Evaluation of palatal dimensions in different facial patterns by using digital dental casts.

OBJECTIVE: To analyze the variations of hard palate volume in adults with normal occlusion and different facial types and patterns, by using a three-dimensional analysis on digital casts. METHODS: The dental casts of 70 Caucasian adults (28 men, 42 women), mean age of 16.4 years (SD 1.3 years), were scanned by using a tridimensional scanner (Delcam PowerSHAPE™, 2010, Birmingham, UK). Close points were selected in the gingival and cervical regions on the lingual surface of the maxillary teeth, to analyze palatal morphology. The facial patterns and types, and the measurements (width, length, height, volume) of the space on the hard palate were compared using analysis of covariance (ANCOVA), with age as the covariate, and sex as the independent variable. The significance level of 5% (p < 0.05) was adopted. RESULTS: This study showed that the measurements of the width and length were similar among the mesofacial, dolichofacial and brachyfacial facial types, although the height and volume of the space on the hard palate were slightly smaller in dolichofacial individuals, and both Pattern I and Pattern II individuals showed no significant changes for the four measurements. The mean values among facial patterns were: Pattern I - width 38.31±2.59 mm; length 37.44±2.42 mm; height 17.03±2.42 mm and volume 10.52±1.72 mm3; Pattern II - width 37.48±2.44 mm; length 37.48±2.44 mm; height 16.79±2.42 mm and volume 10.41±1.65 mm3 (p>0.05 for all variables). CONCLUSION: There were no significant differences for the facial patterns and facial types of the individuals compared in the analyzed sample.

Rapid maxillary expansion in patient with obstructive sleep apnea: case report.

The aim of this case report was to evaluate the polysomnography indices, air space in the oropharyngeal region and quality of life scores using the OSA-18 questionnaire in a patient diagnosed with obstructive sleep apnea before and after rapid maxillary expansion (RME). It is a case report with a male patient, seven years old, with maxillary hypoplasia, who underwent adenotonsillectomy surgery two years ago, had restless sleep, snore more than five times a week. Pre- and post-treatment diagnostic tests were performed, including nasofibroscopy, polysomnography, computed tomography, orthodontic records and the OSA-18 quality of life questionnaire. The treatment consisted of RME with Hyrax maxillary expander. After six months, the exams were redone. The polysomnographic record before treatment: IAH 2.8/h, after treatment 0.5/h. We concluded that rapid maxillary expansion (RME) in children with OSA appears to be an effective treatment.

3D technology to measure dental arches and create a template for lingual brackets technique.

OBJECTIVE: This study aims at identifying anatomical dimensions of dental arches, based on landmarks currently used in the lingual orthodontic technique, and create an archwire form template to be used in orthodontic clinics. METHODS: Maxillary and mandibular dental casts of 140 Caucasian individuals with natural and normal occlusion were digitized (3D), and the images were analyzed with Delcam Power ShapeTM 2010 software. The dental arch shapes and sizes were obtained from 14 landmarks selected on the lingual surface of the teeth. Points and segments defined by the software were used to create an archwire form template. RESULTS: Various dental arch patterns were found for both maxilla and mandible. The smallest sizes were found in females, and the largest were found in male subjects. Six categories were defined for each gender, three for the maxilla and three for the mandible (Small, Medium and Large). A template was created with eighteen anatomic lingual archwire designs, nine for the maxilla and nine for the mandible, for both genders. CONCLUSIONS: Landmarks evaluated in this study showed dental arch differences between genders. This information enables making orthodontic lingual archwires that are more compatible with the anatomical forms and sizes of the maxilla and mandible. The findings also allowed the creation of a template for an anatomic lingual metallic archwire form to be used in the lingual technique.

The impact of positive airway pressure on midface growth: a literature review.

