Daniel Santos Fonseca Figueiredo

Dentoskeletal effects of 3 maxillary expanders in patients with clefts: A cone-beam computed tomography study.

INTRODUCTION The purpose of this study was to evaluate the skeletal and dental changes in the maxillae of patients with clefts treated with 3 expanders: hyrax, fan-type, and inverted mini-hyrax supported on the first premolars. METHODS Thirty patients with unilateral cleft lip and palate with transverse maxillary deficiency were divided into 3 groups, according to the type of expander that they used. Cone-beam computed tomography images were taken before and 3 months after expansion, and the paired t test was used to evaluate the changes in each group. RESULTS The subjects in the inverted mini-hyrax group showed significant forward displacement of the maxilla (P <0.05). On the transversal plane, the hyrax group showed greater expansion in the posterior region than in the anterior region (P <0.05). However, the fan-type and the inverted mini-hyrax groups showed significantly greater maxillary expansion anteriorly than posteriorly (P <0.05). There was a greater tendency for buccal inclination of the supporting teeth when the fan-type was used. The cleft and the noncleft sides expanded symmetrically with all appliances, and there was no difference in dental tipping between these sides (P >0.05). CONCLUSIONS The hyrax expander showed better results for cleft patients requiring anterior and posterior maxillary expansion. The inverted mini-hyrax most effectively restricted posterior expansion, optimizing anterior expansion without causing as much buccal tipping of the supporting teeth as did the fan-type.

Interdisciplinary treatment of a class III patient with congenitally absent maxillary lateral incisors.

UNLABELLED The purpose of this paper is to present a case report of an adult Class III patient presenting bilateral congenitally missing maxillary lateral incisors that compromised occlusal function as well as smile and facial esthetics. After the interdisciplinary diagnosis, spaces for prosthetic substitution were opened with the help of miniscrews. The orthodontic therapy achieved a better dental relationship, and the final interdisciplinary treatment results represented a significant improvement in function and both dental and facial esthetics. CLINICAL SIGNIFICANCE The interdisciplinary treatment of orthodontics and restorative dentistry is very important because the two complement each other in search of the best for the patient. This case demonstrates very well that where orthodontics provided the best tooth position prior to implant placement and restorations.

Two-phase orthodontic treatment of a complex malocclusion: giving up efficiency in favor of effectiveness, quality of life, and functional rehabilitation?

The interceptive orthodontic treatment of patients with complex dentofacial abnormalities is frequently inefficient and produces less than ideal outcomes. Therefore, postponing therapy to a single-phase surgical-orthodontic approach might be considered a reasonable option. However, other relevant aspects of the patients quality of life, such as possible psychosocial problems and functional impairments, should also be considered before deciding whether to intercept a severe dentofacial malocclusion while the patient is still growing, or wait and treat later. This case report describes the nonsurgical treatment of a young patient with a severe Class III open-bite malocclusion associated with a cervical cystic lymphangioma. Despite the poor interceptive therapy prognosis, a 2-phase approach was effective. A reflection about giving up efficiency in favor of effectiveness, functional rehabilitation, and the patients quality of life is included.

An alternative clinical approach to achieve greater anterior than posterior maxillary expansion in cleft lip and palate patients.

Abstract Cleft lip and palate patients commonly present maxillary constriction, particularly in the anterior region. The aim of this case report was to describe an alternative clinical approach that used a smaller Hyrax screw unconventionally positioned to achieve greater anterior than posterior expansion in patients with complete unilateral cleft lip and palate. The idea presented here is to take advantage of a reduced dimension screw to position it anteriorly. When only anterior expansion was needed (patient 1), the appliance was soldered to the first premolar bands and associated to a transpalatal arch cemented to the first molars. However, when overall expansion was required (patient 2), the screw was positioned anteriorly, but soldered to the first molar bands. Intercanine, premolar, and first molar widths were measured on dental casts with a digital caliper. Pre-expansion and postexpansion radiographs and tomographies were also evaluated. A significant anterior expansion and no intermolar width increase were registered in the first patient. Although patient 2 also presented a greater anterior than posterior expansion, a noteworthy expansion occurred at the molar region. The alternative approach to expand the maxilla in cleft patients reported here caused greater anterior than posterior expansion when the Mini-Hyrax was associated to a transpalatal arch, and its reduced dimension also minimized discomfort and facilitated hygiene.

Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders

ABSTRACT Objective: The aim of this study was to evaluate the skeletal and dental effects of rapid maxillary expansion (RME) in cleft patients using two types of expanders. Methods: Twenty unilateral cleft lip and palate patients were randomly divided into two groups, according to the type of expander used: (I) modified Hyrax and (II) inverted Mini-Hyrax. A pretreatment cone-beam computed tomographic image (T0) was taken as part of the initial orthodontic records and three months after RME, for bone graft planning (T1). Results: In general, there was no significant difference among groups (p > 0.05). Both showed a significant transverse maxillary expansion (p < 0.05) and no significant forward and/or downward movement of the maxilla (p > 0.05). There was greater dental crown than apical expansion. Maxillary posterior expansion tended to be larger than anterior opening (p < 0.05). Cleft and non-cleft sides were symmetrically expanded and there was no difference in dental tipping between both sides (p > 0.05). Conclusions: The appliances tested are effective in the transverse expansion of the maxilla. However, these appliances should be better indicated to cleft cases also presenting posterior transverse discrepancy, since there was greater expansion in the posterior maxillary region than in the anterior one.