RESUMO

Esse estudo propectivo teve como objetivo realizar a avaliação das alterações dentoalveolares em modelos digitais de pacientes cuja mordida aberta anterior foi tratada seguindo dois protocolos distintos: esporão lingual e mentoneira. A amostra foi composta por 41 pacientes (27 do sexo feminino e 14 do sexo masculino) com idades entre 7-10 anos (média de idade de 8.37 anos), dentição mista com diagnóstico de mordida aberta anterior (média de -3.43mm) e tratados ao longo de um ano. Os pacientes foram aleatoriamente dividiso em dois grupos de acordo com a terapia realizada: Grupo 1 (n=23) tratados com esporão lingual, e Grupo 2 (n=18) tratados com mentoneira pré-fabricada. Os modelos de gesso foram escaneados, gerando uma imagem tridimensionao em qual as medidas foram realizadas em 2 tempos distintos: T1 (imediatamente antes do tratamento) e T2 (um ano após o início do tratamento). Alteraçnoes transversais, comprimento e perímetro dos arcos dentários superior e inferior, trespasse horizontal e vertical, assim como inclinação dos incisivos centrais foram avaliadas. O Coeficiente de Correlação Interclasse (CCI) e o método Bland-Altman foram aplicados para verificar o erro intra examinador. Os resultados foram analisados através do Teste T pareado e independente adotando uma significância de 5%. Após um ano de tratamento, observou-se alerações estatisticamente significantes em todas as variáveis, exceto perímetro e comprimento dos arcos superio e inferior, inclinação do incisivo central superior e trespasse horizontal. As alterações enre os grupos (T2-T1) apresentaram resultados similares. Concluiu-se que ambos os protocolos apresentaram mudanças semelhantes na mordiada aberta anterior após um ano de tratamento.(AU)

RESUMO

OBJECTIVE: The aim of this study was to test the null hypothesis that there is no difference at the midpalatal suture opening after rapid maxillary expansion (RME) using Expander with Differential Opening (EDO), Hyrax-type and Haas-type expanders. METHODS: Occlusal radiographs of 52 patients (19 males and 33 females; average age= 9.46?1.20 years) treated with RME were divided into three groups, according to the expander used: EDO (n=17), Hyrax-type (n=21) and Haas-type (n=14). The evaluated variables were: A) Distance between the maxillary central incisors at the incisal edge; B) Distance between the alveolar ridges at the midpalatal suture; C) Suture opening at 10-mm distance from the crest to posterior, at the midpalatal suture; D) Suture opening at 20-mm distance from the crest to posterior, at the midpalatal suture; and E) Suture opening at 30-mm distance from the crest to posterior, at the midpalatal suture. To assess the normality of variables, the Shapiro-Wilk test was performed. For intergroup comparison, ANOVA with a significance level of 5% was used. RESULTS: At the region A, Hyrax-type (4.66 mm) and EDO (4.87 mm) groups presented larger openings than the Haas-type group (3.43 mm). In regions B and C, EDO showed a statistically significant greater opening than the Haas-type group. In region D, a smaller opening of the midpalatal suture was observed in the Haas-type group, compared to the Hyrax-type and EDO groups. CONCLUSIONS: EDO and Hyrax-type produced greater immediate skeletal effects, compared with Haas-type, but these differences were about 1 mm and might not be clinically significant.

Assuntos

RESUMO

Pain is common in orthodontic treatment, is subject to individual variation, and is associated with anxiety and stress, which can potentially become catastrophizing. The aim of the present study was to determine the variability of pain response after the insertion of orthodontic separators and to assess the association of pain levels with dental anxiety, catastrophizing, tooth sensitivity, and genetic expression of cytokines. To this end, 70 patients of both genders were divided into two equal groups according to the elastomeric separator used: G1 (Dentaurum) and G2 (Orthometric). Two separators were inserted in the mesial and distal sides of the lower right first molar. Participants were instructed to rate the level of pain at T0 (before insertion), T1 (just after insertion), and T2 (24 hours after insertion) on a visual analog scale. The gingival crevicular fluid was collected at T0 and T2. The levels of anxiety, catastrophizing, tooth sensitivity, and cytokine expression were also assessed. Statistical analysis was performed with the Fisher-Freeman-Halton, chi-squared, Spearman's correlation, and dependent and independent t tests (α=5%). Pain intensity was higher at T2 than at T1, in both groups (P<.05). An association was established (P<.05) between pain intensity at T1 and catastrophizing, and at T2 with anxiety and catastrophizing. Within-group differences in cytokine expression were found between T0 and T2. There was no correlation between cytokine expression and pain levels, anxiety, catastrophizing, and sensitivity at T2. Tooth separation produced variable pain levels, which were influenced by anxiety and catastrophizing, however, pain level was not correlated with increased cytokine expression.

