Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 721
Filtrar
1.
Eur J Paediatr Dent ; 22(1): 35-40, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33719481

RESUMO

BACKGROUND: The aim of this paper is to illustrate the use of a modified vertical holding appliance (G-VHA) to obtain the vertical control of maxillary molars and tongue stimulation in order to achieve a transverse activation in growing patients with dental open bite without the patient's compliance. CASE REPORTS: The G-VHA is a modified trans-palatal bar with a resin pad covering the Omega central loop and two adjunctive lateral loops to ensure the bar flexibility. The G-VHA is designed to direct the force of the tongue against the upper molars to generate intrusion and at the same time to stimulate and re-educate the tongue. Two cases of dental open bite in growing patients are illustrated. Both patients were successfully treated, and the open bite was fully corrected thanks to molar intrusion, following counterclockwise rotation of the mandible and tongue correction. Finishing of alignment was performed in phase II of the treatment with conventional appliances. CONCLUSION: The G-VHA proved to be effective in controlling the vertical position of maxillary molars promoting the counter-clockwise rotation of the mandible and stimulating a different tongue posture.


Assuntos
Mordida Aberta , Cefalometria , Humanos , Mandíbula , Dente Molar , Mordida Aberta/terapia , Desenho de Aparelho Ortodôntico , Técnicas de Movimentação Dentária
3.
Am J Orthod Dentofacial Orthop ; 159(2): 224-233, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33546827

RESUMO

This case report describes the treatment of a 16-year-old female patient with a skeletal open bite and temporomandibular dysfunction. Clear aligners and miniscrews were used to control the occlusal plane and improve the skeletal problem. At the end of treatment, the mandible had rotated counterclockwise, allowing bite closure, upgrading dental and facial esthetics, and improving temporomandibular dysfunction.


Assuntos
Mordida Aberta , Aparelhos Ortodônticos Removíveis , Adolescente , Cefalometria , Feminino , Humanos , Mandíbula , Mordida Aberta/diagnóstico por imagem , Mordida Aberta/terapia
4.
Am J Orthod Dentofacial Orthop ; 159(2): e179-e185, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33483219

RESUMO

INTRODUCTION: The study investigated which patient and orthodontic treatment factors act as predictors for the conclusion of the ongoing treatment in a dental clinic of a specialization program in Orthodontics. METHODS: Data were collected from the records of patients treated from 1997 to 2015. Potential predictors for treatment conclusion were investigated: patient-related factors (PRFs) and treatment-related factors (TRFs). PRFs were sex, age, face balance, Angle malocclusion classification, open bite, denture, facial pattern, facial profile, buccal corridor, crossbite, maxillary deficiency, and sagittal mandibular behavior; and TRFs were therapeutic approaches, treatment modality, extractions, and Bolton discrepancy. The initial and final treatment dates were collected. Descriptive data analysis, univariate, and multivariate logistic regression were performed (5% significance). RESULTS: Of the 903 records, 561 patients were included in the study. It was demonstrated that starting the treatment at a young age (PRF) and the presence of crossbite (TRF) are predictive factors for the treatment conclusion. A vertical facial pattern (dolichofacial or brachyfacial) and a greater number of extractions for orthodontic reasons may contribute positively to the conclusion of the treatment. The frequency of treatment inconclusion was higher during the first 2 years of treatment (more than 50% of the patients that initiated the treatment). CONCLUSIONS: Young age at the beginning of treatment and the presence of crossbite malocclusion can increase the chance of treatment conclusion.


