Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review.

In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative preparation, surgical procedures and post-surgical orthodontics with pertinent literature survey are also discussed.

[Adult orthodontics for a better prosthesis]. / L'orthodontie adulte pour une meilleure prothèse.

INTRODUCTION: Adult patients are seen more frequently in our orthodontic offices. Unlike the adolescent, the adult patient will often need a multidisciplinary approach due to tooth migrations secondary to extractions or periodontal disease. MATERIALS AND METHODS: This article will address the indications and orthodontic solutions to various restorative problems relative to the adult patient. Specific orthodontic mechanics aimed at facilitating and improving the prosthetic outcomes will be described and illustrated with clinical cases.

Concepts, protocol, variations and current trends in surgery first orthognathic approach: a literature review

ABSTRACT In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative preparation, surgical procedures and post-surgical orthodontics with pertinent literature survey are also discussed.

RESUMO Na presente era da Ortodontia de resultados acelerados, a cirurgia ortognática com benefício antecipado (COBA) ganhou popularidade entre muitos clínicos, hospitais terciários e pacientes. A vantagem da COBA é a redução da duração total do tratamento, juntamente com a melhora precoce da estética facial. Na COBA, a ausência de uma fase pré-cirúrgica permite que a cirurgia seja realizada antes e, só então, venha o tratamento ortodôntico abrangente para se alcançar a oclusão desejada. Os conceitos básicos de cirurgia primeiro, cirurgia por último, COBA e a técnica COBA de Sendai, bem como suas variações, são aqui revistos. Também são discutidos no presente artigo, junto com a revisão da literatura pertinente, os recentes avanços da COBA no contexto do preparo pré-cirúrgico, dos procedimentos cirúrgicos e da Ortodontia pós-cirúrgica.

[Perfecting smile esthetics: keep it pink!] / Comment parfaire l'esthétique du sourire : toujours en rose !

INTRODUCTION: Smile aesthetics is based on numerical, physical, physiological and psychological data regarding beauty, while taking into account the desires of the patient. It is determined by the shape, colour and position of the lips, teeth and gingival tissues. Periodontal examination in both the facial and labial settings supports analysis of the gingival display during natural and forced smiling, the health of the periodontium, the gingival contours, the aesthetic gingival line, and the presence of the papillae. MATERIALS AND METHODS: All these data will help establish a gingival aesthetic score to determine the causes of disharmony and possible treatment. DISCUSSION: During implementation of the global orthodontic treatment plan, periodontal plastic surgery can change the gingival appearance and morphology in order to restore the harmony of the smile. Subtractive periodontal plastic surgery treats biological space defects and excess tissue during incomplete passive eruption by gingivectomy or apically positioned flap, combined, or not, with osteoplasty or osteoectomy. Finally, injections of hyaluronic acid in the papillae can plump them up and minimize the size of any black holes.

Orthodontic Treatment Need of Austrian Schoolchildren in the Mixed Dentition Stage.

Malocclusal traits can impair dental health and aesthetical appearance. The index of orthodontic treatment need (IOTN) identifies the patients who benefit the most from orthodontic treatment. The aim of this study was to assess the malocclusion frequencies and the orthodontic treatment need among Austrian children in the mixed dentition stage, since there is no pre-existing data from Austria. In the present study, 157 children aged between 8 and 10 years were examined. Following an anamnesis questionnaire, which included a question about the parents' perceived treatment need, the children were examined clinically and dental impressions were taken. The sagittal molar relationship, overjet, overbite and the presence of cross- or scissor bite were registered. The treatment need was assessed using the dental health component (DHC) of the index of orthodontic treatment need (IOTN). 64.3% (95% CI [56.8, 71.8]) of the children showed Angle class I molar relation, 33.1% (95% CI [25.8, 40.5]) class II and 2.5% (95% CI [0.1, 5.0]) Angle class III relation. Crossbite was found in 36.3% (95% CI [28.8, 43.8]) of the participants. A treatment need for medical reasons (IOTN 4 or 5) was found in 30.6% (95% CI [23.4, 37.8]). There was no statistically significant relationship between objective treatment need and the parents' perception. The malocclusion frequencies and the treatment need assessed in the present study appeared to be comparable to those assessed in other countries. The data supports the opinion that orthodontic screening is important and necessary at this stage of dental development, also due to the discordance between objective and perceived treatment need.

Changes in university orthodontic care over a period of 20 years : Patient characteristics, treatment quality, and treatment costs.

