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1.
Prog Orthod ; 21(1): 35, 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32888097

RESUMO

OBJECTIVES: The aim of this systematic review and meta-analysis is to assess the degree of stability of anterior open bite (AOB) treatment performed through the molar intrusion supported with skeletal anchorage at least 1 year posttreatment. METHODS: This study was registered in PROSPERO (CRD42016037513). A literature search was conducted to identify randomized (RCT) or non-randomized clinical trials based including those considering before and after design. Data sources were electronic databases including PubMed, Cochrane Library, Science Direct, Google Scholar, Scopus, Lilacs, OpenGrey, Web of Science, and ClinicalTrials.gov . The quality of evidence was assessed through the JBI tool and certainty of evidence was evaluated through the GRADE tool. Random effects meta-analysis was conducted when appropriate. RESULTS: Six hundred twenty-four articles met the initial inclusion criteria. From these, only 6 remained. The mean posttreatment follow-up time was 2.5 years (SD = 1.04). The overbite showed a standardized mean relapse of - 1.23 mm (95% CI - 1.64, - 0.81, p < 0.0001). Maxillary and mandibular incisors presented a non-significant mean relapse, U1-PP - 0.04 mm (95% CI - 0.55, 0.48) and L1-MP - 0.10 mm (95% CI - 0.57, 0.37). Molar intrusion showed a relapse rate around 12% for the maxillary molars and a 27.2% for mandibular molars. CONCLUSION: The stability of AOB through molar intrusion using TADs can be considered relatively similar to that reported to surgical approaches, since 10 to 30% of relapse occurs both in maxillary and mandibular molars. The level of certainty ranged between very low and low. RCTs reporting dropout during the follow-up are in dire need.


Assuntos
Mordida Aberta , Procedimentos de Ancoragem Ortodôntica , Cefalometria , Humanos , Maxila , Dente Molar , Técnicas de Movimentação Dentária
2.
Am J Orthod Dentofacial Orthop ; 158(3): 349-356, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862936

RESUMO

INTRODUCTION: The purpose of this study was to use cone-beam computed tomography (CBCT) to determine bone thickness in the mandibular buccal shelf (MBS) and the infrazygomatic crest (IC) in individuals with different vertical facial heights for ultimate placement of miniscrews. METHODS: The sample consisted of 100 individuals aged at least 16 years, of whom 58 were women, and 42 were men. The mean age was 19.18 years (± 5.5 standard deviation). The patients' facial height was determined by the gonial angle. Cross-sectional slices of the MBS and IC were obtained with CBCT to evaluate bone thickness for the insertion of miniscrews in these extra-alveolar sites. Spearman's nonparametric test was used to correlate the gonial angle with MBS and IC thickness. The level of significance was 5%. RESULTS: The gonial angle ranged from 102.4° to 143.2°. Bone thickness in the MBS increased posteriorly, whereas bone thickness in the IC decreased posteriorly. There was an inversely proportional correlation between the gonial angle and the MBS. There was no correlation between the IC and the gonial angle. CONCLUSIONS: Short-faced individuals had higher bone thickness values in the MBS than long-faced ones. There was no correlation between the patients' vertical face height and the bone width in the IC. The best site to install miniscrews in the MBS is buccal to the second molar distal root, whereas in the IC, it is buccal to the first molar mesiobuccal root. CBCT may be necessary to install extra-alveolar miniscrews correctly, especially in the IC.


Assuntos
Procedimentos de Ancoragem Ortodôntica , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico , Estudos Transversais , Feminino , Humanos , Masculino , Mandíbula , Maxila , Dente Molar , Adulto Jovem
3.
Prog Orthod ; 21(1): 34, 2020 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-32893322

RESUMO

BACKGROUND: Miniscrews are effective devices for performing upper incisor intrusion. Different mechanics can be applied depending on the treatment objectives. This study aimed to evaluate the efficacy of one or two anterior miniscrews for upper incisor correction in cases of overbite and angulation in adult patients. METHODS: Forty-four adults with deep overbite were divided into two groups: group 1 was treated with one miniscrew between upper central incisors and group 2 with two miniscrews between upper lateral incisors and canines. Incisor intrusion and length were measured from lateral cephalograms before treatment, after treatment and at least 12 months into retention (T0, T1 and T2). Forces were applied (90 g) from the miniscrews to the archwire using elastomeric chains. ANOVA analysis was used to determine whether differences between evaluation times were statistically significant. RESULTS: Mean root resorption was 2.15 ± 0.85 mm, which ceased after active treatment. Overbite mean correction was - 3.23 ± 1.73 mm with no statistically significant relapse. Overbite correction and incisor intrusion were significantly greater in group 2 (- 3.80 ± 1.43 versus - 2.75 ± 1.63 for OB and 8.19 ± 3.66 versus 5.69 ± 2.66 for intrusion). Resorption and overbite correction were positively related. No counterclockwise rotation of the mandibular plane was observed. CONCLUSIONS: Overbite correction can be performed by means of upper incisor intrusion without rotation of the mandibular plane. Correction of upper incisor intrusion and overbite is greater in patients treated with two miniscrews. The increase in upper incisor buccal angulation is greater with one miniscrew. Root resorption is positively related to the extent of intrusion. Stability is satisfactory regardless of whether one or two miniscrews are used.


