Abordaje miofuncional / Myofunctional approach

La Ortodoncia Miofuncional basa sus objetivos de diagnóstico y tratamiento en el abordaje integral del paciente, tomando el cuerpo en su conjunto y la boca como expresión de desequilibrios funcionales. Los huesos responden a la acción muscular; si no se recupera la función, se compromete la estabilidad de la forma. El objetivo de este artículo es describir el potencial de los dispositivos preformados, que se trabajan en tres fases. • Fase 1: un dispositivo de silicona blanda para relajar los músculos y recuperar la respiración nasal. • Fase 2: un dispositivo de silicona reforzada para estimular el desarrollo transversal de los arcos. Se entrena la correcta posición de la lengua y el cierre labial. Se indican ejercicios de deglución y una alimentación saludable como parte de la terapia. • Fase 3: se instala otro dispositivo de silicona rígida para lograr estabilidad de las estructuras, ganando el paladar libre. Todos los dispositivos cuentan con una guía para la correcta ubicación de la lengua. Restaurar los patrones funcionales saludables es un requisito imprescindible en todo tratamiento de Ortodoncia. Tanto más favorable será si iniciamos el tratamiento en las fases más tempranas en que se diagnostican los Desórdenes Miofuncionales Orofaciales (DMO). Desórdenes Miofuncionales de los músculos y funciones de la cara y la boca Los DMO pueden afectar, directa o indirectamente, la lactancia materna, el crecimiento y desarrollo del esqueleto facial, la masticación, la deglución, el habla, la oclusión, la cinemática de la articulación temporomandibular, la higiene bucal, la estabilidad del tratamiento de Ortodoncia, la estética facial, etcétera. Con la terapia miofuncional, un paciente puede recuperar la alegría de comer, hablar, respirar e incluso dormir más profundamente, y además las mejoras cosméticas pueden ayudar a recuperar la confianza y la autoestima de los pacientes.

OMT (Orofacial myofunctional therapy), is definitely an interesting tool in nowadays, offering a higher range of treatment for both adults and children's… The Myofunctional orthodontics bases its diagnosis and treatment goals, by approaching the patient comprehensively from the macro to the micro, taking the body as a whole and the mouth as an expression of functional imbalances. The bones are slaves to the muscles, if the function not be recovered, it will compromises the stability of form. The aim of this article is to share the potential of preformed devices worked in three Phases •Phase 1: A device of soft silicone to relax the muscles and recover nasal breathing; •Phase Phase 2: reinforced silicone to stimulate the transversal development of the arches along with lip-tongue postures and swallowing exercises, even taking a healthy eating as part of the therapy. •Phase In a Phase 3: Another device of rigid silicone to achieve stability of the structures, gaining the free palate stands out, and all devices have a guide for the correct location of the tongue. Restoring healthy functional patterns is an essential requirement in all orthodontic treatments, even more if we help them from earlier stages of their OMDs (Orofacial Myofunctional Disorders), of the muscles and functions of the face and mouth. OMDs may affect, directly and/or indirectly, breastfeeding, facial skeletal growth and development, chewing, swallowing, speech, occlusion, temporomandibular joint movement, oral hygiene, stability of orthodontic treatment, facial esthetics, and more. We are completely aware that with myofunctional therapy, a patient can regain the joy of eating, speaking, breathing, and even sleeping more soundly, and also cosmetics improvements can help restore confidence and self's teams of our patients

Nuevas herramientas en el tratamiento de la Clase II con alineadores / New tools in the treatment of Class II with aligners

