Treatment of Class III Malocclusion: Atypical Extraction Protocol

The treatment of Angle Class III malocclusion is rather challenging, because the patient’s growth pattern determines the success of long-term treatment. Early diagnosis and treatment are still highly discussed issues in orthodontic literature. This type of early intervention has been indicated more frequently in order to eliminate primary etiological factors and prevent an already present malocclusion from becoming severe. However, when a patient is diagnosed in adulthood, manipulation of the bone bases becomes extremely limited, as there is no longer any potential for growth. Treatments are restricted to dental compensations when possible or orthognathic surgery. However, owing to the high cost and inherent risk of the surgical procedure, this treatment option is often denied by the patient; in such a case, the orthodontist has little choice but to perform, where possible, compensatory treatments to restore a functional occlusion and improve facial esthetics. This article reports a case of Class III malocclusion in a patient who opted for compensatory treatment with lower molar extraction that allowed for correction of the midline and the overjet. Good facial esthetics and functional normal occlusion were achieved at the end of the treatment

Evaluation of the stability of open bite treatment using a removable appliance with palatal crib combined with high-pull chincup

OBJECTIVE: The aim of this prospective study was to cephalometrically analyze the stability of dentoalveolar and skeletal changes produced by a removable appliance with palatal crib associated to high-pull chincup in individuals with anterior open bite treated for 12 months, and compare them to individuals with similar malocclusion and age, not submitted to orthodontic treatment, also followed for the same period. METHODS: Nineteen children with a mean age of 9.78 years old treated for 12 months with a removable appliance with palatal crib associated with chincup therapy were evaluated after 15 months (post-treatment period) and compared with a control group of 19 subjects with mean age of 9.10 years with the same malocclusion that was followed-up for the same period. Seventy-six lateral cephalograms were evaluated at T1 (after correction) and T2 (follow-up) and cephalometric variables were analyzed by statistical tests. RESULTS: The results did not show significant skeletal, soft tissue or maxillary dentoalveolar changes. Overall, treatment effects on the experimental group were maintained at T2 evaluation with an increase of 0.56 mm in overbite. Overjet and maxillary incisors/molars position (vertical and sagittal) remained essentially unchanged during the study period. Only mandibular incisors showed significant changes (labial inclination and protrusion) compared to control group. CONCLUSIONS: Thus, it can be concluded that the early open bite treatment with a removable appliance and palatal crib associated with high-pull chincup therapy provided stability of 95%

Cephalometric effects of the dentoskeletal alterations yielded by the removable appliance with tongue crib associated to chincap therapy on the treatment of anterior open bite

Este estudo clínico, prospectivo e randomizado avaliou cefalometricamente as alterações dentoesqueléticas decorrentes do tratamento da mordida aberta anterior, utilizando aparelho removível com grade palatina associado à mentoneira, durante um período de 12 meses. Selecionou-se consecutivamente 60 jovens leucodermas, de ambos os sexos, com relação de molares normal e mordida aberta anterior, que foram divididos aleatoriamente em dois grupos (controle e tratado) compostos de 30 pacientes cada. O grupo 1 (controle) constituiu-se de 7 jovens do sexo masculino e 23 jovens do sexo feminino, com má oclusão de Classe I com mordida aberta anterior, não submetidos a nenhum tipo de tratamento ortodôntico, com idade média inicial de 8,33 anos (entre 7 anos e 9 anos e 10 meses). O grupo 2 composto de 20 jovens do sexo feminino e 10 do sexo masculino com má oclusão de Classe I com mordida aberta anterior, com idade média inicial de 8,61 anos (entre 7 anos e 9 anos e 11 meses), tratados por meio de aparelho removível com grade palatina associado com a mentoneira. Para a comparação entre os grupos utilizou-se o teste t não pareado. Os resultados permitiram concluir que o aparelho removível associado à mentoneira quando comparado a um grupo controle, não produziu alterações esqueléticas significantes e não produziu efeito significativo sobre a dimensão vertical da face (controle vertical). No entanto, com relação às alterações dentárias, observou-se que os incisivos tanto superiores como inferiores retruíram, inclinaram-se para lingual e extruíram. Os primeiros molares permanentes superiores e inferiores não apresentaram diferenças estatisticamente significantes, em relação ao desenvolvimento vertical e horizontal. O fechamento médio do overbite foi de 5,01mm para o grupo tratado, enquanto que para o grupo controle foi de 1,38mm. Conclui-se que o protocolo de tratamento desta pesquisa proporcionou alterações exclusivamente dentárias para a correção da mordida aberta anterior.This prospective study aimed at conducting a cephalometric evaluation of the dentoskeletal alterations secondary to treatment of anterior open bite by utilization of removable appliance with tongue crib associated to chincap therapy, for a period of 12 months. Sixty young white individuals of both genders were selected, who presented a normal molar relationship and anterior open bite and were randomly divided into two groups (control and treated) comprising 30 patients each, thus characterizing a randomized controlled trial. Group 1 (control) included 7 males and 23 females with Class I malocclusion with anterior open bite, not submitted to any type of orthodontic treatment, with an initial mean age of 8.33 years (ranging from 7 years to 9 years 10 months). Group 2 comprised 20 females and 10 males presenting Class I malocclusion with anterior open bite, with an initial mean age of 8.61 years (ranging from 7 years to 9 years 11 months), who were treated by utilization of a removable appliance with tongue crib associated to chincap therapy. Comparison between groups was conducted by the unpaired t test. The results allowed the conclusion that the removable appliance associated to chincap therapy did not yield significant skeletal alterations or any significant effect on the vertical dimension of the face (vertical control) when compared to a control group. However, with regard to the dental alterations, both maxillary and mandibular incisors were retruded, lingually tipped and extruded. The maxillary and mandibular permanent first molars did not display statistically significant differences in both vertical and horizontal directions. The mean closure of the anterior open bite was 5.01mm for the treated group and 1.38mm for the control group. It was concluded that the treatment protocol followed in this investigation yielded only dental alterations for correction of the anterior open bite

