RESUMO
OBJECTIVE: In orthodontic treatment, indication of dental extractions is very common and frequently used in adult patients. This situation is a recurrent concern among orthodontists, since age and extraction treatment are factors that may increase periodontal support loss. Therefore, this study aimed to evaluate adolescent and adult patients, orthodontically treated with maxillary premolar extractions, and compare both groups regarding the changes in alveolar bone height loss, retrospectively. MATERIALS AND METHODS: Fifty-five patients were selected from the files of an Orthodontic Department and divided into 2 groups. The adolescent group comprised 30 patients with a mean age of 12.7 years (SD=1.4) and the adult group comprised 25 patients with a mean age of 25.0 years (SD=1.8). Periapical radiographs obtained at pre-treatment (T1) and posttreatment (T2) were evaluated. Wilcoxon tests were used to analyse intragroup treatment changes. Mann-Whitney tests were used to compare intergroup and inter-sex initial and final statuses and treatment changes. P<0.05 is considered to be statistically significant. RESULTS: Statistically significant increases in alveolar bone height loss of the maxillary central incisors were observed on the right and left sides of the adolescent (P=0.001 and P=0.002, respectively) and of the adult (P=0.001 and P<0.001, respectively) groups, during treatment. There were no significant differences in alveolar bone height between initial and final state, in treatment effects between adolescent and adult patients, in extraction patterns, and between males and females. CONCLUSIONS: Significant increase in alveolar bone height loss was found in both adult and adolescent patients orthodontically treated with maxillary premolar extractions. However, no significant differences were found regarding alveolar bone height changes after extraction orthodontic treatment between adolescent and adult patients.
Assuntos
Perda do Osso Alveolar , Extração Dentária , Adolescente , Adulto , Perda do Osso Alveolar/diagnóstico por imagem , Dente Pré-Molar/diagnóstico por imagem , Dente Pré-Molar/cirurgia , Cefalometria , Criança , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
Em algumas situações o ortodontista se depara com o dilema entre indicar apenas o tratamento ortodôntico ou o ortodôntico cirúrgico e muitos critérios devem ser considerados antes de uma decisão final ser tomada. O objetivo deste artigo é apresentar o tratamento ortodôntico-cirúrgico de um paciente com má oclusão de Classe I e discutir quais fatores são relevantes durante a escolha do melhor tipo de tratamento para cada caso.(AU)
In some situations, the orthodontist faces the dilemma of indicating only an orthodontic treatment or a surgical-orthodontic treatment and many criteria must be considered before a final decision is taken. The objective of this article is to present the orthodontic-surgical treatment of a Class I malocclusion patient and discuss which factors are relevant when deciding the best treatment approach for each case (AU)
Assuntos
Humanos , Feminino , Adolescente , Má Oclusão , Ortodontia , Cirurgia OrtognáticaRESUMO
Este relato de caso teve como objetivo exemplificar e discutir, à luz da literatura científica, a influência da Classe II, subdivisão, tipo 1, sobre a posição dos terceiros molares inferiores, bem como avaliar o impacto das extrações assimétricas de 3 pré-molares sobre a erupção destes dentes. Previamente ao tratamento, a paciente apresentava os terceiros molares inferiores impactados, sendo que no lado da relação molar de Classe II a impacção era mais severa, provavelmente em decorrência da característica dentoalveolar determinante desta má oclusão, que é a posição mais distal do primeiro molar inferior no lado da Classe II. Após o tratamento observou-se a desimpacção do terceiro molar inferior no lado da Classe I, onde foi realizada a extração de um pré-molar. Porém, no lado oposto, onde nenhuma extração foi realizada, o terceiro molar inferior permaneceu impactado. Concluiu-se que o profissional deve atentar para a propensão da Classe II, subdivisão, tipo 1, apresentar o terceiro molar inferior no lado da Classe II em condição mais desfavorável à erupção, e que este fato, por si, não justificaria a realização de extrações simétricas de 4 pré-molares em razão da menor proporção de sucesso deste protocolo, quando aplicado à Classe II, subdivisão, tipo 1. A extração assimétrica de 2 pré-molares superiores e um pré-molar inferior no lado da Classe I pode favorecer a erupção e/ou desimpacção do terceiro molar inferior neste lado, indicando a necessidade de postergar a decisão da extração.
