Mandibular advancement with clear aligners and functional appliances in the treatment of skeletal ClassⅡmalocclusion: a systematic review and meta-analysis / 华西口腔医学杂志

OBJECTIVES@#This study aimed to conduct a meta-analysis of the efficacy of mandibular advance clear alig-ners with traditional functional appliances as the control group.@*METHODS@#PubMed, Web of Science, Embase, Cochrane Library, China Biomedical Abstracts Database, China Knowledge Network Database, Wanfang Database, and Weipu Database were used in this study. The two groups of researchers screened the literature and extracted data based on the inclusion and exclusion criteria established by PICOS entries, and used the ROBINS-I scale for quality evaluation. Revman 5.4 and Stata 17.0 software were used for meta-analysis.@*RESULTS@#Nine clinical controlled trials were included in this study with a total sample size of 283 cases. No significant difference was found in SNA, SNB, ANB, Go-Pog, U1-SN, Overjet, and other aspects between the invisible group and the traditional group in the treatment of skeletal class Ⅱ ma-locclusion patients; there was a 0.90° difference in mandibular plane angle between the two groups; the growth of the mandibular ramus (Co-Go) in the traditional group was 1.10 mm more than that in the invisible group; the lip inclination of the lower teeth in the invisible group was better controlled, 1.94° less than that in the control group.@*CONCLUSIONS@#The invisible group can better control the lip inclination of the mandibular anterior teeth when guiding the mandible. Furthermore, the mandibular plane angle (MP-SN) can remain unchanged, but the growth of the mandibular ramus is not as good as the traditional group, and auxiliary measures should be taken to improve it in clinical practice.

Orthodontists' preferences in the use and timing of appliances for the correction of malocclusions in growing patients / Preferencias de los ortodoncistas en el uso y momento oportuno de uso de aparatos para la corrección de maloclusiones en pacientes en crecimiento

Objective: To evaluate orthodontists' preferences in the use and timing of appliances for the correction of Class II and Class III malocclusions in growing patients and the sociodemographic factors that influence these preferences. Material and Methods: Active members of the Colombian Orthodontics Society (SCO) were invited to complete a previously validated survey on the use of Class II and Class III correctors in growing patients. Results: 180 orthodontists responded (80 male, 100 female). The appliances used most frequently in the treatment of Class II malocclusion were Planas indirect tracks (32.78%) and Twin-blocks (30.56%). Facemasks (62.22%) and Progenie plates (25%) were the most prevalent appliances used in the treatment of Class III malocclusions. Regarding treatment timing, 52% of the orthodontists stated that Class II malocclusions must be treated during late mixed dentition or early permanent dentition, 42% stated that treatment for Class III malocclusions should occur during early mixed dentition. Appliance use and treatment timing were significantly associated with sex (p= 0.034), years of practice (p= 0.025), and area of work (private clinics or public institutions), (p= 0.039). Conclusion: Twin-blocks and Facemask appliances were the preferred appliances for Class II and Class III treatment, respectively, in growing patients. Most of the orthodontists believed that Class II malocclusions must be treated during late mixed dentition and that Class III malocclusions must be treated during early mixed dentition. Sociodemographic variables are related factors that influence orthodontists' preferences in the use of these appliances.