La maloclusión de Clase II es una de las disarmonías esqueléticas más frecuentes en la población caucásica con una alta prevalencia de retrusión mandibular (aproximadamente el 80% de los casos). Es una situación clínica compleja que no solo implica problemas estéticos, alteraciones en plano sagital, sino que también se asocia a diversas condiciones que requieren nuestra atención, como relación transversal maxilar, respiración bucal, apnea del sueño, deglución atípica, anomalías del aparato visual y malos hábitos orales o signos y síntomas de trastorno de la articulación temporomandibular (ATM). Es importante estudiar y evaluar el momento óptimo de tratamiento del paciente para maximizar su eficacia. La evidencia científica demuestra que el momento óptimo es el estirón prepuberal del paciente, momento al que hasta ahora se podía acceder con los diferentes protocolos de alineadores. El protocolo A6 se puede utilizar desde la dentición primaria, lo que permite aprovechar el primer pico de crecimiento entre los 5 y 7 años, cuando erupcionan los 1º molares permanentes y se puede crear un nuevo plano oclusal correcto que favorezca los movimientos mandibulares, y corregir la dinámica anteroposterior y vertical, abriendo un nuevo camino en la corrección temprana de las maloclusiones.

Class II malocclusion is one of the most frequent skeletal disharmonies in the Caucasian population with a high prevalence of mandibular retrusion, approximately 80% of cases. It is a complex clinical situation that not only involves esthetic problems, or occlusion of the teeth in the sagittal plane, but is also associated with various conditions that require our attention, such as maxillary transverse relationship, mouth breathing, sleep apnea, atypical swallowing, visual apparatus anomalies and bad oral habits or signs and symptoms of TMJ disorder. It is important to study and evaluate the optimal timing of patient treatment to maximize the efficacy of treatment. Scientific evidence shows that the optimal time is the patient's prepubertal growth spurt, a time that until now we could access with the different aligner protocols. The A6 protocol can be used from the primary dentition, which allows us to take advantage of the first growth peak between 5 and 7 years of age, when the 1st permanent molars erupt and we can create a new correct occlusal plane that favors mandibular movements and correct anteroposterior and vertical dynamics, opening a new path in the early correction of malocclusions.

Aesthetic perception of patient in developmental age in interceptive orthodontic treatment.

AIM: Patients at development age show considerable attention to the shape of the face from both an aesthetic and relational point of view, to arouse interest from researchers. There are few studies related to profile analysis in patients of developmental age. Therefore, the objective of the present study was to analyse the importance of the aesthetic perception of the patient in development age in relation to the profile, before and after interceptive orthodontic treatment. MATERIALS: A sample of 25 patients who came to our observation for dentoskeletal malocclusions was considered. A questionnaire was proposed to each patient, before and after the interceptive orthodontic treatment (T0 and T1), to evaluate the aesthetic perception before and after the orthodontic treatment and its psychosocial impact. Profile analysis was performed using photographic documentation (at T0 and T1). The variables considered were the Ricketts line, the facial convexity angle, the nasolabial angle, and the labiomental angle. CONCLUSION: Interceptive orthodontic treatment has proven to be of valid clinical and psychological help. This result is confirmed by the complete aesthetic satisfaction of the patient in the frontal and latero-lateral planes.

An epidemiological study on early orthodontic treatment need among eastern Saudi Arabian children in the mixed dentition stage.

Estimation of early orthodontic treatment need among children is essential for planning orthodontic interventions in the mixed dentition stages thereby reducing the burden in a publicly funded healthcare system. The present study aimed to assess the early orthodontic treatment need among children with mixed dentition in the Eastern Saudi Arabia. A descriptive cross-sectional study was conducted among Saudi children visiting the outpatient clinics in a University dental setting, and data were collected based on Index for preventive and interceptive orthodontic need (IPION). Descriptive statistics, chi-square test and Fisher's exact test were used for data analysis with statistical significance set at p < 0.05. The category of 'no treatment need' accounted for 11.3% while 'moderate treatment need' and 'definite treatment need' categories accounted for 29.3% and 59.4% respectively. There was no statistical difference between males and females in the distribution of the three categories of treatment need (p = 0.513). This study demonstrated a very high need for early orthodontic treatment among Saudi children in the mixed dentition stage. Emphasis should be placed on increased awareness and benefits of seeking early orthodontic treatment involving preventive and interceptive procedures in the mixed dentition.

