A Comparison of Mixed Dentition Dental Development in Cleft Patients Treated With and Without the Latham-type Appliance.

PURPOSE: The purpose of this study was to retrospectively evaluate the Latham-type appliance's effect on the development and eruption of posterior teeth during the mixed dentition stage before palatal expansion and secondary alveolar bone graft(s). METHODS: The charts of complete cleft lip and palate (CLP) patients treated with and without the Latham-type appliance were screened using the following inclusion criteria: nonsyndromic; CLP; and available panoramic radiographs and clinical photographs in the mixed dentition prior to palatal expansion and secondary alveolar bone grafts. Surgical repair for Latham-type appliance patients followed the Latham-Millard protocol. The differences in outcomes were analyzed using Fisher's exact tests. RESULTS: The sample consisted of 65 patients treated with the appliance (Latham group) and 36 subjects who were not (non-Latham group). Similar incidences were found between the non-Latham group and the Latham group for maxillary second premolar agenesis (11 percent versus 10 percent) and enamel defects in the maxillary arch (17 percent versus 14 percent). The incidence of ectopic permanent maxillary first molars was higher in the Latham group than in the non-Latham group (28 percent versus one percent, P=0.01). CONCLUSIONS: A higher incidence of ectopic permanent maxillary first molars was found in patients treated with the Latham-type appliance.

Efeitos do ativador aberto elástico de Klammt no tratamento da má-oclusão de Classe II, divisão 1 / Effects of the Klammt's elastic open activator in the Class II division 1 malocclusion treatment

Objetivo: o objetivo deste trabalho foi avaliar as alteraçõescefalométricas dentárias e esqueléticas provenientes da utilização doativador aberto elástico de Klammt no tratamento da má-oclusão deClasse II, divisão 1. Material e métodos: a amostra foi constituída de 22pacientes que apresentavam má-oclusão de Classe II, divisão 1, comidade média inicial de 9,71 anos (D.p. = 1,39), os quais foram tratadoscom ativador aberto elástico de Klammt por um período médio de 1,58anos (D.p. = 0,74). As telerradiografias em norma lateral foram realizadaspara cada paciente no início e no final do tratamento. As variáveiscefalométricas foram avaliadas pelo teste t dependente nos estágiosinicial e final do tratamento com significância estatística de p < 0,05.Resultados: houve aumento no comprimento da mandíbula durante afase de tratamento. Os incisivos superiores sofreram uma inclinaçãopara lingual e retrusão em relação à sua base óssea, enquanto que osincisivos inferiores apresentaram inclinação para vestibular e protrusão.Conclusão: houve uma melhora significante da relação maxilomandibularproveniente das alterações esqueléticas e dentárias, consequentes dotratamento com o aparelho aberto elástico de Klammt, somadas aocrescimento normal dos indivíduos.

Objective: the aim of this study was to evaluate thedental and skeletal cephalometric changes produced by the use ofKlammt's elastic open activator in the treatment of Class II, division 1malocclusion. Methods: the sample consisted of 22 Class II division 1malocclusion patients, at a mean initial age of 9.71 yeers (s.d.=1,39),which were treated with Klammt's elastic open activator for a meanperiod of 1,58 years (s.d.=0,74). The lateral cephalograms weretaken of each patient at the beginning and at the end of treatment.The cephalometric variables were analized by dependent "t" tests withp < 0,05 to compare measures at initial and tinal stages of treatment.Results: there was increase in effective mandibular length during treatment.Themaxillary incisors presented a palatal inclination and retrusion,while the mandibular incisors had a buccal inclination and protrusion.Conclusion: there was a signiticant improvement in maxillomandibularrelationship derived from the skeletal and dental changes resulting fromtreatment with the Klammt's open elastic activator and from normalgrowth of individuais.

