Gerson Luiz Ulema Ribeiro

Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: a clinical trial study.

INTRODUCTION The purposes of this study were to analyze and compare the immediate effects of rapid and slow maxillary expansion protocols, accomplished by Haas-type palatal expanders activated in different frequencies of activation on the positioning of the maxillary first permanent molars and on the buccal alveolar bones of these teeth with cone-beam computerized tomography. METHODS The sample consisted of 33 children (18 girls, 15 boys; mean age, 9 years) randomly distributed into 2 groups: rapid maxillary expansion (n = 17) and slow maxillary expansion (n = 16). Patients in the rapid maxillary expansion group received 2 turns of activation (0.4 mm) per day, and those in the slow maxillary expansion group received 2 turns of activation (0.4 mm) per week until 8 mm of expansion was achieved in both groups. Cone-beam computerized tomography images were taken before treatment and after stabilization of the jackscrews. Data were gathered through a standardized analysis of cone-beam computerized tomography images. Intragroup statistical analysis was accomplished with the Wilcoxon matched-pairs test, and intergroup statistical analysis was accomplished with analysis of variance. Linear relationships, among all variables, were determined by Spearman correlation. RESULTS AND CONCLUSIONS Both protocols caused buccal displacement of the maxillary first permanent molars, which had more bodily displacement in the slow maxillary expansion group, whereas more inclination was observed in the rapid maxillary expansion group. Vertical and horizontal bone losses were found in both groups; however, the slow maxillary expansion group had major bone loss. Periodontal modifications in both groups should be carefully considered because of the reduction of spatial resolution in the cone-beam computerized tomography examinations after stabilization of the jackscrews. Modifications in the frequency of activation of the palatal expander might influence the dental and periodontal effects of palatal expansion.

Multiloop edgewise archwire in the treatment of a patient with an anterior open bite and a long face.

An adolescent girl with an Angle Class III malocclusion, excessive lower facial height, and anterior open bite sought nonsurgical treatment. She was treated with a multiloop edgewise archwire (MEAW). In association with a chincup, MEAW mechanics allowed the successful correction of the anterior open bite and the molar relationship, without major alterations of the patients profile. Combined orthodontic and surgical treatment should be considered for patients with skeletal anterior open-bite malocclusion. For patients who do not want surgery, however, MEAW treatment is an alternative that can have excellent results.

Avaliação dos efeitos de três métodos de remoção da resina remanescente do braquete na superfície do esmalte

INTRODUCTION: To achieve the correct debonding technique, its essential the appropriate instruments selection to remove the bracket and the remaining resin. OBJECTIVE: To evaluate the enamel surface in a Scanning Electron Microscope (SEM) after the utilization of three methods for removing the remaining resin after debonding the bracket. METHODS: Eighteen bovine incisors were selected and divided into three groups (A, B and C) containing six teeth each. Before the bracket bonding, teeths impression were made with addition silicon and duplicated in epoxy resin, in order to register the enamel characteristics, composing the Control Group. The remaining resin removal methods were: Group A - heavy and medium granulation Soflex, Group B - low-rotation Carbide bur, Group C - high-speed Carbide bur. Soflex polishing, with fine and ultra fine granulation in group A, rubber tips in the groups B and C, and polishing paste on all groups. After the utilization of each step on the resin removing and polish, new impressions were made, duplicated and evaluated in SEM. Then the characteristics of the initial enamel (Group controls) were compared with the aspect of the enamel after the stages of resin removal, making it easier to evaluate the method that generates the smallest abrasion to the enamel. RESULTS AND CONCLUSION: The remaining resin removal with low-rotation tungsten Carbide bur, the polishing with rubber tips and final polish with paste to polish the enamel is the procedure that causes minor damage to the enamel.

Palatal expansion in a patient with solitary median maxillary central incisor syndrome

The objective of this article was to report a clinical case of a patient with solitary median maxillary central incisor syndrome. He was treated with rapid maxillary expansion and evaluated with computed tomography. The boy, aged 6 years 7 months, had a single maxillary central incisor in the midline, posterior crossbite, prominent midpalatal ridge, indistinct philtrum, no incisive papilla, and no labial frenulum. No other systemic anomalies were found. Posteroanterior cephalometric radiography showed skeletal atresia of the maxilla that was corrected with rapid maxillary expansion. A Haas expander was used and activated twice per day (quarter turn per activation) for 15 days. The procedure was monitored with computed tomography to evaluate any effect on the intermaxillary suture and tooth. Although the crossbite was clinically corrected after the expansion, radiographs and tomographs showed no opening of the midpalatal suture. Rapid maxillary expansion resulted in neither midpalatal suture opening nor transverse increase of the maxillary skeletal base in this patient.

