Nonsurgical maxillary orthopedic protraction treatment for an adult patient with hyperdivergent facial morphology, Class III malocclusion, and bilateral crossbite.

Optimal treatment for an adult patient with hyperdivergent facial morphology, Class III malocclusion, bilateral posterior crossbite, and skeletal disharmony usually requires comprehensive orthodontics combined with extractions, orthognathic surgery, or both. However, treatment becomes more challenging when the patient rejects surgery because of fear or cost. This case report presents the orthodontic treatment of a 24-year-old woman with a Class III malocclusion and bilateral posterior crossbite without surgery using orthopedic and comprehensive orthodontic approaches. The extraoral evaluation showed a hyperdivervent pattern, paranasal deficiency, a slightly protrusive lower lip, and an obtuse labiomental angle with a chin deviated to the left. Intraorally, she exhibited a severe Angle Class III malocclusion bilaterally with edge-to-edge to -1 mm overjet, canting of the occlusal plane up to the left with mandibular midline 5.3 mm to the left of the maxillary and facial midlines, and bilateral posterior crossbite with 5.7 mm of arch width discrepancy. Therefore, the patient was diagnosed with skeletal and dental Class III relationship, hyperdivergent pattern, a deviation of the mandible to the left, bilateral posterior crossbite, mild to moderate maxillary and mandibular crowding, slightly proclined maxillary incisors and upright mandibular incisors. After 15 months of treatment, all treatment objectives were achieved, and the appliances were removed. Teeth were well leveled and aligned, ideal overbite and overjet were established with premolars and canines in a Class I relationship, bilateral posterior crossbite was corrected, vertical dimension was controlled, and the smile was improved with a slight improvement in the profile; however, bilaterally, the molar occlusion was not completely settled and remained in a Class III relationship. This case report demonstrates the successful nonsurgical treatment of an adult with Class III malocclusion, hyperdivergent facial morphology, and bilateral posterior crossbite using a midfacial skeletal expander and facemask for orthopedic correction. With reduced costs and fewer risks than surgical treatment options, this treatment protocol offers an alternative to adult patients.

Breathing changes following mini-implant-supported maxillary skeletal expander treatment in late adolescent or adult patients : Assessment of objective and subjective functional breathing changes.

PURPOSE: The aim of this study was to assess objective and subjective breathing changes in adult patients who underwent maxillary skeletal expansion with the mini-implant-supported maxillary skeletal expander (MSE). METHODS: Twenty-nine patients (mean age 18.1 ± 4.3 years) who underwent expansion using the MSE were compared pre- and posttreatment and with a control group (mean age 19.9 ± 2.6 years) to assess objective and subjective functional breathing changes. Objective measurements of the airway including peak nasal inspiratory flow (PNIF) and peak oral inspiratory flow (POIF) were measured utilizing the In-Check medical device (Clement Clarke, Harlow, United Kingdom). Patients reported subjective breathing assessment utilizing the visual analog scale (VAS). Intragroup comparisons were performed with Wilcoxon tests and intergroup comparison with Mann-Whitney U tests. Spearman correlation coefficients were calculated among the studied variables (P < 0.05). RESULTS: Following MSE treatment, there were significantly higher values for PNIF total (P < 0.0001), PNIF right (P < 0.0001), PNIF left (P < 0.0001), and POIF (P < 0.01) compared to pretreatment and control group results. Also, patients reported a significant decrease in troubled breathing as measured by the VAS for breathing through the right nostril (P < 0.01), left nostril (P < 0.001), and both nostrils (P < 0.01). Comparing the objective and subjective variables for both the pre-MSE or post-MSE groups, the results indicated no significant correlation between total PNIF and total VAS. However, the values had significant correlations between PNIF and VAS on each side when the patients were asked to block one nostril. CONCLUSIONS: Objective functional breathing measurements were increased immediately after treatment with MSE. Subjective functional breathing measurements changes were significantly higher after MSE treatment and compared with the control group. MSE presents a nonsurgical alternative to achieving orthopedic expansion in adult patients which may provide a benefit for patients with nasal airway obstruction.

