Examination of temporomandibular disorders in the orthodontic patient: a clinical guide

The possible association between orthodontic treatment and temporomandibular disorders (TMD) is a topic of great interest in the current literature. The true role of orthodontic therapy on the etiology of TMD, however, is still uncertain. From the clinical prospective, a thorough examination of the stomatognathic system is always necessary in order to detect possible TMD signs and symptoms prior to the beginning of the orthodontic therapy. Caution should be exercised when planning, performing and finalizing orthodontics, especially in patients who with history of signs and symptoms of TMD. The clinician must always eliminate patient's pain and dysfunction before initiating any type of orthodontic mechanics. Muscle incoordination, unstable disc-condyle relationship and bone alterations are usual TMD conditions that can interfere with the presenting occlusal relationship. This article reviews these aspects and presents a detailed clinical guide for the examination of the orthodontic patient, considering aspects related to facial pain and dysfunction

3-D Evaluation of temporary skeletal anchorage sites in the maxilla

The selection of temporary anchorage device (TAD) site can be a challenging task since one should not only consider the 2-D distances between roots, but also the entire 3-D space. Thus, the aim of this study was to evaluate the posterior maxillary regio

Tomographic evaluation of dentoskeletal effects of rapid maxillary expansion using Haas and Hyrax palatal expanders in children : a randomized clinical trial

Rapid maxillary expansion (RME) is a usual procedure for correcting the transversal maxillary deficiency. Among the most used appliances are the Haas type (tooth-tissue-borne) and Hyrax (tooth-borne) whose main difference is the design. This study aimed to evaluate the dentoskeletal effects of RME using two different expanders in children. The sample was composed of 42 children of both gender presenting unilateral or bilateral posterior crossbite with mean age 9.49 (SD± 1.35). Patients were randomized into two groups according to the type of expander: Hyrax (n= 21, 9 boys and 12 girls) and Haas (n= 21, 11 boys and 10 girls). Multiplanar coronal and axial slices obtained from cone-beam computed tomography images (i-Cat, Hartsfield, PA, USA) were used at pretreatment (T1) and after 6 months when the expander was removed (T2). Measurements were performed on Dolphin Imaging Systems 11.7 software (Chatsworth, California, USA). The following variables were evaluated: inclinations of the posterior teeth, transverse skeletal widths, length of maxillary dental arch, buccal bone thickness and level of buccal alveolar crest. Statistical analysis performed using chi-squared test to compare the sex ratios between groups and independent t test with the Bonferroni correction for multiple tests. RME increased all maxillary transverse dimensions, regardless of the type of expanders used. Subjects in the Hyrax group experienced significantly increase in the lingual bone thickness (0.94 mm) compare to Haas group (0.21 mm). The Hyrax-type expander produced greater increase in the lingual bone thickness than did the Haas-type expander, but this effect might not be clinically significant. Both appliances presented similar transversal gain and tended to produce similar orthopedic and orthodontic effects

Estabilidade a longo prazo do tratamento da mordida aberta anterior na dentadura mista: relato de caso clínico

Apresentou-se um relato de caso clínico de mordida aberta anterior, tratada em dentadura mista, demonstrando uma das possíveis formas de tratamento, capaz de interferir no crescimento e redirecionar seus vetores. Os protocolos ortodônticos e ortopédicos utilizados foram a expansão lenta da maxila, utilizando grade palatina soldada a um expansor bihélice, com tração alta na mandíbula, num período diário de 16 horas. Oito anos de estabilidade foram alcançados, explicados pelo fato de o tratamento ter sido conduzido no momento oportuno do desenvolvimento, o que estabeleceu equilíbrio entre os músculos peribucais, em conjunto com o período final do crescimento. A combinação do tratamento ortodôntico e ortopédico foi necessária para se evitar a necessidade de tratamento cirúrgico.A clinical case with anterior open-bite, treated in the mixed dentition, is presented. This approach demonstrates one of the possible approaches of treatment, which is capable of interfering with growth and redirecting its vectors. Orthodontic and orthopedic methods were used, consisting of slow maxillary expansion, through a fixed palatal crib soldered in a bi-helix appliance, and high-pull traction on the mandible for 16 hours a day. After eight years of follow-up, stable outcomes were accomplished. These results may be explained by the fact that treatments were performed at the appropriate period of development, thus establishing perioral muscular equilibrium, matching the final period of facial growth. The combination of orthodontic and orthopedic treatments was necessary to prevent the need of further orthognathic surgery treatment

