Assessment of influence of facemask treatment with skeletal anchorage on the temporomandibular joint using magnetic resonance imaging: a preliminary study

ABSTRACT Objective: The aim of the study was to investigate the influence of facemask treatment with skeletal anchorage on the temporomandibular joint (TMJ) using magnetic resonance imaging (MRI), in patients with Class III malocclusion, accompanied by maxillary retrusion. Methods: Fifteen patients with a mean age of 12.1±1.43 years were included in the study. All patients were treated using facemask with skeletal anchorage after eight weeks of Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol. Magnetic resonance imaging was performed before and immediately after facemask treatment for TMJ evaluation. Disc position, condylar translation, degenerative changes of the condyles, and joint effusion were evaluated. To assess whether the alterations associated with the treatment were statistically significant, McNemar and marginal homogeneity tests were used. Results: After facemask treatment, a statistically significant change was observed in the disc position (an anterior disc displacement with/without reduction in five TMJs) (p<0.05). The alteration in the condylar translation was not statistically significant (p>0.05). This treatment did not cause degenerative changes of the condyles or effusion in any of the TMJs. Conclusion: Facemask treatment with skeletal anchorage following the Alt-RAMEC protocol had a minimal influence on the TMJ, only by means of disc position, which was not negligible. Long-term results of such treatment are required for following up the changes observed in the TMJs.

RESUMO Objetivo: O objetivo desse estudo foi investigar a influência do tratamento com máscara facial com ancoragem esquelética na articulação temporomandibular (ATM), por meio de ressonância magnética (RM), em pacientes com má oclusão de Classe III acompanhada de retrusão maxilar. Métodos: Quinze pacientes com idade média de 12,1±1,43 anos foram incluídos no estudo. Todos os pacientes foram tratados com máscara facial com ancoragem esquelética após oito semanas de protocolo de Expansão Rápida da Maxila e Constrição Alternadas (Alt-RAMEC). Os exames de ressonância magnética foram realizados antes e imediatamente após o tratamento com máscara facial, para avaliação da ATM. Foram avaliados posição do disco, translação condilar, alterações degenerativas dos côndilos e derrame articular. Os testes de McNemar e de homogeneidade marginal foram utilizados para avaliar se as alterações associadas ao tratamento foram estatisticamente significativas. Resultados: Após o tratamento com máscara facial, uma mudança estatisticamente significativa foi observada na posição do disco (deslocamento anterior do disco com/sem redução em cinco ATMs) (p<0,05). A alteração na translação condilar não foi estatisticamente significativa (p>0,05). Esse tratamento não causou alterações degenerativas dos côndilos ou derrame em qualquer das ATMs. Conclusão: O tratamento com máscara facial com ancoragem esquelética ápós o protocolo Alt-RAMEC teve uma influência mínima na ATM, apenas quanto à posição do disco, que não foi desprezível. Resultados em longo prazo desse tratamento são necessários para acompanhar as mudanças observadas nas ATMs.

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results

ABSTRACT Introduction: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. Objective: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. Conclusion: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

RESUMO Introdução: A má oclusão de Classe III deve ser interceptada e tratada em idade precoce, a fim de evitar uma futura necessidade de procedimentos complexos e invasivos. O tratamento com máscara facial ortopédica tem o objetivo de obter alterações esqueléticas, minimizando os efeitos colaterais na dentição. O uso de ancoragem óssea em mini-implantes, associada ao protocolo Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) pode ser eficaz no tratamento de um grande número de pacientes Classe III em crescimento. Objetivo: Realizar uma síntese da literatura baseada em evidência sobre o tratamento da má oclusão de Classe III em pacientes adultos jovens, e ilustrar sua aplicação e eficácia por meio do relato de um caso emblemático. Conclusão: A resolução e o acompanhamento em longo prazo do caso apresentado, juntamente com estudos conduzidos em uma amostra maior, demonstram a eficácia da combinação estratégica dos tratamentos ortopédico e ortodôntico usando um expansor palatal híbrido e o protocolo Alt-RAMEC para corrigir a má oclusão de Classe III em pacientes adultos.

ANCHORAGE PREPARATION FOR VARIOUS ORTHODONTIC TREATMENT

There are many kinds of orthodontic movements that make the clinical schedule a genuine test. With the appearance of the skeletal anchorage, it became more straightforward to take care of numerous issues, like anchorage, tipping, interruption among others. The reason for this article was to survey outright anchorage, including signs, implantation site, and any kind of orthodontic element

Influence of the growth pattern on cortical bone thickness and mini-implant stability