Assuntos

RESUMO

Abstract Pain is common in orthodontic treatment, is subject to individual variation, and is associated with anxiety and stress, which can potentially become catastrophizing. The aim of the present study was to determine the variability of pain response after the insertion of orthodontic separators and to assess the association of pain levels with dental anxiety, catastrophizing, tooth sensitivity, and genetic expression of cytokines. To this end, 70 patients of both genders were divided into two equal groups according to the elastomeric separator used: G1 (Dentaurum) and G2 (Orthometric). Two separators were inserted in the mesial and distal sides of the lower right first molar. Participants were instructed to rate the level of pain at T0 (before insertion), T1 (just after insertion), and T2 (24 hours after insertion) on a visual analog scale. The gingival crevicular fluid was collected at T0 and T2. The levels of anxiety, catastrophizing, tooth sensitivity, and cytokine expression were also assessed. Statistical analysis was performed with the Fisher-Freeman-Halton, chi-squared, Spearman's correlation, and dependent and independent t tests (α=5%). Pain intensity was higher at T2 than at T1, in both groups (P<.05). An association was established (P<.05) between pain intensity at T1 and catastrophizing, and at T2 with anxiety and catastrophizing. Within-group differences in cytokine expression were found between T0 and T2. There was no correlation between cytokine expression and pain levels, anxiety, catastrophizing, and sensitivity at T2. Tooth separation produced variable pain levels, which were influenced by anxiety and catastrophizing, however, pain level was not correlated with increased cytokine expression.

RESUMO

Life expectancy rate has increased in the past decades and a crescent number of elderly patients are searching for dental treatment aiming for aesthetic and functional rehabilitation. Geriatric Dentistry is a dental specialty which focuses on the elderly population dental care, specially aiming at preventive and healing care of patients with diseases or systemic and chronic conditions, associated to physiological, physical or psychological deficiencies. Other specialties in Dentistry, such as Orthodontics, have become important allies in this new challenge of the Dental profession. This study aimed at analyzing characteristics involved in orthodontic treatment when associated with gerontologic needs, considering relevant factors to an adequate application based on a case report. The treatment was planned integrating Periodontics, Orthodontics, Prosthodontics and Operative Dentistry practice, allowing the reestablishment of function and aesthetics harmonically. Orthodontic treatment represents a feasible procedure in Geriatric Dentistry, as long as applying light forces and respecting both the characteristics and limitations of these areas of treatment.(AU)

Com o aumento considerável da expectativa de vida da população, um crescente número de pacientes idosos tem procurado tratamento odontológico para reabilitação estética e/ou funcional. A Odontogeriatria, é a especialidade odontológica que enfatiza o cuidado bucal da população idosa, especificamente do atendimento preventivo e curativo de pacientes com doenças ou condições de caráter sistêmico e crônico, associadas a problemas fisiológicos, físicos ou psicológicos. Diversas especialidades odontológicas, dentre elas a Ortodontia, vêm se integrando com esta área odontológica. Este trabalho objetiva abordar as características do tratamento ortodôntico associado a uma atuação odontogeriátrica, considerando os fatores relevantes para a execução do tratamento ortodôntico nesses pacientes a partir do relato de um caso clínico. Planejou-se este caso de forma integrada, envolvendo Periodontia, Ortodontia, Prótese e Dentística Restauradora, que foram capazes de devolver à paciente função e estética. O tratamento ortodôntico representa uma intervenção viável na atuação odontogeriátrica, desde que realizado com forças suaves, considerando as limitações e respeitando as características inerentes a esta atuação. (AU)

