Rapid and slow palatal expansion in bilateral complete cleft lip and palate cone beam CT evaluation: preliminary results

Introduction: The upper dental arch of patients with complete bilateral cleft lip and palate commonly presents constricted due to the absence of the sutures and the lip and palate surgeries performed at an early age. Objective: The objective of this paper is to evaluate and compare the effects of maxillary expansion between two different appliances: Haas / Hyrax and quad-helix, in patients with bilateral complete cleft lip and palate, using cone-beam computed tomography (CT). Material and methods The study sample will consist of 30 patients with bilateral complete cleft lip and palate with maxilla constriction and that had received primary surgeries in childhood. Patients will be divided into two study groups, treated with Haas or Hyrax expanders (Group I = 30) and quadhelix expanders (Group II = 30). For preliminary results there were 23 patients (Group I = 13 and Group II = 10).The CT examination was performed immediately pre-expansion and six months after the expansion, when the appliance was removed. The following dimensions were performed: the maxillary transverse dimensions, the inclination of the posterior teeth, the buccal bone plates thickness and the buccal and lingual bone crest in the molar anchorage in both phases of the study. Changes interphases were evaluated using the Student \"t\" test (p <0,05). Comparison of baseline characteristics of each study group, as well as the intergroup comparison of the effect of the expansion were conducted by independent t test (p <0,05). Preliminary results: To date, no significant difference between groups was found

Bullying of individuals with cleft lip and palate frequency and preventive procedures

Purpose: The purpose of this study was to verify the prevalence of bullying among children and adolescents, the consequences on the social development and educational process, evaluating the public policies for prevention or punishment of this negative behavior. Methods: The study group comprised 121 patients with cleft lip and palate in the process of rehabilitation in a single center from both sexes with age varying from 6 to 35 years. The control group comprised 121 siblings of these patients born without cleft lip and palate. A questionnaire with objective questions on bullying and its consequences was answered by one of the parents or tutors. Preventive procedures were discussed with the parents. The prevalence of bullying was calculated for each group. Intergroup comparisons were performed using Chi-square and Fisher exact tests (p<0.05). Results: Bullying was reported as a frequent occurrence in the group of individuals with cleft lip and palate (50.4%). A higher frequency of bullying against individuals with CLP was found compared to the group of siblings without CLP (22.3%) (p<0.01). The most common type of bullying was oral offense (78.7%) followed by physical with oral offense (19.7%). The school was the most frequent place of bullying occurrence (86.9%). Most of the parents/tutor reported the desire for educational procedures and public policies to prevent this type of aggression. Conclusions: Bullying was more frequent among individuals with cleft lip and palate in comparison with noncleft individuals. Public policies should be implemented for educating and preventing this violence against human being

Intercerter comparison of different maxillary expansion modalities in patients with complete cleft lip and palate

Introduction: The maxillary dental arch of patients with unilateral complete cleft lip and palate is generally constricted showing a transversal deficiency that very frequently requires maxillary expansion. Some centers prefer the rapid orthopedic expansion, using the Hyrax appliance while others prefer the slow maxillary expansion and use the quadhelix appliance. The literature is not clear about each expander promotes the best expansion. Purpose: to compare the occlusal effects of rapid and slow maxillary expansion, in patients with unilateral complete cleft lip and palate, using digital models. Methodology: 34 patients in the mixed dentition composed the sample. The rapid maxillary expansion using hyrax appliance was performed in 17 patients at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (HRCA-USP) and the slow maxillary expansion was performed in 17 patients, using quad-helix appliance, at the Los Angeles Childrens Hospital, University of South California (LOCH-USC). Conventional dental casts was performed before expansion (T1) and 6 months after the expansion (T2), when the appliance was removed. After digitalization of the dental casts (3Shape R700 3D), the maxillary dental arch transverse dimensions, buccolingual inclination of posterior teeth, dental arch perimeter and palate volume was measured. Dependent tests was used to evaluate the changes between phases (p<0.05) and Independent test was used to evaluate the changes between the groups (p<0.05). Conclusions: Both orthopedic expander and the quad-helix produced significant changes in the maxillary arch widths and perimeter. The palate volume increased in the rapid maxillary group and posterior maxillary tooth tipping was bigger in the quad-helix group.FAPES

Periodontal morphology of teeth moved into grafted alveolar cleft a CBCT assessment

Purpose: the purpose of this research was to assess the periodontal morphology of the canine mesialized to the grafted region in patients with unilateral alveolar clefts with by measuring images of cone- beam computed tomography (CBCT) exams. Methods: the sample comprised CBCT exams of 30 patients with unilateral cleft lip and/or palate during retention period after orthodontic comprehensive treatment. Buccal and lingual alveolar bone thickness of the canine in the clefted side (CF) were measured and compared to the canine (CsF) and lateral incisor in the non-cleft side (IL). To assess the buccal and lingual bone crest height, parassagital slices were obtained passing through the center of the crown of each evaluated teeth. It was calculated the distance form the cemento-enamel junction (CEJ) to the buccal and lingual alveolar bone crest. The comparison among the CF values with the CsF and IL was performed with the paired t test or the Wilcoxon test, depending on the distribution of normality. Results: the results showed that the buccal bone plate is thinner than the lingual bone plate in every tooth evaluated. When comparing the CF and the CsF, there was a statistically significant difference to the buccal alveolar bone thickness (p=0,002). When comparing the CF and IL, there was a statistically significant difference to the buccal alveolar bone thickness (p=0,001) and the lingual bone crest height (p=0,000). Conclusion: the mesialization of teeth to grafted alveolar bone in patients with clefts is a viable option under the periodontal and esthetical perception.FAPES