ABSTRACT Introduction: Controversial reports suggest a relationship between growth pattern and cortical alveolar bone thickness, and its effect in the use of mini-implants. Objective: The main purpose of this study was to assess the influence of the growth pattern on the cortical alveolar bone thickness and on the stability and success rate of mini-implants. Methods: Fifty-six mini-implants were inserted in the buccal region of the maxilla of 30 patients. These patients were allocated into two groups, based on their growth pattern (horizontal group [HG] and vertical group [VG]). Cortical thickness was measured using Cone Beam Computed Tomography. Stability of mini-implants, soft tissue in the insertion site, sensitivity during loading and plaque around the mini-implants were evaluated once a month. Intergroup comparisons were performed using t tests, Mann-Whitney tests, and Fisher exact tests. Correlations were evaluated with Pearson's correlation coefficient. Results: The cortical bone thickness was significantly greater in the HG at the maxillary labial anterior region and at the mandibular buccal posterior and labial anterior regions. There was a significant negative correlation between Frankfort-mandibular plane angle (FMA) and the labial cortical thickness of the maxilla, and with the labial and lingual cortical bone thicknesses of the mandible. No significant intergroup difference was found for mini-implant mobility and success rate. No associated factor influenced stability of the mini-implants. Conclusions: Growth pattern affects the alveolar bone cortical thickness in specific areas of the maxilla and mandible, with horizontal patients presenting greater cortical bone thickness. However, this fact may have no influence on the stability and success rate of mini-implants in the maxillary buccal posterior region.

RESUMO Introdução: Relatos controversos sugerem uma relação entre o padrão de crescimento e a espessura do osso alveolar cortical e seu efeito no uso de mini-implantes. Objetivo: Avaliar a influência do padrão de crescimento na espessura do osso cortical alveolar e na estabilidade e taxa de sucesso dos mini-implantes. Métodos: Cinquenta e seis mini-implantes foram inseridos na região vestibular da maxila de trinta pacientes. Esses pacientes foram alocados em dois grupos, com base em seu padrão de crescimento (grupo horizontal [GH] e grupo vertical [GV]). As espessuras corticais foram medidas por meio de tomografias computadorizadas de feixe cônico. A estabilidade dos mini-implantes, tecido mole no local de inserção, sensibilidade durante a carga e o acúmulo de placa ao redor dos mini-implantes foram avaliados uma vez por mês. As comparações intergrupos foram realizadas por testes t de Student, testes de Mann-Whitney e testes exatos de Fisher. As correlações foram avaliadas com o coeficiente de correlação de Pearson. Resultados: A espessura do osso cortical foi significativamente maior no GH na região vestibular anterior da maxila e nas regiões vestibulares posterior e anterior da mandíbula. Houve uma correlação negativa significativa entre o ângulo do plano mandibular (FMA) e a espessura da cortical vestibular da maxila, e com a espessura das corticais vestibular e lingual da mandíbula. Nenhuma diferença significativa entre os grupos foi encontrada com relação à mobilidade do mini-implante e taxa de sucesso. Nenhum fator associado influenciou a estabilidade dos mini-implantes. Conclusões: O padrão de crescimento afeta a espessura da cortical óssea alveolar em áreas específicas da maxila e mandíbula, com pacientes horizontais apresentando maior espessura da cortical óssea. No entanto, esse fato pode não ter influência na estabilidade e na taxa de sucesso dos mini-implantes na região vestibular posterior da maxila.

Una Descripción General y Actualizada de Miniplacas y Minitornillos. Efectos Dentoalveolares y Esqueléticos / A General and Updated Description of Miniplates and Miniscrews. Dentoalveolar and Skeletal Effects

RESUMEN: En ortodoncia, las miniplacas se utilizan como dispositivo de anclaje temporal (TAD) para la realización de movimientos dentales que permiten el uso de fuerzas ortopédicas en ellos. En comparación con los mini tornillos, las miniplacas tienen la ventaja de una tasa de falla muy baja, pero la desventaja es que para la extracción se necesita el mismo acto quirúrgico que se realizó para la instalación. El objetivo de este estudio es realizar una revisión bibliográfica de las indicaciones de miniplacas en pacientes con mordidas abiertas, clase II y anomalías de clase III, y buscar cómo las miniplacas han mejorado los tratamientos de ortodoncia. La información principal se reunió buscando en PubMed con las palabras clave enumeradas a continuación. Afirmamos que las miniplacas están indicadas para la retracción en masa de la arcada, donde se observó que la fuerza de 150 g aplicada en los molares superiores es suficiente no solo para empujar los molares hacia atrás en una clase I corregida, sino también para iniciar la retracción de premolares, caninos e incisivos. En pacientes con mordida abierta, las miniplacas se definen como un método seguro, una alternativa rápida y menos costosa a la cirugía ortognática. Y en pacientes de las clases II y III se utilizan sin producir efectos dentoalveolares que sustituyan a los dispositivos extraorales como máscaras, con dispositivos intraorales y elásticos (BAMP).

ABSTRACT: In orthodontics, miniplates are used as a Temporary Anchoring Device (TAD) for the purpose dental movements, allowing the use of orthopedic forces. In comparison with mini-screws, miniplates have the advantage of a very low rate of failure. Nonetheless, their removal requires the same surgical procedure as during installation, which is an obvious disadvantage. The aim of this study is to review the indications of miniplates in patients with open bite, class II and class III anomalies, and review how miniplates improved orthodontics treatments. Information was obtained by a search in PubMed with the keywords listed below. Miniplates are indicated for retraction in mass of the arcade, where it was seen that the force of 150 g applied on maxillary molars, is sufficient not only to push the molars back into a corrected class I, but also to initiate retraction of premolars, canines, and incisors. In open-bite patients, mini plates, are achieved as a safe method, that is quick and a less expensive alternative to orthognathic surgery. Further, in class II and III patients they are used without producing dentoalveolar effects replacing extraoral devices as facemasks, with intraoral devices and elastics. (BAMP).