Skeletal and dental effects of function-generating bite appliance compared to rapid palatal expander and untreated controls.

INTRODUCTION: Maxillary expansion is a fundamental interceptive orthodontic treatment, which can be achieved through either a rapid expansion protocol or functional devices. However, no data exist about the efficacy of functional devices in achieving skeletal expansion. Therefore, the aim of this study was to compare the effects of the rapid palatal expander (RPE) and the function-generating bite type M (FGB-M) on the transversal dimension of the maxilla, and on the maxillary and mandibular dental arch width. METHODS: One hundred eighty-one skeletal Class I patients, aged between 6 and 12 years and with a cervical vertebral maturation stage II or III, with maxillary transversal deficiency were retrospectively enrolled; among these 55 were treated with FGB-M, 73 were treated with RPE and 51 were untreated subjects retrieved from historical databases. The pre-treatment (T0) and post-treatment (T1) frontal cephalograms were retrieved, and the maxillary and mandibular widths, and the distance between upper and lower first molars were measured. T1-T0 interval was of 17.3 months (RPE), 24.6 months (FGB-M) and 18.2 months (controls). RESULTS: The statistical analysis showed that there were no statistically significant differences between the RPE and FGB-M groups regarding skeletal and dental expansion, while the untreated control group differed significantly from the other two groups. CONCLUSION: The comparison between patients treated with RPE and FGB-M showed that there were no statistically significant differences between the RPE and FGB-M groups regarding the amount of skeletal expansion and dental arch width, suggesting that both appliances can be used to achieve similar results.

Redirection of palatally ectopic maxillary canines: Case report and proposition of an interceptive sequential guideline.

The eruptive deviation of the permanent maxillary canine must be identified early, at the beginning of the second transitional period of the mixed dentition. Acting at this moment is fundamental for its spontaneous redirection and eruption. The aim of the paper is to present a case where the extraction of the deciduous canines was the choice for redirecting the maxillary permanent canines with eruptive palatal deviation, as well as to suggest a sequence of procedures for diagnosis and choice of treatment. The success of deciduous canine extraction in redirecting the ectopic permanent canines is discussed in this case, as well as aspects that might lead to failure. Still, it highlights the importance of computed tomography for choosing conservative treatment or traction, including it in the sequential guideline for acting in these cases.

Early orthodontic treatment need in paediatric age: a prospective observational study in Italian school-children.

AIM: This study evaluates the prevalence of Interceptive Orthodontic Treatment Need (IOTN) in Italian school-children. METHODS: A prospective observational study was conducted to assess the prevalence of IOTN in patients undergoing a first visit at the Santa Chiara Hospital Paediatric Dentistry Unit in Pisa, Italy. Two thousand, one hundred ninetynine subjects met the inclusion criteria and were enrolled in the study; data on age, gender and concomitant systemic pathologies were collected from medical records. All participants were examined for individual IOTN: the presence of anterior and/or unilateral/bilateral crossbite with or without midline deviation, bad habits (finger, sucking habits, mouth breathing, and tongue thrust), overjet > 3 mm, lack of space for 1.2 and 2.2 eruption were investigated. The presence of one of the above mentioned parameters was considered positive for IOTN. Chi-square test was used to evaluate any statistically significant difference (p < 0.05). CONCLUSION: The study confirms the presence of a significant percentage of paediatric patients who need IOTN; early treatment is highly recommended to reduce malocclusion outcomes in the adult population.

Do the various interceptive treatment modalities improve the position of palatally displaced permanent canines? A meta-analysis.

