RESUMO
Discorre-se durante extensa parte do início, em torno do conceito, necessidade e oportunidade de tratamento do apinhamento primário, mas o que predomina em pauta no presente artigo de divulgação é o tratamento do apinhamento na dentadura permanente, com a extração de dentes (mecânica extracionista). A possibilidade de extração de incisivos inferiores dá o tom, trazendo à tona os textos da literatura, em geral pouco recorrentes, que procuram dar fundamento a esta abordagem. Os casos clínicos ilustram esta, entre outras possibilidades convencionais, mostrando uma abertura despreconcebida para extrações chamadas "atípicas", simétricas ou assimétricas, despertando o talento para encontrar soluções óbvias com relação custo-benefício e finalização justificáveis. Sem, no entanto, adotar posição ufanistas
Assuntos
Humanos , Masculino , Feminino , Criança , Adulto , Classificação , TerapêuticaRESUMO
OBJECTIVE: This report is a retrospective study that compares the craniofacial morphology of adult subjects with unoperated bilateral complete cleft lip and palate (BCLP) with that of a noncleft group. METHODS: The study was performed on standardized lateral cephalograms obtained at the Hospital for Research and Rehabilitation of Cleft Lip and Palate, University of São Paulo, Brazil. The research group consisted of 28 subjects (20 males, 8 females) with unoperated BCLP, ranging in age from 15 to 41 years. The control group was matched to the cleft group with regard to gender and age. The findings were analyzed on the basis of the two-way analysis of variance (ANOVA) for cleft and gender. RESULTS: The most striking difference between the groups was the extremely prominent premaxilla in the cleft group that gave the BCLP face a very convex profile. The mandible exhibited a vertical growth pattern that resulted in a steep mandibular plane, an obtuse gonial angle and a long lower face height. The posterior face height was reduced. The cranial base dimensions were smaller, but there was no difference in cranial base angulation. CONCLUSIONS: These findings confirm that in subjects with unoperated BCLP, the initial characteristics of the cleft malformation persist during growth.
Assuntos
Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Ossos Faciais/anormalidades , Ossos Faciais/crescimento & desenvolvimento , Desenvolvimento Maxilofacial , Adolescente , Adulto , Análise de Variância , Estudos de Casos e Controles , Cefalometria , Ossos Faciais/anatomia & histologia , Feminino , Humanos , Incisivo/anormalidades , Masculino , Estudos Retrospectivos , Caracteres Sexuais , Base do Crânio/crescimento & desenvolvimento , Dimensão VerticalRESUMO
This study comprised a sample of 31 patients with Class III malocclusion (21 girls and 10 boys), with ages ranging from 5 years 2 months to 11 years 6 months. All patients were in the deciduous or mixed dentition. The indicated treatment was rapid maxillary expansion, immediately followed by maxillary protraction with the facial mask. Mean treatment time was 8 months, varying from 4 to 24 months. The therapy induced both dental and skeletal alterations. Skeletal alterations consisted of maxillary anterior displacement and mandibular downward and backward rotation, improving facial profile. Dental alterations, known as dentoalveolar compensations, consisted of a tendency of labial tipping of the maxillary incisors and lingual tipping of the mandibular incisors.
Assuntos
Má Oclusão Classe III de Angle/terapia , Ortodontia Interceptora/métodos , Técnica de Expansão Palatina , Cefalometria , Criança , Pré-Escolar , Dentição Mista , Aparelhos de Tração Extrabucal , Feminino , Humanos , Incisivo/fisiopatologia , Masculino , Ortodontia Interceptora/instrumentaçãoRESUMO
This study was designed to investigate the effect of nonsurgical rapid maxillary expansion in adult patients diagnosed as having real or relative transverse maxillary deficiency. Thirty-eight patients were consecutively treated with a fixed rapid maxillary expansion appliance of the Haas design. Successful expansion, as judged by clinical evidence of the creation of a diastema at the central incisors, was possible in 81.5% of the patients. Morbidity ranged from mild discomfort to significant pain, edema, and palatal lesions, which, in most instances, did not compromise the expansion. Only moderate maxillary expansion was possible in most patients, but enough was obtained to facilitate the achievement of satisfactory final interocclusal relations.
Assuntos
Má Oclusão/terapia , Técnica de Expansão Palatina , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Masculino , Maxila/anormalidades , Técnica de Expansão Palatina/efeitos adversos , Técnica de Expansão Palatina/instrumentação , Técnica de Expansão Palatina/estatística & dados numéricos , Resultado do TratamentoRESUMO
The dental compensation presented in patients with the Class III malocclusion, or mandibular prognathism, and its importance to the surgical-orthodontic treatment, was evaluated in this study. The study involved the cephalometric examination of two groups of patients, who were considered either adequately or inadequately treated during the presurgical orthodontic phase. The results showed that dental compensation is common in both the maxillary and mandibular arches. Such compensation is more frequently eliminated from the mandibular arch during presurgical orthodontic treatment. There was some correlation between decompensation and the amount of mandibular reduction during surgery and a strong correlation between cephalometric postsurgical mandibular excess and the lower anterior facial height.