Assuntos
Má Oclusão , Mordida Aberta , Estudos de Coortes , Face , Humanos , Má Oclusão/terapia , Mandíbula , Mordida Aberta/terapia , Ortodontia Corretiva
5.
Angle Orthod ; 90(4): 507-515, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378495

RESUMO

OBJECTIVES: To compare the effects of two different force magnitudes on maxillary posterior segment intrusion using mini-screws. The null hypothesis was that there would be no difference between the two force magnitudes. MATERIALS AND METHODS: Adult patients with skeletal open bite and a dental open bite ranging from 3 to 8 mm were recruited for this trial. The comparator group had 200 g of intrusive force applied for posterior segment intrusion, whereas 400 g of force was applied in the intervention group. Primary outcomes were the amount of posterior teeth intrusion and anterior open bite closure. RESULTS: Twenty-two subjects were randomized to include 11 participants in each group. One participant dropped out in each group, leaving us with 10 subjects to be analyzed per group. There was statistically significant posterior teeth intrusion of 2.42 ± 2.06 and 2.26 ± 1.87 mm for the comparator and intervention groups, respectively, with no difference between them. Statistically significant open bite closure was achieved in both groups, measuring 2.24 ± 1.18 and 3.15 ± 1.06 mm in the comparator and intervention groups, respectively, with no difference between them. CONCLUSIONS: Both the 200 g and 400 g intrusive forces yielded similar outcomes in terms of posterior teeth intrusion and anterior open bite closure.


Assuntos
Mordida Aberta , Procedimentos de Ancoragem Ortodôntica , Adulto , Cefalometria , Humanos , Maxila , Mordida Aberta/diagnóstico por imagem , Mordida Aberta/terapia , Técnicas de Movimentação Dentária
6.
Am J Orthod Dentofacial Orthop ; 158(6): e121-e136, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33250105

RESUMO

INTRODUCTION: This article evaluates and reports on the satisfaction of adult patients across the United States who received orthodontic treatment for anterior open bite malocclusion. The factors that influence satisfaction are also described. METHODS: Practitioners were recruited from the National Dental Practice-Based Research Network. On joining the Network, practitioner demographics and information on their practices were acquired. Practitioners enrolled their adult patients in active treatment for anterior open bite. Patient demographics, patient dentofacial characteristics, and details regarding previous and current treatment were collected through questionnaires at enrollment (T1). Pretreatment lateral cephalograms and intraoral frontal photographs were submitted. Treatment performed, and details related to treatment outcome were recorded through questionnaires at the end of active treatment (T2). Posttreatment lateral cephalograms and intraoral frontal photographs were submitted. Patient satisfaction at T2 was assessed using a 5-point Likert-type scale and open-ended responses. Predictive univariate models were developed to evaluate the factors that affect patient satisfaction. Open-ended responses were reviewed for general trends. RESULTS: T2 data were received for 260 patients, and 248 of these patients completed and returned the patient satisfaction questionnaires. High levels of satisfaction were found in this sample of adult patients receiving treatment for anterior open bite malocclusion. Specifically, 96% of the sample reported being very or somewhat satisfied. Only 10 patients (4%) were not satisfied with the treatment provided or an element of the final result. Successful open bite closure, treatment modality, and certain patient characteristics may affect patient satisfaction. However, there was insufficient power to demonstrate statistical significance because of the very low number of dissatisfied patients. Open-ended responses directly associated with patient satisfaction were received from 23 patients (9%). They relayed positive, neutral, and negative feelings about the treatment received and final results. Additional responses regarding the orthodontic treatment in general, but not specifically linked to patient satisfaction, were received from 119 patients (48%). These comments depict an overwhelmingly positive experience. CONCLUSIONS: Adult patients who received orthodontic treatment for anterior open bite malocclusion were generally satisfied with the treatment provided, as well as the final esthetic and functional results.


