Giovanni Oberti

Maxillary molar distalization with the dual-force distalizer supported by mini-implants: A clinical study

INTRODUCTION The objective of this prospective study was to describe the clinical effects of a bone-supported molar distalizing appliance, the dual-force distalizer. METHODS The study group included 16 patients (mean age, 14.3 years) with Class II molar relationships. Study models and lateral cephalograms were taken before and after the distalizing movement to record significant dental and skeletal changes (Wilcoxon test). RESULTS The average distalization time was 5 months, with a movement rate of 1.2 mm per month; the distalization amounts were 5.9 +/- 1.72 mm at the crown level and 4.4 +/- 1.41 mm at the furcation level. The average molar inclination was 5.6 degrees +/- 3.7 degrees ; this was less than the amount of inclination generated by bone-supported appliances that use single distalizing forces. The correlation between inclination and distalization was not significant, indicating predominantly bodily movement. The teeth anterior to the first molar moved distally also; the second premolars distalized an average of 4.26 mm, and the incisors retruded by 0.53 mm. CONCLUSIONS The dual-force distalizer is a valid alternative distalizing appliance that generates controlled molar distalization with a good rate of movement and no loss of anchorage.

Pulp-Dentine Complex Changes and Root Resorption During Intrusive Orthodontic Tooth Movement in Patients Prescribed Nabumetone

Pulpitis, external root resorption, and pain may be experienced during orthodontic movement. The use of nonsteroidal anti-inflammatory drugs (NSAIDs) has been suggested to control these changes. The purpose of this study was to observe pulp-dentinal reactions, root resorption, tooth pain, and tooth movement after the application of a 4-ounce intrusive orthodontic force to human maxillary first premolars in patients given the NSAID nabumetone. Thirty-four maxillary first premolars were evaluated. A placebo was prescribed to 17 patients after an intrusive force was activated and reactivated for an 8-week period on the right side. The same procedure was repeated on the left side after patients were given nabumetone. Pulp-dentinal reactions and external root resorption were evaluated by histology. Pain and movement were also evaluated. Nabumetone was found to be useful in reducing pulpitis, external root resorption, and pain caused by intrusive orthodontic movement, without altering tooth movement in response to the application of orthodontic force.

Evaluation of temporomandibular disorders in Class III patients treated with mandibular cervical headgear and fixed appliances

INTRODUCTION Our aim in this study was to evaluate the prevalence of temporomandibular disorders (TMD) in Class III patients treated with mandibular cervical headgear (MCH) and fixed appliances. METHODS The sample of 75 patients included 25 patients with no previous orthodontic treatment, 25 Class I patients who had undergone orthodontic treatment with fixed appliances and without extractions, and 25 patients with dentoskeletal Class III disharmonies treated with MCH and fixed appliances. The Helkimo index was used to test the prevalence of TMD symptoms in the 3 groups. The prevalence rates of the Helkimo index in the 3 groups were compared with the z score on proportions. RESULTS No statistically significant differences in the prevalence rates of the Helkimo index scores in the 3 groups were found (P = .367). Most subjects in the 3 groups had an Helkimo index of zero (66.7%). CONCLUSIONS Subjects with Class III malocclusions treated with MCH and fixed appliances do not have greater prevalence of TMD symptoms than do Class I subjects treated with fixed appliances or untreated subjects.

Treatment and posttreatment effects of mandibular cervical headgear followed by fixed appliances in Class III malocclusion

INTRODUCTION In this cephalometric investigation, we compared the treatment and posttreatment effects on patients undergoing an initial phase of mandibular cervical headgear (MCH) therapy followed later by comprehensive edgewise therapy with untreated Class III controls. METHODS The treated sample consisted of 21 patients treated consecutively with MCH before the pubertal growth spurt (average age, 10 years 2 months at the beginning of treatment). At the final observation period (average age, 15 years 3 months), all patients were in decelerative growth phases as determined by the cervical vertebral maturation method. Active treatment and posttreatment effects were evaluated in the treated group with nonparametric statistical analysis for paired samples. The treated sample was compared with a nonparametric statistical test for independent samples with 20 untreated Class III subjects who were matched for malocclusion, sex, and stage of cervical vertebral maturation to the treatment group. RESULTS AND CONCLUSIONS MCH therapy followed by fixed appliances was shown to be an effective treatment for the correction of skeletal Class III malocclusion at postpubertal observation. The favorable skeletal effects consisted mainly of smaller increases in mandibular length and advancement with respect to the controls, with the final outcome of significant improvements in the sagittal skeletal (+4 mm for the Wits appraisal) and dental (+2.7 mm for overjet, -4.4 mm for molar relationship) parameters. This treatment protocol also induced significant downward rotation of the mandible (2.8 degrees ).

