular. Con estos objetivos, se usan activadores funcionales (AF) que estimulan el crecimiento mandibular, redirigiéndolo posterosuperiormente a nivel condilar por medio del avance mandibular. Después del peak de crecimiento puberal, la corrección etiológica es quirúrgica. El objetivo del presente artículo es reportar un tratamiento exitoso de un paciente después de su peak de crecimiento puberal, tratado con un AF removible. MÉTODOS: Paciente de 13 años, 3 meses, braquifacial y con perfil facial convexo, presentaba clase II esqueletal debido a mandíbula retrognática. El paciente tenía dentición permanente completa, clase II de Angle, resalte incisivo y sobremordida aumentados, proinclinación incisiva bimaxilar y mordida en tijera de dientes #2.4 y #2.5. RESULTADOS: Después de ocho meses de tratamiento, se observó posición mandibular estable en clase I esqueletal, verificada mediante exámenes funcionales y radiográficos. Se logró resolución de la mordida en tijera. Mejoraron resalte incisivo y sobremordida, así como la proinclinación incisiva bimaxilar. CONCLUSIONES: El momento ideal para utilizar AF en tratamiento de clases II esqueletales es durante o ligeramente después del peak de crecimiento puberal. Sin embargo, los resultados clínicos del presente caso, permiten recomendar el avance mandibular con AF en pacientes braquifaciales clase II, a pesar de que se haya producido el peak de crecimiento puberal. En estos casos, el uso de AF está dirigido principalmente a beneficios dentarios, pero, al mismo tiempo, puede favorecer el crecimiento mandibular

INTRODUCTION: In growing skeletal class II patients, the ideal treatment is etiological and is obtained by modifying the amount and direction of mandibular growth. With this objective in mind, functional activators (FA) are used as they stimulate growth, redirecting it at the condylar level through forward mandibular advancement. After pubertal growth peak, etiological correction is surgical. OBJECTIVE: The present article aims to report a successful treatment in a patient after pubertal growth peak treated with a removable FA. METHODS: >A 13 years 3 months male patient, skeletal class II due to retrognathic mandible, brachyfacial and with a convex facial profile. The patient had complete permanent dentition, Angle class II, increased overjet and overbite. Maxillary and mandibular incisive proclination. Scissor bite of teeth #2.4 and #2.5. RESULTS: Treatment started using a FA for one year after first evaluation. Following eight months of treatment, stable mandibular position was observed in skeletal class I, verified by functional and radiographic examinations. Resolution of scissor bite was accomplished. Overjet and overbite, and bimaxillary incisive proclination were improved. CONCLUSIONS: The ideal time to use FAs for skeletal management in skeletal class II is during, or slightly after peak pubertal growth. However, the clinical results of present case, allows recommending the forward mandibular advancement in brachyfacial skeletal class II patients, even though pubertal growth peak had occurred. In these cases, the use of FA is primarily aimed at the dental benefits, but, at the same time, favoring mandibular growth

A Prospective Study Comparing Adolescent and Post-Adolescent Periods Regarding Effects of Activator Appliance in Patients with Class II Mandibular Retrognathia by Using 3dMDface Analysis and Cephalometry.

BACKGROUND The purpose of this prospective study was to compare adolescent and post-adolescent growth periods regarding the effectiveness of conventional activator appliance in patients with Class II mandibular retrognathia by using lateral cephalometric radiographs and three-dimensional photogrammetry (3dMDface). MATERIAL AND METHODS We enrolled 2 groups: 15 patients in the adolescent growth period and 17 patients in the post-adolescent growth period. All patients had Class II anomaly with mandibular retrognathia and were treated with conventional activator appliances. Lateral cephalometric radiographs and three-dimensional photogrammetric views were obtained at the beginning and end of the activator treatment of Class II patients. Maxillomandibular discrepancy, mandibular protrusion and lengths, convexity angles, facial heights, and dental measurements were evaluated cephalometrically. Projections of the lips and the chin and volumetric measurements of the lip and the mandibular area were assessed using three-dimensional photogrammetry. RESULTS Conventional activator therapy resulted in similar effects in both growth periods regarding improvements in the mandibular sagittal growth and maxillomandibular relationship (ANB° and the SNB° angles). Mandibular effective length was increased (Co-Gn length) and the maxillary horizontal growth was restricted (decreased SNA° angle) in both groups following the treatment. Treatment duration was significantly longer in the post-adolescent group. Increases in the projections of menton, pogonion, and sublabial points were observed in the three-dimensional photogrammetric views. Total lip volume was reduced while the mandibular volume was significantly increased in both groups. Lower gonial angle showed a greater increase in the post-adolescent group. CONCLUSIONS Correction of Class II anomaly with mandibular retrognathia was achieved with a combination of dental and skeletal changes in both growth periods. Conventional activator therapy may be an alternative treatment approach in the late growth period as it led to significant skeletal and dental changes.

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.