INTRODUCTION: The treatment of obstructive sleep apnea with positive airway pressure in children is restricted due to concerns that it could affect maxilla growth over time. OBJECTIVE: To undertake a systematic review of the literature about the long-term impact of using a positive airway pressure mask on the midface in growing individuals. METHODS: The literature search was conducted in September 2019 using the keywords ("long-term" OR "long term" OR "side effects" OR longitudinal) AND (children OR child OR preschool OR adolescents OR adolescent OR infant OR infants) AND (craniofacial OR "mid-face" OR midface OR midfacial OR facial OR maxillary) AND ("airway pressure" OR ventilation) in the databases PubMed, Web of Science and Lilacs. The search included papers published in English, until September 2019, on the effects of positive airway pressure on midfacial growth. RESULTS: The search strategy identified five studies: two case reports, two cross-sectional studies and one retrospective cohort study. All studies evaluated the long-term effects of a using a nasal mask on the midface in children and adolescents; four showed midface hypoplasia and one no showed difference post- treatment compared to a control. CONCLUSION: Most of the studies demonstrated that long-term use of nasal positive airway pressure in childhood/adolescence is associated with midface hypoplasia.

Short-term evaluation of tegumentary changes of the nose in oral breathers undergoing rapid maxillary expansion.

INTRODUCTION: Rapid maxillary expansion is an orthodontic and orthopedic procedure that can change the form and function of the nose. The soft tissue of the nose and its changes can influence the esthetics and the stability of the results obtained by this procedure. OBJECTIVE: The objective of this study was to assess the changes in nose dimensions after rapid maxillary expansion in oral breathers with maxillary atresia, using a reliable and reproducible methodology through computed tomography. METHODS: A total of 30 mouth-breathing patients with maxillary atresia were analyzed and divided into a treatment group who underwent rapid maxillary expansion (20 patients, 10 of which were male and 10 female, with a MA of 8.9 years and a SD of 2.16, ranging from 6.5 to 12.5 years) and a Control Group (10 patients, 5 of which were male and 5 female, with a MA of 9.2 years, SD of 2.17, ranging from 6.11 to 13.7 years). In the treatment group, multislice computed tomography scans were obtained at the start of the treatment (T1) and 3 months after expansion (T2). The patients of the control group were submitted to the same exams at the same intervals of time. Four variables related to soft tissue structures of the nose were analyzed (alar base width, alar width, height of soft tissue of the nose and length of soft tissue of the nose), and the outcomes between T1 and T2 were compared using Osirix MD software. RESULTS: In the TG, the soft tissues of the nose exhibited significant increases in all variables studied (p<0.05), whereas, changes did not occur in the control group (p>0.05). In the treatment group, mean alar base width increased by 4.87% (p=0.004), mean alar width increased by 4.04% (p=0.004), mean height of the soft tissues of the nose increased by 4.84% (p=0.003) and mean length of the soft tissues of the nose increased by 4.29% (p=0.012). CONCLUSION: In short-term, rapid maxillary expansion provided a statistically significant increase in the dimensions of the soft tissues of the nose.

Rapid maxillary expansion in mouth breathers: a short-term skeletal and soft-tissue effect on the nose.

INTRODUCTION: Rapid maxillary expansion can change the form and function of the nose. The skeletal and soft tissue changes can influence the esthetics and the stability of the results obtained by the procedure. OBJECTIVE: The aim of this retrospective study was to evaluate the short-term effects of rapid maxillary expansion on the skeletal and soft tissue structures of the nose, in mouth-breathing patients, using a reliable and reproducible, but simple methodology, with the aid of computed tomography. METHODS: A total of 55 mouth-breathing patients with maxillary hypoplasia were assessed and were divided into an experimental group treated with rapid maxillary expansion(39 patients, 23 of which were male and 16 female, with an average age of 9.7 years and a standard deviation of 2.28, ranging from 6.5 to 14.7 years) and a control group (16 patients, 9 of which were male and 7 female, with an average age of 8.8 years, standard deviation of 2.17, ranging from 5.11 to 13.7 years). The patients of the experimental group were submitted to multislice computed tomography examinations at two different points in time: (T1) pre-rapid maxillary expansion and (T2) three months after the procedure. The control group underwent to the same exams at the same intervals of time. Four skeletal and soft tissue variables were assessed, comparing the results of T1 and T2. RESULTS: There was in the experimental group a significant increases in all the skeletal and soft tissue variables (p<0.05) but no significant alteration was found in the control group. When comparing the experimental group and the control group, the most important change occurred in the width of the pyriform aperture (p<0.001). CONCLUSION: Rapid maxillary expansion is capable of altering the shape and function of the nose, promoting alterations in skeletal and soft tissue structures. This kind of study may, in the future, permit the proper planning of esthetic procedures at the tip and base of the nose and also the performance of objective measurements in early or late surgical outcomes.