BACKGROUND: Removal of maxillary primary canines and other interceptive treatment modalities in the mixed dentition have been suggested as methods used to increase the rate of normal eruption of palatally displaced permanent canines (PDCs). However, the information on the overall effect on PDCs' position has been inconclusive. OBJECTIVE: To assess whether this practice improves the position of PDCs and to investigate the quality of the evidence. SEARCH METHODS: Unrestricted searches in 7 databases and manual searching of the reference lists in relevant studies were performed up to June 2022 (Medline via PubMed, CENTRAL, Cochrane Database of Systematic Reviews, Scopus, Web of Science, ClinicalTrials.gov, ProQuest Dissertations, and Theses Global). SELECTION CRITERIA: We looked for data on the positional changes of PDCs (mesial inclination, vertical position, canine crown cusp tip to midline) from randomized controlled trials assessing the various interceptive treatment modalities. DATA COLLECTION AND ANALYSIS: Following study retrieval and selection, relevant data were extracted, and the risk of bias was assessed using the Cochrane Risk of Bias 2 Tool. Exploratory synthesis and meta-regression were conducted using the random effects model and the overall quality of the available evidence was assessed with the Grades of Recommendation, Assessment, Development, and Evaluation approach. RESULTS: Five studies (3 at low risk of bias) were identified, involving 238 individuals, followed for up to 18 months post-intervention with OPG (orthopantomogram) or CBCT (cone-beam computed tomography). Exploratory data synthesis showed that PDCs' position improved more in the extraction sites compared to non-extraction. Analysis of the studies at low risk confirmed the above observations (6- and 12-month). Improvements were observed in patients using headgear after extraction of primary canines compared to extraction alone, but not in patients with double extraction of primary canines and first molars. The quality of available evidence was rated at best as moderate. CONCLUSIONS: Interceptive treatment modalities in the mixed dentition may improve the position of PDCs. However, more studies are necessary in order to determine the clinical significance of the changes. REGISTRATION: PROSPERO (CRD42015029130).

Interceptive orthodontics: awareness and prevention is the first cure.

It is widely recognised by the scientific dental community that the correct development of the deciduous and mixed dentitions is paramount to the oral health of paediatric patients. In this respect, interceptive orthodontics plays a fundamental role in the process. Specifically, the paediatric dentist monitors the condition of the mouth from early childhood, distinguishing three age brackets for intervention, each defined by their own characteristics. It would also be desirable for other professionals who treat young patients and their mothers to various extents, such as paediatricians, gynaecologists, obstetricians and speech therapists to share valuable information with us. What follows is a brief summary of important conditions and key information regarding interceptive orthodontics. Age range 0-3 years: breastfeeding during the first months of life has been shown to have a positive effect on the development of the jaws. Later on, the transition to solid food, promoted by the eruption of the deciduous teeth, further stimulates their growth. During this phase, it is recommended to monitor and intercept any muscular hypotonia and low tongue postures. Additionally, it is essential to instruct parents on the proper dietary and lifestyle behaviours needed to ensure the physiological growth of the child, while protecting the health of their oral cavity. Age range 4-6 years: attention should be paid to the deciduous dentition and the development of the upper and lower maxillary bones, along with prompt interception and correction of bad habits such as the continued use of the pacifier, finger sucking, oral breathing and atypical swallowing. Age >6 years: within this phase, the careful monitoring of the space available in the arch, the natural exfoliation of milk teeth, the eruption of the permanent teeth and their occlusal relationship, as well as the maxillomandibular relationship are all important. If necessary, in addition to removing any risk factor, fixed or mobile orthodontic appliances can also be used during the above stages, especially stage 2 and 3, depending on the occlusal and skeletal status of the patient. Early diagnosis of malocclusion is crucial, as well as the sharing of information with other clinicians that deal with children and their parents, who need to be informed about the various therapies that their child may need. The paediatric dentist could, in fact, directly reach out to families to make them understand that malocclusion and other manifestations linked to conditions affecting oral functions such as breathing, sleeping, chewing and feeding often show the first signs as early as pre-school age, long before eruption of the first milk tooth, which is the time when the first dental visit is usually booked! We trust that awareness is the first form of prevention, and this is the message that must be conveyed to all of those involved in paediatric dentistry, patients and professionals alike: awareness and prevention is the first cure.