Objetivo: Evaluar las preferencias de los ortodoncistas en el uso y momento oportuno de uso de aparatología para la corrección de maloclusiones Clase II y Clase III en pacientes en crecimiento y los factores sociodemográficos que influyen en estas preferencias. Material y Métodos: Se invitó a miembros activos de la Sociedad Colombiana de Ortodoncia (SCO) a completar una encuesta previamente validada, sobre el uso de correctores para Clase II y Clase III en pacientes en crecimiento. Resultados: Respondieron un total de 180 ortodoncistas (80 hombres, 100 mujeres). La aparatología más utilizada en el tratamiento de las maloclusiones de Clase II fueron pistas indirectas de Planas (32,78%) y bloques gemelos (30,56%). La máscara facial (62,22%) y las placas progenie (25%) fueron los aparatos más utilizados en el tratamiento de las maloclusiones de Clase III. En cuanto al momento oportuno del tratamiento, el 52% de los ortodoncistas afirmó que las maloclusiones de Clase II deben tratarse durante la dentición mixta tardía o la dentición permanente temprana, el 42% afirmó que el tratamiento para las maloclusiones de Clase III debe ocurrir durante la dentición mixta temprana. El uso de aparatos y el momento oportuno del tratamiento se asociaron significativamente con el sexo (p= 0,034), los años de práctica (p= 0,025) y el área de trabajo (clínicas privadas o instituciones públicas) (p= 0,039). Conclusión: Los aparatos bloques gemelos y la máscara facial fueron los preferidos para el tratamiento de Clase II y Clase III, respectivamente, en pacientes en crecimiento. La mayoría de los ortodoncistas consideran que las maloclusiones de Clase II deben tratarse durante la dentición mixta tardía y que las maloclusiones de Clase III deben tratarse durante la dentición mixta temprana. Las variables sociodemográficas son factores relacionados que influyen en las preferencias de los ortodoncistas en el uso de estos aparatos.

Efficacy of vertical control by using mini-implant anchorage in maxillary posterior buccal area for Angle class Ⅱ extraction patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the efficacy of vertical control by using conventional mini-implant anchorage in maxillary posterior buccal area for Angle class Ⅱ extraction patients.@*METHODS@#Twenty-eight Angle class Ⅱ patients [9 males, 19 females, and age (22.6±2.8) years] were selected in this study. All of these patients were treated by using straight wire appliance with 4 premolars extraction and 2 mini-implant anchorage in maxillary posterior buccal area. In this study, the self-control method was used to measure and analyze the lateral radiographs taken before and after orthodontic treatment in each case, the main cephalometric analysis items were related to vertical changes. The digitized lateral radiographs were imported into Dolphin Imaging Software (version 11.5: Dolphin Imaging and Management Solutions, Chatsworth, California, USA), and marked points were traced. Each marked point was confirmed by two orthodontists. The same orthodontist performed measurement on the lateral radiographs over a period of time. All measurement items were required to be measured 3 times, and the average value was taken as the final measurement result.@*RESULTS@#Analysis of the cephalometric radiographs showed that, for vertical measurements after treatment, the differences of the following measurements were highly statistically significant (P < 0.001): SN-MP decreased by (1.40±1.45) degrees on average, FMA decreased by (1.58±1.32) degrees on average, the back-to-front height ratio (S-Go/N-Me) decreased by 1.42%±1.43% on average, Y-axis angle decreased by (1.03±0.99) degrees on average, face angle increases by (1.37±1.05) degree on average; The following measurements were statistically significant (P < 0.05): the average depression of the upper molars was (0.68±1.40) mm, and the average depression of the upper anterior teeth was (1.07±1.55) mm. The outcomes indicated that there was a certain degree of upper molar depression after the treatment, which produced a certain degree of counterclockwise rotation of the mandibular plane, resulting in a positive effect on the improvement of the profile.@*CONCLUSION@#The conventional micro-implant anchorage in maxillary posterior buccal area has a certain vertical control ability, and can give rise to a certain counterclockwise rotation of the mandible, which would improve the profile of Angle Class Ⅱ patients.