Assuntos
Má Oclusão , Mordida Aberta , Adulto , Estética Dentária , Humanos , Má Oclusão/terapia , Mordida Aberta/terapia , Satisfação do Paciente , Inquéritos e Questionários , Resultado do Tratamento
7.
Am J Orthod Dentofacial Orthop ; 158(6): e137-e150, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33250106

RESUMO

INTRODUCTION: Anterior open bite (AOB) continues to be a challenging malocclusion for orthodontists to treat and retain long-term. There is no consensus on which treatment modality is most successful. This study reports on the overall success rate of AOB orthodontic treatment in the adult population across the United States, as well as 4 major treatment modalities and other factors that may influence treatment success. METHODS: Practitioners and their adult patients with AOB were recruited through the National Dental Practice-Based Research Network. Patient dentofacial and demographic characteristics, practitioner demographic and practice characteristics, and factors relating to orthodontic treatment were reported. Treatment success was determined from posttreatment (T2) lateral cephalometric films and intraoral frontal photographs. Treatment was categorized into 4 main groups: aligners, fixed appliances, temporary anchorage devices (TADs), and orthognathic surgery. Extractions were also evaluated. Bivariate and multivariable models were used to investigate the association between treatment success and treatment modality, pretreatment (T1) dentofacial characteristics, patient and practitioner demographics, and practice characteristics, adjusting for clustering of patients within practice. RESULTS: A total of 254 patients, enrolled by 84 practitioners, contributed to T2 data for this study. There were 29 patients in the aligner group, 152 in fixed appliances, 20 in TADs, and 53 in surgery. A total of 49 patients underwent extractions of teeth other than third molars. Ninety-three percent finished treatment with a positive overbite on the T2 lateral cephalogram, and 84% finished with a positive vertical overlap of all incisors. The small number of aligners and TAD patients limited the ability to compare success rates in these groups. Patients treated with orthognathic surgery had a higher rate of success compared with those treated with fixed appliances only. Treatment success was also associated with academic practice setting, T1 mandibular plane angle ≤30°, no to mild T1 crowding, and treatment duration <30 months. CONCLUSIONS: The overall success of orthodontic treatment in adult patients with AOB who participated in this study was very high. Orthognathic surgery was the only treatment modality that exhibited a statistically higher odds of successful outcomes. Some T1 dentofacial characteristics and treatment factors were associated with the successful closure of AOB.


Assuntos
Má Oclusão de Angle Classe II , Mordida Aberta , Sobremordida , Adulto , Cefalometria , Humanos , Mandíbula , Mordida Aberta/terapia
8.
Prog Orthod ; 21(1): 39, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33078213

RESUMO

AIM: To evaluate the maxillary dentition effects of the extrusion arch for anterior open bite (AOB) correction in mixed dentition patients. MATERIALS AND METHODS: Fourteen subjects with an initial mean age of 9.17 ± 1.03 years presenting with dentoalveolar AOB (mean - 1.28 ± 1.46 mm) and normal facial pattern (FMA = 25.76°) were treated with an extrusion arch. The mean treatment period was 7.79 ± 2.58 months. Lateral cephalograms and dental models were taken before (T0) and after the correction of AOB (T1). Data were analyzed using paired t test to evaluate differences between T0 and T1. For all tests, a significance level of P < .05 was used. RESULTS: All patients achieved positive overbite at T1, with a mean increase of 3.07 mm. The maxillary incisors extruded 1.94 mm. Retroclination of the maxillary incisors (- 6.15°) and an increase in the interincisal angle (5.57°) were observed. There was a significant decrease in the distance between the incisal edge of the maxillary incisors and the molars (- 2.21 mm). There was significant mesial tipping of the maxillary molar (- 11.49°). Significant reductions of overjet (- 1.65 mm), arch perimeter (- 3.02 mm), and arch length (- 2.23 mm) were noted. The transverse maxillary intermolar distance did not change significantly. CONCLUSIONS: The use of a maxillary extrusion arch was effective in the treatment of AOB. Overbite increased due to incisor extrusion, as well as retroinclination and overjet reduction. However, side effects, such as mesial molar tipping and decreases in arch perimeter and length might occur.