Impact of rapid maxillary expansion on nasomaxillary complex volume in mouth-breathers.

OBJECTIVE:: To assess the volumetric changes that occur in the nasomaxillary complex of mouth-breathing patients with transverse maxillary deficiency subjected to rapid maxillary expansion (RME). METHODS:: This was a controlled, prospective intervention study involving 38 mouth-breathing patients presenting with transverse maxillary deficiency, regardless of malocclusion type or race. Twenty-three of them comprised the experimental group, which was composed of 11 (47.8%) boys, and 12 (52.2%) girls, with a mean age of 9.6 years, ranging from 6.4 to 14.2 years and standard deviation of 2.3 years; and 15 of them comprised the control group, composed of 9 (60%) boys and 6 (40%) girls with an mean age of 10.5 years, ranging from 8.0 to 13.6 years, and standard deviation of 1.9 years. All patients were scanned (CT) according to a standard protocol: Initial CT (T1), and CT three months thereafter (T2), and the patients in the experimental group were treated with RME using a Hyrax expander for the correction of maxillary deficiency during the T1-T2 interval. The CT scans were manipulated using Dolphin® Imaging version 11.7 software for total and partial volumetric assessment of the nasomaxillary complex. RESULTS:: The results revealed that in the experimental group there was a significant increase in the size of the structures of interest compared to the control group, both in general aspect and in specific regions. CONCLUSIONS:: Rapid maxillary expansion (RME) provided a significant expansion in all the structures of the nasomaxillary complex (nasal cavity, oropharynx, right and left maxillary sinuses).

Skeletal effects of RME in the transverse and vertical dimensions of the nasal cavity in mouth-breathing growing children.

INTRODUCTION:: Maxillary constriction is a dentoskeletal deformity characterized by discrepancy in maxilla/mandible relationship in the transverse plane, which may be associated with respiratory dysfunction. OBJECTIVE:: The objective of this study was to evaluate the skeletal effects of RME on maxillary and nasal transverse dimensions and compare the differences between males and females. METHODS:: Sixty-one mouth-breathers patients with skeletal maxillary constriction (35 males and 26 females, mean age 9.6 years) were included in the study. Posteroanterior (PA) radiographs were taken before expansion (T1) and 3 months after expansion (T2). Data obtained from the evaluation of T1 and T2 cephalograms were tested for normality with the Kolmogorov-Smirnov method. The Student's t-test was performed for each measurement to determine sex differences. RESULTS:: RME produced a significant increase in all linear measurements of maxillary and nasal transverse dimensions. CONCLUSIONS:: No significant differences were associated regarding sex. The RME produced significant width increases in the maxilla and nasal cavity, which are important for treatment stability, improving respiratory function and craniofacial development.

Oromandibular and limb hypogenesis syndrome: treatment report.

The oromandibular and limb hypogenesis syndrome is characterized by aglossia or hypoglossia presenting with limb anomalies. In this case report, we describe congenital hypoglossia associated with glossopalatine ankylosis and middle finger hypomelia, a type III-D malformation in the Hall Classification. The orthodontic and surgical treatment consisted of 3 maxillary expansions, mandibular surgery, and dental alignment. This extensive treatment resulted in acceptable function and esthetic appearance; however, because of lingual hypoglossia, it did not effect perfect occlusion.

Lateral X-ray view of the skull for the diagnosis of adenoid hypertrophy: a systematic review.