Long-Term Outcomes of Class III Treatment with Mandibular Cervical Headgear Followed by Fixed Appliances

OBJECTIVE To evaluate the stability of the outcomes of mandibular cervical headgear (MCH) and fixed appliance-treated Class III patients at a long-term posttreatment (5 years) observation, compared with well-matched untreated Class III controls, following a previous report on the short-term outcomes of this protocol. MATERIALS AND METHODS The treated group consisted of 20 patients with dentoskeletal Class III malocclusions treated with a two-phase protocol consisting of MCH and fixed appliances, while the control group comprised 18 untreated subjects with similar dentoskeletal Class III malocclusion. Lateral cephalograms of both patients and controls were analyzed at two time points: posttreatment (PT), after two-phase treatment; and long term (LT). All patients were at a postpubertal stage of skeletal maturity at PT, and they showed CS6 at LT, thus revealing completion of pubertal craniofacial growth. RESULTS In the long term, the treatment group showed significantly smaller values for mandibular length (Co-Gn), SNB angle, maxillomandibular differential, and molar relation. When compared with the controls, the treated patients exhibited also greater values for ANB angle, Wits appraisal, and overjet at LT. No significant difference between the two groups was found for the changes occurring from PT to LT. CONCLUSIONS Favorable dentoskeletal outcomes induced by MCH and fixed appliances remained stable in the long term; untreated Class III malocclusion did not show any tendency toward self-improvement during the postpubertal interval.

Distalización de Molares Maxilares con Aparatos Intraorales de Nueva Generación que no Necesitan Colaboración del Paciente

RESUMEN: Las alternativas de tratamiento de las maloclusiones de clase II esquel”ticas y dentales incluyen lasextracciones de dientes permanentes y la distalizaciSn de los molares maxilares con aparatos extraorales e intraorales.Estos œltimos, no necesitan la cooperaciSn del paciente, adem⁄s, en ellos se han hecho variaciones importantes en sumec⁄nica y diseŒo a lo largo de los aŒos. Con˚ el uso de los minitornillos se ha podido eliminar, en gran parte, los efectos dereacciSn como la vestibularizaciSn de los incisivos y la mesializaciSn de los premolares. Este art™culo sintetiza una revisiSnde la literatura de los œltimos 20 aŒos de los diferentes diseŒos y sistemas mec⁄nicos que se han usado con ”xito en ladistalizaciSn de los molares maxilares.˚ PALABRAS CLAVE: movimiento de dientes hacia distal, aparatos ortodoncia, maloclusiSn, clase II de Angle. INTRODUCCIiN ˚La distalizaciSn de los molares maxilares es unade la modalidades de tratamiento en las maloclusionesde clase II esquel”ticas y dentales y pretende conver-tir una relaciSn de distoclusiSn en una neutroclusiSn yresolver el apiŒamiento anterosuperior mediante eldesplazamiento de los molares hacia distal en las eta-pas iniciales del tratamiento˚ (Gonz⁄lez & Fern⁄ndez,2003).˚

Extraccion del primer molar permanente como una alternativa en el tratamiento de ortodoncia.(Extractions of first permanent molars as a choice of the orthodontic treatment)

Abstract Extraction of First permanent molars is a treatment alternative in patients with moderate crowding, bi-maxillary protrusion, open bites, class III, Class II, in cases of extensive caries or other developmental problems or to prevent the placement of implants to replace them. This article describes three different clinical cases in which first, upper and lower permanent molars were chosen to be extracted in order to obtain clinical, facial and oclusal good results.