2 × 4 appliance in the mixed dentition stage: a scoping review of the evidence.

A great emphasis is currently given to the early correction of malocclusions to prevent further complications if left untreated. Interceptive orthodontics not only simplifies but also eliminates the need for later procedures. The 2 × 4 appliance is an orthodontic treatment modality applied during the mixed dentition period, particularly for malpositioned permanent upper incisors. This scoping review was aimed to examine the breadth and depth of the published literature on this clinical topic, as well as knowledge gaps, about this fixed appliance during mixed dentition, for the correction of incipient anterior malocclusions (incisor crowdings, midline diastemas, or crossbites). PubMed, Cochrane Library, Google Scholar, Dentistry & Oral Sciences Source, and two grey literature databases were explored; under a structured PICO question (Patient, Intervention, Comparison, Outcome) and eligibility criteria, for relevant clinical trials, observational studies, and case reports/series (in English or Spanish), using different searching terms. Titles and abstracts were screened. Full-text articles were critically reviewed for bias risk and a data charting table was constructed. 161 references were identified, after which 115 titles remained after removing duplicates. After the abstract screening, 18 potential full-text articles were reviewed. Finally, 16 studies were included, according to the performed critical appraisal. The 2 × 4 appliance is suitable for mixed dentition patients with mild or severe malocclusions, particularly when removable appliance usage is a critical problem.

Is there a better interceptive treatment for unerupted palatally displaced canines? A network meta-analysis.

This systematic review aimed to investigate if there is a better interceptive treatment for palatally displaced canines (PDC) in the mixed dentition stage. The PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE databases were searched for randomized clinical trials related to the research topic. The gray literature and reference lists were also assessed. Network meta-analysis was conducted to analyze the effects of different approaches on PDC eruption. The surface under the cumulative ranking area was calculated to rank the treatments. The certainty of the evidence was evaluated using the GRADE approach. Of the 892 eligible studies, 18 were selected for full-text analysis and 9 for meta-analysis, involving 506 participants and 730 PDC, to compare 9 approaches. The proportion of erupted PDC was significantly higher for all interceptive treatments compared with control (no intervention). Furthermore, the proportion of erupted PDC was higher in patients subjected to rapid maxillary expansion (RME) than those who underwent double extraction of primary canine and primary molar (relative risk (RR) = 2.68 ICr95%: 1.12-9.35). A higher proportion of erupted PDC was found for RME (RR = 3.07 ICr95%: 1.31-10.67), RME plus use of transpalatal arch (TA) plus extraction of primary canine(s) (EC) (RR = 1.43 ICr95%: 1.09-1.95), EC plus use of cervical pull headgear (RR = 1.38 ICr95%: 1.11-1.79), and EC plus use of TA (RR = 1.36 ICr95%: 1.00-1.9) than for EC. RME was most likely to be considered as the best interceptive treatment. Overall, the certainty of the evidence was considered low due to imprecision and indirectness. In conclusion, no intervention in the mixed dentition stage is the worst choice for PDC.

Outcome of Surgical Extraction of Linguoverted Deciduous Mandibular Canine Teeth, Performed as an Interceptive Orthodontic Procedure in Puppies, on Permanent Occlusion.

Linguoversion of deciduous mandibular canine teeth can be a painful condition, interferes with the development and growth of the jaws, and potentially leads to further malocclusions affecting permanent dentition. Extraction of linguoverted deciduous mandibular canines is considered an interceptive orthodontic procedure that would allow unimpeded development of the jaws and permanent teeth. This study assessed clinical records of 124 dogs that had linguoverted deciduous mandibular canine teeth surgically extracted between October 2010 and September 2019 in a veterinary dental referral clinic. Seventy-seven cases fulfilled the study criteria. Fifty-one percent of these patients required further orthodontic treatment of the permanent occlusion and forty-nine percent demonstrated atraumatic permanent occlusion. The study found no correlation of the outcome with age at the time of surgery. The class of malocclusion (class 1 or class 2) at the time of surgery was also not associated with the outcome.