Long-term effects of maxillary skeletal expander treatment on functional breathing.

Objective: : To investigate the long-term effects of maxillary skeletal expander (MSE) treatment on functional breathing. Objective: measures of breathing, the peak nasal inspiratory flow (PNIF), and peak oral inspiratory flow (POIF), and subjective measures of breathing, the visual analog scale (VAS) and nasal obstruction symptom evaluation (NOSE) survey, were used to investigate the long-term effects of MSE in functional breathing. Seventeen patients, mean age 19.4 ± 3.9 years treated at the UCLA Orthodontics Clinic were assessed on their functional breathing at 3 timepoints: pre-expansion (T0), post-expansion (T1), and post-orthodontic treatment (T2). Results: : Immediately after expansion (T1), all the objective functional breathing values were significantly increased in comparison to T0 (P < 0.05). The VAS total, VAS right and VAS left were significantly lower at T1 in comparison to T0 (P < 0.05). At 26.8 ± 3.9 months after MSE expansion (T2), PNIF total, PNIF right, PNIF left, and POIF were significantly higher when compared to T0 (P < 0.05). Also, VAS total, VAS right and VAS left were significantly lower at T2 when compared to T0 (P < 0.05). Additionally, there was a positive correlation between PNIF and the magnitude of expansion at anterior nasal spine and zygomaticomaxillary point (ZMA). There was a positive correlation between total VAS and the magnitude of expansion at the ZMA. There were no significant changes for the NOSE subjective breathing measurement at all time comparisons. Conclusions: : Overall, MSE treatment produces an increased objective and subjective airway improvement that continues to remain stable in the long-term post expansion.

Biomodulation of Induced Tooth Movement by Three Methods, Corticopuncture, Photobiomodulation, and Their Combination: An Animal Study.

Objective: The aim of this study was to assess the effects of accelerated tooth movement (ATM) methods: corticopuncture (CP), photobiomodulation (PBM), and their combination (CP + PBM) by evaluating tooth displacement, alveolar bone changes, and molecular and cellular response compared with conventional induced tooth movement. Materials and methods: Tooth movement and bone changes were evaluated on days 1, 3, and 7 (9 animals per time point) using microtomography, histological, and immunohistochemical evaluation, at compression and tension sites. CP groups received two perforations in the palate and one mesial to the molars. PBM was performed using GaAlAs diode laser applied every other day for 7 days (λ = 808 nm, 100 mW) in two points for 15 sec/point and total energy of 3 J. Results: Tooth movement was significantly increased in all three ATM groups after 7 days compared with the control group (mean 0.24 mm) by 27% PBM (0.31 mm), 45% CP (0.35 mm), and 57% CP + PBM (0.38 mm) (p < 0.05). At the compression side, all ATM groups showed significant decrease in bone density on day 3 (p < 0.05) and significant less bone volume on day 7 compared with Control (p < 0.05). At the tension side, PBM group showed a significant increase in bone density and volume on day 3 (p < 0.05). Immunohistochemistry analysis showed that at the compression side, tartrate-resistant acid phosphatase-positive cells, RANKL, and tumor necrosis factor-alpha expression were highly marked of the PBM and the combined method groups (p < 0.05). PBM and CP + PBM groups showed a significant increase in expression Runt-related transcription factor 2 and osterix (p < 0.05) at the tension side. Conclusions: All ATM groups showed increase on tooth displacement with CP + PBM group showing greatest tooth displacement. CP method appears to stimulate bone catabolism, PBM has more effect on bone formation, and the combined method showing a synergistic effect on bone remodeling.

Pattern of microimplant displacement during maxillary skeletal expander treatment: A cone-beam computed tomography study.