Assuntos
Procedimentos de Ancoragem Ortodôntica , Sobremordida , Adulto , Cefalometria , Humanos , Incisivo , Maxila , Estudos Retrospectivos , Técnicas de Movimentação Dentária
4.
Compend Contin Educ Dent ; 41(8): e10-e15, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32870702

RESUMO

The treatment of incisor protrusion by means of tooth extraction can be challenging for orthodontists, especially during the space closure phase. Moreover, the level of difficulty may increase when anterior movement of the posterior teeth is not desirable. Treatment alternatives may include the use of mini implants, mini plates, and extraoral devices to reinforce anchorage; however, some patients may oppose these aggressive methods. This article describes the use of frictionless segmented mechanics that provide differential moments for controlled space closure during full retraction of the incisors without using extraoral forces or temporary anchorage devices.


Assuntos
Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Cefalometria , Humanos , Incisivo , Fechamento de Espaço Ortodôntico , Técnicas de Movimentação Dentária
5.
Dental Press J Orthod ; 25(3): e1, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32844971

RESUMO

INTRODUCTION: Anterior open bite is one of the most difficult malocclusions to correct in orthodontic treatment. Molar intrusion using miniscrew anchorage has been developed as a new strategy for open bite correction; however, this procedure still has an important concern about prolonged treatment duration in the patient with anteroposterior discrepancy due to the separate step-by-step movement of anterior and posterior teeth. OBJECTIVE: This article illustrates a comprehensive orthodontic approach for dentoalveolar open bite correction of an adult patient, by using miniscrew. CASE REPORT: A woman 19 years and 5 months of age had chief complaints of difficulty chewing with the anterior teeth and maxillary incisor protrusion. An open bite of -2.0 mm caused by slight elongation of the maxillary molars was found. The patient was diagnosed with Angle Class II malocclusion with anterior open bite due to the vertical elongation of maxillary molars. After extraction of the maxillary first premolars, concurrent movements of molar intrusion and canine retraction were initiated with the combined use of sectional archwires, elastic chains and miniscrews. RESULTS: At 4 months after the procedure, positive overbite was achieved subsequent to the intrusion of maxillary molars by 1.5 mm and without undesirable side effects. Class I canine relation was also achieved at the same time. The total active treatment period was 21 months. The resultant occlusion and satisfactory facial profile were maintained after 54 months of retention. CONCLUSION: The presented treatment shows the potential to shorten the treatment duration and to contribute to the long-term stability for open bite correction.


Assuntos
Má Oclusão de Angle Classe II , Mordida Aberta , Procedimentos de Ancoragem Ortodôntica , Adulto , Parafusos Ósseos , Cefalometria , Feminino , Humanos , Dente Molar , Técnicas de Movimentação Dentária
6.
Head Face Med ; 16(1): 16, 2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32713348

RESUMO

BACKGROUND: Bialveolar protrusion is one of the most common chief complaints from the Asian orthodontic patients. Typical orthodontic treatment includes extraction of the bimaxillary premolars and en mass retraction of anterior tooth with maximum anchorage by placing miniscrews. However, excessive pursuit of profile improvement by retraction and intrusion of anterior teeth may result in root resorption, alveolar bone loss, even dehiscence. Thus this retrospective, analytical study was to evaluate the root resorption of anterior teeth after miniscrew assisted en mass retraction in adult bialveolar protrusion patients. MATERIALS AND METHODS: Thirty six adult patients with bimaxillary protrusion had four first premolars extracted, and then miniscrews were placed to provide anchorage. CBCT scans were performed before (T1) and posttreatment (T2). A new improvement project introduced for 3D CBCT registration assessment of root morphology. The paired t-test was used to compare changes from T1 to T2. The relationship between the root resorption and the movement of anterior teeth were assessed by Pearson correlation coefficient analysis. RESULTS: The significant differences were only found in apical third of root and the largest resorption in apical third of the root is always noted in the palatal and distal sectors. Significant correlations were observed in the loss of root in distal and palatal sectors, the root length and volume decrease with the amount of anterior teeth retraction and intrusion. CONCLUSION: The new 3D registration assessment of root morphology will be helpful for the clinicians. Pursuit of large retraction and intrusion leads to obvious anterior teeth root resorption.