Expansor de Williams: passo a passo / Williams expander: step-by-step procedures

Resumo Os apinhamentos suaves a moderados na dentição mista podem ser tratados com expansão rápida da maxila (ERM) associada à expansão lenta do arco dentário inferior. A expansão lenta no arco inferior pode ser conduzida com uma alternativa de aparelho fixo e com parafuso. O objetivo deste artigo consiste em apresentar o protocolo laboratorial e clínico do expansor de Williams. Apresentou-se um caso clínico de uma paciente do sexo feminino, 9 anos de idade, com a face simétrica do Padrão I na dentadura mista, com apinhamento moderado dos incisivos inferiores e apinhamento suave no arco superior. O tratamento foi realizado com expansão superior e inferior. No arco superior, a ERM mediante o aparelho Hyrax foi realizada. No arco inferior, procedeu-se à expansão lenta com expansor de Williams. Obteve-se uma adequada oclusão com o alinhamento dos incisivos permanentes e uma melhora do corredor bucal no sorriso. O expansor de Williams representa uma alternativa para os casos que necessitam expansão lenta do arco dentário inferior, independendo da colaboração do paciente. Quando adequadamente construído, o expansor mostra-se confortável e efetivo. (AU)

Abstract Mild to moderate crowding in the mixed dentition can be treated with rapid maxillary expansion (RME) associated with dentoalveolar expansion of the mandibular arch. Dentoalveolar expansion of the mandibular arch can be conducted with an alternative fixed and screw appliance. The aim of this study is to present the laboratory and clinical protocol of the Williams expander. A clinical report of a female patient, 9 years old, with the symmetrical face in the mixed dentition, with moderate crowding of the lower incisors and mild crowding of the upper arch, was presented. The treatment was carried out with maxillary and mandibular expansion. In the maxillary arch, RME was performed using the Hyrax device. In the mandibular arch, dentoalveolar expansion was performed with a Williams expander. Adequate occlusion was obtained with the alignment of the permanent incisors and an improvement in the buccal corridor in the smile. The Williams expander represents an alternative for cases that require dentoalveolar mandibular expansion, regardless of patient cooperation. When properly constructed, the expander is comfortable and effective.(AU)

Padrão de anomalias dentárias em pacientes com síndrome de down: uma série de casos / Dental anomaly patterns in patients with down syndrome ­ series of cases

Resumo Este artigo possui como objetivo relatar 3 casos clínicos de pacientes com Síndrome de Down (SD) com anomalias dentárias associadas, incluindo agenesia dentária, irrupção ectópica e dentes inclusos. O padrão de anomalias dentárias (PAD) é um assunto amplamente descrito na população sem síndromes. No entanto, o PAD associado à Síndrome de Down ainda é pouco abordado na literatura. O tratamento ortodôntico em pacientes com Síndrome de Down deve ser cuidadosamente monitorado durante o desenvolvimento dentário, considerando a herança genética e o aumento do risco de distúrbios de irrupção dentária e outras anomalias dentárias. Intervenções interceptivas podem contribuir para simplificar o tratamento ortodôntico e reduzir os efeitos adversos (AU)

Abstract Individuals with Down Syndrome (DS) have a higher prevalence of dental anomalies than non-syndromic patients. This series of cases aim to report 3 patients seeking orthodontic treatment with several associated dental anomalies, including tooth agenesis, ectopic eruption and impacted teeth. The dental anomaly pattern (DAP) is well described subject in non-syndromic population. However, DAP in association with DS is still uncovered in the literature. The orthodontic treatment in patients with Down Syndrome should be carefully monitored during dental development, considering the genetic background and the increased risk for dental eruption disturbances and other dental anomalies. Interceptive interventions might contribute to simplify orthodontic treatment and reduce adverse effects (AU)

