Paula Vanessa Pedron Oltramari

Importance of occlusion aspects in the completion of orthodontic treatment

The purpose of this study was to address the therapeutic goals regarding the static and functional occlusion in the completion of orthodontic treatment. For such purpose, a study population comprising 20 female treated Class II malocclusion subjects with an initial mean age of 11 years underwent a two-phase treatment (orthopedics and orthodontics). The patients were diagnosed in centric relation and were treated according to the six keys for normal occlusion and functional occlusal parameters (centric relation, vertical dimension, lateral and anterior guidances, occlusal contacts and direction of forces applied on the teeth). After removal of fixed mechanics, retainers were installed and maintained for two years. Five years after orthodontic completion, the occlusal stability of the patients was evaluated regarding molar relationship and overjet, measured in dental casts. All subjects maintained the normal molar relationship and correct overjet achieved at the end of treatment, indicating a fair level of occlusal stability. The importance of the criteria of the ideal functional occlusion to ensure a better stability after completion orthodontic treatment will be discussed in detail in this paper. In addition, some clinical situations in which localized adjustments are indicated for occlusal refinement will be described.

Tratamento ortopédico da Classe III em padrões faciais distintos

A ma oclusao de Classe III, de origem essencialmente esqueletica, produz uma acentuada deformidade facial. A Classe III pode ser interceptada durante a fase de crescimento e desenvolvimento craniofacial mediante o uso de aparelhos ortopedicos. O crescimento mandibular, predominantemente endocondral na cartilagem condilar, obedece essencialmente ao controle genetico. Portanto, os efeitos dos aparelhos ortopedicos que visam restringir o crescimento da mandibula mostram-se limitados, o que conduz ao pobre prognostico de tratamento precoce da Classe III determinada pelo prognatismo mandibular. Felizmente, o componente esqueletico maxilar responde melhor a aplicacao de forcas ortopedicas, ja que o crescimento osseo intramembranoso mostra-se mais susceptivel a influencias extrinsecas ou ambientais. Deste modo, a Classe III morfologicamente definida pelo retrognatismo maxilar, privilegia-se com o tratamento ortopedico. Este trabalho discute o tratamento interceptivo da Classe III por meio da tracao reversa da maxila em pacientes com padroes faciais distintos, apresentando dois casos clinicos, e ainda ressalta os aspectos atinentes a sua estabilidade.

Examination of temporomandibular disorders in the orthodontic patient: a clinical guide

The possible association between orthodontic treatment and temporomandibular disorders (TMD) is a topic of great interest in the current literature. The true role of orthodontic therapy on the etiology of TMD, however, is still uncertain. From the clinical prospective, a thorough examination of the stomatognathic system is always necessary in order to detect possible TMD signs and symptoms prior to the beginning of the orthodontic therapy. Caution should be exercised when planning, performing and finalizing orthodontics, especially in patients who with history of signs and symptoms of TMD. The clinician must always eliminate patient’s pain and dysfunction before initiating any type of orthodontic mechanics. Muscle incoordination, unstable disc-condyle relationship and bone alterations are usual TMD conditions that can interfere with the presenting occlusal relationship. This article reviews these aspects and presents a detailed clinical guide for the examination of the orthodontic patient, considering aspects related to facial pain and dysfunction.

Histological and molecular temporomandibular joint analyses after mandibular advancement surgery: study in minipigs.

OBJECTIVES The objective of this study was to elucidate the changes occurring in the temporomandibular joint (TMJ) after surgical mandibular advancement with different fixation techniques: bicortical screws (rigid fixation) and miniplates (semi-rigid fixation). STUDY DESIGN Eighteen minipigs were equally and randomly divided into 3 groups: Group I (control), nonoperated animals; Group II, animals submitted to surgical advancement surgery and osteosynthesis by bicortical screws; and Group III, animals submitted to surgical advancement surgery and osteosynthesis by miniplates. Four months after the surgeries, the presence of interleukin (IL)-6 and IL-10 in synovial fluid samples was assessed in ELISA experiments. TMJs were histologically prepared. RESULTS Higher levels of IL-10 (P = .0436) were found for Group II. Descriptive histological analysis was compatible with the ELISA findings. CONCLUSIONS Rigid fixation evokes more pronounced signs of bone remodeling in the TMJ, whereas malleable fixation promotes a more intense inflammatory activity. Therefore, rigid fixation seems to transmit a higher impact of postoperative masticatory forces to the TMJ.

Expansão rápida da maxila ancorada em implantes: uma nova proposta para expansão ortopédica na dentadura permanente

AIM: This study presents a method for maxillary orthopedic expansion, in the permanent dentition, using implants as anchorage. METHODS: Surgical and laboratorial procedures for the construction of a tooth-bone-borne expansor was detailed in a human dry skull. Two titanium implants were placed in the anterior region of the palate and a Hyrax screw was adapted in a way that the expansion was anchored both on the palatal implants and on permanent first molars. RESULTS: The laboratorial experiment in dry skull showed that the procedure is operationally and anatomically possible. The implants supported the force generated by the expansion screw activation and the maxilla halves were transversally split. CONCLUSIONS: Rapid maxillary expansion anchored on implants can increase the efficiency of orthopedic expansion and decrease the periodontal sequela caused by conventional RME. Further clinical studies are necessary to verify these hypotheses.

Long-term stability of an anterior open-bite malocclusion treated in the mixed dentition: a case report

A clinical case with anterior open-bite, treated in the mixed dentition, is presented. This approach demonstrates one of the possible approaches of treatment, which is capable of interfering with growth and redirecting its vectors. Orthodontic and orthopedic methods were used, consisting of slow maxillary expansion, through a fixed palatal crib soldered in a bi-helix appliance, and high-pull traction on the mandible for 16 hours a day. After eight years of follow-up, stable outcomes were accomplished. These results may be explained by the fact that treatments were performed at the appropriate period of development, thus establishing perioral muscular equilibrium, matching the final period of facial growth. The combination of orthodontic and orthopedic treatments was necessary to prevent the need of further orthognathic surgery treatment.