Correção da má oclusão de classe II com propulsor mandibular: revisão de literatura / Correction of class II malocclusion with mandibular trusters: literature review

Introdução: a má oclusão de classe II consiste no desequilíbrio da relação entre as arcadas, podendo ser causada por deficiência mandibular, protrusão maxilar, ou ambas, sendo caracterizada pelo molar inferior distalmente posicionado em relação ao molar superior. Objetivo: este estudo tem o objetivo de apresentar uma revisão de literatura sobre a eficiência dos propulsores mandibulares fixos disponíveis no mercado odontológico no tratamento da má oclusão de classe II. Métodos: a pesquisa foi realizada nas bases de dados Google Acadêmico, SciELO e PubMed, para filtragem dos artigos selecionados. Para revisão de literatura, foram utilizados 17 artigos. Entre os protocolos de tratamento de classe II, esses aparelhos se destacam por serem fixos, por esse motivo, não dependem da colaboração direta do paciente. Com o passar dos anos, os propulsores mandibulares fixos foram cada vez mais aprimorados, oferecendo mais simplicidade na sua instalação e maior conforto ao paciente. Considerações finais: concluiu-se que os aparelhos funcionais propulsores mandibulares fixos são uma ótima escolha para o tratamento compensatório na má oclusão de classe II, sendo eficazes na correção da relação dentária e dependendo de menor cooperação do paciente.(AU)

Introduction: class II malocclusion consists of an imbalance in the relationship between the arches, which can be caused by mandibular deficiency, maxillary protrusion, or both, and is characterized by the mandibular molar distally positioned in relation to the maxillary molar. Objective: this study aims to present a literature review on the efficiency of fixed mandibular thrusters available in the dental market in the treatment of Class II malocclusion. Methods: the research was carried out in the Google Scholar, SciELO and PubMed databases to filter the selected articles. For literature review, 17 articles were used. Among Class II treatment protocols, these devices stand out for being fixed, for this reason, they do not depend on the direct collaboration of the patient. Over the years, fixed mandibular thrusters have been increasingly improved, offering more simplicity in their installation and greater comfort to the patient. Final considerations: it was concluded that the fixed mandibular thrusters functional devices are a great choice for compensatory treatment in Class II malocclusion, being effective in correcting the dental relationship and depending on less patient cooperation.(AU)

Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation

ABSTRACT The Herbst appliance can be very effective in treatment of Class II patients with mandibular retrognathism. Because of the continuous action in a full-time basis, treatment time using it normally takes from six to ten months, and is usually followed by a second phase of full fixed appliances, in order to obtain both occlusal refinement and long term stability. Despite Herbst appliance's effectiveness in the occlusal and dentoalveolar perspectives, its facial results may differ among patients with different growth patterns, as well as in distinct stages of skeletal maturation. In the current paper, two patients with different facial patterns are presented, who were treated under the same protocol, using Herbst and full fixed appliances in different skeletal maturation stages, and both dentoalveolar and facial results are compared and discussed.

RESUMO Um número significativo de pacientes que procuram o tratamento ortodôntico apresenta má oclusão de Classe II acompanhada pelo retrognatismo mandibular. Abordagens ortopédicas para avanço mandibular são comumente utilizadas enquanto houver crescimento facial remanescente e, nesses casos, o estágio de maturação esquelética deve ser avaliado para definir a melhor época de intervenção terapêutica. Após concluída a fase ortopédica, normalmente é realizada uma segunda fase ortodôntica para refinamento oclusal, com o intuito de oferecer maior estabilidade das correções em longo prazo. No presente artigo, serão discutidos os resultados do avanço mandibular ortopédico considerando-se diferentes estágios de crescimento.

Attractiveness of the facial profile: comparison of Class II patients treated with Twin Force® or intermaxillary elastics