AIM: The aim of the present study was to analyze whether there were changes in the severity of malocclusions of patients treated at the Department of Orthodontics, University of Giessen, Germany over a period of 20 years (1992-2012) and if the implementation of the KIG system (German index of treatment need) in 2001 had any effect on the patient cohort. Furthermore, the study aimed to analyze the influence of the severity of malocclusion on treatment quality and economic efficiency (relation payment per case/treatment effort). MATERIALS AND METHODS: The files of all 5385 patients admitted to the orthodontic department between 1992 and 2012 were screened and the following information was recorded: patient characteristics, treatment duration, KIG, treatment outcome, and costs. RESULTS: In the KIG period, patients were older, pretreatment malocclusions were more severe, treatment took longer, required more appointments, and did not achieve the same degree of perfection as in the pre-KIG period. Patients with a higher pretreatment KIG category had longer treatments and did not achieve the same degree of perfection as patients with lower KIG categories. Although total payment was slightly higher for the more severe cases, their cost-per-appointment ratio was significantly lower. CONCLUSION: In the present university department, a shift of the orthodontic care task towards more complex cases has occurred over the last 20 years. Generally the quality of orthodontic treatment was good, but it has been demonstrated that the higher KIG cases did not end up at the same level of excellence as the lower KIG cases. Furthermore, KIG 5 patients had a longer treatment duration, and required more appointments than lower KIG cases.

Modern trends in Class III orthognathic treatment: A time series analysis.

OBJECTIVE: To examine the current trends in surgical-orthodontic treatment for patients with Class III malocclusion using time-series analysis. MATERIALS AND METHODS: The records of 2994 consecutive patients who underwent orthognathic surgery from January 1, 2004, through December 31, 2015, at Seoul National University Dental Hospital, Seoul, Korea, were reviewed. Clinical data from each surgical and orthodontic treatment record included patient's sex, age at the time of surgery, malocclusion classification, type of orthognathic surgical procedure, place where the orthodontic treatment was performed, orthodontic treatment modality, and time elapsed for pre- and postoperative orthodontic treatment. RESULTS: Out of the orthognathic surgery patients, 86% had Class III malocclusion. Among them, two-jaw surgeries have become by far the most common orthognathic surgical treatment these days. The age at the time of surgery and the number of new patients had seasonal variations, which demonstrated opposing patterns. There was neither positive nor negative correlation between pre- and postoperative orthodontic treatment time. Elapsed orthodontic treatment time for both before and after Class III orthognathic surgeries has been decreasing over the years. CONCLUSION: Results of the time series analysis might provide clinicians with some insights into current surgical and orthodontic management.

[TMJ and orthodontics, "past, present and future"]. / ATM et orthodontie, « passé, présent et futur ¼.

In the past, the ATM was mainly associated with the growth of the mandibular condyle. Many studies (on rats) showed the role of condylar cartilage in the growth response following stimulation by orthopedic appliances. From where, Class II dysmorphosis "orthopedic" treatments to grow the mandible; but this concept is discussed in the literature in the absence of fully conclusive results and especially since the contribution of orthognathic surgery. Currently, the operating concept is the mechanical stimulation and therefore the function will shape the ATM during growth and that, from an early age. Prevention of dysmorphoses must go through behavioral counseling to be adopted by parents from the birth of their child: to stimulate mandibular propulsion breastfeeding, then by a hard diet inducing an alternating unilateral chewing. Ignorance of the specificity of temporomandibular dysfunction (TMD) notably among teenagers has, in the past, left a doubt about the positive or negative role that could have orthodontic treatment on the TMJ. Currently, the best knowledge of TMJ and TMD provides a better therapeutic conduct: behavioral counseling especially for the girl hyperdivergente with small condyles, control of the condylar position, occlusal adjustments at the end of orthodontic treatment. The future of TMJ in relation with orthodontics is based on prevention, screening and deepening of our knowledge. The orthodontist will thus not make a treatment in patients at risk or will identify it and finish the treatment perfectly.