Tracionamento ortodôntico de incisivo central superior impactado associado a odontoma ­ relato de caso / Orthodontic traction of impacted upper central incisor associated with odontoma ­ case report

Resumo A impacção dental, distúrbio irruptivo caraterizado pelo impedimento de erupção espontânea do dente, apresenta baixíssima prevalência para incisivos centrais superiores. Os fatores etiológicos mais comumente envolvidos são a presença de dentes supranumerários, tumores odontogênicos e trauma na dentição decídua. A impacção do incisivo central superior provoca grande comprometimento estético e psicossocial. O sucesso da intervenção ortodôntica depende de diagnóstico precoce, localização do dente e relação deste com dentes adjacentes. Sendo assim, o cuidadoso diagnóstico, planejamento individualizado e criterioso acompanhamento radiográfico são imprescindíveis. O objetivo deste estudo foi relatar o caso clínico de um paciente em fase de dentadura mista com incisivo central impactado pela presença de um odontoma. Foi realizado o tracionamento ortodôntico pela técnica de erupção fechada com ancoragem em dentes posteriores. Foi mantida a integridade radicular do dente tracionado, bem como a dos dentes adjacentes. Além disso, foi obtida adequada margem gengival. Concluiu-se que o tracionamento de incisivos centrais superiores impactados, quando executado de maneira criteriosa, promove estética e função satisfatórias com consequente melhora na autoestima e interação psicossocial do paciente. (AU)

Abstract Dental impaction, an irruptive disorder characterized by the impediment of spontaneous tooth eruption, presents a very low prevalence for maxillary central incisors. The etiological factors are the presence of supernumerary teeth, odontogenic tumor, and primary dentition injuries. The impaction of the upper central incisor causes great aesthetic and psychosocial impairment. The orthodontic intervention success depends on early diagnosis, tooth location, and relationship with adjacent teeth. Therefore, careful diagnosis, individualized treatment planning, and careful radiographic follow-up are essential. This study aimed to report the clinical case of a patient with a central incisor impacted by the presence of an odontoma. Orthodontic traction was performed by the closed eruption technique with anchorage in posterior teeth. Tooth root integrity was maintained, as well as that of adjacent teeth. In addition, adequate gingival margin was obtained. It was concluded that an accurate traction of impacted upper central incisors promotes satisfactory aesthetics and function, with consequent improvement in the patients self-esteem and psychosocial interaction.(AU)

Tratamento ortodôntico de paciente portador de síndrome de Treacher Collins ­ relato de caso / Orthodontic treatment of a patient with Treacher Collins syndrome ­ case report

Resumo Este trabalho é uma descrição de um caso clínico de paciente portador de Síndrome de Treacher Collins (STC). O paciente em questão é menor de idade e foi submetido a tratamento ortodôntico interceptivo de má oclusão de classe II, característica da síndrome devido à retrognatia, no Centro de Atenção e Pesquisa em Anomalia Craniofacial (CEAPAC), Cascavel ­ PR. As disostoses faciais são um conjunto de anomalias raras do esqueleto craniofacial, a mais comumente descrita é a STC, que é uma doença rara, sem predisposição por sexo ou raça. Os sintomas e a severidade desta síndrome diferem de indivíduo para indivíduo, mesmo entre membros da mesma família. Suas características comuns são as anormalidades dos pavilhões auriculares, hipoplasia dos ossos da face, obliquidade antimongolóide das fendas palpebrais com coloboma palpebral inferior e fissura palatina e o principal problema anatômico é a hipoplasia do terço médio da face e o hipodesenvolvimento da mandíbula e mento, o que leva o paciente portador desta síndrome apresentar por suas características faciais uma má oclusão de classe II muitas vezes associadas à mordida aberta, além de outros problemas orais como, por exemplo, as patologia das glândulas salivares, respiração bucal e apinhamento dentário. O tratamento ortodôntico intercepetivo do menor, embora após terminado tenha permanecido com má oclusão de classe II, obteve mudanças em parâmetros cefalométricos e faciais do paciente.(AU)

