A influência do tratamento ortopédico nas estruturas faciais de indivíduos com má oclusão de Classe II, 1ª Divisão: um estudo comparativo

The purpose of this investigation was to comparatively evaluate the cephalometric changes in soft and hard tissues related to treatment of Class II, division 1 malocclusion with activator-headgear and Bionator appliances. Twenty-four individuals formed the activator-headgear group and twenty-five comprised the Bionator group, while other twenty-four presenting the same malocclusion did not receive any intervention and served as controls. Lateral headfilms were taken at the beginning and at the end of the observation period and were digitized with computerized cephalometrics; cephalometric analysis was performed and the results were submitted to statistical test. According to the methodology employed, our findings suggested that both appliances do not significantly alter the growth path, and also they were not able to modify the posterior inferior height and the sagittal and vertical position of the upper lip. The lower lip and the soft menton were only slightly modified by the orthopedic appliances, but the mentolabial sulcus showed a significant decrease in deepness compared to the control group. Of statistical significance, only the anterior inferior hard and soft facial heights and the lower lip height increased more in the treated groups.Esta pesquisa teve por objetivo avaliar, comparativamente, as alterações cefalométricas tegumentares e esqueléticas, decorrentes do tratamento das más oclusões de classe II, 1a divisão, com o ativador combinado com a ancoragem extrabucal e com o bionator. O grupo tratado com o ativador combinado com a ancoragem extrabucal foi composto por 24 indivíduos e o grupo tratado com o bionator compreendeu 25 pacientes, enquanto que outros 24 indivíduos compuseram o grupo controle, apresentando a mesma má oclusão, porém sem terem sido submetidos a nenhuma terapia ortodôntica. Obteve-se telerradiografias laterais de todos os indivíduos no início e final do período de observação que foram digitalizadas e seus traçados cefalométricos computadorizados realizados e submetidos ao teste estatístico. De acordo com a metodologia empregada, os resultados sugerem que ambos os aparelhos não foram capazes de alterar, significaticamente, o padrão de crescimento facial assim como a altura facial posterior inferior e o posicionamento sagital e vertical do lábio superior. Os aparelhos ortopédicos alteraram ligeiramente o lábio inferior e o mento tegumentar, porém o sulco mentolabial foi signifivativamente reduzido nos grupos tratados em comparação com o grupo controle. As alturas faciais esquelética e tegumentar, bem como a altura do lábio inferior foram significativamente aumentadas com a terapia ortopédica, alcançando diferença estatística em relação ao grupo controle

Influence of treatment with and without extractions on the growth pattern of dolichofacial patients

OBJECTIVE: The objective of this retrospective study was to compare, by means of lateral cephalograms, the facial growth pattern changes due to the treatment with and without extractions of four first premolars in dolichofacial individuals. METHODS: Groups 1 and 2 were constituted of 23 dolichofacial patients each, with Class II malocclusion, division 1 and initial age average of 12.36 and 12.29 years, respectively. Patients from Group 1 were treated without extractions and Group 2 was treated with extraction of the four first premolars, given that both used occipital headgear. Groups were compatibilized according to age, treatment period, gender and malocclusion severity. The t test was applied for intergroups comparison. RESULTS: Most variables (SN.PP, SN.Ocl and FMA) did not present statistically significant difference between groups. CONCLUSION: Although the treatment with extractions tend to reduce the mandibular plane angle (SN.GoGn) and the facial axis (NS.Gn), the analyzed treatment protocols did not affect in a clinically relevant way the facial growth pattern

A multidisciplinary approach for the management of hypodontia: case report

Hypodontia is the congenital absence of one or more teeth and may affect permanent teeth. Several options are indicated to treat hypodontia, including the maintenance of primary teeth or space redistribution for restorative treatment with partial adhesive bridges, tooth transplantation, and implants. However, a multidisciplinary approach is the most important requirement for the ideal treatment of hypodontia. This paper describes a multidisciplinary treatment plan for congenitally missing permanent mandibular second premolars involving orthodontics, implantology and prosthodontic specialties

