Age dependence of compliance with orthodontic treatment in children with large overjet. An interview study.

Large overjet has been associated with an increased risk of trauma of the permanent maxillary incisors, especially before 10 years of age. The prevalence of an overjet of more than 6 mm in 10-year-old Swedish children is about 15%. To prevent trauma by reducing the overjet, this treatment be set in early in life. However, compliance with orthodontic treatment is a significant and well known problem and may be associated with the age of the patient. This study concerns children treated with an open activator with built in headgear (HG activator). The aim of treatment was to reduce the trauma risk in these patients as early as possible, and an objective of the study was to gain better knowledge of young children's (6-13 years of age) motivation for and response to correction of large overjet. In-depth interviews focusing on motivation were held with 18 children. Interviews were transcribed verbatim and analysed according to Grounded Theory, a qualitative method. The results indicate the importance of parental involvement for younger children's compliance. Older children seem to have a higher degree of internal motivation for treatment and less need for parental support for compliance with treatment. If treatment compliance can not be ensured through parents' wholehearted involvement and control it seems to be better to delay treatment until the child is older.

Modified pendulum appliance including distal screw and uprighting activation for non-compliance therapy of Class-II malocclusion in children and adolescents.

In present-day orthodontics there is an increasing call for therapeutic procedures and appliances allowing those delivering the treatment maximum independence from patient cooperation. This requires both the development of new therapeutic appliances and the optimization of existing ones (via modification). The present study aims to analyze the therapeutic outcomes obtained by using a pendulum appliance (distal screw and integrated molar uprighting activation), modified and independent of patient cooperation. The dentoalveolar and skeletal outcomes and secondary outcomes were observed in 50 children and adolescents. The dentoalveolar outcomes were as follows: 72.5% of the clinically visible increase in space were gained by distal molar movement and 27.5% by mesialization of the anterior segment. The molars showed slight distal tipping and extrusion, while the incisors showed slight labial tipping. In terms of time, the molars were moved distally by an average of 0.67 mm per month. Skeletal changes taking place during treatment using the pendulum appliance are negligible. Further advantages of the pendulum appliance are independence from patient cooperation and good acceptance by patients.

Effect of appliance reactivation after decay of initial activation on osteoclasts, tooth movement, and root resorption.

Clinical orthodontists frequently reactivate appliances following decay. Studies of tooth movement and tissue responses following reactivations indicate that linear tooth movement and rapid recruitment of osteoclasts can be achieved if reactivation is timed to coincide with the latter part of the bone remodeling cycle initiated by the first activation. Both can be delayed if reactivations are timed for the early part of the previous cycle. The objective of this study was to examine tooth movement, root resorption, and osteoclast recruitment following appliance reactivation after the first activation had decayed. Bilateral orthodontic appliances were activated with 40 cN in 144 rats to mesially tip the maxillary molars. After 16 days, rats were randomized into two groups of 72. In group 1, appliances were reactivated in precisely the same manner as the first activation. In group 2, appliances were sham-reactivated. Rats were sacrificed at 1, 3, 5, 7, 10, and 14 days. Orthodontic movement was measured cephalometrically; changes in osteoclasts and root resorption were assessed at both compression and tension sites histomorphometrically; tartrate-resistant acid phosphatase (TRAP) was measured in alveolar bone and serum biochemically. Orthodontic tooth movement was linear in group 1, but osteoclasts required 3 to 5 days to appear. There were no group- or time-related differences in root resorption. Bone TRAP levels were elevated in both groups but dropped significantly (p<0.01) in group 2 at day 7. Appliance reactivations that followed decay of the first activation produced efficient tooth movement without increased risk of root resorption, but these changes were not accompanied by rapid osteoclast recruitment at compression sites. Timing appliance reactivations for the latter portion of the previous bone remodeling cycle could have significant clinical advantages because the delay period seen in tooth movement following a single activation or short-term reactivation can be avoided.

Stability of skeletal changes after activator treatment of patients with class III malocclusions.

The aim of this study was to examine the skeletal changes produced by Class III activator during the treatment of patients with skeletal Class III malocclusions and to characterize the stability of these changes in the years after treatment. The samples consisted of 19 girls and 9 boys. Their mean age was 9.6 +/- 1.4 years at the beginning of the treatment. The average treatment time was 1 +/- 0.5 years. Measurements were obtained from cephalometric head films taken before treatment, at the end of treatment, and 6.6 +/- 2.1 years after the end of activator treatment. During the treatment, the Class III activator produced a statistically significant increase in the ANB angle, and this change remained through the postactivator period. The gonial angle exhibited a compensatory decline during the postactivator period. The skeletal profile was improved with treatment and was not lost during the posttreatment period despite significant increase in maxillomandibular differential. This study indicates that Class III activator may be a viable mode for the initial stage of skeletal Class III treatment, in conjunction with the period of postfunctional fixed or removable appliance therapy to improve the occlusion.