Alterações dentoesqueléticas verticais e horizontais induzidas pelo Ativador Elástico Aberto de Klammt / Vertical and horizontal dentoskeletal changes induced by the Klammt Open Elastic Activator

O objetivo deste estudo foi avaliar as alterações dentoesqueléticas verticais ehorizontais induzidas pelo Ativador Elástico Aberto de Klammt no tratamento das rnás-oclusôesde Classe II, divisão 1. A amostra de 34 crianças foi dividida em dois grupos de 17 indivíduoscada (dez meninas, sete meninos), pareados por idade e gênero, com idade inicial média de8,5 anos. Os dados foram analisados usando o teste t Student para comparações intragrupoe intergrupos. Os resultados do trabalho mostraram que o aparelho promoveu restriçãodentoalveolar do crescimento maxilar; incremento no deslocamento vertical da sínfise mandibularassociado ao crescimento horizontal normal da mandíbula; verticalização dos incisivossuperiores; restrição da migração anterior dos molares superiores; maior padrão de erupçãoe deslocamento anterior normal dos incisivos e dos molares inferiores. Foi concluído que oaparelho Klammt produz alterações predominantemente dentoalveolares horizontais no arcosuperior e verticais no arco inferior e alterações esqueléticas verticais na mandíbula.

The aim of this study was to evaluate the vertical and horizontal dentoskeletalchanges induced by the Klammt Open Elastic Activator in the treatment of the Class II Division1 malocclusion. The sample of 34 children was divided into two groups of 1 7 subjects each(ten girls, seven boys), matched by age and gender and with an initial mean age of 8. 5 years.The data was analyzed using a Student's t-test for intragroup and intergroup comparison. Theresults showed that the appliance promoted dentoalveolar restriction of the maxilar growthwithin normal anteroposterior and vertical growth of the maxillary apical base; increment in thevertical displacement the mandibular symphysis associated with normal horizontal growth ofthe mandible; palatal tipping of the upper incisors; restriction of the anterior migration of theupper molars; greater eruption pattern and normal anterior displacement of the lower incisorsand molars. It was concluded that Klammt appliance induce changes that are predominantlyhorizontal dentoalveolar in upper arch and vertical dentoalveolar in lower arch and verticalskeletal changes in the mandible.

Changes in upper airway width associated with Class II treatments (headgear vs activator) and different growth patterns.

OBJECTIVE: To investigate the upper airways for anteroposterior width against different growth patterns and for alterations during various Class II treatments. MATERIALS AND METHODS: Cephalograms from three treatment groups (headgear, activator, and bite-jumping appliance) were evaluated by a single investigator at baseline and at the end of orthodontic treatment. Cephalograms were used to determine upper airway width at different levels in the anteroposterior plane. Patients in the headgear group were additionally divided into six subsets on the basis of y-axis values to assess the influence of different growth patterns. RESULTS: Small increases in pharyngeal width were noted at all vertical level segments, both at baseline and during orthodontic treatments. No significant differences in these small increases were noted across various treatment modalities and growth patterns. CONCLUSION: Upper airway changes did not significantly vary with the different treatment modalities investigated in the present study. Nevertheless, reductions in pharyngeal width potentially triggering or exacerbating obstructive sleep apnea syndrome (OSAS) are always possible in the headgear phase.

Injerto de tejido conectivo subpediculado y colgajo de avance coronal para el tratamiento de una recesióngingival en paciente con tratamiento de ortodoncia: Presentación de un caso / Connective tissue graft and coronally advanced flap for treatment of a gingival recession in a patient with orthodontics treatment: a case report

A menudo es notable la presencia de recesiones gingivales en pacientes con tratamiento ortodóncico, debido a que el movimiento ocasionado por la aparatología, afecta directamente el periodonto. Las recesiones gingivales constituyen una preocupación tanto estética como funcional para el paciente. Estas pocas veces resultan en la pérdida de los dientes; sin embargo, se asocian, por lo general con afecciones tales como; sensibilidad dental e irritación del tejido marginal, causada por la incapacidad del paciente para remover la placa .Existen diversas técnicas para contrarrestar estos defectos, entre las que encontramos: el injerto de tejido conectivo subepitelial, injerto de matriz dérmica acelular, injerto gingival libre y la regeneración tisular guiada. Se presenta un caso de un paciente con retracción del margen gingival a nivel del incisivo central inferior derecho y ausencia de encía adherida asociada al tratamiento ortodóncico, describiéndosela técnica quirúrgica utilizando tejido conectivo subepitelial del paladar combinado con un colgajo de avance coronal, obteniéndose excelentes resultados estéticos y una buena cobertura radicular (AU)