Estabilidade do tratamento de apinhamento anterossuperior

OBJECTIVE: To evaluate the stability and the relapse of maxillary anterior crowding treatment on cases with premolar extraction and evaluate the tendency of the teeth to return to their pretreatment position. METHODS: The experimental sample consisted of 70 patients of both sex with an initial Class I and Class II maloclusion and treated with first premolar extractions. The initial mean age was 13,08 years. Dental casts' measurements were obtained at three stages (pretreatment, posttreatment and posttreatment of 9 years on average) and the variables assessed were Little Irregularity Index, maxillary arch length and intercanine. Pearson correlation coefficient was used to know if some studied variable would have influence on the crowding in the three stages (LII1, LII2, LII3) and in each linear displacement of the Little irregularity index (A, B, C, D, E) in the initial and post-retention phases. RESULTS: The maxillary crowding relapse ( LII3-2) is influenced by the initial ( LII1), and the teeth tend to return to their pretreatment position. CONCLUSION: The results underline the attention that the orthodontist should be given to the maxillary anterior relapse, primarily on those teeth that are crowded before the treatment

Class II malocclusion treatment changes with the Jones jig, Distal jet and First Class appliances

Objective: Maxillary molar distalization with intraoral distalizer appliances is a non-extraction orthodontic treatment used to correct molar relationship in patients with Class II malocclusion presenting maxillary dentoalveolar protrusion and minor skeletal discrepancies. This study compares the changes caused by three distalizers with different force systems. Methodology: 71 patients, divided into three groups, were included. The Jones jig group (JJG, n=30; 16 male, 14 female, 13.17 years mean age) was treated with the Jones jig for 0.8 years. The Distal jet group (DJG, n=25; 8 male, 17 female, 12.57 years mean age) was treated with the Distal jet for 1.06 years. The First Class group (FCG, n=16; 6 male, 10 female, 12.84 years mean age) was treated with the First Class for 0.69 years. Intergroup treatment changes were compared using one-way ANOVA, followed by post-hoc Tukey’s tests. Results: Intergroup comparisons showed significantly greater maxillary incisor protrusion in DJG than in FCG (2.56±2.24 mm vs. 0.74±1.39mm, p=0.015). The maxillary first premolars showed progressive and significantly smaller mesial angulation in JJG, FCG and DJG, respectively (14.65±6.31º, 8.43±3.99º, 0.97±3.16º; p<0.001). They also showed greater mesialization in JJG than FCG (3.76±1.46 mm vs. 2.27±1.47 mm, p=0.010), and greater extrusion in DJG compared to JJG (0.90±0.77 mm vs 0.11±0.60 mm, p=0.004). The maxillary second premolars showed progressive and significantly smaller mesial angulation and mesialization in JJG, FCG and DJG, respectively (12.77±5.78º, 3.20±3.94º, -2.12±3.71º and 3.87±1.34 mm, 2.25±1.40 mm, 1.24±1.26 mm, respectively; p<0.001). DJG showed smaller distal angulation of maxillary first molars (-2.14±5.09º vs. -7.73±4.28º and -6.05±3.76º, for the JJG and FCG, respectively; p<0.001) and greater maxillary second molars extrusion (1.17±1.41 mm vs -0.02±1.16 mm and 0.16±1.40 mm, for the JJG and FCG, respectively; p=0.003). Overjet change was significantly larger in DJG compared to FCG (1.79±1.67 mm vs 0.68±0.84; p=0.046). Treatment time was smaller in FCG (0.69±0.22 years vs 0.81±0.33 years and 1.06±0.42 years, comparing it with the JJG and DJG, respectively; p=0.005). Conclusion: The three appliances corrected the Class II molar relationship by dentoalveolar changes. The Distal jet produced smaller molar distal angulation than the Jones jig and First Class. The First Class appliance showed less anchorage loss, greater percentage of distalization and shorter treatment time than the Jones jig and Distal jet

Influence of initial occlusal severity on time and efficiency of Class I malocclusion treatment carried out with and without premolar extractions