OBJECTIVES: Many studies have been developed aiming to reveal the usefulness of cavum X-rays and telerradiographies as diagnostic tools for the detection of upper airway obstruction due to adenoid hypertrophy. However, the scientific literature is diverse and controversial. Therefore, a systematic review is proposed; with the objective to determine the diagnosis value of lateral X-ray view of the skull regarding adenoid hypertrophy. METHODS: Searching was conducted on Pubmed, Lilacs, Cochrane Library, Embase, and Web of Knowledge databases; and was restricted to studies published in English, Portuguese or Spanish languages, carried out on humans under 18 years of age. All the obtained publications were first submitted to a pre-selection, and then, full-texts (n=66) were analyzed and selected by independent examiners. The resultant studies (n=11) were systematically and critically analyzed, and qualified according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) questionnaire, an assessment tool designed to qualify diagnostic tests accuracy studies. RESULTS: Searching and selection procedures generated 11 studies which were considered adequate to be systematically analyzed. Accordingly, large variation was observed concerning the evaluation methods of radiographic and fibronasoendoscopic exams, and the sample characteristics. Additionally, little amount of scientific evidences could be provided, since few radiographic variables were analyzed simultaneously. Moreover, assessment methods were, at most, subjective or poorly described. QUADAS application revealed other significant limitations related to the sampling, such as inadequate spectrum of the investigated "disease" (adenoid hypertrophy), and poor report of the subjects' enrollment and participation process. Further, QUADAS revealed inadequacies regarding methodological features, including poor description of the radiographic exams and assessment methods. In addition, it was also shown that most of the studies did not specify the moment in clinical time when both exams were performed; neither reported a strategy of "blindness" by the examiners. CONCLUSIONS: Despite such limitations, the majority of the resultant data indicates that lateral X-rays might be considered somewhat useful, even though it could not be clearly demonstrated. Future research should then adhere to greater methodological rigor, in order to investigate the significance of radiographies as a screening test.

Evaluation of nasal capacity before and after rapid maxillary expansion.

BACKGROUND: This study analyzed the effects of orthodontic maxillary expansion on the nasal cavity dimensions measured by acoustic rhinometry. METHODS: A prospective study was performed. Fifty patients (27 male and 23 female patients) who had maxillary hypoplasia in relation to the mandible were studied. Patients presented either deciduous or mixed dentition, with age ranging from 4 to 14 years old. Twenty patients (11 male and 9 female patients) between the ages of 4 and 11 years, who also had deciduous or mixed dentition but without maxillary hypoplasia, served as a control group. A modified Biederman appliance was used for approximately 20 days to achieve the maxillary expansion in the treatment group. Acoustic rhinometry, with measurements of the right and the left nasal cavity, was performed before starting the maxillary expansion (T1) and at its conclusion (T2). This procedure was conducted also at a comparable time interval in the control group. RESULTS: The treated group showed a significant increase in the majority of the values of transversal areas and nasal volumes when compared with the nontreated group. CONCLUSION: In children with maxillary hypoplasia, rapid maxillary expansion can not only move the maxilla and alveolar arches laterally but it can also increase the size of the nasal cavities.

Caninos permanentes retidos por palatino: diagnóstico e terapêutica: uma sugestão técnica de tratamento / Palatine impacted permanent maxillary canines: diagnose and therapeutics

Os dentes seguem uma seqüência de erupção favorável no desenvolvimento da oclusão normal, mas algum distúrbio desse mecanismo, nesse período de transição da dentadura mista para a permanente, pode levar a alterações na seqüência ou mesmo no trajeto de erupção, levando a impactação de dentes. Os caninos superiores permanentes, depois dos terceiros molares, apresentam maior ocorrência de impactação, especialmente na região palatina, mesmo na presença de espaço suficiente para o seu alinhamento na arcada dentária. Na impossibilidade do diagnóstico precoce, esforços serão empregados para reposicionar o dente no arco dentário evitando sua extração, dada a sua importância no equilíbrio, harmonia e função do arco dentário. Nos casos não diagnosticados ou tratados inadequadamente podem ocorrer perturbações mecânicas, infecciosas ou neoplásicas. O prognóstico depende da posição do canino em relação às estruturas adjacentes e à possibilidade de movimentação ortodôntica. O presente trabalho aborda os principais fatores a serem considerados nos casos de caninos superiores permanentes impactados, tais como processo de erupção, etiologia, diagnóstico e uma forma de tração proposta para caninos impactados. Também será apresentado um caso clínico em que se optou pelo tratamento ortodôntico-cirúrgico, cuja técnica de tração tem-se mostrado bastante eficiente nos casos de impactação de caninos no palato.