Assuntos
Má Oclusão de Angle Classe II , Mordida Aberta , Cefalometria , Criança , Dentição Mista , Humanos , Mordida Aberta/terapia , Estudos Prospectivos
9.
Rev. ADM ; 77(5): 261-266, sept.-oct. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1147137

RESUMO

Una de las consecuencias de la desprogramación neuromuscular es la rotación mandibular en sentido horario, evidenciando el punto prematuro de contacto y aumentando la dimensión vertical del paciente. En pacientes clase II con componente vertical, es un problema realizar este tipo de tratamiento, ya que por lo general este efecto de posterorrotación mandibular hace el perfil más convexo, y en algunos casos genera mordida abierta anterior, la cual se debe corregir posteriormente con el tratamiento de ortodoncia, cirugía o prótesis, lo que alarga el tiempo total de tratamiento por la necesidad de control vertical. El presente caso se trata de una mujer de 45 años de edad, dolicofacial, con tendencia a mordida abierta, mordida dual, sobremordida vertical y horizontal disminuidas, motivo de consulta dolor articular, el cual no le permite continuar con sus labores diarias, el tratamiento realizado fue desprogramación neuromuscular con un guarda oclusal inferior con el propósito de aliviar sintomatología articular y control vertical con microtornillos palatinos previo a tratamiento ortodóncico (AU)


One of the effects of the neuromuscular deprogramming treatment is the mandibular clockwise rotation, making the light premature occlusal contact more evident and increasing the patient vertical dimension. In Class II patients with vertical component is difficult to treat them due to profile worsening as an effect of the clockwise rotation creating in some patient's anterior open bite, this has to be corrected later in treatment with orthodontic intrusion, surgery or prosthodontic treatment, increasing the total time of treatment with the vertical control necessity. This case report is a 45 years old patient, dolichofacial, with anterior open bite tendency, dual bite, decreased overjet and overbite, her chief complaint was temporomandibular joint dysfunction which dont allow her to do her daily duties, the treatment for her was neuromuscular deprogramming splint for the temporomandibular joint pain, and vertical control with temporary anchorage devices (miniscrews) before the orthodontic treatment (AU)


Assuntos
Humanos , Pessoa de Meia-Idade , Dimensão Vertical , Síndrome da Disfunção da Articulação Temporomandibular/terapia , Implantes Dentários , Mordida Aberta/terapia , Rotação , Placas Oclusais , Manifestações Neuromusculares , Sobremordida/terapia , Mandíbula/fisiologia , México
10.
Dental Press J Orthod ; 25(4): 16-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965382

RESUMO

INTRODUCTION: When miniplates are used as anchoring for orthodontic mechanics for anterior open bite correction by retraction of anterior teeth and posterior teeth intrusion and retraction, orthodontically induced inflammatory external apical root resorption is clinically negligible. METHODS: A homogeneous sample of 32 patients was used, and the roots of the teeth were compared on CT scans performed before and after orthodontic treatment. RESULTS: The observed root resorption was minimal, and this can be explained by the uniform distribution of forces in several teeth, simultaneously, in the set of the dental arch and in the bone that supports the teeth. CONCLUSION: The most important thing to prevent root resorption in orthodontic practice, besides being concerned with the intensity of the applied forces, is to be careful with its distribution along the roots of each tooth, in the dental arch and in the bone that supports the teeth.


Assuntos
Mordida Aberta/diagnóstico por imagem , Mordida Aberta/terapia , Procedimentos de Ancoragem Ortodôntica , Reabsorção da Raiz/diagnóstico por imagem , Reabsorção da Raiz/etiologia , Reabsorção de Dente , Humanos , Técnicas de Movimentação Dentária/efeitos adversos
11.
Dental Press J Orthod ; 25(4): 75-84, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32965391

RESUMO

Adult patients with anterior open bite and hyperdivergent retrognathic phenotype demand complex treatments, as premolar extractions, molar intrusion or orthognathic surgery. In the present clinical case, a young adult patient without significant growth, with Class I and anterior open bite, was treated with four premolar extractions. The therapeutic result shows good intercuspation, good facial esthetic, good function balance, and stability in a two-year post-fixed treatment follow-up.


