Omar Gabriel da Silva Filho

Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis

There is an agreement among orthodontists that a posterior crossbite relationship should be treated early. The Haas expansion appliance is frequently chosen whenever a maxillary skeletal constriction exists in the deciduous, mixed, or permanent dentition. In this study we evaluated the efficacy of rapid maxillary expansion for 32 children between 5 and 11 years of age, by inspection of anteroposterior radiographs. Our results confirm previous data in the literature that the triangular opening in the frontal alveolar area is greater than in other parts of the midpalatal suture. It is evident that with expansion there is a real orthodontic effect, even at an early age.

Isolated Influences of Lip and Palate Surgery on Facial Growth: Comparison of Operated and Unoperated Male Adults with UCLP

Our aim was to evaluate the isolated effects of cheiloplasty and palatoplasty on dentofacial morphology. Ninety-three lateral cephalograms of white male adult patients with complete unilateral cleft lip and palate were analyzed in this study. The sample was divided into three groups according to the surgical treatment received: (1) nonoperated group (NO)-35 patients without surgical treatment; (2) operated lip group (OL)-23 subjects with lip closure only; (3) operated lip and palate group (OLP)-35 individuals with both lip and palatal closure. No statistically significant differences in the cephalometric measurements between the OL and OLP groups were found. There were, however, several significant differences between these two groups (OL and OLP) and the nonoperated group (NO). Thus, the differences in dentofacial morphology in patients with unilateral cleft lip and palate, seem to be influenced principally by the surgically repaired lip. Influences of the palatal repair appeared to be minimal and statistically insignificant.

Early treatment of the Class III malocclusion with rapid maxillary expansion and maxillary protraction

This study comprised a sample of 31 patients with Class III malocclusion (21 girls and 10 boys), with ages ranging from 5 years 2 months to 11 years 6 months. All patients were in the deciduous or mixed dentition. The indicated treatment was rapid maxillary expansion, immediately followed by maxillary protraction with the facial mask. Mean treatment time was 8 months, varying from 4 to 24 months. The therapy induced both dental and skeletal alterations. Skeletal alterations consisted of maxillary anterior displacement and mandibular downward and backward rotation, improving facial profile. Dental alterations, known as dentoalveolar compensations, consisted of a tendency of labial tipping of the maxillary incisors and lingual tipping of the mandibular incisors.

Influence of surgery on maxillary growth in cleft lip and/or palate patients

Using a sample of 204 caucasian adults of both sexes, with complete unilateral cleft lip and alveolus, isolated cleft palate and complete unilateral cleft lip, alveolus and palate, the influence of surgery on maxillary morphology and spatial position for the three main types of cleft lip and/or palate were evaluated. 113 cleft patients operated on at conventional timings were compared to 91 cleft patients who had never been operated on. Findings permit the conclusion that cheiloplasty in cleft lip and alveolus patients is associated with osseous remodelling in the anterior alveolar region, without significant changes in anterior nasal spine or other areas of the maxilla. In isolated cleft palate subjects palate repair does not promote significant changes in maxillary morphology and spatial position. The most evident effects were seen in the cleft lip, alveolus and palate group: reconstructive surgery in these patients leads to a severe maxillary retroposition associated with a downward rotation.

Secondary Bone Graft and Eruption of the Permanent Canine in Patients with Alveolar Clefts: Literature Review and Case Report

This paper emphasizes the important role that secondary bone grafting plays on the treatment of patients with alveolar clefts. The authors present a literature review and, based on panoramic radiographs, retrospectively and longitudinally analyze the behavior of permanent canines after completion of secondary bone grafting in 50 patients at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil. Twelve patients with unilateral cleft lip and alveolus and 38 patients with complete unilateral cleft lip and palate (n = 50) had undergone bone grafts to repair their residual alveolar clefts before the eruption of their permanent canines. These patients were observed over an average period of 3 years. In 94% of the sample (47 patients), the permanent canines presented intra-alveolar movement toward the oral cavity. In 72% of those 47 patients (36 patients), the permanent canines spontaneously erupted through the grafted area. In 6% of the 47 patients (3 patients), the permanent canines required orthodontic traction.

Mandibular growth in patients with cleft lip and/or cleft palate--the influence of cleft type.

A total of 229 adult white patients with cleft lip or palate were evaluated, through cephalometric radiographs, to determine cleft-type influence on mandibular structure and spatial position. The sample includes adult patients with unilateral complete cleft lip and alveolus (n = 50), complete cleft lip and palate (n = 118), and isolated cleft palate (n = 61). A group of 65 subjects with normal occlusion and without cleft lip or palate was used as a control group. All groups were matched according to sex. When compared, the cleft groups and the normal group showed that the mandibular structure was significantly different. The mandible in the cleft groups displayed shorter mandibular ramus and body length, without difference between the cleft types. Mandibular position relative to cranial base was similar in the cleft groups with involvement of the palate, and differed significantly from that observed in the group with cleft lip and alveolus and in the subjects without cleft. Palatal clefts induce a significant downward and backward rotation of the mandible associated with a more obtuse gonial angle. Thus a small mandible is a structural characteristic of all cleft types studied. However, mandibular shape and spatial position are strongly influenced in clefts that involve the palate.