Management of skeletal Class III with facial asymmetry using skeletal anchorage: 4-year follow-up

ABSTRACT Introduction: Skeletal Class III malocclusion with asymmetry is one of the most difficult problems to correct in orthodontics. A functional shift of the mandible in growing patients may occur accompanying a Class III, due to constricted maxillary arch and occlusal interferences. Studies have indicated that posterior unilateral crossbite develops early and has a low rate of spontaneous correction. It may further lead to development of mandibular and facial asymmetry by growth and displacement of mandible if left untreated in growing patients. Objective: This article reports the clinical case of a thirteen-year-old female patient in CVMI transition stage that had maxillary hypoplasia with a developing facial asymmetry. Results: The case was successfully managed with bone-anchored facemask therapy and with elimination of occlusal interferences with guided occlusion. Reverse twin block in the retention phase maintained the results achieved. Conclusion: A four-year follow-up evaluation revealed successful maintenance of the treatment results.

RESUMO Introdução: A má oclusão de Classe III esquelética com assimetria é um dos problemas mais difíceis de se corrigir na Ortodontia. O desvio funcional da mandíbula em pacientes em fase de crescimento pode ocorrer acompanhado da Classe III, devido à atresia maxilar e interferências oclusais. Estudos têm indicado que a mordida cruzada posterior unilateral se desenvolve precocemente e apresenta baixo índice de correção espontânea. Isso pode levar ao desenvolvimento de assimetria mandibular e facial, resultante do crescimento e deslocamento da mandíbula, caso os pacientes não sejam tratados na fase de crescimento. Objetivo: O presente artigo relata o caso clínico de uma paciente com treze anos de idade, com IMVC em estágio de transição e que apresentava hipoplasia maxilar com assimetria facial em desenvolvimento. Resultados: O caso foi tratado com sucesso por meio de terapia com máscara facial osseossuportada, eliminando as interferências oclusais por meio de uma oclusão guiada. O uso do aparelho Twin-block reverso como contenção preservou os resultados atingidos. Conclusão: O acompanhamento após quatro anos confirmou a manutenção dos resultados do tratamento.

Occlusal plane canting: a treatment alternative using skeletal anchorage

ABSTRACT A canted occlusal plane is the cause of unaesthetic smile, and also represents a challenge, due to the complex orthodontic procedures involved in its treatment. The skeletal anchorage allows successful treatment of this asymmetry in the majority of cases, with less dependency on the patient cooperation and reducing the necessity of orthognatic surgery. Given this condition, this article aims at discussing the main aspects related to the diagnosis of occlusal plane canting, treatment plan, and orthodontic mechanics using skeletal anchorage either by mini-implants or miniplates. In this context, five cases will be reported, showing the main details related to the orthodontic mechanics used to correct the occlusal plane, avoiding side effects and successfully reaching treatment objectives and long-term stability.

RESUMO O plano oclusal inclinado é causa de um sorriso esteticamente desagradável e representa um desafio, devido à complexidade dos procedimentos ortodônticos envolvidos no seu tratamento. A ancoragem esquelética permite a correção da inclinação do plano oclusal, na maior parte dos casos, sem a necessidade de cirurgia ortognática e com menor dependência da colaboração dos pacientes. Com base nisso, o objetivo desse artigo é discutir os principais aspectos relacionados ao diagnóstico, plano de tratamento e mecânica ortodôntica envolvida no tratamento do plano oclusal inclinado com mini-implantes ou miniplacas. Nesse contexto, cinco casos serão apresentados, demonstrando os principais detalhes relacionados à mecânica utilizada na correção do plano oclusal inclinado com a utilização de ancoragem esquelética.

Orthodontic Traction of the Permanent Molar Using Skeletal Anchorage: A Case Report / 대한소아치과학회지

Treatment options for impacted permanent molars include orthodontic traction, surgical repositioning, transplantation, and extraction of the impacted teeth. Orthodontic traction is recommended because it is the most conservative method. However, it has limitations, such as loss of tooth anchorage. In an effort to overcome these limitations, skeletal anchorage devices tailored for orthodontic use were developed. In this case report, 3 patients were diagnosed with impacted permanent molars. The impacted teeth of these patients were surgically exposed, the orthodontic devices were attached, and the skeletal anchorage devices were implanted for the successful traction of the impacted teeth.