Objective: To analyze the microimplant (MI) displacement pattern on treatment with a maxillary skeletal expander (MSE) using cone-beam computed tomography (CBCT). Methods: Thirty-nine participants (12 males and 27 females; mean age, 18.2 ± 4.2 years) were treated successfully with the MSE II appliance. Their pre- and post-expansion CBCT data were superimposed. The pre- and post-expansion anterior and posterior inter-MI angles, neck and apical inter-MI distance, plate angle, palatal bone thickness at the MI positions, and suture opening at the MI positions were measured and compared. Results: The jackscrew plate was slightly bent in both anterior and posterior areas. There was no significant difference in the extent of suture opening between the anterior and posterior MIs (p > 0.05). The posterior MI to hemiplate line was greater than that anteriorly (p < 0.05). The apical distance between the posterior MIs was greater than that anteriorly (p < 0.05). The palatal thickness at the anterior MIs was significantly greater than that posteriorly (p > 0.01). Conclusions: In the coronal plane, the angulation between the anterior MIs in relation to the jackscrew plate was greater than that between the posterior MIs owing to the differential palatal bone thickness.

Tomographic assessment of palatal suture opening pattern and pterygopalatine suture disarticulation in the axial plane after midfacial skeletal expansion.

OBJECTIVE: The purpose of this study was to assess the palatal suture opening and the pterygopalatine suture disarticulation pattern in the tomographic axial plane after treatment with midfacial skeletal expander (MSE). MATERIALS AND METHODS: Pre- and post-expansion CBCT records of 50 subjects (20 males, 30 females, mean age 18 ± 3 years) who were treated with MSE (Biomaterials Korea, Seoul, Korea) appliance were superimposed and compared using OnDemand software. Reference planes were identified and the angulation of the midpalatal suture opening after expansion was calculated as well as the frequency of the pterygopalatine suture split. RESULTS: After MSE treatment, the mean palatal suture opening angle (SOA) was 0.57°. (- 0.8° to 1.3°). There was no significant difference between males and females in terms of the palatal suture opening pattern (P > 0.05). Only 3 out of 50 (6%) subjects presented SOA above 1 degree. Also, 3 out of 50 (6%) patients presented a negative SOA value. With regard to the pterygopalatine suture split, 84 sutures out of 100 (84%) presented openings between the medial and lateral pterygoid plates on both right and left sides. Partial split was detected with 8 patients (5 females, 3 males). Five patients had split only in the medial pterygoid plates of both pterygomaxillary sutures, and 3 patients exhibited disarticulation on the right side only. No significant differences were found in the frequency of suture opening between males and females (P = 1.000). CONCLUSIONS: MSE appliance performed almost parallel expansion in the axial view. Remarkably, this study shows that pterygopalatine suture can be split by MSE appliance without the surgical intervention; the disarticulation of pterygopalatine suture was visible in most of the patients.

Differential assessment of skeletal, alveolar, and dental components induced by microimplant-supported midfacial skeletal expander (MSE), utilizing novel angular measurements from the fulcrum.

BACKGROUND: In order to assess skeletal expansion, alveolar bone bending, and dental tipping after maxillary expansion, linear and angular measurements have been performed utilizing different craniofacial references. Since the expansion with midfacial skeletal expander (MSE) is archial in nature, the aim of this paper is to quantify the differential components of MSE expansion by calculating the fulcrum locations and applying a novel angular measurement system. METHODS: Thirty-nine subjects with a mean age of 18.2 ± 4.2 years were treated with MSE. Pre- and post-expansion CBCT records were superimposed and compared. The rotational fulcrum of the zygomaticomaxillary complex was identified by localizing the interfrontal distance and modified interfrontal distance. Based on the fulcrum, a novel angular measurement method is presented and compared with a conventional linear method to assess changes of the zygomaticomaxillary complex, dentoalveolar bone, and maxillary first molars. RESULTS: From 39 patients, 20 subjects have the rotational fulcrum of the zygomaticomaxillary complex at the most distant points of the interfrontal distance (101.6 ± 4.7 mm) and 19 subjects at the most distant points of the modified interfrontal distance (98.9 ± 5.7 mm). Linear measurements accounted for 60.16% and 56.83% of skeletal expansion, 16.15% and 16.55% of alveolar bone bending, and 23.69% and 26.62% of dental tipping for right and left side. Angular measurements showed 96.58% and 95.44% of skeletal expansion, 0.34% and 0.33% alveolar bone bending, and 3.08% and 4.23% of dental tipping for the right and left sides. The frontozygomatic, frontoalveolar, and frontodental angles were not significant different (P > 0.05). CONCLUSIONS: In the coronal plane, the center of rotation for the zygomaticomaxillary complex was located at the most external and inferior point of the zygomatic process of the frontal bone or slightly above and parallel to the interfrontal distance. Due to the rotational displacement of the zygomaticomaxillary complex, angular measurements should be a preferred method for assessing the expansion effects, instead of the traditional linear measurement method.