Análise da expansão rápida da maxila por meio da tomografia computadorizada Cone-Beam

Whenever a maxillary arch is diagnosed as skeletally atresic the treatment of choice is usually maxillary orthopedic expansion, involving separation of the midpalatal suture. Basically, this suture used to be assessed with the aid of a maxillary occlusal radiograph, which limited its posteroanterior evaluation. Similarly, quantifying this atresia in cephalometric x-rays always posed an obstacle for clinicians owing to considerable superimposition of facial structures. With the advent of computed tomography, this technology has revolutionized diagnostic methods in dentistry because it provides high dimensional accuracy of the facial structures and a reliable method for quantifying the behavior of the maxillary halves, tooth inclination, bone formation at the suture in the three planes of space, as well as alveolar bone resorption and other consequences of palatal expansion.

Orthodontic traction in a patient with cleidocranial dysplasia: 3 years of follow-up.

This case report describes the treatment and long-term follow-up care of a patient diagnosed with cleidocranial dysplasia who had multiple impacted permanent and supernumerary teeth. The aim of the treatment was to provide an adequate esthetic and functional reconstruction of the occlusion with good periodontal care. The patient was treated with a multidisciplinary therapeutic protocol including orthodontic and surgical procedures, and traction of 11 permanent teeth. The proposed objectives of good occlusion, normal function, healthy periodontium, and balanced profile were achieved, and the 3-year follow-up records showed stable results.

A invaginação gengival e o fechamento ortodôntico de espaços de extrações: conduta clínica

Este estudo tem como objetivo enfatizar a relacao entre ortodontistas e periodontistas no intuito de melhorar os resultados do tratamento ortodontico. A observacao da formacao de invaginacoes gengivais durante o fechamento do espaco de extracoes pode gerar dificuldades na finalizacao e estabilizacao dos dentes adjacentes a estes espacos. A recidiva de dentes movimentados ortodonticamente pode ocorrer em virtude das fibras transeptais. O correto paralelismo radicular, uma fibrotomia criteriosa e a retencao imediata e adequada sao procedimentos indispensaveis para se atingir a estabilidade nos casos tratados. Melhores resultados podem ser obtidos com a realizacao de fibrotomia supracrestal no local da extracao prevenindo a recidiva nesta regiao. Resumo

Understanding the basis of space closure in Orthodontics for a more efficient orthodontic treatment

ABSTRACT Introduction: Space closure is one of the most challenging processes in Orthodontics and requires a solid comprehension of biomechanics in order to avoid undesirable side effects. Understanding the biomechanical basis of space closure better enables clinicians to determine anchorage and treatment options. In spite of the variety of appliance designs, space closure can be performed by means of friction or frictionless mechanics, and each technique has its advantages and disadvantages. Friction mechanics or sliding mechanics is attractive because of its simplicity; the space site is closed by means of elastics or coil springs to provide force, and the brackets slide on the orthodontic archwire. On the other hand, frictionless mechanics uses loop bends to generate force to close the space site, allowing differential moments in the active and reactive units, leading to a less or more anchorage control, depending on the situation. Objective: This article will discuss various theoretical aspects and methods of space closure based on biomechanical concepts.

Evaluation of the rapid and slow maxillary expansion using cone-beam computed tomography: a randomized clinical trial

ABSTRACT OBJECTIVE: The aim of this randomized clinical trial was to evaluate the dental, dentoalveolar, and skeletal changes occurring right after the rapid maxillary expansion (RME) and slow maxillary expansion (SME) treatment using Haas-type expander. METHODS: All subjects performed cone-beam computed tomography (CBCT) before installation of expanders (T1) and right after screw stabilization (T2). Patients who did not follow the research parameters were excluded. The final sample resulted in 21 patients in RME group (mean age of 8.43 years) and 16 patients in SME group (mean age of 8.70 years). Based on the skewness and kurtosis statistics, the variables were judged to be normally distributed and paired t-test and student t-test were performed at significance level of 5%. RESULTS: Intermolar angle changed significantly due to treatment and RME showed greater buccal tipping than SME. RME showed significant changes in other four measurements due to treatment: maxilla moved forward and mandible showed backward rotation and, at transversal level both skeletal and dentoalveolar showed significant changes due to maxillary expansion. SME showed significant dentoalveolar changes due to maxillary expansion. CONCLUSIONS: Only intermolar angle showed significant difference between the two modalities of maxillary expansion with greater buccal tipping for RME. Also, RME produced skeletal maxillary expansion and SME did not. Both maxillary expansion modalities were efficient to promote transversal gain at dentoalveolar level. Sagittal and vertical measurements did not show differences between groups, but RME promoted a forward movement of the maxilla and backward rotation of the mandible.

Forced eruption for all four maxillary incisors prior to implant rehabilitation

Periodontally compromised teeth are a common problem observed in adults, and the extraction is a viable solution in some of these situations. When prosthetic rehabilitation with implants take place after the extraction, orthodontic extrusion may convert the tooth indicated for extraction into a useful tooth. A 48-year-old womans chief complaint was the esthetics of her maxillary incisors with advanced periodontal disease. The incisors were orthodontically erupted to augment the bone topography for implant recipient sites and prosthetic rehabilitation. Three implants were selected and inserted in a single surgical procedure without any complications. A 10 months follow-up showed that the implants were stable with the prosthetic crowns preserving the surrounding soft tissues, and improving overall aesthetics and function.