Analysis of effects from usage of skeletal anchorage-assisted Pendulum appliance on vertical component of craniofacial structure

PURPOSE: The purpose of this study was to evaluate distalizing effects from the Pendulum appliance on vertical component of craniofacial structures. MATERIALS AND METHODS: 20 Patients who visited for orthodontic treatments are assigned to two groups. Group I, SN-MP > 37 degrees are showing hyperdivergent pattern. Group II, 29 < SN-MP < 37 degrees are showing mesocephalic pattern. Each group are consisted of 10 people. RESULTS AND CONCLUSIONS: Differences between skeletal classifications result in significant differences at labioversion of lower incisors and distalized amount, which is larger at Group I (P <.05). Group II has only shown significant distalized molars (P < .05). Labioversion of lower incisors has not shown significant change. Skeletal anchorage-assisted Pendulum appliance doesn't deteriorate vertical component nor significantly improve.

Fracture strength of orthodontic mini-implants

ABSTRACT Objective: This study aimed at evaluating the design and dimensions of five different brands of orthodontic mini-implants, as well as their influence on torsional fracture strength. Methods: Fifty mini-implants were divided into five groups corresponding to different manufactures (DEN, RMO, CON, NEO, SIN). Twenty-five mini-implants were subjected to fracture test by torsion in the neck and the tip, through arbors attached to a Universal Mechanical Testing Machine. The other 25 mini-implants were subjected to insertion torque test into blocks of pork ribs using a torquimeter and contra-angle handpiece mounted in a surgical motor. The shape of the active tip of the mini-implants was evaluated under microscopy. The non-parametric Friedman test and Snedecor's F in analysis of variance (ANOVA) were used to evaluate the differences between groups. Results: The fracture torque of the neck ranged from 23.45 N.cm (DEN) to 34.82 N.cm (SIN), and of the tip ranged from 9.35 N.cm (CON) to 24.36 N.cm (NEO). Insertion torque values ranged from 6.6 N.cm (RMO) to 10.2 N.cm (NEO). The characteristics that most influenced the results were outer diameter, inner diameter, the ratio between internal and external diameters, and the existence of milling in the apical region of the mini-implant. Conclusions: The fracture torques were different for both the neck and the tip of the five types evaluated. NEO and SIN mini-implants showed the highest resistance to fracture of the neck and tip. The fracture torques of both tip and neck were higher than the torque required to insert mini-implants.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar o desenho e as medidas de cinco marcas diferentes de mini-implantes ortodônticos, e sua influência na resistência à fratura em torção. Métodos: cinquenta mini-implantes foram divididos em cinco grupos, correspondentes a diferentes fabricantes (DEN, Dentaurum; RMO, Rocky Mountain Orthodontics; CON, Conexão; NEO, Neodent; SIN, Sistema de Implantes Nacional). Vinte e cinco mini-implantes foram submetidos ao teste de fratura por torção no pescoço e na ponta, com mandris fixados a uma máquina universal de testes mecânicos. Os outros 25 mini-implantes foram submetidos ao teste de torque de inserção em blocos de costelas suínas, utilizando-se um torquímetro e um contra-ângulo montado em motor cirúrgico. O formato da ponta ativa dos mini-implantes foi avaliado por microscopia. O teste não-paramétrico de Friedman e o teste F de Snedecor na análise de variância (ANOVA) foram utilizados para avaliar as diferenças entre os grupos. Resultados: o torque de fratura do pescoço variou de 23,45 N.cm (DEN) a 34,82 N.cm (SIN); e o da ponta, entre 9,35 N.cm (CON) e 24,36 N.cm (NEO). O valor do torque de inserção variou de 6,6 N.cm (RMO) a 10,2 N.cm (NEO). As características que mais influenciaram os resultados foram: diâmetro externo, diâmetro interno, razão entre o diâmetro interno e o externo, e a presença de fresagem na região apical do mini-implante. Conclusões: os torques de fratura foram diferentes entre os cinco tipos avaliados, tanto no pescoço quanto na ponta. Os mini-implantes NEO e SIN foram os mais resistentes à fratura do pescoço e da ponta. Os torques de fratura tanto na ponta quanto no pescoço foram maiores do que o torque necessário para a inserção dos mini-implantes.

Zygomatic miniplates for skeletal anchorage in orthopedic correction of Class III malocclusion: A controlled clinical trial / 대한치과교정학회지

OBJECTIVE: To evaluate the effects of facemask therapy, which was anchored from the zygomatic buttresses of the maxilla by using two miniplates, in skeletal Class III patients with maxillary deficiency. METHODS: Eighteen skeletal Class III patients (10 girls and 8 boys; mean age, 11.4 ± 1.28 years) with maxillary deficiency were treated using miniplate-anchored facemasks, and their outcomes were compared with those of a Class III control group (9 girls and 9 boys; mean age, 10.6 ± 1.12 years). Two I-shaped miniplates were placed on the right and left zygomatic buttresses of the maxilla, and a facemask was applied with a 400 g force per side. Intragroup comparisons were made using the Wilcoxon test, and intergroup comparisons were made using the Mann-Whitney U-test (p < 0.05). RESULTS: In the treatment group, the maxilla moved 3.3 mm forward, the mandible showed posterior rotation by 1.5°, and the lower incisors were retroclined after treatment. These results were significantly different from those in the control group (p < 0.05). No significant anterior rotation of the palatal plane was observed after treatment. Moreover, changes in the sagittal positions of the maxillary incisors and molars were similar between the treatment and control groups. CONCLUSIONS: Skeletally anchored facemask therapy is an effective method for correcting Class III malocclusions, which also minimizes the undesired dental side effects of conventional methods in the maxilla.