Assuntos
Procedimentos de Ancoragem Ortodôntica , Reabsorção da Raiz , Adulto , Humanos , Maxila , Estudos Retrospectivos , Técnicas de Movimentação Dentária
7.
J Clin Pediatr Dent ; 44(3): 202-208, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32644891

RESUMO

Objectives: The aim of study was to evaluate skeletodental and soft tissue treatment effects and the amount of maxillary molar distalization with modified C-palatal plates vs. Greenfield molar distalizer appliances in adolescents. Study design: The samples consisted of pre- and posttreatment lateral cephalograms collected from 39 patients with Class II malocclusion. The MCPP group was comprised of 21 patients (mean age: 11.7 ± 1.3 years) treated with MCPP appliances while the GMD group included 18 patients (mean age: 11.2 ± 0.9 years) treated with GMD. Fixed orthodontic treatment started with the distalization process in both groups. From each cephalograpm, twenty-nine variables were measured for analysis and then the two groups were compared. Descriptive statistics, a paired t-test, and multivariate analysis of variance were performed to compare the treatment effects within and between the groups. Results: There was significant treatmentrelated change in the sagittal position of the maxilla and the mandible within each group. However, there were no statistically significant inter-group differences. The mean maxillary first molar distalization was 3.96 mm in the MCPP group vs. 2.85 mm in the GMD group. Both groups showed minimal distal tipping, but the maxillary incisors were significantly extruded by 3.04 ± 0.89 mm (P < .001) in GMD group. There was no significant difference in treatment duration between the groups. Conclusions: The maxillary first molars of both the MCPP and GMD groups were effectively distalized and there were significant skeletal changes in the maxilla. However, the maxillary incisors were significantly extruded in the GMD group.


Assuntos
Má Oclusão de Angle Classe II , Procedimentos de Ancoragem Ortodôntica , Adolescente , Cefalometria , Criança , Humanos , Maxila , Dente Molar , Desenho de Aparelho Ortodôntico , Aparelhos Ortodônticos , Técnicas de Movimentação Dentária
9.
J Orofac Orthop ; 81(5): 340-349, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32632653

RESUMO

PURPOSE: The purpose of this study was twofold: first, to evaluate the precision of guided orthodontic mini-implant (OMI) placement planned on virtual superimposition of plaster models and lateral cephalograms with regard to the bone support and, second, to investigate the effects of silicone guide extension. METHODS: A total of 40 OMIs were placed in the paramedian area of the anterior palates of 20 cadaver heads. Digitalized models and the corresponding lateral cephalograms were superimposed for planning the OMI positions, and tooth-supported (TS) and soft-tissue-supported (STS) templates were manufactured. Thereafter, postoperative cone beam computed tomography (CBCT) was performed, and the straight (A) and right-angle distance (B) from the implant tip to the nasal floor, the distance from the implant shoulder to the hard palate (C) and the angle (α) between the implant and palate plane with the preoperative (T0) and postoperative (T1) positions were measured. RESULTS: The postoperative distances A, B, and C were less than the planned implant positions. However, significant difference between T0 and T1 was only noted in terms of distance A using the TS templates (T0: 4.7 ± 2.3 mm, T1: 3.0 ± 2.3 mm; p = 0.008) and distance B using the STS template (T0: 3.1 ± 3.5 mm, T1: 2.3 ± 3.2 mm; p = 0.041). There were no significant differences in all average deviations (∆ Ceph/CBCT) between the two templates. CONCLUSIONS: Guided OMI placement planned by virtual superimposition of digitized models and the corresponding lateral cephalogram is fundamentally feasible. However, the position closer to the nasal floor needs critical assessment for correct implantation. The silicone template expansion seems to have only a minor effect on transfer accuracy.


