Terumi Okada Ozawa

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.

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

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.

A New Yardstick for Rating Dental Arch Relationship in Patients With Complete Bilateral Cleft Lip and Palate

Objective To develop yardsticks for assessment of dental arch relationship in young individuals with repaired complete bilateral cleft lip and palate appropriate to different stages of dental development. Participants Eleven cleft team orthodontists from five countries worked on the projects for 4 days. A total of 776 sets of standardized plaster models from 411 patients with operated complete bilateral cleft lip and palate were available for the exercise. Statistics The interexaminer reliability was calculated using weighted kappa statistics. Results The interrater weighted kappa scores were between .74 and .92, which is in the “good” to “very good” categories. Conclusions Three bilateral cleft lip and palate yardsticks for different developmental stages of the dentition were made: one for the deciduous dentition (6-year-olds’ yardstick), one for early mixed dentition (9-year-olds’ yardstick), and one for early permanent dentition (12-year-olds’ yardstick).

The Americleft Project: A Proposed Expanded Nasolabial Appearance Yardstick for 5- to 7-Year-Old Patients With Complete Unilateral Cleft Lip and Palate (CUCLP)

Objective To develop a yardstick of reference photographs for nasolabial appearance assessments of 5- to 7-year-old patients with complete unilateral cleft lip and palate (CUCLP). Design Blind retrospective analysis of clinical records and comparison to historical controls. Patients Subjects were two groups of 6- to 12-year-olds (n = 124 and n = 135) and one group of 5- to 7-year-olds (n = 149) with nonsyndromic CUCLP from three previous Americleft studies, including cohorts from seven different cleft/craniofacial centers. Interventions All patients received the infant management protocols of their respective centers. Eleven trained and calibrated judges (five participated in all three studies) did blind ratings of nasolabial appearance using the Asher-McDade method. Main Outcome Measures Patients receiving the most consistent ratings between judges, selected first from the groups of 6- to 12-year-olds, were used to create a pilot yardstick for eventual use in the third study of 5- to 7-year-olds. For each of the Asher-McDade categories, 8 of the 5- to 7-year-old patients receiving the most consistent scores between raters were ranked by 10 judges for a final elimination to leave three per category. Results Using this method of successive changes in rating methods, a new reference yardstick for nasolabial appearance rating was established and linked to the original Asher-McDade method as well as the single examples in a previously published yardstick for patients with CUCLP. Pilot testing using the yardstick improved reliabilities. Conclusions Use of an expanded nasolabial yardstick of reference photographs representative of the range of possibilities of each of the five Asher-McDade categories is now available to see if reliability of these ratings can be improved.

Anomalias dentárias associadas: o ortodontista decodificando a genética que rege os distúrbios de desenvolvimento dentário

This article aims to approach the diagnosis and orthodontic intervention of the dental anomalies, emphasizing the etiological aspects which define these developmental irregularities. A genetic interrelationship seems to exist determining some dental anomalies, considering the high frequency of associations. The same genetic defect may give rise to different phenotypes, including tooth agenesis, microdontia, ectopias and delayed dental development. The clinical implications of the associated dental anomalies are relevant, since early detection of a single dental anomaly may call the attention of professionals to the possible development of other associated anomalies in the same patient or in the family, allowing timely orthodontic intervention.

Association analysis of clinical aspects and vitamin D receptor gene polymorphism with external apical root resorption in orthodontic patients

INTRODUCTION Vitamin D is responsible for the regulation of certain genes at the transcription level, via interaction with the vitamin D receptor, and influences host immune responses and aspects of bone development, growth, and homeostasis. Our aim was to investigate the association of TaqI vitamin D receptor gene polymorphism with external apical root resorption during orthodontic treatment. METHODS Our subjects were 377 patients with Class II Division 1 malocclusion, divided into 3 groups: (1) 160 with external apical root resorption ≤1.43 mm, (2) 179 with external apical root resorption >1.43 mm), and (3) 38 untreated subjects. External apical root resorption of the maxillary incisors was evaluated on periapical radiographs taken before and after 6 months of treatment. After DNA collection and purification, vitamin D receptor TaqI polymorphism analysis was performed by polymerase chain reaction-restriction fragment length polymorphism. Univariate and multivariate analyses were performed to verify the association of clinical and genetic variables with external apical root resorption (P <0.05). RESULTS There was a higher proportion of external apical root resorption in orthodontically treated patients compared with the untreated subjects. In patients orthodontically treated, age higher than 14 years old, initial size of the maxillary incisor root superior to 30 mm, and premolar extraction were associated with increased external apical root resorption. Genotypes containing the C allele were weakly associated with protection against external apical root resorption (CC + CT × TT [odds ratio, 0.29; 95% confidence interval, 0.07-1.23; P = 0.091]) when treated orthodontic patients were compared to untreated individuals. CONCLUSIONS Clinical factors and vitamin D receptor TaqI polymorphism were associated with external apical root resorption in orthodontic patients.