Microimplantes, una nueva opción en el tratamiento de Ortodoncia

Los microimplantes son pequeños pines de titanio o de aleación de titanio de 1,2 mm de diámetro y 6 mm de longitud. Están diseñados con una superficie suave para que no se oseointegren. Son utilizados en Ortodoncia como anclaje temporal. Han sido usados como anclaje esqueletal, también para distalizar y protraer molares, intruir molares e incisivos, para el cierre de espacios edéntulos extensos que con los métodos convencionales en ortodoncia habría sido imposible. Los microimplantes son removidos con relativa facilidad una vez efectuado el procedimiento. Como toda técnica nueva, es importante que los clínicos sepan elegir bien en qué casos van a utilizar los micro implantes y los sitios de su colocación.

The miniimplants are small devices of 1,2 mm of wide and 6 mm of length. Manufactured with a smooth machined surface that is not designed to osseointegrate. In orthodontics they are used as temporary anchorage for molar distalization, protraction and intrusion of molars and incisors. Also for closing wide edentulous spaces once considered impossible with conventional orthodontics.. The miniimplants are easily removed. As with any new technique clinicians should be aware in which cases use this devices and the sites of placing them.

Distalización de molares maxilares utilizando dispositivos de anclaje esqueletal directo en pacientes con maloclusiones Clase II. Revisión bibliográfica

Introducción: La relación molar de Clase II de Angle se encuentra aproximadamente en un 20% de la población. Cuando la maloclusión es de origen dentario, generada principalmente por una migración de los segmentos laterales, la opción de tratamiento más frecuente para generar espacio y establecer una relación molar de Clase I, es la distalización molar. Un gran número de aparatos y protocolos de tratamiento se han descrito en la literatura. Uno de los más utilizados es el Péndulo, pero debido a su diseño que utiliza anclaje dentario, y a que su fuerza pasa a nivel de la corona de los primeros molares, presenta muchas desventajas. Objetivo: El propósito de esta revisión es analizar los dispositivos de distalización molar que utilizan anclaje esqueletal directo, en los que la fuerza aplicada pasa cerca del centro de resistencia del primer molar superior, con el objetivo de determinar si son superiores en cuanto a eficiencia y minimización de los efectos adversos, cuando se compara con los aparatos convencionales. Resultado: De un total de 25 artículos seleccionados con base en el año de publicación y el empleo de anclaje esqueletal, se utilizaron 7 artículos para revisión, basados en criterios de inclusión y exclusión. Discusión: Al comparar los aparatos, se observa gran variabilidad en duración de tratamiento, cantidad y tasa de distalización. A pesar de estas diferencias todos mostraron éxito clínico el finalizar la mecánica de distalización. Por otra parte, existe una distalización espontánea de los segundos premolares superiores e incluso de los primeros premolares, pero con estos dispositivos que no utilizan estas piezas dentarias como anclaje y que, por lo tanto, quedan libres y son distalizados con la ayuda de las fibras transeptales. Conclusión: Se concluye que la distalización molar ha demostrado ser un procedimiento eficaz cuando se utilizan aparatos con anclaje esqueletal directo y con un vector de fuerza que pase cerca del centro de resistencia de los primeros molares. Estos métodos no generan efectos secundarios en la región de anclaje cuando se compara con aparatos convencionales, donde existen migración mesial de premolares y piezas anteriores. En todos los casos analizados los molares superiores se distalizaron a una relación de clase I en un corto período , incluso a pesar de la presencia de los segundos y terceros molares maxilares.

Introduction: The Angle Class II molar ratio is approximately 20% of the population. When malocclusion is of dental origin, mainly generated by a migration of lateral segments, the most frequent treatment option to generate space and to establish a Class I molar relationship is molar distalization. A large number of treatment devices and protocols have been described in the literature. One of the most used is the Pendulum, but because of its design that uses dental anchorage and its force happens at the level of the crown of the first molars, presents many disadvantages. Objective: The purpose of this review is to analyze molar distalization devices using direct skeletal anchors, in which the applied force passes near the center of resistance of the upper first molar, in order to determine if they are superior in efficiency and minimization of adverse effects when compared with conventional appliances. Results: The search process included a total of 25 articles selected based on year of publication and use of skeletal anchorage, 7 articles were finally used for review, based on inclusion and exclusion criteria. Discussion: When comparing the devices, there is great variability in duration of treatment, amount of distalization and rate of distalization. In spite of these differences all showed clinical success to finalize the mechanics of distalization. On the other hand, here is a spontaneous distalization of the second upper premolars and even the first premolars with these devices that do not use these dental pieces as an anchorage, therefore, they remain free and are distalized with the help of the transseptal fibers. Conclusion: It is concluded that molar distalization has proved to be an effective procedure when using devices with direct skeletal anchors and with a force vector passing close to the resistance center of the first molars. These methods do not generate side effects in the anchoring region when compared to conventional apparatus where there is mesial migration of premolars and anterior parts. In all the cases analyzed, the maxillary molars were distalized to a class I relationship in a short period of time, even in spite of the presence of the second and third maxillary molars.