Effectiveness of intra- and extraoral aids to the bionator. A controlled study within the scope of the "Wuerzburg concept".

A bimaxillary device is effective only if the therapeutic position of the mandible is maintained for as long a period as possible by day and night, i.e. the lower jaw cannot "drop" from the construction bite position. One simple means of preventing the mandible from dropping out of the bimaxillary appliance during sleep and thus of ensuring adaptation of the muscles and of the joint structures during the night without impairing active adaptation during daytime functions (speaking, swallowing) is being used at Wuerzburg University Department of Orthodontics: In connection with anterior traction, which anchors the bimaxillary appliance to the maxilla, attachments are fixed to the mandibular canines or first premolars, so that the mandible is kept in the therapeutic position during the night by means of elastics. Besides the description of this method, the results of a clinical study on its effectiveness are presented in this paper. In the experimental group (20 Class II/1 patients) treated with the combination of bionator with anterior extraoral traction and up-and-down elastics, the increase of the SNB angle and accordingly of the ANB angle was twice as great as in a control group treated only with bionator and extraoral traction without additional securing of the mandible.

The influence of the spring activator on the mobility of the lower jaw in traumatically injured patients.

For functional rehabilitation and improvement of mandibular mobility, 14 patients with dislocated collum or collum fracture dislocations were treated with a spring activator after surgical-conservative treatment. With an interincisal distance of < 12 mm, therapy was started with a loop spring. The average age of the patients was 26.6 years. Eight patients showed additional traumatic injuries, 2 patients were seriously polytraumatically injured. The clinical investigations referring to the maximum mouth opening and maximal interincisal distance resulted in a good to very good functional rehabilitation in all cases. The average maximal interincisal distance of 31.7 mm at the beginning of the spring activator therapy could be increased to 47.3 mm. The largest increase of the maximal interincisal distance was observed after 4 weeks of therapy. The type of reaction, however, differed interindividually. Three patients showed a spontaneous improvement of the interincisal distance within the first 2 to 3 weeks of removal of intermaxillary fixation, whereas 7 patients showed no improvement or only slightly improved values until insertion of the spring activator. An enlargement of the interincisal distance could be achieved in almost every patient within a relatively short period of time despite a drastically reduced mouth opening. Consequently, because of its mode of action in the form of a neuromuscular influence, the spring activator is especially suitable for the functional rehabilitation of patients with fractures of the condylar process.

Disciplina Alexander: seqüência de tratamento completa de maloclusäo classe II divisäo 2 / Alexander Discipline: sequence of a complet teatment of class II division 2 maloclusion

Neste relato de caso clínico o autor apresenta a seqüência de tratamento completa da Disciplina Alexander. O paciente com 13 anos de idade, portador de uma maloclusäo classe II divisäo 2 de Angle, com apinhamento no segmento antero-superior e inferior e falta de espaço para erupçäo do canino superior esquerdo. Para o tratamento foi indicado o Distalador Removível da Reabilitaçäo Dinâmica Funcional dos Maxilares (RDFM) para a obtençäo do espaço para o canino e imediatamente após a dilataçäo, aparelho fixo da Disciplina Alexander

O uso das aletas funcionais Gomes nos tratamentos das mordidas abertas anteriores / The treatment of the open bites using the Gomes functional walls

Os autores propöe uma nova aparatologia nos tratamentos das mordidas abertas anteriores, procurando demonstrar as alteraçöes ósseas, musculares e posturais causadas pela maloclusäo e sua correçäo utilizando as Aletas Funcionais Gomes

O uso do P.E.T. (Polietileno Tereftalato) na construçäo de aparatos ortopédicos funcionais / The use of P.E.T. in the construction of functional orthopedics appliances

Este trabalho objetiva demonstrar como o P.E.T. (Politileno Tereftalato) pode ser utilizado como elemento ativo na construçäo de aparatos ortopédicos funcionais (ativadores) e compara o sistema tradicional (aço e tornos) com o sistema plástico para esta finalidade

Avaliaçäo cefalométrica comparativa das alteraçöes esqueléticas, dentárias e faciais ocorridas em pacientes com má oclusäo de classe II, divisäo 1, tratados com traçäo extra bucal ortopédica e com Bionator de Balters / Cephalometric evaluation of the facial, dental and skeletal changes occurred in class II, divisäo 1, patients following orthopedic heagear and Balters' Bionator therapy