Dental arch dimensions in Class II division 1 malocclusions with mandibular deficiency.

Abstract Objective: To test the hypothesis that there is no difference in the dimensions of the upper and lower dental arches in Class II division 1 malocclusion with a mandibular deficiency compared to normal Class I occlusion dental arches. Materials and Methods: Photocopies of the dental arches of 48 patients exhibiting Class II division 1 malocclusion with mandibular deficiency and of 51 individuals with normal occlusion were compared. Mandibular deficiency was diagnosed clinically. All 99 individuals were in the permanent dentition. The ages of the subjects ranged from 11 years 4 months to 20 years (mean age = 12 years 5 months). Results: When compared to subjects with normal occlusion, the upper dental arches of the Class II division 1 patients presented reduced transverse dimensions and longer sagittal dimensions while the lower arches were less influenced. Conclusion: The hypothesis is rejected. Significant differences are present between the dimensions of the upper and lower dental arches in Clas...OBJECTIVE To test the hypothesis that there is no difference in the dimensions of the upper and lower dental arches in Class II division 1 malocclusion with a mandibular deficiency compared to normal Class I occlusion dental arches. MATERIALS AND METHODS Photocopies of the dental arches of 48 patients exhibiting Class II division 1 malocclusion with mandibular deficiency and of 51 individuals with normal occlusion were compared. Mandibular deficiency was diagnosed clinically. All 99 individuals were in the permanent dentition. The ages of the subjects ranged from 11 years 4 months to 20 years (mean age = 12 years 5 months). RESULTS When compared to subjects with normal occlusion, the upper dental arches of the Class II division 1 patients presented reduced transverse dimensions and longer sagittal dimensions while the lower arches were less influenced. CONCLUSION The hypothesis is rejected. Significant differences are present between the dimensions of the upper and lower dental arches in Class II division 1 malocclusion (with a mandibular deficiency and in the permanent dentition) compared to normal Class I occlusion dental arches.

Facial profile evaluation of isolated Pierre Robin sequence.

Objective To evaluate numerically the facial profile of children with isolated Pierre Robin sequence (PRS) and to compare them with a control group that has no pathologies and exhibits regular and balanced facial growth, with no skeletal alterations. Patients Eighty-three children aged 5 to 10 years (PRS group, n = 60; control group, n = 23) were selected. Setting Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo (HRAC-USP). Children from the control group were taken from the program of Interceptive Orthodontics at HRAC-USP. Design Angular and ratio analyses of the facial profiles in both groups were realized through digital photographs. The PRS group was subdivided into two groups—complete and incomplete—according to the sagittal extension of the cleft palate, to investigate the possible influence of cleft extension on the face. Results The facial convexity angle and the facial inferior third angle were considerably higher in the PRS groups than in the control group and were not significantly different between PRS groups. Nasolabial angle did not differ between groups. Conclusion The facial profile was more convex in individuals with PRS than in those with regular facial growth and with no pathology. The mandible was responsible for the convexity of the profile in PRS because of its lack off anterior projection. An important relationship between the extension of the cleft palate and alterations in facial profile in PRS was not observed.

A altura facial anterior inferior nas más oclusões do padrão II, deficiência mandibular

Controversias na leitura cefalometrica da AFAi (Altura Facial Anterior inferior) e no diagnostico clinico baseado na analise facial em casos de mas oclusoes do padrao II por deficiencia mandibular, motivaram este artigo. Compusemos uma amostra formada por 26 pacientes portadores desta ma oclusao, sem distincao de genero e idade, tratados no curso de especializacao da PROFIS do HRAC - USP, Bauru. A amostra foi caracterizada utilizando-se um conjunto de medidas cefalometricas classicas (SNA, SNB, ANB, NAP, AFAi, SNPO, SNGoGn, CoA, CoGn) e testamos uma forma alternativa para medir a AFAi, onde os pontos espinha nasal anterior (ENA) e mentoniano (Me) foram projetados perpendicularmente a um plano frontal que passa por nasio, perpendicular ao plano de Frankfurt (Nperp A) e a distância entre eles medida linearmente. Os resultados foram confrontados com os valores obtidos da medicao da AFAi como preconizado por McNamara, em 1984. Encontrou-se uma relacao inversa entre a AFAi convencional e a AFAi perpendicular. Esta diferenca foi estatisticamente significante para toda a amostra e apresentou alta correlacao. A AFAi perpendicular foi sempre menor em toda amostra e exibiu uma tendencia de ser tanto menor quanto maior fosse o valor de SNGoGn. Estes achados levaram a crer que a AFAi perpendicular, medida como preconizada neste artigo, torna o triângulo de McNamara mais equilibrado. Isso confere a avaliacao cefalometrica a capacidade de identificar a diminuicao da AFAi, caracteristica facial tipica do portador de deficiencia mandibular, alem de permitir um entendimento mais claro dos efeitos do tratamento nessa dimensao.