RESUMO

Rapid maxillary expansion (RME) is the protocol of choice for early treatment of transverse malocclusions and it is achieved with fixed expanders that produce heavy forces to achieve midpalatal suture opening. One third of patients with maxillary constriction have a greater transversal deficiency at the intercanine width than at the intermolar. The aim of this article is to present a protocol for early treatment of posterior crossbite with the use of the expander with differential opening (EDO) for RME. It is a new appliance to perform RME and its main advantage would be to allow the expansion individualization. EDO was proposed aiming to promote greater expansion on the anterior rather than on the posterior region. A 9 year-old female sought treatment. The interceptive treatment plan was based on using EDO for RME. The post-expansion orthopedic response showed an opening of 7.5 mm between the maxillary central incisors, at the level of the incisal edge. It was observed an opening of 4.8mm in the midpalatal suture. The opening at a distance of 10 mm and 20 mm from the crest to posterior at the midpalatal suture were 3.9mm and 2.8mm. The upper intercanine distance showed an increase of 9.31 mm. The upper intermolar distance had increased 8.04 mm. The upper arch perimeter showed a difference from 74.02 mm to 80.11 mm . And the upper arch length, from 29.83 mm to 31.56 mm. The posterior crossbite was 2 mm overcorrected. Early diagnosis and treatment of posterior crossbite has a very favorable prognosis. (AU)

A expansão rápida da maxila (ERM) é a técnica de escolha para o tratamento precoce das más oclusões transversais e é ativada com expansores fixos que produzem forças pesadas para possibilitar a abertura da sutura palatina mediana. Um terço dos pacientes com atresia maxilar apresenta uma maior deficiência transversal na região intercaninos do que na região intermolares. O objetivo desse artigo é apresentar um protocolo de tratamento precoce para a mordida cruzada posterior utilizando o expansor maxilar Diferencial (EMD) para realizar a ERM. EMD é um novo dispositivo que pode ser empregado para realização da ERM e sua principal vantagem seria permitir a individualização da expansão. EMD foi proposto para proporcionar maior expansão na região anterior do que na região posterior da maxila. Uma menina de 9 anos de idade buscou tratamento. O plano de tratamento interceptativo proposto foi ERM utilizando o dispositivo EMD. A resposta ortopédica pós expansão mostrou uma abertura de 7,5 mm entre os incisivos centrais superiores, ao nível da borda incisal. Foi observada uma abertura de 4,8 mm na sutura palatina mediana. A abertura a uma distância de 10 mm e 20 mm da crista para posterior na sutura palatina mediana foi de 3,9 mm e 2,8 mm. A distância intercaninos superior apresentou aumento de 9,31 mm. A distância intermolares superiores aumentou 8,04 mm. O perímetro do arco superior apresentou diferença de 74,02 mm para 80,11 mm. E o comprimento do arco superior, de 29,83 mm para 31,56 mm. A mordida cruzada posterior foi sobrecorrigida em 2 mm. O diagnóstico precoce e o tratamento da mordida cruzada posterior tem um prognóstico muito favorável. (AU)

RESUMO

Abstract There is an increasing demand for orthodontic treatment by adult patients in dental offices. Orthodontic treatment in adults has particular characteristics, because, in addition to not showing active growth, there are situations that demand interrelation with other areas of dentistry, such as, Periodontics, Dental Prosthesis, Restorative Dentistry and Implantology. The objective of this work was to describe a clinical case of an adult patient with periodontal involvement, establishing the main considerations to be taken in the orthodontic treatment of adult patients with periodontal involvement. The results obtained in the clinical case showed that it is possible to treat patients with periodontal involvement as long as some precautions are taken, such as strict hygiene control, in association with the specialty of periodontics, a reduced sequence of wires, in order to shorten treatment time, using low intensity forces, to minimize damage to periodontal tissues. The orthodontic treatment performed, gave the patient the desired smile functionality and aesthetics, prioritizing a strict hygiene control, the use of light forces, simplification in orthodontic movement, as well as the use of fixed and permanent restraints in areas of reduced periodontium. (AU)

