Fernanda C. Goldenberg

Using computed tomography to evaluate maxillary changes after surgically assisted rapid palatal expansion.

Surgically assisted rapid palatal expansion (SARPE) is the procedure of choice for treating transverse maxillary deficiency in adult patients. The use of computed tomography (CT) as a method of evaluating the efficiency of this procedure has not been yet reported. Consequently, few landmarks for use in evaluating maxillary expansion have been defined. The goals of the present study were to define parameters to assess skeletal changes after SARPE and to use CT to evaluate those parameters. From June of 2004 to May of 2005, 15 patients underwent SARPE (a modified Le Fort I maxillary osteotomy without pterygomaxillary separation, together with a sagittal palatal osteotomy) according to a defined protocol. To determine the pattern of transversal expansion, linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla were evaluated in axial and coronal views. The cross-sectional area of the maxilla was calculated to obtain general information about maxillary expansion. The reliability of the method was confirmed. Significant overall expansion was observed. However, different patterns of expansion were seen in the three regions analyzed. In the anterior and intermediate portions of the maxilla, the increase in maxillary width was greater than that observed in the posterior portion. The transverse expansion of the maxilla achieved through SARPE without pterygoid plate separation was less than uniform. The accurate evaluation of the postoperative changes was heavily dependent upon images acquired through CT.

Hyrax appliance opening and pattern of skeletal maxillary expansion after surgically assisted rapid palatal expansion : a computed tomography evaluation

OBJECTIVE The objective of this study was to evaluate, using computed tomography, correlations between Hyrax appliance opening and post-SARPE skeletal changes. STUDY DESIGN Fifteen patients underwent SARPE according to a specific protocol and were followed. Linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla were evaluated. The correlation between maxillary expansion and appliance opening was investigated. RESULTS Significant overall expansion was observed. In the anterior and intermediate portions of the maxilla, the increase in maxillary width was greater than that observed in the posterior portion. The degree of appliance opening was significantly greater than that of the skeletal expansion. Also, no linear correlation between appliance opening and regional maxillary expansion was established. CONCLUSION The transverse expansion of the maxilla was less than uniform. The lack of linear correlation between appliance opening and skeletal expansion is attributable to multiple factors, including those related to the device, the surgical technique, and the craniofacial deformity itself.

Avaliação qualitativa entre as radiografias cefalométricas laterais digital e convencional

AbstractAim: This study aimed to evaluate, by cephalometric tracing and measurements, the difficulty in the localization of structures and points on both conventional and digital lateral cephalograms. Methods: The sample comprised 30 lateral cephalograms, being 15 conventional and 15 digital. These radiographs were taken from 15 Brazilian adult subjects, with achievement of one conventional and one digital cephalogram for each subject. Results: The obtained data revealed no statistically significant difference between the two study methods. Conclusion: Thus, it was concluded that, regardless of the utilized method, the professional performing the cephalometric tracing, either manually or with a computer software, should be well trained and calibrated for that. Keywords: Cephalometric radiography. Conventional radiography. Digital radiography. 8. HOUSTON, W. J. B. The analysis of errors in orthodontic measure-ments. Am. J. Orthod. , St. Louis, v. 83, no. 5, p. 382-390, 1983.9. MILES, D. A.; LANGLAIS, R. P.; PARKS, E. T. Digital X-rays are here. Why aren´t you using them?

Assessment of changes in smile after rapid maxillary expansion

INTRODUCTION: This study evaluated changes in the smile characteristics of patients with maxillary constriction submitted to rapid maxillary expansion (RME). METHODS: The sample consisted of 81 extraoral photographs of maximum smile of 27 patients with mean age of 10 years, before expansion and 3 and 6 months after fixation of the expanding screw. The photographs were analyzed on the software Cef X 2001, with achievement of the following measurements: Transverse smile area, buccal corridors, exposure of maxillary incisors, gingival exposure of maxillary incisors, smile height, upper and lower lip thickness, smile symmetry and smile arch. Statistical analysis was performed by analysis of variance (ANOVA), at a significance level of 5%. RESULTS: RME promoted statistically significant increase in the transverse smile dimension and exposure of maxillary central and lateral incisors; maintenance of right and left side smile symmetry and of the lack of parallelism between the curvature of the maxillary incisal edges and lower lip border. CONCLUSIONS: RME was beneficial for the smile esthetics with the increase of the transverse smile dimension and exposure of maxillary central and lateral incisors.

Avaliação das alterações dentárias na maxila em pacientes submetidos à expansão rápida da maxila assistida cirurgicamente sem o envolvimento da sutura pterigomaxilar

OBJETIVO: avaliar as alteracoes nos arcos dentarios superiores no sentido transversal e a quantidade de inclinacoes nos dentes de apoio do aparelho de expansao tipo Hyrax em pacientes submetidos a expansao rapida da maxila assistida cirurgicamente (ERMAC) e a efetividade dessa tecnica cirurgica utilizada. A amostra foi composta por 34 pares de modelos de gesso de 17 pacientes, sendo 6 do genero masculino e 11 do genero feminino. METODOS: as medidas foram realizadas em modelos de gesso por meio de medicao das alteracoes nos planos vertical e transversal. O procedimento cirurgico adotado foi uma osteotomia nas paredes laterais da maxila sem o envolvimento da lâmina pterigoide, osteotomia da espinha nasal a linha media dentaria (incisivos centrais anteriores), separacao da sutura palatina mediana por meio de cinzel e separacao do septo nasal. O inicio das ativacoes ocorreu no terceiro dia pos-operatorio, sendo uma pela manha e uma a noite. RESULTADOS: houve expansao significativa estatisticamente na regiao dos caninos, primeiros e segundos pre-molares, primeiros e segundos molares, respectivamente de 6,03mm, 9,82mm, 8,66mm, 9,72mm e 5,67mm. Avaliando o comportamento dos dentes de apoio do disjuntor quanto as inclinacoes das coroas dentarias, notou-se que ocorreu uma vestibularizacao assimetrica, pois para os primeiros molares os valores encontrados foram 6,89o (direito) e 9,56o (esquerdo), e para os primeiros pre-molares os valores obtidos foram 4,74o (esquerdo) e 3,26o (direito), sendo esse considerado estatisticamente nao-significativo. CONCLUSOES: a tecnica cirurgica empregada para esta pesquisa mostrou ser eficiente para se obter alteracao transversal maxilar, ocorrendo inclinacao dentoalveolar dos dentes de apoio do disjuntor.