Changes produced by the pendulum appliance with skeletal anchorage and comparison with conventional pendulum appliance / Alterações produzidas com o aparelho pêndulo com ancoragem esquelética e comparação com o aparelho pêndulo convencional

Os propósitos destas pesquisas foram primeiramente avaliar as alterações esqueléticas, dento-alveolares e tegumentares obtidas com o aparelho pêndulo com ancoragem esquelética (BAPA) em pacientes com má oclusão Classe II e, posteriormente compará-los com os efeitos produzidos com o aparelho pêndulo com ancoragem convencional (CPA). A amostra composta de 18 pacientes (14 meninas;4 meninos) com idade média de 14.01 (D.P. 1.08) com má oclusão de Classe II tratados com BAPA como dispositivo distalizador antes do aparelho fixo, no Departamento de Ortodontia da Faculdade de Odontologia da Universidade Cidade de São Paulo. Telerradiografias laterais foram tomadas no início do tratamento (T0) e no final da distalização (T1), mensuradas e posteriormente analisadas estatisticamente. Apenas o período da distalização ativa foi avaliado. O grupo controle foi composto de 18 pacientes (14 meninas;4 meninos) com idade média de 13.61 (D.P. 1.24) com a mesma má oclusão tratados com CPA como dispositivo distalizador antes do aparelho fixo, no Departamento de Ortodontia da Faculdade de Odontologia de Bauru, Universidade de São Paulo. Para avaliar os efeitos desta amostra foi utilizada a mesma metodologia acima mencionada. Posteriormente, para comparar as alterações entre os grupos, a amostra tratada com CPA foi denominada Grupo 1 (G1), e a amostra tratada com BAPA denominada Grupo 2 (G2). O tempo médio de distalização foi 5.76 e 6.16 meses, no G1 e G2 respectivamente. Ambos os grupos foram compatibilizados em relação à idade inicial, tempo de tratamento, severidade da má oclusão de Classe II e características cefalométricas iniciais. A comparação intra-grupo foi realizada com teste t dependente, e a comparação intergrupos foi realizada com o teste t. Em G2 houve aumento significante da altura facial anteroinferior, distalização molar, inclinação distal e intrusão significante dos primeiros e segundos molares superiores. Os primeiros pré-molares apresentaram distalização e extrusão significantes. A sobremordida diminuiu e a relação molar melhoraram significativamente. Comparando as alterações do tratamento entre grupos, foram significativamente maiores a distalização, inclinação distal e intrusão dos primeiros molares no G2 comparados ao G1. Os incisivos superiores inclinaram para vestibular no G1, e ligeiramente retroinclinaram para lingual no G2, além disso os primeiros pré-molares foram distalizados no G2, porém foram mesializados no G1. O Grupo 1 apresentou aumento significativamente maior da sobressaliência, e menor correção da relação molar de Classe II do que G2. A distalização dos molares superiores foi obtida com sucesso em ambos os grupos, entretanto, utilizando o BAPA observou-se várias vantagens, tais como: Distalização exclusiva dos molares superiores; movimento distal espontâneo dos pré-molares superiores; sem efeitos colaterais indesejáveis nos incisivos superiores e nos lábios; e também o estabelecimento de uma relação molar de Classe I.(AU)

The purposes of these investigations were firstly to evaluate the dentoalveolar, skeletal and soft tissue effects obtained with the bone-anchored pendulum appliance (BAPA) in patients with Class II malocclusion and secondly, to compare these effects with the conventional pendulum appliance (CPA). A sample of 18 patients (14 females; 4 males) with a mean age of 14.01 years (S.D 1.08) with Class II malocclusion treated with BAPA as distalizer device before fixed appliance in Orthodontic Department at the Dental School, University of São Paulo City. Lateral headfilms were taken at the beginning of treatment (T0) and at the end of distalization period (T1), measured and then statistically analyzed. Only the active distalization period was evaluated. The comparison group was composed by 18 patients (14 females; 4 males) with a mean age of 13.61 years (S.D 1.24) with the same malocclusion treated with CPA before fixed appliance in Orthodontic Department at Bauru Dental School, University of São Paulo. To evaluate the effects in this sample was used the same methodology abovementioned. Then, to compare changes between groups, the sample treated with CPA was named Group 1 (G1), and the sample treated with BAPA was named Group 2 (G2). The average distalization period was 5.76 and 6.16 months, respectively for G1 and G2. Both groups were compatibilized regarding initial age, treatment time, severity of Class II malocclusion and initial cephalometric characteristics. Intragroup comparisons were performed using dependent t tests and intergroup comparisons were performed using t tests. In G2 there was significant increase in the lower anterior face height, molar distalization, distal tipping and intrusion of the first and second maxillary molars. The first premolars had significant distalization and extrusion. Overbite significantly decreased and molar relationship was significantly improved. Comparing the groups, there were significantly greater maxillary first molar distalization, distal tipping and intrusion in G2 compared to G1. The maxillary incisors were labially tipped in G1 and lingually tipped in G2. The first premolars were distalized in G2 while were mesialized in G1. G1 showed a significantly greater overjet increase and smaller Class II molar relationship correction than G2. Distalization of the maxillary molars was successfully achieved in both groups, but using the BAPA several advantages were observed including exclusive maxillary molars distalization, spontaneous distal movement of the maxillary premolars, no undesirable side effects in the maxillary incisors and lips and establishment of a Class I molar relationship.(AU)