ABSTRACT Objective: To compare the facial profile attractiveness of Class II patients treated with Twin Force® or intermaxillary elastics. Methods: Sample comprised 47 Class II patients divided into two groups: G1) TWIN FORCE - 25 patients treated with fixed appliances and Twin Force® fixed functional appliance (mean initial age was 17.91 ± 7.13 years, mean final age was 20.45 ± 7.18 years, and mean treatment time was 2.53 ± 0.83 years); G2) ELASTICS - 22 patients treated with fixed appliances and Class II intermaxillary elastics (mean initial age was 15.87 ± 5.64 years, mean final age was 18.63 ± 5.79 years and mean treatment time was 2.75 ± 0.60 years). Lateral cephalograms from pretreatment and posttreatment were used. Cephalometric variables were measured and silhouettes of facial profile were constructed and evaluated by 48 laypeople and 63 orthodontists, rating the attractiveness from 0 (most unattractive profile) to 10 (most attractive profile). Intergroup comparisons were performed with Mann-Whitney and independent t-tests. Results: At pretreatment, facial profile of the Twin Force® group was less attractive than the Elastics group. Treatment with Twin Force® or Class II elastics resulted in similar facial profile attractiveness, but the facial convexity was more reduced in the Twin Force® group. Orthodontists were more critical than laypeople. Conclusions: Treatment with Twin Force® or Class II elastics produced similar facial profile attractiveness at posttreatment. Profile attractiveness was reduced with treatment in the elastic group, and improved in the Twin Force® group. Facial convexity was more reduced with treatment in the Twin Force® group.

RESUMO Objetivo: Comparar a atratividade do perfil facial em pacientes Classe II tratados com Twin Force® ou elásticos intermaxilares. Métodos: A amostra foi composta por 47 pacientes Classe II divididos em dois grupos: G1 - Twin Force® (25 pacientes tratados com aparelhos fixos e o aparelho funcional Twin Force®; idade inicial média de 17,91 ± 7,13 anos, idade final média de 20,45 ± 7,18 anos, e tempo médio de tratamento de 2,53 ± 0,83 anos); G2 - Elásticos (22 pacientes tratados com aparelhos fixos e elásticos intermaxilares de Classe II, idade inicial média de 15,87 ± 5,64 anos, idade final média de 18,63 ± 5,79 anos, e tempo médio de tratamento de 2,75 ± 0,60 anos). Foram usadas telerradiografias laterais pré- e pós-tratamento. As variáveis cefalométricas foram mensuradas, e silhuetas do perfil facial foram construídas e avaliadas por 48 leigos e 63 ortodontistas, que pontuaram a atratividade entre 0 (perfil menos atraente) e 10 (perfil mais atraente). As comparações intergrupos foram realizadas com os testes Mann-Whitney e t de Student para amostras independentes. Resultados: Na fase pré-tratamento, o perfil facial no grupo Twin Force® foi menos atrativo do que no grupo Elásticos. Os tratamentos com o Twin Force® ou com Elásticos de Classe II resultaram em atratividade semelhante do perfil facial, mas a convexidade facial foi mais reduzida no grupo Twin Force®. Os ortodontistas foram mais críticos do que os leigos. Conclusões: Apesar de os tratamentos com o Twin Force® ou com Elásticos de Classe II terem resultado em atratividade semelhante do perfil facial após o tratamento, a atratividade do perfil foi reduzida com o tratamento no grupo Elásticos e melhorou no grupo Twin Force®. A convexidade facial foi mais reduzida com o tratamento no grupo Twin Force®.

Anclaje esquelético para el tratamiento de las anomalías de clase II y mordida abierta anterior: informe de un caso / Skeletal anchorage for the treatment of class II anomalies and anterior open bite: report of a case

El reporte de este caso tiene como objetivo demostrar la utilidad de los anclajes esqueléticos temporarios como son las miniplacas cigomáticas y los microimplantes "buccal shelf" en el tratamiento ortodóncico, en una paciente de 17 años 10 meses de edad, clase II vertical, dólicofacial, con mordida abierta anterior y aumento de la altura facial inferior. Después de la primera fase de tratamiento, siguiendo la secuencia de arcos para completar la alineación, se utilizaron anclajes esqueléticos extrarradiculares con una mecánica de intrusión con fuerzas elásticas durante 10 meses. Se intruyeron sus piezas posteriores superiores e inferiores y se distalizó la arcada superior, corrigiéndose la oclusión. El mentón retrognático y su perfil convexo mejoraron con la autorrotación de la mandíbula (AU)