Relação entre o ponto A e a alteração da inclinação dos incisivos superiores / Relationship between point A and the change of the maxillary incisors inclination

O presente estudo propôs avaliar, cefalometricamente, a alteração do ponto A no plano sagital após mudança na inclinação dos incisivos superiores. Métodos: 21 pares de telerradiografias tomadas, no início e no final do tratamento ortodôntico, foram coletados de uma clínica particular na cidade de Aracaju (SE). A amostra foi dividida em dois grupos, de acordo com a movimentação dos incisivos pós-tratamento: Ipro, onde os incisivos proclinaram (n=12); e Iretro, onde os incisivos retroinclinaram (n=9). O ponto A e a inclinação dos incisivos maxilares foram mensurados em relação às linhas ortogonais formadas pelo plano horizontal de Frankfurt e pelo plano pterigoideo vertical. Todos os dados foram medidos duas vezes, com um intervalo de 15 dias, e as médias foram submetidas ao teste t emparelhado e ao teste de correlação de Pearson. Resultados: quando os incisivos maxilares proclinaram 5,26°, o ponto A retraiu 1,54 mm (r=0,75; p < 0,0001), em uma taxa de 1:3,4 mm/graus. Quando os incisivos maxilares retroinclinaram 5,44º, o ponto A avançou 0,71 mm (r=0,81; p < 0,05), em uma taxa de 1:7,7 mm/graus. Conclusão: o ponto A é influenciado diretamente pela alteração na inclinação dos incisivos superiores e tende a acompanhar o movimento do ápice destes dentes.

This study aims to cephalometrically evaluate the changes at point A on the sagittal plane by measuring dental incisor inclinations before and after treatment. Methods: a total of 21 pairs of pre- and post-treatment lateral cephalograms were collected from a private clinic in Aracaju (SE). The sample was divided into 2 groups according to incisors inclination after treatment: Ipro, proclination after treatment (n=12) and Iretro: retroclination after treatment (n=9). The point A and the maxillary incisor inclinations were measured in relation to the orthogonal lines formed between the Frankfurt horizontal and the pterygoid vertical planes. Data were measured twice within a fifteen day interval, and means were subjected to the paired t and Pearson's correlation tests. Results: when maxillary incisors proclined 5.26° degrees, point A retracted 1.54 mm (r=0.75; p < 0.0001), establishing a ratio of 1:3.4 mm/degrees. When the maxillary incisors retroclined 5.44 degrees, the point A advanced 0.71 mm (r=0.81; p < 0.05), establishing a ratio of 1:7.7 mm/degrees. Conclusion: the point A is directly affected by changes in the upper incisor inclinations and tends to follow the apex movement of these teeth.

A eficácia do sistema Invisalign na estética e função – revisão sistemática / The efficacy of Invisalign system in aesthetics and function – a systematic review

O sistema Invisalign é um método de movimentação ortodôntica baseado em uma tecnologia 3D, que consiste em uma alternativa para pacientes que almejam a estética e o restabelecimento funcional. Nesse contexto, objetivou-se descrever os efeitos do tratamento com Invisalign, o grau de motivação dos pacientes e a relação entre outras mecânicas ortodônticas. Pesquisaram-se as palavras-chaves Invisalign, treatment outcomes, esthetics e malocclusion no Pubmed, obtendo-se 93 resultados. Foram selecionados 16 artigos entre 2004 e 2014 com base em títulos e resumos. Destes, 12 consistiam em estudos clínicos e quatro em relatos de casos. Um estudo mostrou que a experiência profissional pode estar relacionada ao índice de sucesso do tratamento com alinhadores. Em relação ao ClinCheck, dois estudos demonstraram uma maior precisão durante a constrição lingual ou rotação de caninos. Dois estudos constataram que procedimentos, como desgaste interproximal e protrusão, contribuíram para melhores finalizações dos tratamentos. Comparando as técnicas ortodônticas, três estudos demonstraram que o sistema Invisalign obteve bons resultados no nivelamento dos arcos, porém, o tratamento convencional ou autoligado proporciona maiores benefícios para a correção da má-oclusão e para uma maior estabilidade no período de pós-tratamento. Dois estudos destacaram que o aparelho lingual e o aparelho fixo proporcionaram níveis mais elevados de dor, quando comparado aos alinhadores. Quatro relatos de casos evidenciaram que a utilização de acessórios e a realização de redução interproximal podem favorecer para correção de apinhamento, sobremordida e sobressaliência. Em suma, os estudos mostraram que o sistema Invisalign possui muitas vantagens, entretanto, é necessário que a técnica seja indicada corretamente...