An assessment of the magnitude, parallelism, and asymmetry of micro-implant-assisted rapid maxillary expansion in non-growing patients.

BACKGROUND AND OBJECTIVES: Micro-implant-assisted expanders have shown significant effects on the mid-face, including a degree of asymmetry. The aim of this study is to quantify the magnitude, parallelism, and asymmetry of this type of expansion in non-growing patients. METHODS: A retrospective study on a sample of 31 non-growing patients with an average age of 20.4 years old, with cone beam computed tomography images taken before and right after expansion using maxillary skeletal expander (MSE) were assessed for skeletal expansion at three landmarks bilaterally. RESULTS: Average magnitude of total expansion was 4.98 mm at the anterior nasal spine (ANS) and 4.77 mm at the posterior nasal spine (PNS) which showed statistical significance using a paired t test with p < 0.01. Average expansion at the PNS was 95% of that at the ANS. The sample was divided into symmetric (n = 15) and asymmetric (n = 16) based on the difference in expansion at the ANS, with 16 out of 31 patients exhibiting statistically significant asymmetry. CONCLUSIONS: MSE achieves distinctly parallel expansion in the sagittal plane but can exhibit asymmetrical expansion in the transverse plane.

Manejo bajo sedación consciente de quiste de erupción en infante / Management under conscious sedation of an infant with eruption cyst

El quiste de erupción es un quiste extra óseo justo antes de la erupción de los dientes, se presenta de color negro azulado, debido a su contenido sanguinolento. Los problemas clínicos causados por su presencia son: retraso de erupción y dolor durante la masticación. No precisa tratamiento si las lesiones desaparecen por sí solos al romperse espontáneamente, permitiendo la erupción dental, aunque no siempre sucede esto y en caso de dolor o infección. El objetivo del presente estudio fue reportar el caso de un infante de 1 año y 8 meses que presentaba quiste de erupción, con aparente buen estado de salud que fue referido a la Clínica de Postgrado de la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos. El tratamiento quirúrgico de elección fue la ulectomía bajo sedación consciente, la excisión simple del quiste de erupción se realizó a nivel del diente 63, cuyo propósito fue evacuar su contenido y eliminar la presión intracística. Se realizó la monitorización del proceso de erupción dental para asegurar un desarrollo adecuado y evolución favorable, devolviendo la salud de los tejidos blandos y manteniendo una buena salud oral.

It is called eruption cyst, follicular growth just before the eruption of teeth, this lesion cystic extra-bone type is presented in black-blue color, due to its bloody content. Clinical problems caused by the presence of cyst are delayed eruption and pain during chewing. No treatment required if the lesions disappear on their own to break spontaneously, allowing tooth eruption, except in case of infection. The aim of this study was to report the case of an infant patient of one year-old and 8 months, with good overall health, referring to the Specialty Pediatric Dentistry, Faculty of Dentistry at Universidad National Mayor of San Marcos. The surgical treatment was indicated ulectomy under conscious sedation, the simple excision of the eruption cyst was performed at the level of the tooth 63, whose purpose was to evacuate their contents and removing the intracistic pressure. The dental eruption process was monitored to ensure proper development and favorable evolution, restoring the health of soft tissues and maintaining good oral health.