Avaliação digital tridimensional da movimentação dentária com alinhadores transparentes / Three-dimensional digital assessment of tooth movement with transparent aligners

O objetivo deste estudo foi avaliar a concordância das medidas obtidas em modelos sobrepostos em dois programas com as medidas propostas pelo software ClinCheck; além de avaliar a eficácia da movimentação dentária obtida por alinhadores dentários, por meio de sobreposições de modelos digitais. Sete pacientes foram submetidos a tratamento ortodôntico com o sistema Invisalign. Os modelos digitais iniciais e finais fornecidos pela Align Technology foram sobrepostos nos programas 3D Slicer 4.6.2 e GOM Inspect 2017 para mensurar as movimentações dentárias e comparar com as que foram propostas pelo software ClinCheck; os modelos iniciais e finais obtidos clinicamente foram digitalizados e sobrepostos no software GOM Inspect 2017 para mensurar os movimentos dentários obtidos clinicamente e comparar com as medidas propostas pelo software ClinCheck. Posteriormente, os dados das sobreposições dos modelos iniciais e finais fornecidos pelo Align Technology foram comparados pela Análise de Concordância de BlandAltman. No programa GOM Inspect 2017, houve concordância em dois dos seis movimentos avaliados; já no programa 3D Slicer 4.6.2, foi encontrada concordância em três dos seis movimentos. Já os dados das sobreposições dos modelos iniciais e finais obtidos clinicamente foram comparados pelo teste de Wilcoxon. Os movimentos de extrusão, translação vestibular e translação mesial na maxila não apresentaram diferença estatisticamente significativa. Todos os movimentos na mandíbula e os movimentos de intrusão, translação lingual e translação distal na maxila apresentaram diferença estatisticamente significante. Apesar de clinicamente a diferença encontrada entre os softwares analisados e o ClinCheck ser desprezível, não podemos substituir o ClinCheck por outros softwares. Desta forma, para substituir um método por outro, o ideal seria que todas as análises apresentassem concordância com o software ClinCheck. Já para a comparação da movimentação dentária obtida clinicamente com a que foi proposta pela Align Technology, percebemos que movimentos dentários na mandíbula são imprecisos. Os movimentos de extrusão, translação vestibular e translação mesial na maxila foram identificados como precisos. As diferenças obtidas foram clinicamente desprezíveis considerando os movimentos isolados, mas significantes quando consideramos todos os movimentos propostos para um grupo de dentes. (AU)

The aim of this study was to evaluate the agreement of measures obtained by superimposition of models in two different programs with the measures proposed by the ClinCheck software; besides evaluating the efficacy of tooth movement obtained by dental aligners, through superimposition of digital models. Seven patients underwent orthodontic treatment with the Invisalign system. The initial and final digital models provided by Align Technology were superimposed on 3D Slicer 4.6.2 and GOM Inspect 2017 software to measure dental movements and compare with those proposed by the ClinCheck software; the initial and final models clinically obtained were digitized and superimposed on the GOM Inspect 2017 software to measure clinically obtained dental movements and compare with the measures proposed by the ClinCheck software. Subsequently, the superimposition data of the initial and final models provided by Align Technology were compared by the Bland-Altman Concordance Analysis. In the GOM Inspect 2017 software, there was agreement in two of the six movements evaluated; nevertheless, in the 3D Slicer 4.6.2 program, concordance was found in three of the six movements. The superimposed data of the initial and final models obtained clinically were compared by the Wilcoxon test. The movements of extrusion, vestibular translation and mesial translation in the maxilla did not present a statistically significant difference. All mandible tooth movements and the movements of intrusion, lingual translation and distal translation in the maxilla presented a statistically significant difference. Although clinically the difference found between the analyzed software and ClinCheck is negligible, we can not replace ClinCheck with other software. Thus, to substitute one method for another, ideally all analyzes would agree with ClinCheck software. In order to compare the dental movement obtained clinically with that proposed by Align Technology, we noticed that dental movements in the mandible are imprecise. The movements of extrusion, vestibular translation and mesial translation in the maxilla were identified as accurate. The differences obtained were clinically negligible considering the isolated movements, but significant when considering all the proposed movements for a group of teeth. (AU)

Predictability of orthodontic movement with orthodontic aligners: a retrospective study.