Three-dimensional finite element analysis of a newly designed onplant miniplate anchorage system / 华中科技大学学报（医学）（英德文版）

The purpose of this research was to evaluate the structural stress and deformation of a newly designed onplant miniplate anchorage system compared to a standard anchorage system. A bone block integrated with a novel miniplate and fixation screw system was simulated in a three-dimensional model and subjected to force at different directions. The stress distribution and deformation of the miniplate system and cortical bone were evaluated using the three-dimensional finite element method. The results showed that the stress on the plate system and bone was linearly proportional to the force magnitude and was higher when the force was in a vertical direction (Y-axis). Stress and deformation values of the two screws (screw 1 and 2) were asymmetric when the force was added along Y-axis and was greater in screw 1. The highest deformation value of the screws was 7.5148 μm, much smaller than the limit value. The load was decreased for each single miniscrew, and the ability of the new anchorage system to bear the load was also enhanced to some degree. It was suggested that the newly designed onplant miniplate anchorage system is effective, easily implanted and minimally invasive.

Maxillary protraction using skeletal anchorage and intermaxillary elastics in Skeletal Class III patients / 대한치과교정학회지

The aim of this case report is to describe the treatment of a patient with skeletal Class III malocclusion with maxillary retrognathia using skeletal anchorage devices and intermaxillary elastics. Miniplates were inserted between the mandibular lateral incisor and canine teeth on both sides in a male patient aged 14 years 5 months. Self-drilling mini-implants (1.6 mm diameter, 10 mm length) were installed between the maxillary second premolar and molar teeth, and Class III elastics were used between the miniplates and miniscrews. On treatment completion, an increase in the projection of the maxilla relative to the cranial base (2.7 mm) and significant improvement of the facial profile were observed. Slight maxillary counterclockwise (1degrees) and mandibular clockwise (3.3degrees) rotations were also observed. Maxillary protraction with skeletal anchorage and intermaxillary elastics was effective in correcting a case of Skeletal Class III malocclusion without dentoalveolar side effects.

Comparative evaluation of molar distalization therapy using pendulum and distal screw appliances / 대한치과교정학회지

OBJECTIVE: To compare dentoalveolar and skeletal changes produced by the pendulum appliance (PA) and the distal screw appliance (DS) in Class II patients. METHODS: Forty-three patients (19 men, 24 women) with Class II malocclusion were retrospectively selected for the study. Twenty-four patients (mean age, 12.2 +/- 1.5 years) were treated with the PA, and 19 patients (mean age, 11.3 +/- 1.9 years) were treated with the DS. The mean distalization time was 7 months for the PA group and 9 months for the DS group. Lateral cephalograms were obtained at T1, before treatment, and at T2, the end of distalization. A Mann-Whitney U test was used for statistical comparisons of the two groups between T1 and T2. RESULTS: PA and DS were equally effective in distalizing maxillary molars (4.7 mm and 4.2 mm, respectively) between T1 and T2; however, the maxillary first molars showed less distal tipping in the DS group than in the PA group (3.2degrees vs. 9.0degrees, respectively). Moreover, significant premolar anchorage loss (2.7 mm) and incisor proclination (5.0degrees) were noted in the PA group, whereas premolar distal movement (1.9 mm) and no significant changes at the incisor (0.1degrees) were observed in the DS group. No significant sagittal or vertical skeletal changes were detected between the two groups during the distalization phase. CONCLUSIONS: PA and DS seem to be equally effective in distalizing maxillary molars; however, greater distal molar tipping and premolar anchorage loss can be expected using PA.

Miniplacas como ancoragem esquelética temporária em ortodontia / Miniplates for temporary skeletal anchorage in orthodontics

A ancoragem é um dos fatores determinantes para o sucesso do tratamento ortodôntico e seu controle é fundamental para a obtenção dos resultados desejados. Os recursos de ancoragem mais utilizados comumente são limitados e, muitas vezes, dependem da colaboração do paciente. Na busca pela solução deste problema, a ancoragem esquelética, por meio das miniplacas, surge como uma excelente opção, tendo a grande vantagem de serem estáveis, sendo utilizadas para a movimentação de dentes individualmente ou em grupo. O presente estudo teve como objetivo realizar uma revisão de literatura, discorrendo sobre as diversas aplicações clínicas das miniplacas, suas vantagens e desvantagens, sua forma, tamanho e design, o procedimento cirúrgico de colocação e remoção, bem como a mecânica ortodôntica possível de ser realizada sobre as mesmas. De acordo com a literatura consultada, pode-se concluir que as miniplacas são efetivas como dispositivo de ancoragem esquelética, permitem uma movimentação dentária tridimensionalmente previsível sem trazer danos ao osso e/ou tecido periodontal, muito menos perda de vitalidade pulpar ou reabsorções radiculares.