It is often marked the presence of gingival recession in patients with orthodontic treatment, because the movement caused by the apparatus, directly affects the periodontium. Gingival recessions are a concern aesthetic and functional for the patient. These rarely result in tooth loss, but are associated, usually with conditions such as: tooth sensitivity and irritation of the marginal tissue, caused by the inability of the patient to remove the plaque. There are various techniques to decrease these defects, among which are: the subepithelial connective tissue graft, acellular dermal matrix graft, free gingival graft and guided tissue regeneration. It is reported a case of a patient with retraction of the gingival margin at the lower right central incisor and the absence of adherent gums associated with orthodontic treatment, described the surgical technique using subepithelial connective tissue of the palate combined with a flap of coronal positioning, obtaining excellent aesthetic results and a good root coverage (AU)

[Treatment of the obstructive sleep apnea syndrome. Side effects of a mandibular advancement device]. / Behandeling van het obstructief slaapapneusyndroom. Neveneffecten van een mandibulair repositieapparaat.

The obstructive sleep apnea syndrome is characterised by repeatedly occurring complete or partial obstructions of the upper airway during sleep, which can be accompanied by serious oxygen desaturations. This can result in cardiovascular co-morbidity and excessive daytime sleepiness, with an increased chance of motor vehicle accidents and diminished performance at work. The use of a mandibular advancement device appears to be an effective therapy. In the long term, however, the possibility of dental side effects should be taken into consideration. Development of a relative mesio-occlusion has frequently been observed. Side effects are usually mild and transient. To objectively evaluate whether the side effects are stable or progressive, a thorough follow-up is needed. It is therefore desirable that treatments with a mandibular advancement device are carried out by dentists or specialists with experience and special expertise in this area.

Indicaciones y efectos terapeuticos del activador de andresen: reporte de un caso / Indications and therapeutic effects andresen activator: a case report

En el tratamiento de las maloclusiones clase II por retrognatismo mandibular se han utilizado gran número de aparatos funcionales. El presente trabajo resume las principales características e indicaciones de uno de los Aparatos Funcionales más utilizado en Europa: el Activador de Andresen. Este estudio reporta un caso de una maloclusión Clase II División 1 tratado exitosamente con el Activador de Andresen

Authors have reviewed the principal characteristics of the most utilized functional dispositive in orthodontic in Europe: Andresen Activator. Factors like construction of the appliance, state of growth, direction of growth and necessity of cooperation determine the success of all functional appliances, inclusive the Andresen Activator. The aim of this study was to examine a case with Class II Division 1 malocclusion, which was treated with the Andresen Activator

Effects of unilateral molar distalization with a modified pendulum appliance.

INTRODUCTION: The purpose of this study was to evaluate skeletal and dentoalveolar changes due to unilateral distalization and to determine side effects. METHODS: Cephalograms and dental casts before and after distal movement of the maxillary molars with pendulum appliances in 15 consecutively treated patients (5 girls and 10 boys, 12.06 +/- 1.32 years), were included in this study. The duration of distalization was 8.46 +/- 2.23 months. RESULTS: Cephalometric analysis showed no remarkable growth between the 2 measurement times. The mean value for distalization of the first molars was 3.83 +/- 1.09 mm, with distal tipping of 6.45 degrees . The maxillary second molars were also moved distally 2.83 +/- 1.32 mm and tipped distally 14.7 degrees . No significant changes in the position of the third molars were measured. The mean reciprocal mesial movement of the premolars was 1.18 +/- 1.31 mm, with distal tipping of 1.94 degrees . The incisors moved 0.84 +/- 0.79 mm mesially, with mesial tipping of 0.02 degrees and extrusion of 1.21 mm. There was also a significant influence on the contralateral anchorage unit. However, unilateral distalization reduced incisor proclination and induced moderate distal movement of the contralateral anchorage unit based on rotation around a virtual axis perpendicular to the Nance button. CONCLUSIONS: Effective distal molar movement and less anchorage loss at the front teeth are advantages of unilateral distalization.