Assuntos
Má Oclusão Classe III de Angle/terapia , Mandíbula/cirurgia , Prognatismo/cirurgia , Migração de Dente/terapia , Cefalometria , Terapia Combinada , Feminino , Humanos , Masculino , Má Oclusão Classe III de Angle/complicações , Má Oclusão Classe III de Angle/cirurgia , Mandíbula/anormalidades , Ortodontia Corretiva/métodos , Procedimentos Cirúrgicos Ortognáticos , Prognatismo/complicações , Estudos Retrospectivos , Estatísticas não Paramétricas , Migração de Dente/etiologia , Migração de Dente/fisiopatologia , Resultado do Tratamento , Dimensão VerticalRESUMO
Our aim was to evaluate the isolated effects of cheiloplasty and palatoplasty on dentofacial morphology. Ninety-three lateral cephalograms of white male adult patients with complete unilateral cleft lip and palate were analyzed in this study. The sample was divided into three groups according to the surgical treatment received: (1) nonoperated group (NO)-35 patients without surgical treatment; (2) operated lip group (OL)-23 subjects with lip closure only; (3) operated lip and palate group (OLP)-35 individuals with both lip and palatal closure. No statistically significant differences in the cephalometric measurements between the OL and OLP groups were found. There were, however, several significant differences between these two groups (OL and OLP) and the nonoperated group (NO). Thus, the differences in dentofacial morphology in patients with unilateral cleft lip and palate, seem to be influenced principally by the surgically repaired lip. Influences of the palatal repair appeared to be minimal and statistically insignificant.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Desenvolvimento Maxilofacial , Adolescente , Adulto , Cefalometria , Fenda Labial/patologia , Fenda Labial/fisiopatologia , Fissura Palatina/patologia , Fissura Palatina/fisiopatologia , Ossos Faciais/crescimento & desenvolvimento , Ossos Faciais/patologia , Humanos , Lábio/cirurgia , Masculino , Mandíbula/crescimento & desenvolvimento , Mandíbula/patologia , Maxila/crescimento & desenvolvimento , Maxila/patologia , Palato/cirurgia , Crânio/crescimento & desenvolvimento , Crânio/patologia , Dimensão VerticalRESUMO
P-A cephalometric analysis was performed on the craniofacial morphology in 88 Brazilian men with nonoperated and operated cleft lip and palate. For the comparative study, these subjects were divided into the following four groups: (1) 31 nonoperated unilateral cleft lip and palate (UCLP), (2) 24 nonoperated bilateral cleft lip and palate (BCLP), (3) 16 operated UCLP, (4) 17 operated BCLP. Thirty Brazilian men without cleft lip and palate were used as control subjects. In comparison with the control subjects, nonoperated BCLP and UCLP showed remarkable facial deformity characterized by increased width of various facial parts. Facial morphology of surgically treated BCLP and UCLP, however, was very similar to that of noncleft subjects, apart from the immediate cleft region. There was no remarkable difference in the facial morphology between nonoperated BCLP and UCLP, except for the cleft width and the deviation of nasal septum base, while the only significant difference between operated BCLP and UCLP was in the cleft width.
Assuntos
Cefalometria , Fenda Labial/patologia , Fissura Palatina/patologia , Adolescente , Adulto , Processo Alveolar/crescimento & desenvolvimento , Processo Alveolar/patologia , Brasil , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Ossos Faciais/crescimento & desenvolvimento , Ossos Faciais/patologia , Humanos , Masculino , Maxila/crescimento & desenvolvimento , Maxila/patologia , Septo Nasal/crescimento & desenvolvimento , Septo Nasal/patologia , Crânio/crescimento & desenvolvimento , Crânio/patologiaRESUMO
A total of 229 adult white patients with cleft lip or palate were evaluated, through cephalometric radiographs, to determine cleft-type influence on mandibular structure and spatial position. The sample includes adult patients with unilateral complete cleft lip and alveolus (n = 50), complete cleft lip and palate (n = 118), and isolated cleft palate (n = 61). A group of 65 subjects with normal occlusion and without cleft lip or palate was used as a control group. All groups were matched according to sex. When compared, the cleft groups and the normal group showed that the mandibular structure was significantly different. The mandible in the cleft groups displayed shorter mandibular ramus and body length, without difference between the cleft types. Mandibular position relative to cranial base was similar in the cleft groups with involvement of the palate, and differed significantly from that observed in the group with cleft lip and alveolus and in the subjects without cleft. Palatal clefts induce a significant downward and backward rotation of the mandible associated with a more obtuse gonial angle. Thus a small mandible is a structural characteristic of all cleft types studied. However, mandibular shape and spatial position are strongly influenced in clefts that involve the palate.
Assuntos
Fenda Labial/fisiopatologia , Fissura Palatina/fisiopatologia , Mandíbula/crescimento & desenvolvimento , Mandíbula/fisiopatologia , Desenvolvimento Maxilofacial , Adolescente , Adulto , Estudos de Casos e Controles , Cefalometria , Fenda Labial/patologia , Fissura Palatina/patologia , Feminino , Humanos , Masculino , Mandíbula/patologia , Valores de ReferênciaRESUMO
Using a sample of 204 caucasian adults of both sexes, with complete unilateral cleft lip and alveolus, isolated cleft palate and complete unilateral cleft lip, alveolus and palate, the influence of surgery on maxillary morphology and spatial position for the three main types of cleft lip and/or palate were evaluated. 113 cleft patients operated on at conventional timings were compared to 91 cleft patients who had never been operated on. Findings permit the conclusion that cheiloplasty in cleft lip and alveolus patients is associated with osseous remodelling in the anterior alveolar region, without significant changes in anterior nasal spine or other areas of the maxilla. In isolated cleft palate subjects palate repair does not promote significant changes in maxillary morphology and spatial position. The most evident effects were seen in the cleft lip, alveolus and palate group: reconstructive surgery in these patients leads to a severe maxillary retroposition associated with a downward rotation.