INTRODUCTION: The aim of this retrospective study was to compare the occlusal outcomes, duration and efficiency of Class I malocclusion treatment carried out with and without premolar extractions in patients with different degrees of initial malocclusion severity. METHODS: Complete records of 111 patients were obtained and divided into two groups: Group 1 consisted of 65 patients at an initial mean age of 13.82 years old treated with four premolar extractions; whereas Group 2 consisted of 46 patients at an initial mean age of 14.01 years old treated without extractions. Two subgroups were obtained from each group (1A, 1B, 2A and 2B) with different degrees of malocclusion severity according to the initial values of PAR index. Compatibility was assessed using chi-square and t-tests. The subgroups were compared by means of Analysis of Variance (ANOVA).The variables that might be related to treatment duration and efficiency were assessed using the multiple linear regression analysis. RESULTS: Initial malocclusion severity was positively related to the amount of occlusal correction and consequently to a higher efficiency index. Moreover, extraction protocol showed a positive relationship with treatment duration and a negative relationship with treatment efficiency. CONCLUSION: Extraction and non-extraction protocols for correction of Class I malocclusion provide similar satisfactory results; however, the extraction protocol increases the overall treatment duration. Orthodontic treatment is more efficient in cases with high initial malocclusion severity treated with a non-extraction protocol

Angle Class II correction with MARA appliance

Objetivo: avaliar os efeitos proporcionados pelo aparelho MARA no tratamento da má oclusão de Classe II, 1ª divisão. Métodos: utilizou-se uma amostra de 44 jovens, divididos em dois grupos — Grupo MARA, com idade inicial média de 11,99 anos e tratado com o aparelho MARA por um período médio de 1,11 ano; e Grupo Controle, com idade inicial média de 11,63 ano e observado por um período médio de 1,18 ano, sem nenhum tratamento. Utilizou-se as telerradiografias em norma lateral para comparar os grupos quanto às variáveis cefalométricas das fases inicial e final. Para essas comparações, aplicou-se o teste t de Student. Resultados: o aparelho MARA proporcionou efeitos na restrição do crescimento maxilar, sem nenhuma alteração do desenvolvimento mandibular, com melhora da relação maxilomandibular, aumento da altura facial anteroinferior e inclinação anti-horária do plano oclusal funcional. Na arcada superior, os incisivos foram lingualizados e retruídos, e os molares foram distalizados e inclinados para distal. Na arcada inferior, ocorreu vestibularização e protrusão nos incisivos, e mesialização e inclinação mesial dos molares. Por fim, observou-se uma redução significativa nos trespasses horizontal e vertical, e uma melhora evidente na relação molar. Conclusão: pode-se concluir que o aparelho MARA foi eficaz na correção da má oclusão de Classe II, 1ª divisão, promovendo alterações esqueléticas e, principalmente, dentárias.Objective: To assess the effects produced by the MARA appliance in the treatment of Angle’s Class II, division 1 malocclusion. Methods: The sample consisted of 44 young patients divided into two groups: The MARA Group, with initial mean age of 11.99 years, treated with the MARA appliance for an average period of 1.11 years, and the Control Group, with initial mean age of 11.63 years, monitored for a mean period of 1.18 years with no treatment. Lateral cephalograms were used to compare the groups using cephalometric variables in the initial and final phases. For these comparisons, Student’s t test was employed. Results: MARA appliance produced the following effects: Maxillary growth restriction, no change in mandibular development, improvement in maxillomandibular relationship, increased lower anterior facial height and counterclockwise rotation of the functional occlusal plane. In the upper arch, the incisors moved lingually and retruded, while the molars moved distally and tipped distally. In the lower arch, the incisors proclined and protruded, whereas the molars mesialized and tipped mesially. Finally, there was a significant reduction in overbite and overjet, with an obvious improvement in molar relationship. Conclusions: It was concluded that the MARA appliance proved effective in correcting Angle’s Class II, division 1 malocclusion while inducing skeletal changes and particularly dental changes