The objective of this report case is to demonstrate the usefulness of temporary skeletal anchors such as zygomatic miniplates and buccal shelf microimplants in orthodontic treatment, in a 17-year-old 10-month-old, vertical class II, dollicofacial patient with anterior open bite and increased lower facial height. After the first treatment phase, following the arch sequence to complete the alignment, extra-radicular skeletal anchors were used with intrusion mechanics with elastic forces for 10 months. Its upper and lower posterior pieces were intruded and the upper arch was distalized, correcting the occlusion. e retrognathic chin and its convex profile improved with autorotation of the jaw (AU)

Clinical efficacy of counterclockwise rotating the functional occlusal plane using micro-implant anchorage / 浙江大学学报·医学版

To evaluate the therapeutic effect of using micro-implant anchorage (MIA) to rotate the functional occlusal plane (FOP) counterclockwise. Forty skeletal class Ⅱ high-angle patients who had completed orthodontic treatment were enrolled, including 20 patients treated with MIA orthodontic system (MIA group) and the other 20 patients treated with traditional sliding straight wire appliance (control group). Cephalometric measurements on the lateral cranial radiographs before and after treatment were performed, all acquired data were statistically analyzed with SPSS 26.0. At the end of treatment, MIA group obtained better effect of FOP and mandibular plane counter-clockwise rotation than the control group. In the MIA group, the average change of FOP-frankfort horizontal plane (FH), FOP-SN and mandibular plane angle (MP-FH) angle was -4.5(-7.3, -3.7)°, (3.3)° and -1.7(-3.0, -0.9)°, respectively. In the control group, the average change of FOP-FH, FOP-SN and MP-FH angle was -0.1(-4.1, 3.0)°, (-0.1±5.1)° and -0.4(-2.4, 0.7)°, respectively. There was significant difference between the change of the two groups (all <0.05). Compared with the traditional sliding straight wire appliance, counterclockwise rotation of FOP can be more effectively reversed by using MIA orthodontic system, and the MP-FH can be reduced as well.

Desprogramación neuromuscular en paciente con maloclusión esquelética clase II previo a tratamiento ortodóncico-quirúrgico / Neuromuscular deprogramming in malocclusion class II patient before an orthodontic-surgery treatment

Los pacientes con problemas esqueléticos clase II que han terminado su crecimiento, generalmente, se tratan con cirugía ortognática o extracciones de piezas dentarias. Un objetivo del tratamiento es obtener estabilidad a largo plazo. El presente caso clínico es de un paciente masculino de 15 años de edad con clase II esquelética sagital que se realizó desprogramación neuromuscular con un plano de acrílico, que permitió determinar la verdadera discrepancia intermaxilar y obtener que la articulación temporomandibular estuviera en una posición estable en relación céntrica del paciente previo a su tratamiento ortodóncico prequirúrgico (AU)

In patients with class II skeletal problems who have finished their growth; they are treated with orthognathic surgery or dental extractions usually. One treatment goal is to obtain long-term stability. The present case report is of a 15 years old male patient with skeletal sagittal class II who underwent neuromuscular deprogramming with an acrylic plane, which allowed to determine the true skeletal discrepancy and achieve a stable position of the temporomandibular joint in centric relation before the orthodontic treatment (AU)

Aditamento deslizante sobre microimplante, para la corrección de maloclusión Clase II división 1: reporte de un caso clínico / Sliding Jig on Microimplant for the correction of Class II division 1 malocclusion: case report

La maloclusión de Clase II ha sido tratada con diferentes técnicas y con diferentes aparatos que, en su conjunto, promueven la corrección del problema. Cada uno de ellos tiene sus propias indicaciones, y proporciona la mejora de la función, la estética, la salud y la estabilidad de los tratamientos ortodónticos. Se ha demostrado la efectividad de muchos de ellos para la corrección de este problema. El objetivo de este trabajo es presentar la confección y el mecanismo de acción de un aditamento ortodóntico auxiliar para el movimiento dentario, conocido como "aditamento deslizante sobre microimplante" (ADSM), utilizado con aparatos fijos en el tratamiento de la maloclusión Clase II(AU)