Resumo É crescente a procura de tratamento ortodôntico por pacientes adultos nos consultórios odontológicos. O tratamento ortodôntico em adultos, apresenta características particulares, pois, além de não apresentar crescimento ativo, ocorrem situações que demandam a inter-relação com outras áreas da odontologia como a, Periodontia, Prótese dentária, Dentística Restauradora e Implantodontia. O objetivo desse trabalho foi descrever um caso clínico de paciente adulta comprometida periodontalmente, estabelecendo as principais considerações a serem tomadas no tratamento ortodôntico de pacientes adultos com comprometimento periodontal. Os resultados obtidos no caso clínico, demonstraram, que é possível tratar os pacientes com comprometimento periodontal desde que sejam tomados alguns cuidados, como controle restrito de higienização, em associação com a especialidade da periodontia, uma sequência reduzida de fios, com o intuito de abreviar o tempo de tratamento, utilizando forças de baixa intensidade, para minimizar danos aos tecidos periodontais. O tratamento ortodôntico realizado, devolveu a paciente a funcionalidade e a estética do sorriso almejada, priorizando um controle rígido de higienização, o uso de forças leves, a simplificação na movimentação ortodôntica, bem como o uso de contenções fixas e permanentes em áreas de periodonto reduzido. (AU)

RESUMO

ABSTRACT Objective: The aim of this study was to test the null hypothesis that there is no difference at the midpalatal suture opening after rapid maxillary expansion (RME) using Expander with Differential Opening (EDO), Hyrax-type and Haas-type expanders. Methods: Occlusal radiographs of 52 patients (19 males and 33 females; average age= 9.46?1.20 years) treated with RME were divided into three groups, according to the expander used: EDO (n=17), Hyrax-type (n=21) and Haas-type (n=14). The evaluated variables were: A) Distance between the maxillary central incisors at the incisal edge; B) Distance between the alveolar ridges at the midpalatal suture; C) Suture opening at 10-mm distance from the crest to posterior, at the midpalatal suture; D) Suture opening at 20-mm distance from the crest to posterior, at the midpalatal suture; and E) Suture opening at 30-mm distance from the crest to posterior, at the midpalatal suture. To assess the normality of variables, the Shapiro-Wilk test was performed. For intergroup comparison, ANOVA with a significance level of 5% was used. Results: At the region A, Hyrax-type (4.66 mm) and EDO (4.87 mm) groups presented larger openings than the Haas-type group (3.43 mm). In regions B and C, EDO showed a statistically significant greater opening than the Haas-type group. In region D, a smaller opening of the midpalatal suture was observed in the Haas-type group, compared to the Hyrax-type and EDO groups. Conclusions: EDO and Hyrax-type produced greater immediate skeletal effects, compared with Haas-type, but these differences were about 1 mm and might not be clinically significant.

RESUMO Objetivo: O objetivo do presente estudo foi testar a hipótese nula de que não existe diferença na abertura da sutura palatina mediana após a expansão rápida da maxila (ERM) usando os expansores Diferencial, tipo Hyrax e tipo Haas. Métodos: Radiografias oclusais de 52 pacientes (19 do sexo masculino e 33 do sexo feminino; idade média: 9,46 ? 1,20 anos) tratados com ERM foram divididas em três grupos, de acordo com o tipo de expansor usado: Diferencial (n = 17), tipo Hyrax (n = 21) e tipo Haas (n = 14). As variáveis avaliadas foram: A) distância entre os incisivos centrais superiores na borda incisal; B) distância entre os rebordos alveolares na sutura palatina mediana; C) abertura da sutura a 10 mm de distância da crista para posterior, na sutura palatina mediana; D) abertura da sutura a 20 mm da crista para posterior, na sutura palatina mediana; e E) abertura da sutura a 30 mm da crista para posterior, na sutura palatina mediana. Para verificar a normalidade das variáveis, utilizou-se o teste de Shapiro-Wilk. Para comparação intergrupos, usou-se a ANOVA com nível de significância de 5%. Resultados: Na região A, os grupos tipo Hyrax (4,66 mm) e Diferencial (4,87 mm) apresentaram uma abertura maior do que o grupo tipo Haas (3,43 mm). Nas regiões B e C, o Diferencial mostrou abertura significativamente maior do que o grupo tipo Haas. Na região D, uma abertura menor da sutura palatina mediana foi observada no grupo tipo Haas, comparado aos grupos tipo Hyrax e Diferencial. Conclusões: Os expansores Diferencial e tipo Hyrax produziram maiores efeitos esqueléticos imediatos, comparados ao tipo Haas, mas essas diferenças foram de aproximadamente 1 mm e podem não ser clinicamente significativas.