Influence of low-level laser on bone remodeling during induced tooth movement in rats

Objective: To analyze the effect of low-level laser on bone remodeling during induced tooth movement in rats. Materials and Methods: A diode laser (808 nm, 100 mW, 54 J on an area of 0.0028 cm2) was used. The application was continuous, punctual, and with contact. Forty-two 70-day-old Wistar rats had the maxillary left first molar moved using a force level of 25 g. In two experimental subgroups the movement was performed over 7 days and in three subgroups the movement occurred over 14 days. In the 7-day movement subgroups, one subgroup received laser irradiation on day 1 only; the other subgroup received laser irradiation on days 1, 3, and 5. In the 14-day movement subgroups, one subgroup received laser irradiation on day 1 only; the second on days 1, 3, and 5; and the third on days 1, 3, 5, 7, 9, 11, and 13. The control group was also divided into two subgroups, and movement occurred over two different periods of treatment (7 days and 14 days) without laser application; these were used as controls for the respective experimental subgroups. Inter-subgroup comparison was performed with Kruskal-Wallis, followed by Mann-Whitney and analysis of variance, followed by Tukey tests within the 7- and 14-day subgroups. Results: The subgroup with three laser applications showed significantly greater osteoclastic activity and bone resorption than the other subgroups in the 7-day movement subgroups. Conclusions: Low-level laser application significantly increased the osteoclastic but not the osteoblastic activity during the initial phases of tooth movement. In addition, the osteoclastic activity was dose-dependen

Prevalência de mesiodens em pacientes ortodônticos nos estágios de dentição decídua e mista e sua associação com outras anomalias dentárias

OBJECTIVE: To determine the prevalence of mesiodens in deciduous and mixed dentitions and its association with other dental anomalies. MATERIAL AND METHODS: Panoramic radiographs of 1,995 orthodontic patients were analyzed retrospectively, obtaining a final sample of 30 patients with mesiodens. The following aspects were analyzed: gender ; number of mesiodens; proportion between erupted and non-erupted mesiodens; initial position of the supernumerary tooth; related complications; treatment plan accomplished; and associated dental anomalies. The frequency of dental anomalies in the sample was compared to reference values for the general population using the chi-square test (c2), with a significance level set at 5%. RESULTS: The prevalence of mesiodens was 1.5% more common among males (1.5:1). Most of the mesiodens were non-erupted (75%) and in a vertical position, facing the oral cavity. Extraction of the mesiodens was the most common treatment. The main complications associated with mesiodens were: delayed eruption of permanent incisors (34.28%) and midline diastema (28.57%). From all the dental anomalies analyzed, only the prevalence of maxillary lateral incisor agenesis was higher in comparison to the general population. CONCLUSION: There was a low prevalence of mesiodens (1.5%) in deciduous and mixed dentition and the condition was not associated with other dental anomalies, except for the maxillary lateral incisor agenesis.OBJETIVO: determinar a prevalência de mesiodens nos estágios de dentição decídua e mista, e verificar sua associação com outras anomalias dentárias. MÉTODOS: radiografias panorâmicas de 1.995 pacientes ortodônticos foram analisadas retrospectivamente, obtendo-se uma amostra de 30 pacientes com o mesiodens. Os seguintes aspectos foram analisados: distribuição entre os sexos, número de mesiodens; se irrompido ou não irrompido; posição; complicações; tratamento instituído, e anomalias dentárias associadas. A frequência de anomalias dentárias na amostra estudada foi comparada a valores de referência para a população em geral por meio do teste qui-quadrado (c2), com um nível de significância de 5% (p < 0,05). RESULTADOS: a prevalência de mesiodens foi de 1,5%, sendo mais comum no sexo masculino (1,5:1). A maior parte dos mesiodens estavam não irrompidos (75%) e numa posição vertical, voltada para a cavidade bucal. O tratamento mais empregado foi a exodontia. As principais complicações associadas ao mesiodens foram o atraso na erupção dos incisivos permanentes (34,28%) e diastema mediano (28,57%). Pacientes com mesiodens não apresentaram prevalência aumentada de microdontia, agenesia de dentes permanentes ou outros supranumerários. De todas as anomalias analisadas, apenas a prevalência de agenesia de incisivo lateral superior mostrou-se aumentada em comparação à população em geral. CONCLUSÃO: o mesiodens foi encontrado em uma prevalência baixa (1,5%) nas dentições decídua e mista, e não apresentou associação com outras anomalias dentárias, com exceção da agenesia de incisivo lateral superior