Assuntos
Mordida Aberta/diagnóstico por imagem , Mordida Aberta/terapia , Procedimentos de Ancoragem Ortodôntica , Procedimentos Cirúrgicos Ortognáticos , Cefalometria , Humanos , Fenótipo , Técnicas de Movimentação Dentária , Adulto Jovem
13.
Am J Orthod Dentofacial Orthop ; 158(4): 547-554, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32828611

RESUMO

INTRODUCTION: This study aimed to investigate dentofacial changes in patients treated with maxillary molar intrusion with zygomatic anchors. METHODS: The study group was composed of 19 patients with anterior open bite who had intrusion of the posterior dentoalveolar segment using an acrylic appliance supported by bilateral zygomatic miniplates. The study was carried out on lateral cephalograms of the subjects taken before treatment and after intrusion. RESULTS: Cephalometric changes obtained with maxillary molar intrusion were statistically significant. ANB, Wits, SN-GoGn, PP-MP, ANS-Me, NA-APo, SN-OP, U1-OP, U6-NF, overjet, and overbite values were also statistically significant. CONCLUSIONS: Posterior dentoalveolar intrusion by zygomatic anchorage was an effective method for anterior open bite treatment. Although overbite and vertical skeletal measurements changed because of posterior dentoalveolar intrusion, the soft tissue was not significantly affected.


Assuntos
Má Oclusão de Angle Classe II , Mordida Aberta/diagnóstico por imagem , Mordida Aberta/terapia , Procedimentos de Ancoragem Ortodôntica , Cefalometria , Humanos , Maxila/diagnóstico por imagem , Técnicas de Movimentação Dentária
14.
J Craniofac Surg ; 31(2): 530-533, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31977686

RESUMO

BACKGROUND: Large maxillofacial venous malformation (VM) lesions can affect the craniofacial skeleton, causing occlusal and craniofacial deformity. Few studies have discussed the management of these skeletal disorders. It is unclear whether orthodontic treatment and orthognathic surgery are necessary after such a VM lesion has been significantly reduced. METHODS: A 13-year-old boy with a large, extensive maxillofacial VM lesion, severe facial asymmetry, macroglossia, and lower lip hypertrophy visited our department in 2010. He received more than 100 sclerotherapy treatments and 20 laser treatments in the past 8 years. RESULTS: The patient's cosmetic disfigurement greatly improved, and the VM lesion diminished by more than 80%. Changes in the bite and craniofacial skeleton progressed from "normal" to "open bite with skeletal deformity" and finally to "spontaneously close to normal". CONCLUSIONS: During the progression of VM, removal of pathogenic factors can inhibit the aggravation of open bite deformity and promote the spontaneous improvement, thereby circumventing the need for complicated osteotomy, orthodontic intervention and/or orthognathic surgery.


Assuntos
Macroglossia/congênito , Macroglossia/terapia , Anormalidades Maxilofaciais/terapia , Mordida Aberta/terapia , Adolescente , Oclusão Dentária , Assimetria Facial , Humanos , Terapia a Laser , Masculino , Procedimentos Cirúrgicos Ortognáticos , Escleroterapia , Veias
15.
Chin J Dent Res ; 23(4): 297-307, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33491362

RESUMO

Ideally, orthognathic surgery is indicated to treat skeletal Class III malocclusion with severe open bite in adults. In this borderline case, however, camouflage treatment without any skeletal anchorage was chosen. This report describes the orthodontic treatment of a 23-year-old man who presented with multiple orthodontic problems including severe open bite of the anterior and posterior teeth up to the first molars, bilateral posterior crossbite, bilateral Class III molar relationship, severe crowding, increased vertical dimension, and dental and facial midline deviation. The treatment included the extraction of four wisdom teeth, uprighting and distalisation of the mandibular arch with molar intrusion using curved NiTi wires with intermaxillary elastics. After 36 months of treatment, satisfactory improvements in the vertical overlap, horizontal overlap and sagittal malocclusion were achieved. The design of the mechanical system used in this case confirmed stable results at the 4-year follow-up.