RESUMO

Abstract Orthodontic-surgical treatment with the "Surgery First Approach" provides immediate facial aesthetic improvements and significantly reduces the patient's orthodontic treatment time, avoiding the transient worsening of the facial profile due to dental decompensation that occurs in surgical cases. Thus, this clinical case describes the retreatment of a 22-year-old female leukoderma patient, whose main complaint was related to the proclination of upper and lower incisors. The patient used a mio-relaxing plate for 30 days, which evidenced the skeletal mandibular deficiency and the ½ bilateral Class II malocclusion. Orthognathic surgery first approach associated with the extraction of the 4 premolars was chosen considering the patient's aesthetic demand. The use of a mio-relaxing plate in the diagnostic stage was essential for the real diagnosis of mandibular deficiency and the technique employed made it possible to conclude the treatment avoiding aesthetic commitment, with excellent results. (AU)

Resumo O tratamento ortodôntico-cirúrgico por meio do benefício antecipado proporciona melhorias estéticas faciais imediatas e reduz de maneira significativa o tempo de tratamento ortodôntico do paciente, evitando a piora transitória do perfil facial devido à descompensação dentária que ocorre em casos cirúrgicos. Assim, este caso clínico descreve o retratamento de uma paciente com 22 anos de idade, leucoderma, sexo feminino, que apresentava queixa principal relacionada à inclinação vestibular dos dentes anteriores. Após uso de placa miorrelaxante por 30 dias, verificou-se a presença de Classe II esquelética com deficiência mandibular e ½ Classe II dentária bilateral. Considerando a demanda estética da paciente, optou-se pela abordagem ortodôntico-cirúrgica com Benefício Antecipado associada à extração de 4 pré-molares para correção da inclinação dentária anterior. O uso da placa miorrelaxante foi fundamental para o diagnóstico real da deficiência mandibular e a técnica empregada possibilitou concluir o tratamento evitando o comprometimento estético pré-cirúrgico, com obtenção de excelentes resultados. (AU)

RESUMO

This 2-year-follow up study compared and evaluated the stability of early anterior open bite (AOB) treatment based on different appliances. Children from 7 to 10 years with Angle Class I, AOB larger than 1.0 mm and fully erupted maxillary and mandibular permanent central incisors were eligible. The initial sample was 99 patients distributed, by simple randomization, into four groups: BS (bonded spurs), CC (chincup), FPC (fixed palatal crib) and RPC (removable palatal crib). Cephalometric analysis was performed at baseline (T1), final (T2) and 2-year post-treatment (T3) by taking the overbite measurements as the main outcome. Blinding was possible to cephalometric analysis. At T3, with dropouts, there were 63 individuals, being BS (n=15; overbite 0.19 mm; 11.54 years; 10 female (F)/5 male (M)); CC (n=11; overbite -0.19 mm; 11.41 years; 8 F/3 M); FPC (n=21; overbite 1.23 mm; 11.44 years; 15 F/6 M) and; RPC (n=16; overbite 0.73 mm; 11.67 years; 6 F/10 M). Changes in dentoskeletal variables and breaking deleterious oral habits during the follow up were statically analyzed with p<.05. Mandibular skeletal linear measurements and vertical dental components have gradually increased with age, manly at pubertal growth spurt and at the establishment of permanent dentition after treatment. Incisor teeth extrusion had impact on AOB correction and stability in 4 groups, which recorded a 1.15 mm-improvement of overbite after treatment (T3-T2). The experimental appliances were effective with stable results, being FPC the device recorded the highest AOB correction and the lowest patient withdrawal rate.

Assuntos