Comparison of manual, digital and lateral CBCT cephalometric analyses

Objective: The aim of this study was to compare the reliability of three different methods of cephalometric analysis. Material and Methods: Conventional pretreatment lateral cephalograms and cone beam computed tomography (CBCT) scans from 50 subjects from a radiological clinic were selected in order to test the three methods: manual tracings (MT), digitized lateral cephalograms (DLC), and lateral cephalograms from CBCT (LC-CBCT). The lateral cephalograms were manually analyzed through the Dolphin Imaging 11.0™ software. Twenty measurements were performed under the same conditions, and retraced after a 30-day period. Paired t tests and the Dahlberg formula were used to evaluate the intra-examiner errors. The Pearson's correlation coefficient and one-way analysis of variance (ANOVA) tests were used to compare the differences between the methods. Results: Intra-examiner reliability occurred for all methods for most of the measurements. Only six measurements were different between the methods and an agreement was observed in the analyses among the 3 methods. Conclusions: The results demonstrated that all evaluated methodologies are reliable and valid for scientific research, however, the method used in the lateral cephalograms from the CBCT proved the most reliable

Immediately loaded osseointegrated implants for orthodontic anchorage: study in minipigs

O objetivo deste trabalho foi avaliar a taxa de sucesso, a quantidade de perda óssea em altura e a interação osso/implante para três diferentes protocolos: 1) implantes osseointegráveis mantidos sem carga durante período de reparo de 120 dias; 2) implantes submetidos a interferências oclusais; e 3) implantes que receberam carga imediata para ancoragem ortodôntica. Foram utilizados doze minipigs BR-1, nos quais foram instalados 70 implantes osseointegráveis de titânio (3,75mm diâmetro x 8,50mm comprimento), divididos em 5 grupos: Grupo 1 (n=12), implantes sem carga sepultados na mesial de caninos; Grupo 2 (n=6), implantes sem carga em áreas de extração; Grupo 3 (n=12), implantes expostos a interferências oclusais; Grupo 4 (n=20), implantes submetidos à carga ortodôntica imediata; Grupo 5 (n=20), implantes instalados em áreas de extração e submetidos à carga ortodôntica imediata. Ao término do período experimental, os animais foram eutanasiados e biópsias da região de interesse coletadas. Realizou-se avaliação clínica para estabelecer a porcentagem de sucesso (Teste Exato de Fisher), análise radiográfica para quantificar a perda óssea em altura (programa de análise de imagens KS300-Zeiss®, ANOVA) e análise histológica para descrever as características da interface osso/implante. A análise dos dados demonstrou: 1) Grupos 1, 2, 4 e 5 - taxa de sucesso, quantidade de perda óssea em altura e interação osso/implante semelhantes; 2) Grupo 3 - taxa de insucesso e quantidade de perda óssea significantemente maiores que os demais grupos, além de apresentar ausência de interação osso/implante. Os resultados clínicos, radiográficos e histológicos revelados nos grupos submetidos à carga ortodôntica imediata em relação aos grupos sem carga demonstraram que a perda óssea na região da crista óssea periimplantar é aceitável e não compromete a estabilidade clínica dos implantes. Desta forma, a utilização de carga imediata para ancoragem em Ortodontia não prejudica a posterior utilização desses implantes para a reabilitação protética, objetivo primário da indicação deste protocolo. Estudos clínicos prospectivos são necessários para comprovar estes dados.This research aimed at evaluating the success rate, the bone height loss, and the bone/implant interface in three different protocols: 1) osseointegrated implants maintained without load during a repair period of 120 days; 2) osseointegrated implants submitted to occlusal interferences; and 3) immediately loaded osseointegrated implants for orthodontic anchorage. Twelve BR-1 minipigs were used, in which 70 osseointegrated titanium implants were inserted (3.75mm diameter x 8.50mm length), divided into 5 groups: Group 1 (n=12), submerged implants without load; Group 2 (n=6), implants without load in extraction sites; Group 3 (n=12), implants exposed to occlusal interferences; Group 4 (n=20), exposed implants submitted to immediate orthodontic load; Group 5 (n=20), exposed implants inserted in extraction sites and submitted to immediate orthodontic load. At the end of the experimental period, the animals were euthanized and biopsies of the areas of interest were harvested. The clinical analysis (Exact Fisher Test) revealed the success rate of the inserted implants, the radiographic analysis quantified the bone height loss (image analysis program KS300-Zeiss®, ANOVA), and the histological analysis showed the bone/implant interface characteristics. The data analysis revealed: 1) Groups 1, 2, 4 and 5 - similar success rate, bone height loss and bone/implant interface characteristics; 2) Group 3 - statistically greater fail rate and bone height loss, and absence of bone/implant interaction characteristics. Clinical, radiographic and histological results presented in the groups submitted to immediate orthodontic load compared with the other without load demonstrated that the bone loss in the bone crest area is acceptable, and does not compromise the clinical stability of the implants. Therefore, the use of immediate load for orthodontic anchorage did not jeopardize the subsequent use of the implants for oral prosthetic rehabilitation, the main objective of this protocol. Further clinical studies are necessary to confirm these data