Assuntos
Má Oclusão , Mordida Aberta , Procedimentos de Ancoragem Ortodôntica , Adulto , Cefalometria , Seguimentos , Humanos , Masculino , Mandíbula , Mordida Aberta/terapia , Técnicas de Movimentação Dentária , Adulto Jovem
16.
Am J Orthod Dentofacial Orthop ; 156(4): 555-565, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31582127

RESUMO

A common dilemma when treating anterior open bite is understanding its etiology. Idiopathic condylar resorption (ICR) can cause open bite in affected individuals. Although it is prudent to not treat patients with ICR until active resorption has ceased, orthodontists may begin treating them because anterior open bite from ICR may not appear before or during their orthodontic treatment. This article reports a 12-year-old female who was diagnosed with ICR 10 months after completion of her orthodontic treatment for a Class II Division 1 malocclusion. When a young patient with a high mandibular angle and previous skeletal or dental Class II malocclusion returns with an open bite during the retention phase, the patient's condyles must be carefully examined to determine whether any temporomandibular joint disorder, such as ICR, is present. Currently, the controversy over the cause and the cure for ICR is continuing to challenge orthodontists in diagnoses and treatments. Orthodontists should closely monitor and offer informed treatment options to patients with risk factors for ICR or signs of its pathology that might develop at any stage of orthodontic treatment, including the retention period.


Assuntos
Reabsorção Óssea/complicações , Reabsorção Óssea/terapia , Má Oclusão de Angle Classe II/terapia , Côndilo Mandibular/patologia , Doenças Mandibulares/patologia , Doenças Mandibulares/terapia , Mordida Aberta/etiologia , Mordida Aberta/terapia , Ortodontia Corretiva/métodos , Transtornos da Articulação Temporomandibular/terapia , Reabsorção Óssea/diagnóstico por imagem , Cefalometria , Criança , Terapia Combinada , Estética Dentária , Feminino , Humanos , Má Oclusão de Angle Classe II/diagnóstico por imagem , Doenças Mandibulares/diagnóstico por imagem , Mordida Aberta/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Resultado do Tratamento
17.
Am J Orthod Dentofacial Orthop ; 156(3): 303-311, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474260

RESUMO

INTRODUCTION: One of the goals of malocclusion treatment is to improve the oral health-related quality of life (OHRQoL) of patients. The aim of this trial was to assess the OHRQoL of children before, during, and after anterior open bite (AOB) correction, compared with nontreated children, in a 2-arm parallel single-blind randomized controlled trial. METHODS: Eighty children with AOB aged 8-10 years were randomly assigned to 2 groups (n = 40 each): a group treated with the use of fixed palatal crib (FPC; TG) and a control group (nontreated; CG). Randomization was performed with the use of BioEstat software. The outcome (OHRQoL) was assessed with the use of the validated Brazilian Portuguese version of the Child Perceptions Questionnaire (CPQ8-10) applied before (baseline, phase 1), 3 months after FPC placement (phase 2), and 1 month after FPC removal (phase 3) in the TG. In the CG, CPQ8-10 was applied at baseline (phase 1), 3 months (phase 2), and 12 months (phase 3). Data were analyzed by means of a blinded statistic with the use of Friedman, Wilcoxon, and Mann-Whitney tests (α = 0.05). RESULTS: All participants finished the RCT, and demographic characteristics were similar between groups. In phase 1, the TG had lower scores for the "social well-being" domain (P = 0.02). In phase 2, the CG had higher scores than the TG for the "emotional well-being" and "social well-being" domains, but the opposite was observed for "oral symptoms" and "functional limitations" (P < 0.001). In phase 3, the TG showed a lower impact on OHRQoL than the CG in all domains and in the overall score (P < 0.001). In the 3 phases, the CG showed progressive increase (mean scores 70.37, 74.70, and 84.22, respectively; P < 0.001) and the TG a decrease (mean scores 70.20, 70.80, and 6.05, respectively; P < 0.001) in overall scores. The increase of scores in the CG was considered to represent a serious harm. CONCLUSIONS: Correction of AOB had a positive impact and failure to correct it had a negative impact on the OHRQoL of children. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement.