BACKGROUND: The aim of this study was to evaluate the predictability of F22 aligners (Sweden & Martina, Due Carrare, Italy) in guiding teeth into the positions planned using digital orthodontic setup. METHODS: Sixteen adult patients (6 males and 10 females, mean age 28 years 7 months) were selected, and a total of 345 teeth were analysed. Pre-treatment, ideal post-treatment-as planned on digital setup-and real post-treatment models were analysed using VAM software (Vectra, Canfield Scientific, Fairfield, NJ, USA). Prescribed and real rotation, mesiodistal tip and vestibulolingual tip were calculated for each tooth and, subsequently, analysed by tooth type (right and left upper and lower incisors, canines, premolars and molars) to identify the mean error and accuracy of each type of movement achieved with the aligner with respect to those planned using the setup. RESULTS: The mean predictability of movements achieved using F22 aligners was 73.6%. Mesiodistal tipping showed the most predictability, at 82.5% with respect to the ideal; this was followed by vestibulolingual tipping (72.9%) and finally rotation (66.8%). In particular, mesiodistal tip on the upper molars and lower premolars were achieved with the most predictability (93.4 and 96.7%, respectively), while rotation on the lower canines was the least efficaciously achieved (54.2%). CONCLUSIONS: Without the use of auxiliaries, orthodontic aligners are unable to achieve programmed movement with 100% predictability. In particular, although tipping movements were efficaciously achieved, especially at the molars and premolars, rotation of the lower canines was an extremely unpredictable movement.

Península capilar segmentada, como prevenção da ascensão capilar e seu desalinhamento nas ritidoplastias / Segmented scalp peninsula to prevent a raised hairline and misalignment in rhytidoplasty

INTRODUÇÃO: A ritidoplastia tem demonstrado excelentes resultados no tratamento da flacidez facial ao longo dos tempos, porém em alguns casos selecionados, nos quais o paciente apresenta flacidez facial acentuada associada com implantação capilar pré-auricular alta, observamos, após a tração dos retalhos, uma ascensão da implantação capilar acima da raiz da helix, causando um aspecto inestético facial e configurando um estigma cirúrgico para o procedimento. O objetivo desse estudo é demonstrar uma técnica cirúrgica com intuito de prevenir a ascensão capilar e manter o seu correto alinhamento, no lifting facial. MÉTODOS: Foram operados 25 pacientes, submetidos à ritidoplastia, dos quais 12 realizamos a península capilar segmentada. Foi realizada uma análise descritiva desse grupo, quanto à idade, altura da implantação capilar, tempo cirúrgico, elevação do "pé do cabelo", necrose, hematoma pós-operatório, cicatrizes inestéticas e neuropraxia. RESULTADOS: Em relação à população analisada, realizamos a península capilar segmentada em 12 pacientes, ou seja, 48%, a idade variou entre 41 e 74 anos, sendo a média de 60 anos. O retorno às atividades habituais variou de 10 a 21 dias. Não ocorreram alterações inestéticas da implantação da linha capilar na "costeleta" nos 12 pacientes submetidos à península capilar segmentada, houve um (4%) caso de hematoma, nenhum caso de necrose ou neuropraxia. CONCLUSÃO: A península capilar segmentada demonstrou ser uma técnica de fácil execução, baixo índice de complicações e com resultados estéticos satisfatórios.

INTRODUCTION: Rhytidoplasty has shown excellent results in the treatment of facial laxity over the years, but in a few cases in which the patient has increased facial laxity associated with high preauricular scalp implantation, we observed elevation of implantation above the root of the helix after flap traction, resulting in an unesthetic facial appearance and marring the surgical procedure. The objective of this study was to demonstrate a surgical technique designed to prevent hairline recession and maintain correct alignment for the facelift. METHODS: Of 25 patients who underwent rhytidoplasty, 12 received a segmented scalp peninsula. Descriptive analysis in this group included age, level of scalp implantation, surgical time, elevation of the hairline, necrosis, postoperative hematoma, unesthetic scars, and neuropraxia. RESULTS: We analyzed the results of a segmented scalp peninsula in 12 patients, ranging in age between 41 and 74 years, with a mean of 60 years. The return to usual activities ranged from 10 to 21 days. No unesthetic changes resulted from placement of the hairline on the sideburn in these 12 patients; there was one (4%) case of hematoma, but no case of necrosis or neuropraxia. CONCLUSION: The segmented scalp peninsula is an easily performed technique, with a low risk of complications and with satisfactory esthetic results.

Correção da mordida aberta anterior com a utilização do aparelho expansor removível com concha suspensa Celli-C / Anterior open bite correction with the removable expander appliance with suspended shell Celli-C

Introdução: quando a mordida aberta anterior é corrigida em idade precoce, promove-se a remodelação do processo dentoalveolar anterior, o reequilíbrio miofuncional e a reorganização do processo de crescimento e desenvolvimento facial inerentes ao indivíduo. Objetivo: apresentar o tratamento de uma paciente de 9 anos e 5 meses de idade, realizado com o aparelho Celli-C, utilizado para a correção da mordida aberta dentoalveolar anterior. Resultados: os resultados obtidos após 10 meses de tratamento mostraram que a mordida aberta anterior foi corrigida com adequado reposicionamento das estruturas dentoalveolares, favorável reorganização do equilíbrio maxilomandibular e com a obtenção de um adequado selamento labial — fator importante para a reorganização do processo de crescimento e desenvolvimento dentofacial. Conclusão: o aparelho Celli-C consiste em um recurso eficaz para correção da mordida aberta anterior, de forma rápida e satisfatória.