Estudio comparativo de la acidez del medio bucal en presencia de aditamentos metálicos y sus implicaciones en los fenómenos corrosivos / No disponible

En Odontología se utilizan tratamientos ortodonticos para solucionarproblemas de mal oclusión. Con este fin suelen utilizarse materialesmetálicos, entre los que figuran los brackets. Partiendo de laaseveración de que la acidez producto del metabolismo bacterianoen la cavidad bucal puede originar corrosión en estos materiales, elpropósito de este trabajo experimental consiste en analizar la acidezdel medio bucal en presencia de estos aditamentos metálicos. Paraello se procedió a tomar las muestras a 30 pacientes de los cuales15 eran portadores de ortodoncia y 15 sin ortodoncia para detectarla acidez producto del crecimiento bacteriano a través del test deSnyder. Los resultados obtenidos fueron analizados estadísticamente,determinado que en ambos grupos de pacientes se detectócrecimiento bacteriano y disminución en el pH del medio bucal.Con este comportamiento y conociendo que la acidez de los medioscontribuye en los procesos corrosivos se afirma que dicha acidezresultante del crecimiento bacteriano podría significar unos de losfactores que producen deterioro por corrosión de los materialesmetálicos usados en Odontología

In Dentistry ortodontics treatments are used to solve to problemsbad occlusion among others. With this aim material metalists usuallyare used, between whom they appear brackets. Starting off of theasseveration of which the acidity product of the bacterial metabolismin the buccal cavity can originate corrosion in these materials, theintention of this experimental work consists of analyzing the acidityof buccal means in the presence of these metallic additions. For it itwas come to take the samples to 30 patients of who 15 were carryingof ortodontics treatments and 15 without ortodontics treatments todetect the acidity product of the bacterial growth through the test ofSnyder. The obtained results were analyzed statistically, determinedthat in both groups of patients it detected bacterial growth anddiminution in pH of buccal means. With this behavior and knowingthat the acidity of means contributes in the corrosive processes wecould conclude that this resulting acidity of the bacterial growthcould mean of the factors that produce deterioration by corrosion ofthe used metallic materials in Dentistry

Cambios cefalométricos con el uso del activador de Klammt en diferentes magnitudes de protrusión mandibular / Cephalometric changes with the use of Klammt's activator-appliance in different magnitudes of mandibular protrusion

Se realizó un estudio prospectivo durante el año 1999 en 16 niños con maloclusión de clase II división I de Angle, escogidos entre los que acudieron en busca de tratamiento a la Clínica Docente de Santa Clara en el año 1998. Todos usaron el activador abierto elástico de Klammt, pero con diferente magnitud en el avance mandibular: el grupo 1 quedó conformado por pacientes con avance total de la mandíbula y el grupo 2 con un adelantamiento por etapas. Las telerradiografías iniciales y al año, permitieron conocer que en el grupo 1 hubo cambios significativos en la posición mandibular, longitud mandibular y posición de incisivos superiores (p<0,05). En el grupo 2 se observaron estos cambios, pero más marcados (Z con mayor valor absoluto), y aparecen otros como la relación maxilomandibular, la posición del incisivo superior, así como la inclinación y la posición de los incisivos inferiores con respecto a la mandíbula. Concluimos que en ambos grupos hubo cambios significativos en variables esqueléticas y dentarias, pero más marcados y extensos en el grupo con un avance mandibular por etapas(AU)

A prospective study was conducted during 1999 among 16 children with class II division 1 Angle's maloclussion that were selected among those who seeked treatment at the Dental Teaching Clinic of Santa Clara, in 1998. All of them used the open elastic Klammt's activator-appliance, but with a different magnitude in the mandibular advance. Group 1 was composed of patients with total mandibular advance, whereas patients in group 2 presented an advance by stages. The initial teleradiographies and at a year allowed to know that in group 1 there were significant changes in the mandibular position, mandibular length and the position of upper incisors (P<0.05). These changes were more marked in group 2 (Z with a higher absolute value) and there were others as the maxillomandibular relationship, the position of the upper incisor and the inclination and position of the lower incisors in relation to the mandible. It was concluded that in both groups there were significant changes in skeletal and dental variables, but they were more marked and extensive in the group with a mandibular advance by stages(AU)

Temporomandibular joint effects of activator treatment: a prospective longitudinal magnetic resonance imaging and clinical study.