The teeth follow a favorable sequence of eruption on the development of a normal occlusion, but some disturbance of that mechanism at the period of transition of the mixed denture for the permanent one, may provoke alterations in the sequence or even in the eruption path, resulting in impactation of teeth. The permanent maxillary canine, after the third molars, is the most commonly impacted tooth, especially at the palatine area, even though enough space be present for its alignment in the dental arcade. If a precocious diagnosis is not possible, efforts should be used for replace the tooth in the dental arch avoiding its extraction, because its importance for the aesthetic balance and the functional occlusion. The not diagnosed or inadequately negotiated cases may incur mechanical, infectious or neoplasics disturbances. The prognostic depends on the position of the maxillary canine with relation to the adjacent structures and to the possibility of orthodontic movement. The present work approaches the main factors to be considered in the cases of impacted permanent maxillary canine, such as eruption process, etiology, diagnosis and a proper way of palatal impacted canines traction used by ower orthodontic team. A clinical case will also be presented which opted for a surgical-orthodontic treatment, showing a traction technique which have been demonstrated quite efficient in palatal impacted canines cases.

Extração de incisivo inferior permanente com finalidade ortodôntica / Permanent lower incisor extraction for orthodontic purpose

Baseando na revisão da literatura pesquisada, discutiu-se as indicações e contraindicações, bem como as vantagens e desvantagens das extrações dos incisivos inferiores permanentes com finalidade ortodôntica, com objetivo de verificar-se a validade desse procedimento na correção das más oclusões. Concluiu-se que a extração do incisivo inferior permanente é, quando corretamente indicada, uma alternativa eficaz associada ao tratamento ortodôntico na obtenção de uma adequada harmonização do equilíbrio dentário e estética facial. A maioria dos trabalhos publicados restringiu-se em citar indicações e contraindicações, bem como as vantagens e desvantagens, associados ou não a relatos de casos clínicos, contudo sem avaliação em longo prazo dos resultados obtidos.

Agenesi dos incisivos laterais superiores: alternativas de tratamento / Agenesis of upper lateral incisors: alternative treatments

O objetivo do tratamento ortodôntico, além da obtenção de oclusão e funçãoadequadas, é a melhora da estética facial. Nos casos de agenesia dos incisivos lateraissuperiores temos duas principais alternativas de tratamento: fechamento ortodôntico dosespaços e a abertura ou manutenção dos espaços para futura reabilitação protética ouimplantes. Este trabalho teve por finalidade relatar um caso clínico e retratar as vantagense as desvantagens das duas formas de tratamento. Grande parte dos tratamentos é realizadapor meio do fechamento de espaço. Portanto, a literatura é escassa nos trabalhosque relatam o fechamento do espaço pelas outras formas. Salientamos também que ainteração das especialidades é de suma importância para o resultado final. A indicação damelhor terapia dependerá, além do senso crítico com relação à estética e à função, de umamplo entendimento sobre a influência do crescimento em estabilidade e longevidade naregião dos incisivos laterais. Desta forma, é de suma importância informar ao paciente aspossibilidades, a fim de optar junto com o profissional pelo melhor tratamento.

The objective of the orthodontic treatment, besides obtaining an occlusionand appropriate function, is the improvement of the facial aesthetics. In cases of agenesis ofthe superior lateral incisors, we have two main alternatives of treatment: orthodontic closureof the spaces and opening or maintenance of the space for future prosthetic rehabilitationor implantations. This study aims to report a clinical case and depict the advantages anddisadvantages of both types of treatment. Many treatments are performed by closing thespace, 50 the literature is scarce in the orthodontic journals that include the closure of thespace for other forms. We emphasize that the interaction of the specialties is fundamentalimportance for the outcome. Theindication of the best therapy will depend, beyond the criticalsense with aesthetic and the function, and beyond that, an ample understanding about theinfluence of the growth in the stability and longevity in the area of the lateral incisors. Thepatient must be informed, always, of the posslbilities and must chose with the professional,the best treatment.