Assuntos
Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Cirurgia Assistida por Computador , Tomografia Computadorizada de Feixe Cônico , Implantação Dentária Endo-Óssea , Imageamento Tridimensional
10.
Am J Orthod Dentofacial Orthop ; 158(3): 343-348, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32709579

RESUMO

The general boundaries to tooth movement are within the adjacent compact and trabecular bones, gingiva, mucosa, and muscular envelope. Findings from finite element analysis of maxillary posterior teeth distalization against mini-implants suggest that stiff outer and interproximal compact bone resists tooth movement, regardless of bone thickness, and that teeth should be steered away from this bone during orthodontic treatment. However, individual variation in the tooth-bone interface dictates the course and outcome of treatment, offering the basis for inferences on the limits of mini-implant anchorage and the presumed influence of the regional acceleratory phenomenon through decortication and microperforation, 2 modalities advocated to effect faster tooth movement.


Assuntos
Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Osso Cortical , Maxila , Desenho de Aparelho Ortodôntico , Técnicas de Movimentação Dentária
11.
Am J Orthod Dentofacial Orthop ; 158(2): 273-285, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32620481

RESUMO

A gummy smile is one of the most problematic characteristics in patients with a Class II Division 2 malocclusion, and the correction of vertical position and incisor torque is often challenging for the orthodontist. This case report describes the orthodontic treatment of a 31-year-old woman, assisted by miniscrew mechanics for maxillary arch distalization and correction of a gummy smile with a brachyfacial pattern. Two different mechanics were used. Miniscrews were placed in both maxillary tuberosities, and the maxillary arch was successfully distalized, correcting the Class II relationship. Interradicular miniscrews were placed for maxillary and mandibular incisor intrusion to correct the gummy smile, overbite, and torque. Finally, periodontal surgery was performed to lengthen the maxillary incisor crowns. Satisfactory smile esthetics and good occlusion were achieved. Follow-up after 24 months confirmed that the outcome was stable.


Assuntos
Má Oclusão de Angle Classe II , Adulto , Cefalometria , Estética Dentária , Feminino , Humanos , Incisivo , Maxila , Dente Molar , Procedimentos de Ancoragem Ortodôntica , Técnicas de Movimentação Dentária
15.
J Evid Based Dent Pract ; 20(2): 101401, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32473793

RESUMO

OBJECTIVE: To compare the clinical effectiveness of mini-implants (MIs) and conventional anchorage appliances used for orthodontic anchorage reinforcement in patients with class I or II malocclusion with bimaxillary protrusion. MATERIALS AND METHODS: Literature search was conducted through PubMed, Embase, and Cochrane from inception to July 2018. The following Medical Subject Heading terms were used for the search string: "skeletal anchorage", "temporary anchorage devices", "miniscrew implant", "mini-implant", "micro-implant". Standardized mean difference (SMD) and 95% confidence interval (CI) of horizontal and vertical movements of teeth from baseline were used for comparison. RESULTS: A total of 12 studies were included in the final analysis. MI group significantly lowered mesial movement of molars compared to conventional anchorage group (SMD = -1.48, 95% CI = -2.25 to -0.72; P = .0002). There was significantly higher retraction of incisors in the MI group than in the conventional group (SMD = -0.47 mm, 95% CI = -0.87 to -0.07; P = .02). No significant difference was seen in vertical movement of molars (SMD = -0.21 mm, 95% CI = -0.87 to 0.45; P = .52) and incisors (SMD = -0.30, 95% CI = -1.18 to 0.58; P = .5). CONCLUSION: MIs seem to be more effective than the conventional anchorage devices in terms of minimizing unintended mesial movement of molars with maximum retraction of anterior teeth.


Assuntos
Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Humanos , Dente Molar , Técnicas de Movimentação Dentária
16.
J Evid Based Dent Pract ; 20(2): 101402, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32473811

RESUMO

OBJECTIVES: New methodological approaches, such as the umbrella review, constitute an important pathway for synthesizing the scientific evidence provided from studies with a high level of evidence. This study aims to summarize the results on the effectiveness of temporary anchorage devices (TADs) and the factors that contribute to their success or failure during orthodontic treatment in patients of different age groups and to identify the gaps in knowledge based on analysis of the scientific literature. METHODS: An umbrella review of systematic reviews and meta-analyses was performed. A quality evaluation and a descriptive analysis of the included studies were conducted. The study protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018094463). RESULTS: Seventeen systematic reviews and meta-analyses were considered (10 descriptive and 7 with meta-analysis; 12 of high quality and 5 of moderate quality). Variability was observed in the type of intervention and the type of system (TADs). Most of the studies reported high success rates (≥90%), and just one systematic review indicated a low rate of success (≤56%) for the mini-screws. All the studies discussed several factors related to the success of the TADs. These factors were classified as device-related factors, patient-related factors, procedure-related factors, and orthodontic treatment-related factors. Conceptual and methodological gaps were observed when considering the data analysis, the terminology used, and the orthodontic protocols. CONCLUSIONS: The results should be analysed cautiously because of several research gaps related to the methodological quality and the high heterogeneity of the original studies and because of the necessity to add several clinical and sociodemographic variables to enrich the data analysis.


