Outcomes of permanent canines on the cleft side after secondary alveolar grafting using different materials in complete unilateral cleft lip and palate

Abstract The prevalence of impaction of the permanent canine on the cleft side (PCCS) ranges from 12-35% after alveolar bone grafting (ABG). PCCSs usually develop above other permanent teeth in the alveolar process, gradually becoming vertical until they reach the occlusal plane. The type of cleft, hypodontia of lateral incisor on the cleft side, slower PCCS root development, and genetic factors are predictors of impaction and/or its ectopic eruption. Objective: To compare the behavior of PCCS in individuals with complete unilateral cleft lip and palate (UCLP) subjected to secondary alveolar grafting (SAG) with different materials. Methodology: This retrospective longitudinal study analyzed 120 individuals undergoing SAG with iliac crest bone, rhBMP-2, and mandibular symphysis. The individuals were selected at a single center and equally divided into three groups. Panoramic radiographs were analyzed by the Dolphin Imaging 11.95 software to measure PCCS angulation and PCCS height from the occlusal plane at two different timepoints. Results: No statistical significance was found between grafting materials (P=0.416). At T1, the PCCS height from the occlusal plane was greater for rhBMP-2 and mandibular symphysis compared to iliac crest bone. The lateral incisor on the cleft side was not related to success or lack of eruption of PCCS (P=0.870). Conclusion: Impaction rates of PCCS were similar for the materials studied. Absence of the lateral incisor on the cleft side did not prevent spontaneous eruption of PCCSs.

Is there a consensus for CBCT use in Orthodontics?

This article aims to discuss current evidence and recommendations for cone-beam computed tomography (CBCT) in Orthodontics. In comparison to conventional radiograph, CBCT has higher radiation doses and, for this reason, is not a standard method of diagnosis in Orthodontics. Routine use of CBCT in substitution to conventional radiograph is considered an unaccepted practice. CBCT should be indicated with criteria only after clinical examination has been performed and when the benefits for diagnosis and treatment planning exceed the risks of a greater radiation dose. It should be requested only when there is a potential to provide new information not demonstrated by conventional scans, when it modifies treatment plan or favors treatment execution. The most frequent indication of CBCT in Orthodontics, with some evidence on its clinical efficacy, includes retained/impacted permanent teeth; severe craniofacial anomalies; severe facial discrepancies with indication of orthodontic-surgical treatment; and bone irregularities or malformation of TMJ accompanied by signs and symptoms. In exceptional cases of adult patients when critical tooth movement are planned in regions with deficient buccolingual thickness of the alveolar ridge, CBCT can be indicated provided that there is a perspective of changes in orthodontic treatment planning.

O presente artigo visa discutir as evidências e recomendações atuais concernentes à indicação da tomografia computadorizada de feixe cônico (TCFC) em Ortodontia. Devido à dose de radiação mais elevada em relação às radiografias, a TCFC não é o método padrão de diagnóstico em Ortodontia. O seu uso rotineiro, em substituição à documentação convencional, é considerado uma prática inaceitável. A TCFC deve ser indicada com muito critério, e somente após uma análise clínica, quando os benefícios para o diagnóstico e tratamento superarem os riscos de uma dose mais elevada de radiação. Deve ser requisitada estritamente quando houver um potencial de prover novas informações não demonstradas em exames radiográficos convencionais, modificando o plano de tratamento ou facilitando a sua execução. As indicações mais frequentes em Ortodontia, que demonstram algum nível de evidência sobre sua eficácia clínica, podem ser resumidas em casos de dentes permanentes retidos; anomalias craniofaciais complexas; discrepâncias faciais severas com indicação de tratamento ortodôntico-cirúrgico; e malformações ou irregularidades ósseas na ATM acompanhadas de sinais e sintomas. Em casos excepcionais, em pacientes adultos em que se planeja movimentos dentários críticos em áreas com espessura óssea vestibulolingual deficiente, a TCFC pode ser indicada, desde que se vislumbre uma perspectiva de alteração no plano de tratamento ortodôntico.

Reabilitação de mandíbula severamente reabsorvida com implantes curtos e prótese fixa total parafusada / Rehabilitation of severely resorbed mandible with short dental implants and a total fixed, screw-retained prosthesis

Pacientes com atrofia óssea avançada dos maxilares ainda consistem em um desafio para a reabilitação oral. A literatura sugere várias opções de tratamento e cabe ao profissional escolher qual é a mais indicada conforme as condições psicossomáticas e financeiras do paciente. Este artigo relata e discute, embasado na literatura pertinente, o caso de uma paciente portadora das características ósseas acima, onde o tratamento escolhido foi a confecção de uma prótese total superior convencional e uma prótese fixa inferior suportada por implantes curtos com minipilares angulados devido à perda óssea vertical severa e ao prognatismo mandibular.

Patients with advanced bone jaw atrophy still consist of a challenge for oral rehabilitation. The literature suggests several treatment options, and clinicians must choose which is the most appropriate according to financial and psychological conditions. This article reports and discusses, based on relevant literature, the case of a patient with those characteristics, where the treatment of choice was the construction of a conventional denture and a lower fixed screw-retained, implant-supported prosthesis with short implants and mini-abutments due to the severe vertical bone loss and mandibular prognathism