Abstract This work is a description of a clinical case of a patient with Treacher Collins Syndrome (CTS). The patient in question is younger and underwent interceptive orthodontic treatment of class II malocclusion, characteristic of the syndrome due to retrognathia, at the Center for Attention and Research in Craniofacial Anomaly (CEAPAC), Cascavel ­ PR. Facial dysostosis is a set of rare anomalies of the craniofacial skeleton, the most commonly described being CTS, it is a rare disease, without predisposition by sex or race. The symptoms and severity of this syndrome differ from individual to individual, even among members of the same family. Its common features are auricular pavilion abnormalities, facial bone hypoplasia, antimongoloid obliquity of the palpebral fissures with lower palpebral coloboma and cleft palate, and the main anatomical problem is hypoplasia of the middle third of the face and hypodevelopment of the mandible and chin, which Due to their facial characteristics, patients with this syndrome have a Class II malocclusion, often associated with an open bite, in addition to other oral problems such as salivary gland pathology, mouth breathing and dental crowding. The minor's interceptive orthodontic treatment, although after it ended, he remained with class II malocclusion, resulted in changes in the patient's cephalometric and facial parameters.(AU)

Factors associated with the municipal provision of orthodontics in the Brazilian Unified Health System.

BACKGROUND: The Brazilian federal government issued Ministerial Ordinance No. 718 in 2010 to expand the funding of orthodontic treatment provided by Brazilian municipalities via the Unified Health System (SUS in Portuguese). AIM: To identify social and structural factors associated with Brazilian municipalities that provide fixed orthodontic appliance therapy and interceptive orthodontic therapy. METHODS: Official Brazilian government databases were used for data collection. Poisson regression with robust variance was used for statistical analysis. RESULTS: Municipalities hosting Dental Specialty Centers (DSCs) with greater installed capacity (type III DSC with 7 dental chairs or over), which employed dentists specializing in pediatric dentistry and orthodontics, were more likely to offer orthodontic services via SUS. CONCLUSIONS: Federal, state, and municipal managers need to review the funding of orthodontic services via SUS, which can be used for creating DSCs and hiring professionals with expertise in orthodontics.

Interceptive orthodontic management of mandibular lateral incisor-canine transposition using simplified and efficient biomechanical approach: A case report.

PURPOSE: Ectopic eruption anomaly, manifesting as tooth transposition, often presents a complex therapeutic challenge. Mandibular lateral incisor- canine transposition, although observed with rarity, tends to have major impact on development of proper dentition and adversely influence physical, nutritional, aesthetic and overall psychosocial well being of the patient. This report chronicles individualized one-phase orthodontic management of the case of incomplete transposition between mandibular right lateral incisor and canine in a 9-year-old boy during mixed dentition period. METHODS: Interceptive orthodontic treatment was initiated with placement of 2×4 fixed appliance in lower arch. A combination of continuous arch wire technique involving the use of improved superelastic nickel-titanium wire in conjunction with TMA rectangular wire loop was utilized to achieve biomechanically efficient mesial movement of mandibular lateral incisor. Treatment continued with sequential bonding of brackets to the rest of the mandibular dentition until the levelling and alignment of the buccal segment dentition was achieved. RESULTS: Well-timed early interceptive treatment involving simplified and controlled movements helped reinstate tooth order, promote free eruption of buccal segment teeth, reduce anchorage burden and achieve predictable and biologically compatible outcome without the use of lingual arch as an additional source of reinforcing anchorage. CONCLUSION: From an aesthetic, occlusal and functional standpoint, the treatment approach used in the reported case and the therapeutic outcome proved to be highly satisfactory. By optimizing the eruption and alignment patterns of the permanent teeth, preadolescent interceptive orthodontic treatment helps mitigate the burden of malocclusion and risks of complex orthodontic treatment in permanent dentition.