Assuntos
Procedimentos de Ancoragem Ortodôntica , Humanos , Metanálise como Assunto , Revisões Sistemáticas como Assunto
18.
Am J Orthod Dentofacial Orthop ; 157(6): 832-842, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32487313

RESUMO

Maxillary LeFort impaction surgery can lead to improvements in facial proportions, smile esthetics, and improved function for patients with long lower facial height and anterior open bite. Sometimes, because of patient wishes, corrective jaw surgery might not be the most appropriate choice for treatment. This report describes the orthodontic retreatment of a 25-year-old woman with a history of 2 orthodontic treatments and 1 corrective jaw surgery, each with anterior open bite relapse. This third orthodontic treatment plan addressed her chief concern and focused on maximizing esthetics, function, and long-term stability. A problem list was used to design a treatment plan that incorporated myofunctional therapy, fixed appliances, and temporary anchorage devices to intrude her maxillary teeth and correct her orthodontic problems. Molar intrusion lasted 8.5 months, and total treatment time in fixed appliances lasted 22 months. The treatment was successful in addressing her chief concerns by shortening her lower facial third, relieving her lip strain, closing her anterior open bite, and achieving a Class I molar and canine occlusion. Overall, posttreatment stability was excellent at approximately 1-year follow-up, and the patient stated that she was very happy with the result.


Assuntos
Mordida Aberta , Procedimentos de Ancoragem Ortodôntica , Adulto , Cefalometria , Estética Dentária , Feminino , Humanos , Terapia Miofuncional , Aparelhos Ortodônticos Fixos , Técnicas de Movimentação Dentária
19.
Indian J Dent Res ; 31(2): 318-322, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32436916

RESUMO

The sequelae of chronic edentulous space is the supraeruption of the opposing teeth which hinders prosthodontic replacement. Molar intrusion of overerupted teeth can be done using miniscrew implants which serves as a promising technique, especially in adult patients. This case report highlights pre-prosthodontic therapy by pure molar intrusion using Temporary Anchorage Device (TAD) in an adult patient seeking prosthesis to enhance chewing efficiency.


Assuntos
Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Adulto , Humanos , Maxila , Dente Molar , Desenho de Aparelho Ortodôntico , Prostodontia , Técnicas de Movimentação Dentária
20.
Am J Orthod Dentofacial Orthop ; 157(5): 651-661, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32354438

RESUMO

INTRODUCTION: This study aimed to evaluate and compare the skeletal effects of monocortical and bicortical mini-implant anchorage on maxillary skeletal expansion (MSE) using cone-beam computed tomography in young adults. METHODS: The sample comprised 48 patients (aged 19.4 ± 3.3 years; 19 male, 29 female) treated with maxillary skeletal expander and was divided into 3 groups according to insertion pattern of mini-implants used. G1, 4-all-bicortical penetration (n = 17); G2, 2-rear-bicortical penetration (n = 17); G3, non-4-bicortical penetration (n = 14). Cone-beam computed tomography scans were taken before treatment and 3 months after activation. RESULTS: The transverse width of maxilla, nasal bone, lateral pterygoid plate, zygomatic bone, and temporal bone increased similarly in G1 and G2. Contrarily, G3 produced less skeletal expansion, having no effects on the temporal bone. Significant increases in width were seen in all 3 groups regarding transverse dentolinear measurements. A triangular expansion pattern was also observed, but G1 and G2 showed more parallel expansion than G3. In addition, G1 and G2 showed less inclination of anchorage teeth compared with G3. The loss of vertical alveolar bone, although only in a small amount, was observed in all groups. CONCLUSIONS: MSE with non-4-bicortical penetration produced fewer orthopedic effects and more unwanted dentoalveolar side effects, whereas MSE with 2-rear-bicortical and 4-all-bicortical penetration showed similar skeletal effects, which means that 2-rear-bicortical penetrating mini-implants were critical to skeletal expansion.


Assuntos
Implantes Dentários , Procedimentos de Ancoragem Ortodôntica , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Masculino , Maxila , Técnica de Expansão Palatina , Adulto Jovem
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