Assuntos
Mordida Aberta/psicologia , Mordida Aberta/terapia , Saúde Bucal , Qualidade de Vida , Brasil , Criança , Estética Dentária , Feminino , Humanos , Masculino , Má Oclusão/complicações , Ortodontia Corretiva , Método Simples-Cego , Inquéritos e Questionários
18.
Am J Orthod Dentofacial Orthop ; 156(3): 312-325, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474261

RESUMO

INTRODUCTION: This aim of this paper is to describe and identify the practitioner and patient characteristics that are associated with treatment recommendations for adult anterior open bite patients across the United States. METHODS: Practitioners and patients were recruited within the framework of the National Dental Practice-Based Research Network. Practitioners were asked about their demographic characteristics and their treatment recommendations for these patients. The practitioners also reported on their patients' dentofacial characteristics and provided initial cephalometric scans and intraoral photographs. Patients were asked about their demographic characteristics, previous orthodontic treatment, and goals for treatment. Four main treatment groups were evaluated: aligners, fixed appliances, temporary anchorage devices (TADs), and orthognathic surgery. Extractions were also investigated. Predictive multivariable models were created comparing various categories of treatment as well as extraction/nonextraction decisions. RESULTS: Ninety-one practitioners (mostly orthodontists) and 347 patients were recruited from October 2015 to December 2016. Increased aligner recommendations were associated with white and Asian patients, the presence of tongue habits, and female practitioners. TADs were recommended more often in academic settings. Recommendations for orthognathic surgery were associated with demographic factors, such as availability of insurance coverage and practitioner race/ethnicity, and dentofacial characteristics, such as anteroposterior discrepancies, more severe open bites, and steeper mandibular plane angles. Extraction recommendations were largely associated with severe crowding and incisor proclination. CONCLUSIONS: Both doctor and patient demographic factors, as well as dentofacial characteristics, were significantly associated with treatment recommendations for adult anterior open bite patients.


Assuntos
Mordida Aberta/terapia , Ortodontia Corretiva/estatística & dados numéricos , Ortodontistas/estatística & dados numéricos , Padrões de Prática Odontológica/estatística & dados numéricos , Idoso , Cefalometria , Feminino , Humanos , Incisivo , Masculino , Mandíbula , Pessoa de Meia-Idade , Mordida Aberta/diagnóstico por imagem , Mordida Aberta/epidemiologia , Aparelhos Ortodônticos/estatística & dados numéricos , Ortodontia Corretiva/instrumentação , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos , Inquéritos e Questionários , Técnicas de Movimentação Dentária/instrumentação , Técnicas de Movimentação Dentária/métodos , Técnicas de Movimentação Dentária/estatística & dados numéricos , Estados Unidos/epidemiologia
19.
J Med Case Rep ; 13(1): 252, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31409402