Stability evaluation of early open bite treatment using a removable appliance with palatal crib combined with high-pull chincup

O objetivo desta pesquisa foi avaliar cefalometricamente a estabilidade das alterações dentoesqueléticas e tegumentares, no protocolo de tratamento com o aparelho removível com grade palatina associado à mentoneira, em jovens portadores de mordida aberta anterior, tratados por 12 meses e comparar com um Grupo de jovens portadores de má oclusão semelhante que não foram submetidos ao tratamento ortodôntico. Avaliou-se um total de 76 telerradiografias em norma lateral de 38 jovens. Dois Grupos compuseram a amostra: o Grupo 1 (controle) composto por 19 jovens (idade média de 9,10 anos) que não receberam qualquer tratamento para a correção de sua má oclusão e o Grupo 2 (tratado) composto por 19 jovens (idade média de 9,78 anos) que receberam o protocolo de tratamento durante 12 meses. Verificou-se a estabilidade do tratamento da má oclusão durante aproximadamente 15 meses após a remoção dos aparelhos. Os dados obtidos nas medidas cefalométricas (diferenças das médias das alterações) para os dois Grupos foram computados pelo teste t de Student não pareado. Os resultados mostraram que os componentes esquelético e tegumentar não apresentaram alterações significantes. O overbite, overjet e posicionamento dos dentes superiores mantiveram-se estáveis. Os incisivos inferiores vestibularizaram e protruíram no Grupo tratado enquanto o Grupo controle apresentou maior extrusão destes dentes. Os molares inferiores também extruíram mais significantemente no Grupo controle. Pode-se concluir que o protocolo de tratamento da mordida aberta anterior utilizando aparelho removível com grade palatina associado à mentoneira mostrou estabilidade de aproximadamente 95%, ressaltando a grande importância deste tratamento em idade precoce.The aim of this study was to cephalometrically investigate the stability of early open bite treatment. Nineteen children with a mean age of 9.78 years old that were treated for 12 months with a removable appliance with palatal crib associated with chincup were evaluated after 15 months (posttreatment period) and compared with a control group of 19 subjects with mean age of 9.10 years with the same malocclusion that was followed-up for the same period. The 76 lateral cephalograms were evaluated at T1 (after correction) and T2 (follow-up) and cephalometric variables were analyzed with statistical tests. The results did not show significant skeletal, soft tissues or maxillary dentoalveloar changes. Overall, treatment effects in the experimental group were maintained at T2 evaluation with an increase of 0.56mm in overbite. Overjet and maxillary incisors/molars position (vertical and sagittal) remained essentially unchanged during the study period. Only mandibular incisors showed some significant changes (labial inclination and protrusion) compared with the controls. Thus, it can be conclude that the early open bite treatment with a removable appliance and palatal crib associated with high-pull chincup therapy provided stability of 95%

Treatment of Class III Malocclusion: Atypical Extraction Protocol

The treatment of Angle Class III malocclusion is rather challenging, because the patient’s growth pattern determines the success of long-term treatment. Early diagnosis and treatment are still highly discussed issues in orthodontic literature. This type of early intervention has been indicated more frequently in order to eliminate primary etiological factors and prevent an already present malocclusion from becoming severe. However, when a patient is diagnosed in adulthood, manipulation of the bone bases becomes extremely limited, as there is no longer any potential for growth. Treatments are restricted to dental compensations when possible or orthognathic surgery. However, owing to the high cost and inherent risk of the surgical procedure, this treatment option is often denied by the patient; in such a case, the orthodontist has little choice but to perform, where possible, compensatory treatments to restore a functional occlusion and improve facial esthetics. This article reports a case of Class III malocclusion in a patient who opted for compensatory treatment with lower molar extraction that allowed for correction of the midline and the overjet. Good facial esthetics and functional normal occlusion were achieved at the end of the treatment