Anchorage is one of the determining factors for the success of orthodontic treatment and its control is fundamental to achieve the desired results. In this context, skeletal anchorage using miniplates can be an excellent choice, due to advantages as stability and the possibility of moving a group of teeth as well as a single tooth. This study aimed to conduct a literature review, discussing the various clinical applications of miniplates, their advantages and disadvantages, their shape, size and design, surgical placement and removal, as well as their possibilities regarding orthodontic mechanics. It was concluded that miniplates are effective as ann anchorage device, allowing predictable three- dimensional tooth movement without bringing damage to bone and/or periodontal tissue, and reducing the loss of pulp vitality or root resorption.

Alterações dentárias transversais em pacientes submetidos à expansão rápida da maxila com ancoragem esquelética / Tranversal dental changes in patients submitted to rapid maxillary expansion with skeletal anchorage

O objetivo desse trabalho foi verificar as possíveis variações nas distâncias interdentárias entre caninos, primeiros pré-molares e primeiros molares superiores em modelos de gesso e em tomografias computadorizadas de feixe cônico (TCFC) antes e após a expansão rápida da maxila (ERM) com ancoragem esquelética, correlacionando essas medidas com a abertura da sutura palatina mediana. A amostra consistiu de 13 pacientes com idade média de 16 anos que se submeteram à ERM com um aparelho do tipo Haas ancorado no palato com parafusos de titânio. Para a comparação entre os momentos de avaliação (inicial e final) e entre os métodos (modelos de gesso e TCFC) foi utilizado o teste t de Student para amostras pareadas (p<0,05). Para avaliar a associação entre as variáveis foi estimado o coeficiente de correlação de Pearson. Na comparação entre os momentos estudados houve diferença estatística significante em todas as distâncias interdentárias avaliadas nos dois métodos utilizados, bem como na abertura da sutura. Na comparação entre os métodos não houve diferença estatística significante. Também não houve correlação entre a diferença das distâncias interdentárias e a abertura da sutura. Concluiu-se que houve um aumento significante na largura do arco dentário superior, mas que não correspondeu a um aumento proporcional da abertura da sutura palatina mediana aos níveis dos elementos dentários analisados.

The purpose of this study was to verify possible differences of interdental distances between upper canines, first premolars and first molars in plaster casts and in cone-beam computed tomography (CBCT) before and after rapid maxillary expansion (RME) with skeletal anchorage and correlating these distances with the opening of midpalatal suture. The sample was composed of 13 patients, mean age of 16 years old, that were submitted to RME with Haas appliance anchored to the palatal plate with titanium screws. To compare the stages of evaluation (beginning and ending) and the methods (plaster casts and CBCT) Student t test for paired samples was used (p<0.05). To evaluate the association among measurements Pearson´s correlation was estimated. When comparing moments of measurements, there was significant statistical difference in all interdental distances evaluated in both methods as well as in the suture opening. There was no statistical difference in the comparison of both methods. There was no correlation between interdental differences and suture opening either. It was concluded that there was a significant increase in the width of the maxillary dental arch that however did not correspond to a proportional augmentation of the opening of midpalatal suture at the level of the studied dental elements.

Tratamento da Classe II com miniplacas / Treatment of Class II with miniplates

O objetivo deste artigo é relatar o tratamento ortodôntico de uma paciente adulta, portadora de Classe II divisão 1ª com o auxílio de miniplacas. A paciente apresentava discrepância maxilomandibular (ANB = 8º), relação de Classe II de caninos e molares de ambos os lados, sobremordida profunda, sobressaliência aumentada e incisivos superiores protruídos. O perfil facial era convexo e o terço inferior levemente aumentado. O plano de tratamento consistiu em alinhamento e nivelamento dos arcos superior e inferior e, posteriormente, realizou-se a instalação das miniplacas que forneceram ancoragem para a distalização do arco superior. O resultado clínico pode ser considerado satisfatório para um tratamento esquelético compensatório.

The aim of this article is to report the orthodontic treatment of an adult patient, carrier of Class II division 1ª with the aid of miniplates. The patient had maxillomandibular discrepancy (ANB = 8), Class II relationship of canines and molars on both sides, deep overbite, increased overjet and, upper incisor protrusion. The facial profile was convex and the lower third slightly increased. The treatment plan consisted of alignment and leveling of the upper and lower arches and later held the installation of miniplates that provided anchorage for distalization of the maxillary arch. The clinical outcome can be considered satisfactory for treatment compensatory skeletal.