RESUMO

BACKGROUND: Chronic insomnia and obstructive sleep apnea are both common sleep disorders. Chronic insomnia is thought to result from stress-related physiologic hyperarousal (somatic arousal) that makes it difficult for an individual to fall or stay asleep. Obstructive sleep apnea is thought to result from obstructive respiratory events causing arousals, sleep fragmentation, and recurrent oxygen desaturation. Although the two disorders seem different, they predispose to the same long-term, stress-related illnesses, and when they occur in the same individual, each affects the other's response to treatment; they interact. This report of three cases describes patients with both chronic insomnia and obstructive sleep apnea in whom the chronic insomnia remitted with no specific treatment following treatment of obstructive sleep apnea with maxillomandibular advancement. CASE PRESENTATIONS: Our three Caucasians patients each presented with severe, chronic insomnia associated with somatic arousal and fatigue occurring either alone, in association with bipolar disorder, or with temporomandibular joint syndrome. Polysomnography revealed that each patient also had mild obstructive sleep apnea, despite only one snoring audibly. One patient experienced a modest improvement in her somatic arousal, insomnia severity, and fatigue with autotitrating nasal continuous positive airway pressure, but the other two did not tolerate nasal continuous positive airway pressure. None of the patients received treatment for insomnia. All three patients subsequently underwent maxillomandibular advancement to treat mild obstructive sleep apnea and experienced prolonged, complete resolution of somatic arousal, chronic insomnia, and fatigue. The patient with bipolar disorder also experienced complete remission of his symptoms of depression during the 1 year he was followed postoperatively. CONCLUSIONS: These three cases lend support to the hypothesis that chronic insomnia and obstructive sleep apnea share a pathophysiology of chronic stress. Among patients with obstructive sleep apnea, the stress response is directed at inspiratory airflow limitation during sleep (hypopnea, snoring, and inaudible fluttering of the throat). Therefore, when chronic insomnia and obstructive sleep apnea occur in one individual, aggressive treatment of obstructive sleep apnea may lead to a reduction in chronic stress that causes the patient's chronic insomnia to remit.


Assuntos
Avanço Mandibular/métodos , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Distúrbios do Início e da Manutenção do Sono/etiologia , Distúrbios do Início e da Manutenção do Sono/terapia , Adulto , Transtorno Depressivo/complicações , Feminino , Humanos , Masculino , Doenças Maxilares/complicações , Doenças Maxilares/diagnóstico por imagem , Doenças Maxilares/cirurgia , Mordida Aberta/complicações , Mordida Aberta/diagnóstico por imagem , Mordida Aberta/terapia , Polissonografia , Autorrelato , Síndrome da Disfunção da Articulação Temporomandibular/complicações , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico por imagem , Síndrome da Disfunção da Articulação Temporomandibular/cirurgia , Adulto Jovem
20.
Am J Orthod Dentofacial Orthop ; 156(1): 125-136, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256825

RESUMO

This case report describes the successful treatment of a 14-year-old girl with severe bilateral idiopathic condylar resorption and resultant mandibular retrusion, increased overjet, and anterior open bite. The nonextraction treatment plan included (1) aligning and leveling the teeth in both arches, (2) performing Le Fort I maxillary osteotomy, bilateral condylectomy, and mandibular joint replacement, and (3) postsurgical correction of the malocclusion. The orthodontic treatment was initiated with the use of custom lingual appliances followed by orthognathic surgery planned with virtual surgical planning. Patient-fitted and customized temporomandibular joint implants were designed and manufactured based on the patient's stereolithic bone anatomic model. Treatment was concluded with detailed orthodontic finishing. Optimum esthetic and functional results were achieved with the cooperation of 2 specialties and the use of state-of-the-art technology.


Assuntos
Braquetes , Prótese Articular , Côndilo Mandibular/cirurgia , Mordida Aberta/cirurgia , Mordida Aberta/terapia , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos/métodos , Transtornos da Articulação Temporomandibular/terapia , Adolescente , Pontos de Referência Anatômicos , Reabsorção Óssea/complicações , Reabsorção Óssea/diagnóstico por imagem , Reabsorção Óssea/cirurgia , Reabsorção Óssea/terapia , Cefalometria , Estética Dentária , Feminino , Humanos , Imageamento Tridimensional , Mandíbula/cirurgia , Côndilo Mandibular/diagnóstico por imagem , Maxila/cirurgia , Mordida Aberta/diagnóstico por imagem , Aparelhos Ortodônticos , Aparelhos Ortodônticos Fixos , Ortodontia Corretiva/instrumentação , Osteotomia , Planejamento de Assistência ao Paciente , Radiografia Panorâmica , Articulação Temporomandibular/diagnóstico por imagem , Articulação Temporomandibular/cirurgia , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico por imagem , Transtornos da Articulação Temporomandibular/cirurgia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...