Alinhadores invisíveis: indicações, limitações biomecânicas e a problemática da mensuração das forças aplicadas / Invisible aligners: indications, biomechanical limitations and the problem of measuring the forces applied

Os alinhadores invisíveis ganharam o seu espaço no arsenal do ortodontista moderno, mas, como toda nova tecnologia, o uso indiscriminado sem atentar-se para as suas indicações e limitações é preocupante. Os anseios por uma estética adequada não podem sobrepujar os resultados clínicos alcançados. O presente artigo realiza uma breve revisão da literatura dos alinhadores invisíveis, com finalidade de discutir a sua problemática biomecânica, assim como as indicações e limitações da mensuração da força aplicada. Dessa maneira, serão apresentados dois casos clínicos com essa proposta de tratamento como alternativa no cotidiano do ortodontista.

Tudo o que você precisa saber sobre a placa de Hawley / All you need to know about the Hawley appliance

A Placa de Hawley, um aparelho removível consagrado na literatura ortodôntica, ocupa um lugar de destaque na Ortodontia. É utilizada principalmente após a finalização da Ortodontia corretiva, com a finalidade de manter a estabilidade do tratamento. Este artigo abordará a placa de Hawley, sua evolução e versatilidade, descrevendo várias indicações possíveis além da contenção, como: a realização de pequenos movimentos de inclinação e de rotação; a extrusão de dentes posteriores; a preservação de espaço e fixação de dentes de estoque, servindo como prótese temporária. Seu desenho permite a incorporação de grade palatina, parafuso expansor, molas digitais, orifício reeducador da postura lingual e arco facial para o AEB conjugado. Entretanto, deve-se lembrar que a movimentação ortodôntica com aparelhos removíveis envolve somente movimentos de inclinação dentária, o que limita a sua aplicação.

Review of oral appliances for treatment of sleep-disordered breathing.

Between 1982 and 2006, there were 89 distinct publications dealing with oral appliance therapy involving a total of 3,027 patients, which reported results of sleep studies performed with and without the appliance. These studies, which constitute a very heterogeneous group in terms of methodology and patient population, are reviewed and the results summarized. This review focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index or respiratory disturbance index), ability of oral appliances to reduce snoring, effect of oral appliances on daytime function, comparison of oral appliances with other treatments (continuous positive airway pressure and surgery), side effects, dental changes (overbite and overjet), and long-term compliance. We found that the success rate, defined as the ability of the oral appliances to reduce apnea/hypopnea index to less than 10, is 54%. The response rate, defined as at least 50% reduction in the initial apnea/hypopnea index (although it still remained above 10), is 21%. When only the results of randomized, crossover, placebo-controlled studies are considered, the success and response rates are 50% and 14%, respectively. Snoring was reduced by 45%. In the studies comparing oral appliances to continuous positive airway pressure (CPAP) or to uvulopalatopharyngoplasty (UPPP), an appliance reduced initial AHI by 42%, CPAP reduced it by 75%, and UPPP by 30%. The majority of patients prefer using oral appliance than CPAP. Use of oral appliances improves daytime function somewhat; the Epworth sleepiness score (ESS) dropped from 11.2 to 7.8 in 854 patients. A summary of the follow-up compliance data shows that at 30 months, 56-68% of patients continue to use oral appliance. Side effects are relatively minor but frequent. The most common ones are excessive salivation and teeth discomfort. Efficacy and side effects depend on the type of appliance, degree of protrusion, vertical opening, and other settings. We conclude that oral appliances, although not as effective as CPAP in reducing sleep apnea, snoring, and improving daytime function, have a definite role in the treatment of snoring and sleep apnea.

Distalamiento molar bilateral en el maxilar superior sin colaboración del paciente antes de la realización de la cirugía ortognática correctora; caso clínico que comprende su terapéutica la utilización del Quad Pendulum / Bilateral molar distalization in the superior maxilla without patient collaboration before the orthognathic surgey

La fase de nivelado prequirúrgica puede necesitar el distalamiento progresivo de los primeros y segundos molares. Si el mismo es realizado con aparatología que no requiera la colaboración del paciente y con anclaje dental exclusivamente, los molares deben ser distalados consecutivamente, para minimizar la pérdida de anclaje. El quad pendulum, péndulo modificado especialmente para poder tratar pacientes adultos, permite la distalación molar mediante el uso de cuatro resortes, cada uno de los cuales puede ser activado separadamente. Este péndulo modificaco puede ser anclado en un implante intraóseo