This case report aimed to illustrate and discuss, in the light of scientific literature, the influence of Type 1 Class II subdivision malocclusion on the positioning of the mandibular third molar and to evaluate the impact of the asymmetric extraction of 3 premolars on the eruption of that tooth. Before treatment, the patient had impacted mandibular third molars. The Class II side showed more severe impaction, probably due to the main dentoalveolar feature of this malocclusion, which is the mandibular first molar more distally positioned on the Class II side. After treatment, mandibular third molar were disimpacted on the Class I side, where premolar extraction was performed. However, in the opposite side, where no extraction was performed, the impaction of the mandibular third molar was kept unchanged. It was concluded that the professional should be aware that the Type 1 Class II subdivision malocclusion is prone to present less favorable condition for eruption of the mandibular third molar on the Class II side. Nevertheless, this fact itself could not justify making symmetric extraction of 4 premolars because this protocol presents a smaller occlusal success rate when applied to the Type 1 Class II subdivision malocclusion. In addition, asymmetric extraction of 2-maxillary premolars and a mandibular premolar on the Class I side can benefit the eruption and/or disimpaction of the mandibular third molar in this side, indicating the need to postpone the extraction decision.
Assuntos
Humanos , Feminino , Adulto , Má Oclusão Classe II de Angle , Dente Serotino , Ortodontia Corretiva , Extração Dentária , Dente ImpactadoRESUMO
A intrusão dentária é um movimento extremamente requisitado na Ortodontia, quando um dente apresenta-se extruído em relação aos seus adjacentes por perda de antagonista, por desgaste dentário ou fratura e também nos casos de mordidas abertas, nas quais se deseja a intrusão de todo o bloco posterior com a intenção de fechar a mordida aberta anterior. Esse artigo visa estabelecer critérios de escolha para a eleição de procedimentos clínicos baseados na fisiologia do periodonto e na mecânica empregada, ficando restrito aos movimentos individuais ou de dois dentes, não tendo, portanto, o objetivo de se aprofundar nos tratamentos de mordidas abertas, assunto esse com vasto material disponível na literatura.
The dental intrusion is extremely required in Orthodontics, when a tooth presents extruded in relation to its adjacent caused due the loss of antagonist, tooth wear or even fracture, and also in cases of open bite in which the intrusion of posterior block may help closing the anterior open bite. This article aims to establish selection criteria for the election of clinical procedures based on the physiology of the periodontium and mechanics employed, being restricted to individual movements or two teeth, therefore not having the purpose of delving into the open bite treatments, which has dense report in the literature.
Assuntos
Humanos , Reabilitação Bucal , Técnicas de Movimentação Dentária , Extrusão OrtodônticaRESUMO
A má oclusão de Classe III tem como aliada no tratamento precoce a protração maxilar por meio da máscara facial. Embora esse aparelho seja altamente efetivo, do ponto de vista esquelético e dentário, demanda colaboração total do paciente, o que nem sempre é atingido devido o aparelho ser externo e causar um problema estético, principalmente quando usado em público. Para ajudar no tratamento (às vezes até substituí-lo), é proposto um novo dispositivo, o Bimax III, aparelho dento-suportado utilizado em conjunto com elásticos de Classe III, que embora ainda não haja estudos comprovando sua eficácia esquelética, responde muito bem à movimentação dentária, pois é facilmente aceito pelo paciente. A proposta desse artigo é apresentar o referido aparelho e sugerir outras formas de tratamento para a correção da Classe III precoce.
The treatment of early Class III malocclusion has an ally in maxillary protraction through the facemask. Although this device is highly effective in terms of skeletal and dental outcomes, full compliance of the patient is needed. This is often hard to achieve since the device is external and cause an aesthetic problem, especial ly when used in public. To assist in the treatment (or sometimes even replace it) a new device is proposed, the Bimax III, a dental-supported device used in conjunction with Class III elastics. Although there are no studies proving its skeletal effectiveness, it responds very well to the tooth movement because it is readily accepted by the patient. The purpose of this paper is to present the mentioned appliance and suggest other forms of early Class III treatment.