The aim of this prospective longitudinal clinical and magnetic resonance imaging (MRI) study was to analyze the effect of Activator treatment on the disc-condyle complex and the posterior attachment of the temporomandibular joint (TMJ) considering the degree of compliance in the evaluation. The material was comprised of 30 class II, division I patients (nine girls and 21 boys) who underwent Activator treatment. The average pretreatment age of the subjects was 11.4 years. Parasagittal MRIs in closed mouth position from before and after one year of Activator treatment were analyzed metrically. Possible clinical and subclinical soft tissue lesions of the posterior attachment of the TMJ were assessed by passive joint loading before, after six months, and after one year of Activator treatment. The overjet was continuously documented as a clinical measure for treatment reaction. To assess patient compliance, the subjects had to perform daily wearing-time records. Furthermore, the Activator was clinically inspected for fitting accuracy and signs of wear. The results revealed the following: (1) during the one-year treatment period the sagittal dental arch relationship improved, but a class I occlusion could not be achieved in all patients; (2) on average, a physiologic position of disc, condyle, and fossa was present both before and after one year of Activator treatment; (3) a pretreatment physiologic disc-condyle relationship was unaffected by Activator therapy; 4) a pretreatment disc displacement could not be repositioned during Activator treatment; (5) the prevalence of a subclinical capsulitis of the inferior stratum of the posterior attachment increased during Activator treatment; and (6) the degree of compliance had no influence on the disc-condyle relationship or the reaction of the posterior attachment of the TMJ.

Occlusal side effects caused by a mandibular advancement appliance in patients with obstructive sleep apnea.

Mandibular advancement appliances (MAA) have been established as an alternative treatment option for obstructive sleep apnea (OSA). Although the therapeutic effect of these devices has been proven both clinically and polysomnographically through various studies, there are very few follow-up examinations in existence concerning possible dental side effects caused by the MAA. However, if lifelong treatment of OSA is considered, these follow-up examinations are of utmost importance. This article presents 2 cases with unexpected dental side effects and occlusal alterations caused by MAA therapy.

[A method for preventing and treating maxillodental anomalies related to disordered nose breathing]. / Metod profilaktiki i lecheniia zubocheliustnykh anomalii, sviazannykh s narusheniem nosovogo dykhaniia.

Eleven children aged 5-9 years with maxillodental abnormalities were treated using positioners. Negative effects of positioners and activators (increase of dental caries, hygienic index, and acid resistance of the enamel) are analyzed.

Comparison of Hyrax and bonded expansion appliances.

The majority of rapid maxillary expansion studies have reported the use of appliances with metal bands attached to the posterior teeth. Tooth extrusion, dental tipping, and an increase in the vertical dimension are often encountered, which may not coincide with treatment objectives. Bonded appliances using interocclusal acrylic may control the vertical dimension and expand the maxillary halves in a more bodily and symmetrical fashion. The purpose of this clinical trial was to determine, by radiographic analysis, the differences between a conventional banded expander (Hyrax) and a bonded acrylic expander. Fourteen patients who exhibited a need for expansion were enrolled in the study. The results suggest that the increase in the vertical dimension often seen with the more conventional Hyrax appliance may be minimized or negated with the bonded appliance. However, there appeared to be no significant difference between the amount of dental tipping or symmetrical expansion between the two appliances, as previously theorized.

Dental appliances in the treatment of snoring. A comparison between an activator, a soft-palate lifter, and a mouth-shield.

Different dental appliances have been recommended in the treatment of snoring. The aim of the present study was to compare three different dental appliances regarding patient tolerance and the effect of snoring. Fifteen consecutive snorers were randomly selected to treatment with either a mandibular advancement device (activator), a soft-palate lifter or a mouth-shield. The activator satisfactorily reduced snoring in four out of five patients. At four-year follow-up, two patients had discontinued the treatment, one due to craniomandibular disorder. The soft-palate lifter had insufficient effect on snoring in four out of five patients. The results suggest that the activator has a satisfactory tolerance and effect on snoring, while the soft-palate lifter and the mouth-shield are ineffective in the treatment of snoring.