Distalamiento molar bilateral en el maxilar superior sin colaboración del paciente antes de la realización de la cirugía ortognática correctora; caso clínico que comprende su terapéutica la utilización del Quad Pendulum / Bilateral molar distalization in the superior maxilla without patient collaboration before the orthognathic surgey

La fase de nivelado prequirúrgica puede necesitar el distalamiento progresivo de los primeros y segundos molares. Si el mismo es realizado con aparatología que no requiera la colaboración del paciente y con anclaje dental exclusivamente, los molares deben ser distalados consecutivamente, para minimizar la pérdida de anclaje. El quad pendulum, péndulo modificado especialmente para poder tratar pacientes adultos, permite la distalación molar mediante el uso de cuatro resortes, cada uno de los cuales puede ser activado separadamente. Este péndulo modificaco puede ser anclado en un implante intraóseo(AU)

Fatigue resistance of removable orthodontic appliance reinforced with glass fibre weave.

The aim of this study was to measure the fatigue resistance of fibre-reinforced composite (FRC) reinforced polymeric parts of a removable orthodontic appliance beside the clasp. The effect of quantity and position of FRC-reinforcement were investigated. In addition, the influence of water storage on the fatigue properties was determined. The test specimens for eight groups (n=6) were manufactured from autopolymerizing acrylic resin. Polymethylmethacrylate pre-impregnated woven glass fibre was used as reinforcement of acrylic resin specimens at the region of steel wire clasp. The test specimens of the control group were not reinforced. In the second group, the test specimens were reinforced with one fibre layer (thickness: 0.06 mm) on the tension side, and in the third and fourth group with two fibre layers. Fatigue resistance was measured by applying repeated bending force to the clasp. The highest fatigue resistance values were achieved when the test specimens were fibre-reinforced with two fibre layers. The lowest fatigue resistance values resulted when the test specimens were not reinforced (P=0.046, anova). Water storage had a tendency to decrease the fatigue resistance in all fibre reinforced test specimen groups. The results suggest that use of the woven polymer pre-impregnated glass FRC-reinforcement increases the fracture resistance of orthodontic appliance made of acrylic polymer.

Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion.

To evaluate the clinical usefulness and tolerability of an oral jaw-positioning appliance in the treatment of obstructive sleep apnea syndrome in children, we studied 32 patients (mean age, 7.1 +/- 2.6 yr; 20 males) with symptoms of obstructive sleep apnea, malocclusion, and a baseline apnea index > 1 event/h. A group of 19 subjects was randomly assigned to a 6-mo trial of an oral appliance; the remainder acted as control subjects. At baseline and after the trial all patients underwent physical examination, a standard polysomnography, and orthodontic assessment. A modified version of the Brouillette questionnaire related to obstructive sleep apnea symptoms was administered to parents before and after the trial and a clinical score was calculated. Of the 32 subjects enrolled, 4 treated subjects and 5 control subjects were lost to follow-up. Polysomnography after the trial showed that treated subjects all had significantly lower apnea index (p < 0.001) and hypopnea index values (p < 0.001) than before the trial, whereas in untreated control subjects these values remained almost unchanged. Clinical assessment before and after treatment showed that in 7 of the 14 subjects (50%) the oral appliance had reduced (a fall of at least 2 points in the respiratory score) and in 7 had resolved the main respiratory symptoms, whereas untreated patients continued to have symptoms. In conclusion, treatment of obstructive sleep apnea syndrome with an oral appliance in children with malocclusion is effective and well tolerated.

Distalamiento de molares / Molar distalization

El propósito de este artículo es que el ortodoncista cuando vaya a utilizar un aparato de cualquier tipo (ortopédico u ortodóntico), obtenido en el mercado odontológico, o presenciado en un Congreso, conozca cuál es el sistema de fuerzas que genera el mismo, que en definitiva eso es lo que hace que los dientes se muevan, o no, según lo indique el plan de tratamiento

Distalamiento de molares / Molar distalization

El propósito de este artículo es que el ortodoncista cuando vaya a utilizar un aparato de cualquier tipo (ortopédico u ortodóntico), obtenido en el mercado odontológico, o presenciado en un Congreso, conozca cuál es el sistema de fuerzas que genera el mismo, que en definitiva eso es lo que hace que los dientes se muevan, o no, según lo indique el plan de tratamiento (AU)

Oral appliances for the treatment of snoring and obstructive sleep apnea.

Oral appliances have been used by dentists for several decades to treat snoring and obstructive sleep apnea. Although these devices are regulated by the Food and Drug Administration, most have undergone only sparse clinical testing for efficacy and safety. Most otolaryngologists are not well-versed in their applicability as treatment options. This review summarizes the historical development of oral appliances, the types of available devices, the current literature regarding devices, and pertinent regulatory issues as they relate to the ongoing debate over appliance use and potential misuse.