Morfologia alveolar sob a perspectiva da tomografia computadorizada: definindo os limites biológicos para a movimentação dentária

Introduction: Computed tomography (CT) permits the visualization of the labial/buccal and lingual alveolar bone. Objectives: This study aimed at reporting and discussing the implications of alveolar bone morphology, visualized by means of CT, on the diagnosis and orthodontic treatment plan. Methods: Evidences of the interrelationship between dentofacial features and labial/buccal and lingual alveolar bone morphology, as well as the evidences of the effects of the orthodontic movement on the thickness and level of these periodontal structures were described. Results: Adult patients may present bone dehiscences previously to orthodontic treatment, mainly at the region of the mandibular incisors. Hyperdivergent patients seems to present a thinner thickness of the labial/buccal and lingual bone plates at the level of the root apex of permanent teeth, compared to hypodivergent patients. Buccolingual tooth movement might decentralize teeth from the alveolar bone causing bone dehiscences. Conclusion: The alveolar bone morphology constitutes a limiting factor for the orthodontic movement and should be individually considered in the

Influence of lip repair on craniofacial morphology of patients with complete bilateral cleft lip and palate.

Abstract Objective: The aim of this study was to compare two groups of adult male patients with complete bilateral cleft lip and palate (BCLP) on the basis of lateral cephalometric radiographs. Patients: The first group of adult male patients with complete BCLP was comprised of 13 unoperated patients with an average age of 21 years. The second group was comprised of 14 patients with an average age of 21 years 7 months, who had been operated only on the lip prior to 2 years of age. Design: The following measurements were evaluated: angle and length of cranial base; maxillary spatial positioning and length; mandibular spatial positioning; morphology and length; maxillomandibular relationship; vertical facial length; dental positioning; interdental arch relationship; and soft profile. Results: The results suggest that lip repair has a significant influence on certain areas of the craniofacial complex, mainly the premaxilla and the upper incisors. Conclusions: The most significant findings consequent to lip r...

Alveolar Bone Morphology in Patients With Bilateral Complete Cleft Lip and Palate in the Mixed Dentition: Cone Beam Computed Tomography Evaluation

Objectives To verify the thickness and level of alveolar bone around the teeth adjacent to the cleft by means of cone beam computed tomography (CBCT) in patients with complete bilateral cleft lip and palate prior to bone graft surgery and orthodontic intervention. Method The sample comprised 10 patients with complete bilateral cleft lip and palate (five boys and five girls) in the mixed dentition. The mean age was 9.5 years, and all subjects showed a G3 interarch relationship according to the Bauru index. The thickness of alveolar bone surrounding the maxillary incisors and the maxillary canines was measured in CBCT axial section using the software iCAT Xoran System. The distance between the alveolar bone crest and the cement-enamel junction (CEJ) was measured in cross sections. Results The tomography images showed a thin alveolar bone plate around teeth adjacent to clefts. No bone dehiscence was observed in teeth adjacent to clefts during the mixed dentition. A slight increase in the distance between the alveolar bone crest and the CEJ was observed in the mesial and lingual aspects of canines adjacent to cleft. Conclusion In patients with BCLP in the mixed dentition, teeth adjacent to the alveolar cleft are covered by a thin alveolar bone plate. However, the level of alveolar bone crest around these teeth seems to be normal, and no bone dehiscence was identified at this age.

Rapid Maxillary Expansion After Secondary Alveolar Bone Grafting in Patients With Alveolar Cleft

Objective: To test the hypothesis that it is possible to perform rapid maxillary expansion (RME) after alveolar bone grafting in patients with clefts of the lip and palate (CLP) without compromising the final result of the bone graft. Design: Occlusal and periapical radiographs of the grafted area of 17 unilateral and 11 bilateral patients with CLP (n  =  28) were obtained before and after RME. Setting and sample population: Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), University of São Paulo. Twenty-eighty patients with CLP who had undergone RME. Interventions: RME was performed in patients with CLP who had already undergone RME before secondary bone grafting but with relapse of the maxillary dental arch constriction, as well as in patients with CLP who had never undergone expansion before bone grafting. Outcome measure: Qualitative evaluation in occlusal and periapical radiographs after alveolar bone grafting. Results: Findings showed opening of the midpalatal suture in 42.8% of patients in this study. Regardless of the success rate of RME, the alveolar bone grafting was not affected when the procedures were inverted. Conclusion: The hypothesis was accepted. RME can be performed after secondary alveolar bone grafting without affecting it.