Estudo cefalométrico entre as alteraçöes resultantes de dois tipos de tratamento ortodôntico em jovens com má oclusäo de classe II, 1ª divisäo, de Angle / Cephalometric study between the alterations resulting of two types of orthodontic treatment in young with Angle class II, division 1 malocclusion

O diagnóstico das anormalidades dentofaciais associado ao conhecimento sobre o crescimento e desenvolvimento craniofacial possibilita a elaboraçäo de um plano de tratamento individualizado e mais adequado para o paciente. Atualmente objetiva-se além da correçäo das más relaçöes oclusais, melhor harmonia da estética facial. As más oclusöes devem ser tratadas segundo a sua natureza, ou seja, conforme as deficiências esqueléticas e/ou dentárias. Especificamente, na Classe II, 1ª divisäo, com envolvimento esquelético pode-se utilizar aparelhos ortopédicos funcionais para melhorar a relaçäo sagital, desde que o paciente encontre-se num período de crescimento e desenvolvimento craniofacial. Nesta pesquisa comparou-se cefalometricamente as alteraçöes decorrentes de duas formas de tratamento da Classe II, 1ª divisäo, em pacientes de ambos os sexos e com potencial de crescimento craniofacial. No primeiro grupo, composto por 25 pacientes, sendo 12 do sexo masculino e 13 do sexo feminino, foi tratado com a aparelhagem da técnica Edgewise. Os pacientes do segundo grupo, num total de 25, sendo 12 do sexo masculino e 13 do sexo feminino, utilizaram inicialmente um aparelho funcional, o ativador combinado com a ancoragem extrabucal occipital, para a normalizaçäo da relaçäo maxilomandibular no sentido ântero-posterior. Após esta fase, finalizou-se o tratamento destes pacientes com aparelhagem da técnica Edgewise. A amostra constou de 2 telerradiografias, em norma lateral, por paciente, tomadas no início e no final do tratamento. Objetivou-se comparar as alteraçöes cefalométricas médias de cada grupo, ocorridas entre a fase inicial e final de cada grupo, considerando a existência do dimorfismo sexual. Diante dos resultados obtidos e metodologia utilizada, julga-se lícito concluir que: * as comparaçöes entre as alteraçöes médias ocorridas nos dois grupos, tanto na maxila como na mandíbula, näo apresentaram diferenças estatisticamente significantes, refletindo alteraçöes semelhantes na relaçäo maxilo-mandibular; * as comparaçöes entre as alteraçöes médias dos ângulos FMA e Sn.GoGn näo apresentaram diferenças estatisticas na influência do padräo de crescimento dos pacientes. As alteraçöes médias da altura facial ântero-inferior, mostrou um dimorfismo sexual significante nos pacientes do grupo I, mas näo notou-se a diferença de valor estatístico entre os incrementos médios da AFAI, quando comparados os valores dos pacientes dos dois grupos; * em relaçäo às diferenças...

Temporomandibular disorders after early Class II treatment with bionators and headgears: results from a randomized controlled trial.

Symptoms and signs of temporomandibular disorders were assessed in children enrolled in a randomized controlled trial of early treatment for Class II malocclusion. Children (mean age of 9.8 years) were assigned to a treatment protocol (bionator, n = 60; observation, n = 60; headgear/bite plane, n = 71) using randomized block stratification. Temporomandibular joint (TMJ) sounds, joint capsule pain to palpation, and muscle pain to palpation were scored as binary responses (present/absent in a subject). Determinations were made by blinded, calibrated examiners initially (DC1) and after a Class I molar correction was achieved or 2 years had elapsed (DC3). Univariate relationships among explanatory factors (group assignment, gender, age, time interval between DC1 and DC3, Class II severity, mandibular plane angle, preparatory treatment, whether Class I molar relation was achieved) and binary responses were explored using Chi square tables and ANOVA methods. Logistic regression modeled the relationship between binary responses and the explanatory variables. At DC1, the 3 groups were equivalent in the explanatory variables (P > .05). Subjects with a TMJ sound, joint pain, and/or muscle pain at follow-up were more likely those who had the sign at baseline (P < .01). Early treatment with bionators and headgear/bite planes did not place healthy children without these signs at risk for developing these signs. Only increasing age (for the development of sounds, P < .04) and failure to achieve a Class I molar relation (for development of muscle pain, P < .04) placed sign-free children at greater risk. Subjects with TMJ pain at baseline were 7 times more likely to have pain at follow-up if they had been treated with a headgear/bite plane or observed than if they had been treated with a bionator (P = .007). We conclude that an immediate benefit or risk for children receiving early Class II treatment with bionators and headgear/bite planes with respect to temporomandibular joint function does not exist with the prospect that Class II children with TMJ capsule pain may benefit from bionator therapy.