Osteotomia unilateral da maxila: técnicas e relato de casos clínicos / Unilateral maxillary osteotomy: techniques and clinical reports

A correção da relação transversal é uma das prioridades dentro da Ortodontia. Uma das causas da deficiência transversal é a atresia maxilar, que pode ou não estar acompanhada de uma mordida cruzada posterior. Possui etiologia multifatorial e deve ser diagnosticada e tratada em estágios precoces. Após a completa maturidade esquelética, a expansão rápida da maxila assistida cirurgicamente (ERMAC) constitui uma boa opção para a correção de mordidas cruzadas unilaterais e bilaterais em pacientes adultos. Desse modo, o presente estudo teve como objetivo fazer uma revisão da literatura da ERMAC para a correção da atresia maxilar unilateral e apresentar dois casos clínicos para ilustrar o recurso.

Verticalização de segundo molar inferior permanente: relato de caso / Mandibular second permanent molar uprighting: study of a case

Este artigo relata o caso de uma paciente do sexo feminino, com 17 anos de idade, cujo segundo molar permanente inferior do lado direito apresentava-se incluso e impactado. Após a extração do terceiro molar do mesmo lado foi exposta a superfície disto-vestibular do segundo molar impactado, colado um acessório ortodôntico e sua desinclusão foi realizada com fio e mola de Nitinol. Após aproximadamente 5 meses o dente se encontrava posicionado no arco dentário

Instalaçäo da dentiçäo permanente, desde a mista, através de desgastes orientados nos dentes decíduos / Instalation of the permanent dentition obtained by means of the atrition of the deciduos teeth

Os autores mostram, através da revisäo de literatura, como orientar a instalaçäo da dentiçäo permanente através de desgastes realizados nos dentes decíduos

Extração de incisivo inferior permanente: relato de caso clínico / Permanent lower incisor extraction: case report

Neste trabalho de revisão de literatura foi observado que a extração de incisivo inferior com finalidade ortodôntica não é indicada na maioria dos tratamentos ortodônticos. A extração do incisivo inferior constitui em uma terapia alternativa limitada a certas situações oclusais como por exemplo: discrepância de volume dentário anterior, doença periodontal avançada, primeiros molares em relação de Classe I e boa relação vertical da sobremordida. Indicações, contra-indicações, vantagens e desvantagens

Métodos de correçäo das mordidas abertas anteriores / Methods of correction of the anterior open bite

Neste trabalho propô-se a discutir os diversos métodos de correçäo das mordidas abertas anteriores sugeridos desde as primerias publicaçöes até as mais recentes, em funçäo de que o tratamento desta anomalia oclusal pode ser executado com diferentes recursos, sem contudo, serem eficientes para todos os casos. Fente à inexistência de uma correlaçäo didática entre os diversos métodos propostos, pretendeu-se a partir de suas justificativas e indicaçöes relaciona-los a fim de facilitar a compreensäo didática do tema.

Traçäo de canino para a posiçäo do incisivo central que foi extraído por dilaceraçäo - acompanhamento por longo tempo / Canine traction to the central incisor position which was extracted because of dilaceration - long term evaluation

O presente artigo relata o caso de uma paciente do sexo feminino, G.N., 9 anos em 1979, que tinha o incisivo central superior direito permanente ausente no exame clínico e que após a obtençäo das radiografias mostrou estar impactado e severamente dilacerado, o que inviabilizou seu posicionamento na arcada dentária. Optou-se entäo pela extraçäo do incisivo dilacerado e traçäo do canino superior direito para a sua posiçäo. Após o posicionamento ortodôntico do canino, este foi ajustado para a nova posiçäo e o ajuste oclusal foi feito também na cúspide palatina do primeiro pré-molar superior direito que passou a ocupar a posiçäo do canino direito. O caso mostra estabilidade vinte anos após o tratamento