Assuntos
Humanos , Feminino , Criança , Má Oclusão Classe III de Angle , Aparelhos OrtodônticosRESUMO
OBJECTIVE: To compare maximum torque produced by different muscular groups and its influence on mini-implant insertion torque and fracture prevention. DESIGN: A prospective study involving in vivo and in vitro laboratory experiments. MATERIALS AND METHODS: Eighty-seven professionals were evaluated for maximum torque produced using a screwdriver with combined action between thumb and index fingers [maximum digital torque (MDT)] and by forearm supination movement [maximum brachial torque (MBT)]. Ninety mini-implants distributed over nine different diameters and twenty commercially available mini-implants of two different diameters and trademarks were fractured to determine the fracture torque (FT). The fracture resistance index (FRI) was obtained from: FRI_MDTâ=âFT/MDT and FRI_MBTâ=âFT/MBT. The analysis of variance (ANOVA) and t tests were used to compare the groups. RESULTS: MDT was smaller than MBT and both were smaller in females. FT increased for each 0·1 mm of diameter increment. FRI_MDT was greater than FRI_MBT for all diameters. FRI_MDT>1 was found when the diameter was greater than or equal to 1·5 mm. FRI_MBT>1 occurred with diameters equal or greater than 1·7 mm for females and 1·8 mm for males. The 1.5 mm and 1.6 mm diameter of commercially available and mini-implants presented FRI_MBT<1 and FRI_MDT>1. CONCLUSIONS: Digital torque was 42% smaller than brachial torque, and it was mechanically safer and biologically more compatible, allowing fracture prevention of 1·5 mm or thicker mini-implant diameter due to insertion torque limitation at 15 N/cm.
Assuntos
Implantes Dentários , Antebraço/fisiologia , Mãos/fisiologia , Músculo Esquelético/fisiologia , Procedimentos de Ancoragem Ortodôntica/instrumentação , Fenômenos Biomecânicos , Falha de Equipamento , Feminino , Dedos/fisiologia , Humanos , Masculino , Desenho de Aparelho Ortodôntico , Estudos Prospectivos , Fatores Sexuais , Supinação/fisiologia , Polegar/fisiologia , Torque , Torção MecânicaRESUMO
PURPOSE: To compare the maximum torque produced by different muscle groups and its influence on mini-implant insertion torque and fracture prevention. MATERIALS AND METHODS: Eighty-seven professionals were evaluated for the maximum torque produced on a screwdriver by a combined action between the thumb and index finger (maximum digital torque [MDT]) and by the forearm supination movement (maximum brachial torque [MBT]). Ninety mini-implants distributed among 9 different diameters were fractured to determine the fracture torque (FT). The fracture resistance index (FRI) was obtained from: FRI_MDT = FT/MDT and FRI_MBT = FT/MBT. Analysis of variance and t tests were used to compare the groups. RESULTS: The MDT was smaller than the MBT, and the 2 measurements were smaller in female subjects. The FT increased for each 0.1-mm increment in diameter. The FRI_MDT was greater than FRI_MBT for all diameters. An FRI_MDT greater than 1 was found when the diameter was greater than or equal to 1.5 mm. An FRI_MBT greater than 1 occurred with diameters equal to or greater than 1.7 mm for female subjects and 1.8 mm for male subjects. CONCLUSIONS: The digital torque was 42% smaller than the brachial torque, and it was mechanically safer and biologically more compatible, allowing the prevention of the fracture of mini-implants with a diameter 1.5 mm or thicker owing to an insertion torque limitation at 15 N-cm.
Assuntos
Parafusos Ósseos , Antebraço/fisiologia , Mãos/fisiologia , Músculo Esquelético/fisiologia , Procedimentos de Ancoragem Ortodôntica/instrumentação , Adulto , Análise de Variância , Fenômenos Biomecânicos , Falha de Equipamento , Feminino , Força da Mão/fisiologia , Humanos , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , Caracteres Sexuais , Estatísticas não Paramétricas , TorqueRESUMO
INTRODUCTION: The aim of this study was to evaluate the effect of mini-implant diameter on fracture risk and self-drilling efficacy. METHODS: A sample of 405 mini-implants with 9 diameters from 1.2 to 2.0 mm was used. Ten mini-implants of each diameter were placed in artificial bone, and 25 were placed in pig iliac bone to evaluate placement torque (PT) and axial placement load (APL), which represents self-drilling efficacy. Ten mini-implants of each diameter were used to determine fracture torque (FT). The different diameters were compared regarding PT, FT, and APL. The fracture risk of each diameter was evaluated by the fracture resistance index (FT/PT × [FT-PT]). The PT and APL changes during placement were correlated. RESULTS: Only PT and FT were different for all mini-implant diameter changes. PT and FT showed a strong correlation with the mini-implant diameter, but the APL was weakly to moderately correlated. The fracture resistance index was remarkably greater for each 0.1 mm added in diameter. The PT increased significantly, whereas the APL was progressively reduced during placement. CONCLUSIONS: Increases in mini-implant diameters significantly influenced the increases of PT and FT on quantities that progressively reduced the fracture risk. The self-drilling efficacy was not strongly influenced by diameter.