Class II malocclusion has been treated with different techniques and with different devices, which as a whole promote the correction of the problem. Each of them has its own indications and provides the improvement of function, aesthetics, health and stability of orthodontic treatments. The effectiveness of many of them has been demonstrated for the correction of this problem. The objective of this work is to present the making and the mechanism of action of an auxiliary orthodontic attachment for the dental movement known as Sliding Jig on Microimplant (SJOM), which is used in association with fixed appliances in the treatment of Class II malocclusion(AU)

Diagnóstico y plan de tratamiento de la Clase II / Diagnosis and treatment planning of Class II

En este artículo se consideran las condiciones que pueden modificar la valoración de la relación esquelética en el diagnóstico de la Clase II: desprogramación a relación céntrica, valoración de la clase esquelética, posición sagital del maxilar y de la mandíbula, el espacio de las vías aéreas, el torque de incisivos superiores e inferiores, la forma de la sínfisis, la interrelación con los planos vertical y transversal, y los caracteres faciales secundarios. A partir de estas conclusiones diagnósticas se desarrolla un plan de tratamiento que es equivalente tanto en casos de dentición mixta como permanente, pero utilizando diferentes aparatologías para conseguir mejores resultados de acuerdo al estado evolutivo de las arcadas dentarias(AU)

In this article, the conditions that can modify the evaluation of skeletal relationship in the diagnosis of Class II malocclusions are considered: deprogramming to centric relation, evaluation of skeletal class, sagittal position of maxilla and mandible, upper airways space, lower and upper incisors torque, shape of the symphysis, interrelationship between vertical and transverse planes, and secondary facial characteristics. From these diagnostic conclusions, a treatment plan is developed, that is similar in both mixed and permanent dentition cases, but using different appliances to get better results according to the evolutionary state of dental arches(AU)

Control vertical mediante bite block en relación céntrica / Vertical control through bite block in centric relation

Paciente femenina de ocho años y cuatro meses, con patrón esquelético de clase II severa y overjet de 10 mm, fue tratada con Bite-Block Céntrico como método de control vertical. Después de cinco meses de terapia con aparatología fija de primera fase se logró control vertical y reducción de las desviaciones de la clase esquelética. Posteriormente se continuó con tratamiento activo durante 18 meses, se dio de alta de la primera fase cuando los objetivos del tratamiento como alineación, nivelación, overbite y overjet fueron adecuados. Los registros postratamiento demostraron una buena estabilidad articular, oclusión funcional y una mejora en la estética facial. El montaje en céntrica postratamiento demuestra estabilidad condilar con el uso de Bite-Block Céntrico como método de control vertical (AU)

Female patient of eight years and four months, with skeletal pattern of severe class II and 10 mm overjet, was treated with Bite-Block Centric as a vertical control method. After five months of therapy with fixed appliances of the first phase, vertical control and reduction of the deviations of the skeletal class were achieved. Subsequently continued with active treatment for 18 months, was discharged from the first phase when the treatment objectives such as alignment, leveling, overbite and overjet appropriate. Post-treatment records showed good joint stability, functional occlusion and an improvement in facial aesthetics. The posttreatment centric assembly demonstrates condylar stability with the use of Centric Bite-Block as a vertical control method (AU)

Class II malocclusion treatment changes with the Jones jig, Distal jet and First Class appliances