Este estudo foi conduzido com o propósito de realizar uma avaliaçäo cefalométrica das alteraçöes esqueléticas, dentárias e faciais ocorridas em pacientes portadores de má oclusöes classe II, divisäo 1, tratados com traçäo extra bucal ortopédica e com Binator de Balters. Objetivando dissociar as alteraçöes especificamente produzidas pela terapia daquelas decorrentes do processo de crescimento crânio facial espontâneo, foram estudados também 2 grupos de controle de indivíduos com o mesmo tipo de má oclusäo, porém sem nenhum tratamento. A amostra se constituiu de 80 telerradiografias obtidas de 40 indivíduos com idades entre 7 anos e 5 meses e 13 anos e 7 meses (média de 10 anos e 9 meses), portadores de má oclusäo de classe II, divisäo 1. Telerradiografias iniciais foram realizadas em todos os pacientes e os cefalogramas obtidos foram usados para o diagnóstico cefalométrico das más oclusöes. Assim, os indivíduos foram entäo divididos em 4 grupos, a saber: *grupo A , constituído por indivíduos apresentando protrusäo maxilar tratados com Bianator de Balters num período médio de 9,7 meses; *grupo B, constituído por indivíduos apresentando retrusäo mandibular tratados com Bionator de Balters por um período médio de 10,8 meses; *grupo C, de indivíduos com protrusäo mandibular sem nenhum tratamento; *grupo D, de indivíduos com retrusäo mandibular, também sem tratamento. Os grupos C e D, chamados de grupo de controle, foram observados por um período médio de 9,3 meses. Após a realizaçäo das telerradiografias finais e a obtençäo dos cefalogramas correspondentes, os dados obtidos foram comparados estatisticamente. A análise cefalométrica empregada foi a proposta por MCNAMARA JR., associada à avaliaçäo do ângulo naso-labial

Fratura bicondilar em crianças: tratamento conservador com aparelho ortopédico / Bilateral condylar fracture in children: an orthopedic functional treatment

Os autores apresentam um caso clínico de fratura bilateral de cöndilo em criança de 5 anos de idade que foi tratada unicamente com aparelho ortopédico funcional (Bionatur de Balters). Este aparelho estimula a musculatura envolvida com a articulaçäo temporomandibular (ATM), especialmente o músculo pterigoideo lateral, permitindo um bom resultado, mesmo em casos de fratura com grande desvio dos fragmentos, reduzindo os riscos de seqüelas que os tratamentos cruentos poderiam deixar, como lesäo do nervo facial, ou mesmo seqüela dos tratamentos conservadores por fixaçäo rígida como no caso de Anquilose Mandibular

Estudo cefalométrico radiográfico sobre a influência do Bionator de Balters no crescimento mandibular e o incremento vertical do ramo ascendente da mandíbula, nos tratamentos das más-oclusões de Classe II divisão 1ª com retrognatismo mandibular / Radiografic cephalometric study of the influence of the Bionator of Balters on the mandibular growth and the vertical increment of the mandibular ramus, in the treatment of the Class II division 1 malocclusions with mandibular retrognathism

Estudo cefalométrico em telerradiografias em norma lateral, com a finalidade de avaliar o efeito do tratamento com o Bionator de Balters sobre a altura do ramo ascendente da mandíbula, em pacientes portadores de más-oclusões de Classe, divisão 1º com retrognatismo mandibular. A amostra tratada contou com um total de 33 pacientes, sendo 23 do sexo feminino e 10 do sexo masculino, com média de idade de 10 anos e tempo de controle radiográfico de 18,6 meses. Averiguou-se a variável linear mandibular XI-DC, comparando a diferença encontrada em sua medida entre os momentos de tratamento T1 e T2, com a expectativa de seu incremento, de acordo com a previsão de crescimento. A variável Ba-Na também foi estudada, fornecendo um parâmetro de crescimento de Ricketts. A análise estatística dos resultados indicou que não foram encontradas diferenças significantes para a variável Ba-a frente à previsão. A variável XI-DC apresentou incremento significantemente maior que sua previsão

O uso das aletas bi-laterais no tratamento das maloclusões de Classe III de angle / The use of bilateral wing in the treatment of Angle's Class III malocclusions

A utilização do próprio mecanismo desencadeador da maloclusão, para o tratamento da mesma, proporcionou ao profissional a eliminação por completo de suas seqüelas, desde que o tratamento seja iniciado na fase de crescimento, evitando a extração de elementos dentários, e a cirurgia ortognática

Ativador elástico aberto / Open elastic activator

Os autores descrevem algumas variaçöes do ativador elástico, desenvolvido em 1955 pelo Prof. George Klammt, da cidade de GÖrlitz, Alemanha, relacionando cada tipo com sua aplicaçäo específica

Tratamento da má oclusäo de classe II divisäo 1ª com ativador conjugado à traçäo alta relato de um caso clínico / Malocclusion class II treatment 1ª division with a headgear activador combination clinical case report

Os relatam o tratamento de um paciente com má oclusäo de Classe II, divisäo 1ª, através da ortopedia funcional dos maxilares. Após o uso de um ativador conjugado com traçäo alta, os resultados mostraram que houve uma restriçäo do crescimento vertical da maxila e um aumento sagital da mandíbula