Invisalign is a method of orthodontic movement based on a 3D technology that is an alternative for patients who aims the aesthetic and functional recovery. In this context, the objective was to describe the effects of treatment with Invisalign, the degree of motivation of patients and the relationship between other orthodontic mechanics. The study was carried keywords Invisalign, treatment outcomes, aesthetics, malocclusion in Pubmed, obtaining 93 results. We selected 16 articles (2004-2014) based on titles and abstracts. These, twelve consisted in clinical studies and four in case reports. One study showed that professional experience may be related to the success rate of treatment with aligners. Regarding Clincheck, two studies demonstrated greater accuracy during lingual constriction or rotation of canines. Two studies found that procedures such as interproximal wear and protrusion, lead to better treatments submissions. Comparing orthodontic techniques, three studies demonstrated that the Invisalign system obtained good results in leveling of the arches, but the conventional treatment or self-ligated provide greater benefits for the correction of malocclusion and greater stability in the post-treatment. Two studies highlighted that the lingual braces and fixed appliance provided higher levels of pain, compared to aligners. Four case reports showed that the use of accessories and performing interproximal reduction may favor to correct crowding, overbite and overjet. In short, studies have shown that the Invisalign system has many advantages, however it is necessary that the technique is correctly indicated...

Ortodoncia: pasado, presente y futuro / Orthodontics: past, present and future

En las últimas décadas, la ortodoncia ha sufrido cambios radicales debidos, principalmente, a progresos tecnológicos que han modificado la práctica clínica y las técnicas de tratamiento. El avance de las técnicas ha ocultado o, tal vez, ayudado a olvidar problemas aún no resueltos desde el nacimiento de la especialidad. Necesitamos nuevos paradigmas que prioricen el estudio de cuestiones básicas a las que se busca respuesta desde los orígenes de nuestra disciplina (AU)

Ortodoncia: pasado, presente y futuro / Orthodontics: past, present and future

En las últimas décadas, la ortodoncia ha sufrido cambios radicales debidos, principalmente, a progresos tecnológicos que han modificado la práctica clínica y las técnicas de tratamiento. El avance de las técnicas ha ocultado o, tal vez, ayudado a olvidar problemas aún no resueltos desde el nacimiento de la especialidad. Necesitamos nuevos paradigmas que prioricen el estudio de cuestiones básicas a las que se busca respuesta desde los orígenes de nuestra disciplina

Combined surgical-orthodontic treatment: how did it evolve and what are the best practices now?

It has been 50 years since the landmark presentation by Hugo Obwegeser at Walter Reed Army Hospital. At that conference, Professor Obwegeser offered American surgeons techniques to correct facial skeletal deformities with access through intraoral incisions. As important advances in surgical technique and anesthesia evolved for the surgical procedures, a major contribution by American orthodontists in collaboration with surgeons was the creation of a common diagnostic, planning, and treatment scheme for use by both clinician groups in the treatment of dentofacial deformities, the skeletal and dental problems of the most severely affected 5% of the population. This article summarizes what American orthodontists and surgeons have learned in the late 20th and early 21st centuries, and forecasts what might be the future of treatment for patients with dentofacial deformities.

Evolution of occlusion and temporomandibular disorder in orthodontics: Past, present, and future.

Occlusion has been an important consideration in orthodontics since the beginning of the discipline. Early emphasis was placed on the alignment of the teeth, the stability of the intercuspal position, and the esthetic value of proper tooth positioning. These factors remain important to orthodontists, but orthopedic principles associated with masticatory functions must also be considered. Orthopedic stability in the masticatory structures should be a routine treatment goal to help reduce risk factors associated with developing temporomandibular disorders.

Tratamento ortodôntico com aparelho autoligável / Orthodontic treatment with self-ligating appliance

Várias inovações tecnológicas são introduzidas com frequência no mercado ortodôntico. entre elas, podemos destacar os aparelhos autoligáveis, que prometem encurtar o tempo de tratamento, pois têm como característica a baixa fricção, que facilita o início do movimento dentário, pela diminuição da resistência inicial à movimentação. Essa característica de autoligação, comum a todos os braquetes dessa geração, desperta bastante interesse entre os ortodontistas, pois esses acreditam que os tratamentos ortodônticos tornam-se mais fáceis e rápidos. Durante a movimentação dentária, o atrito pode ser estático ou dinâmico, e está intimamente relacionado com o material do braquete, com o contato de arco com o braquete e, principalmente, com o sistema de amarração. Devido à possibilidade de ter controle sobre essas variáveis que influenciam na movimentação ortodôntica, a escolha do sistema de braquetes deverá estar relacionada com os objetivos do tratamento, ou seja, em casos que demandam grandes movimentações por meio do deslizamento, onde o controle de torque não é relevante, braquetes autoligáveis terão melhor desempenho do que os convencionais.