Abstract Objective Maxillary molar distalization with intraoral distalizer appliances is a non-extraction orthodontic treatment used to correct molar relationship in patients with Class II malocclusion presenting maxillary dentoalveolar protrusion and minor skeletal discrepancies. This study compares the changes caused by three distalizers with different force systems. Methodology 71 patients, divided into three groups, were included. The Jones jig group (JJG, n=30; 16 male, 14 female, 13.17 years mean age) was treated with the Jones jig for 0.8 years. The Distal jet group (DJG, n=25; 8 male, 17 female, 12.57 years mean age) was treated with the Distal jet for 1.06 years. The First Class group (FCG, n=16; 6 male, 10 female, 12.84 years mean age) was treated with the First Class for 0.69 years. Intergroup treatment changes were compared using one-way ANOVA, followed by post-hoc Tukey's tests. Results Intergroup comparisons showed significantly greater maxillary incisor protrusion in DJG than in FCG (2.56±2.24 mm vs. 0.74±1.39mm, p=0.015). The maxillary first premolars showed progressive and significantly smaller mesial angulation in JJG, FCG and DJG, respectively (14.65±6.31º, 8.43±3.99º, 0.97±3.16º; p<0.001). They also showed greater mesialization in JJG than FCG (3.76±1.46 mm vs. 2.27±1.47 mm, p=0.010), and greater extrusion in DJG compared to JJG (0.90±0.77 mm vs 0.11±0.60 mm, p=0.004). The maxillary second premolars showed progressive and significantly smaller mesial angulation and mesialization in JJG, FCG and DJG, respectively (12.77±5.78º, 3.20±3.94º, -2.12±3.71º and 3.87±1.34 mm, 2.25±1.40 mm, 1.24±1.26 mm, respectively; p<0.001). DJG showed smaller distal angulation of maxillary first molars (-2.14±5.09º vs. -7.73±4.28º and -6.05±3.76º, for the JJG and FCG, respectively; p<0.001) and greater maxillary second molars extrusion (1.17±1.41 mm vs -0.02±1.16 mm and 0.16±1.40 mm, for the JJG and FCG, respectively; p=0.003). Overjet change was significantly larger in DJG compared to FCG (1.79±1.67 mm vs 0.68±0.84; p=0.046). Treatment time was smaller in FCG (0.69±0.22 years vs 0.81±0.33 years and 1.06±0.42 years, comparing it with the JJG and DJG, respectively; p=0.005). Conclusion The three appliances corrected the Class II molar relationship by dentoalveolar changes. The Distal jet produced smaller molar distal angulation than the Jones jig and First Class. The First Class appliance showed less anchorage loss, greater percentage of distalization and shorter treatment time than the Jones jig and Distal jet.

Esthetic perception of facial profile changes after extraction and nonextraction Class II treatment

Abstract This retrospective study evaluated facial profile pleasantness determined by two protocols of Class II treatment. The sample comprised facial profile silhouettes obtained retrospectively from the pretreatment (T1) and posttreatment (T2) cephalograms of 60 patients (42 males and 18 females) divided into two groups. One group of 30 patients (mean age of 12.84 years) was treated with the extraction of maxillary first premolars (mean treatment time of 2.7 years), and the other group of 30 patients (mean age of 12.81 years) was treated with a mandibular advancement appliance (Forsus) (mean treatment time of 2.49 years). The facial profile silhouettes (T1 and T2) were randomly distributed in an album containing one patient per sheet. The examiners consisted of 60 orthodontists and 60 lay individuals, who analyzed the profiles in regard to facial pleasantness, using the Likert scale. A comparison between stages T1 and T2 of the two treatment protocols and between the examiners was performed by mixed-design analysis of variance at a significance level of 5%. The results demonstrated a significant difference between T1 and T2 (greater scores for T2 compared to T1), and between lay individuals and orthodontists (orthodontists assigned higher scores), but with no significant difference between the treatment protocols. Both protocols produced positive effects on the facial profile esthetics, from the standpoint of lay individuals and orthodontists.