Contextual and Individual Determinants of Anterior Open Bite in Adolescents

Objective: Studying the broader determinants of anterior open bite (AOB) may guide more equitable policies.This study estimates the prevalence of AOB in Brazilian adolescents and its association with contextual and individual determinants. Methodology: The data for dentofacial anomalies in 15- to 19-year-olds from the National Oral Health Survey SBBrasil 2010 were analysed (N = 4748). AOB was based on the Dental Aesthetic Index (AOB = 0; AOB > 0); the contextual variables were the Human Development Index (HDI) and the Gini Index (2010). The individual sociodemographic variables included sex (male, female), self-reported skin colour/race (white, black, brown, and indigenous + yellow), family income (≥4 minimum wage [MW]; 0–3 MW), and educational attainment (ideal, delayed). The individual clinical variables were decayed, missing, and filled teeth (DMFT) (0, ≥1), first permanent molar loss (0, ≤3, 4), and molar relationship (normal, half cusp, full cusp). Multilevel logistic regression models with random intercepts and fixed slopes were used to estimate odds ratios (ORs) and confidence intervals (95% CIs). Results: AOB prevalence in Brazil was 8.78% (95% CI, 6.85–11.20) at 15 to 19 years of age. The lowest prevalence was in São Luis (2.63%; 95% CI, 0.58–11.03) and the highest was in João Pessoa (29.85%; 95% CI, 15.93–48.85), both capitals of the northeast Brazilian region. A higher prevalence of AOB (OR, 1.71; 95% CI, 1.04–2.80) was observed in municipalities with a lower HDI. Adolescents who declared their skin colour black, with lower family income, with delayed education, with DMFT ≥ 1, who lost 4 permanent first molars, and who had a complete molar cusp relationship were more likely to have AOB. Conclusions: AOB varied amongst Brazilian municipalities. The HDI plays an important role in the prevalence of AOB; individual social determinants have also been associated with AOB malocclusion in adolescents

Orthodontic Protocol Using Mini-Implant for Class II Treatment in Patient with Special Needs

Improving facial and dental appearance and social interaction are the main factors for special needs (SN) patients to seek orthodontic treatment. The cooperation of SN patients and their parents is crucial for treatment success. Objective. To show through a case report the satisfactory results, both functional and esthetic, in patients with intellectual disability, congenital nystagmus, and severe scoliosis. Materials Used. Pendulum device with mini-implants as anchorage unit. Results. Improvement of facial and dental esthetics, correction of Class II malocclusion, and no root resorption shown in the radiographic follow-up. Conclusion. Knowing the limitations of SN patients, having a trained team, motivating and counting on the cooperation of parents and patients, and employing quick and low-cost orthodontic therapy have been shown to be the essential factors for treatment success

Avaliação microbiológica da contaminação residual em diferentes tipos de alicates ortodônticos após desinfecção com álcool 70% Microbiological evaluation in different kinds of orthodontic pliers after disinfection with 70% alcohol

OBJETIVO: o objetivo deste trabalho foi verificar, por meio de análises microbiológicas, a contaminação de diferentes tipos de alicates ortodônticos (139, Weingart, removedor de bandas e de corte distal) após a lavagem com água e sabão e fricção de álcool 70% por um minuto. MÉTODOS: todos os alicates foram, inicialmente, esterilizados em autoclave durante 20 minutos, a 121ºC e pressão de 1atm. Após o atendimento ortodôntico, os alicates utilizados foram depositados individualmente em recipientes estéreis tipo béquer, fechados com papel kraft e transportados ao laboratório de Microbiologia. Esses alicates foram submetidos, numa primeira etapa, à coleta imediata de microrganismos e à semeadura para contagem de bactérias. Posteriormente, os mesmos alicates foram lavados com água corrente e sabão, e friccionados por um minuto com gaze (esterilizada) embebida em álcool 70% (P/P). Novos testes bacteriológicos foram, então, realizados. Os alicates esterilizados do grupo controle foram submetidos aos mesmos testes bacteriológicos, todavia não haviam sido utilizados na clínica. RESULTADOS: os resultados demonstraram uma grande quantidade e variedade de bactérias residuais após a realização da desinfecção com o álcool 70%. CONCLUSÕES: mesmo alicates que não são inseridos na cavidade bucal do paciente, como o 139, mas que são pegos pelo ortodontista, cujas luvas entram em contato com saliva e/ou sangue, devem ser esterilizados, pois somente a desinfecção não é suficiente para impedir a potencial infecciosidade desses instrumentos.<br>AIM: The aim of this study was to verify, by means of microbiological analysis, the contamination in different kinds of orthodontic pliers (Distal End Cutter, Bird Beak, Band Remover and Weingart), after washing with water and detergent and followed by disinfection with 70% alcohol for 1 minute. METHODS: All the pliers were, initially, sterilized in autoclave for 20 minutes, at 121ºC and 1atm of pressure. After the orthodontic appointment, the pliers were adequately transported to Microbiology Laboratory and the evaluations of variety and quantity of bacteria were made. Afterward, the same pliers were washed with water and detergent, and rubbed with gauze with 70% alcohol (p/p) for 1 minute. New bacteriological tests were done and compared to a control group of non utilized pliers. RESULTS: Results showed a great quantity and variety of residual bacteria after the disinfection with alcohol. CONCLUSIONS: Even pliers not inserted in patient mouth, but only handed by clinician, should be sterilized, once merely disinfection is not an adequate method for infection control