El paciente ortodóncico en dentición mixta y los trastornos del sueño / The orthodontic patient with mixed dentition and sleep disorders

Los desórdenes respiratorios del sueño (DRS) y, principalmente, roncopatías y apneas obstructivas afectan aproximadamente al 7% de los pacientes ortodóncicos. Los DRS no solo son importantes por la cantidad de pacientes afectados, sino por la gravedad de los posibles efectos secundarios a nivel de la salud general del paciente. La obstrucción de las vías aéreas superiores (VAS) provoca alteraciones del crecimiento y deformaciones craneofaciales importantes, por lo que el tratamiento temprano y la prevención de la respiración oral es muy importante.El papel del ortodoncista es muy importante en el diagnóstico y en el tratamiento de los DRS, pero también en su prevención, realizando tratamientos que aumenten la dimensión y la permeabilidad de las VAS. El protocolo de exploración interdisciplinar en niños y adolescentes y la cefalometría de vías aéreas son importantes en el diagnóstico y deben ser tenidos en cuenta en el plan de tratamiento. Pero las pruebas más significativas, el CBCT de vías aéreas y la polisomnografía no son pruebas rutinarias por la dificultad logística y el precio de estas pruebas. En este artículo también se recomiendan los tratamientos de ortodoncia más indicados en estos casos y que tienden al aumento de la dimensión de las VAS (AU)

Sleep breathing disorders (SBD) and in the first place, roncopathy and obstructive apnea, affect approximately 7% of orthodontic patients. The SBD are not only important for the number of affected patients, but also for the severity of the possible side effects at the level of general health of a patient. The upper air ways (UAW) obstruction provokes important alterations in growth and craniofacial deformations, and this is why the early treatment and prevention of mouth breathing are very important. The role of an orthodontist in diagnosis and treatment of SBD is very important, but it is also in its prevention, carrying out the treatments which increase the dimension and permeability of UAW. The protocol of interdisciplinary examination.In children and adolescents and the air ways cephalometry analysis have an important role in diagnosis and they should be taken into account in treatment planning. But the most important tests, the air ways CBCT and polysomnography, are not routine tests due to the complicated logistics and their cost. In this article, the orthodontic treatments most indicated in these cases are recommended, because they tend to increase the UAW dimension (AU)

La ortodoncia y la cirugía ortognática como aliadas en el tratamiento / Orthodontics and orthognathic surgery as treatment allied

¿Qué es la estética? Es más que un concepto frívolo. Tiene que ver con la armonía facial, la autoestima, la autoimagen, la percepción de belleza. Es un concepto que involucra al individuo en su totalidad, en su ser, que va más allá de frivolidad estética. Muchos pacientes que vienen a la consulta no expresan inicialmente su real demanda. Expresan problemas funcionales, pero su real preocupación, en la mayor parte de los casos, es estética. Pueden manifestar que no pueden comer bien, masticar un alimento o que no respiran bien o sesean, pero su motivación principal es estética y tiene que ver con su propia autoestima. Las funciones de respiración, deglución, fonación, masticación, oclusión deben estar entre los objetivos a conservarse o restituirse por parte del especialista, pero el tratamiento sería un fracaso si no atendemos la demanda, a veces no bien explicitada, por el paciente y que responde a su profunda necesidad real. Para la OMS, la salud puede definirse como el estado completo de bienestar físico, mental y social. Nuestro objetivo, como agentes de salud, será poder satisfacer la demanda explícita o encubierta con la mayor estética y la mayor funcionalidad (AU)

What is aesthetics? It is more than a frivolous concept. It has to do with facial harmony, self-esteem, self-image, the perception of beauty. It is a concept, which involves the individual as a whole, in his being, which goes beyond aesthetic frivolity. Many patients who come to the office do not initially express their real demand. They express functional problems, but their real concern, in most cases, is aesthetic. They may state that they cannot eat well, chew a food or that they do not breathe well or sedate, but their main motivation is aesthetic and has to do with their own self-esteem. The functions of breathing, swallowing, phonation, chewing, occlusion should be among the objectives to be retained or restored by the specialist, but the treatment would be a failure if we do not meet the demand sometimes not well explained by the patient and responding to their Deep real need. For WHO, health can be defined as the complete state of physical, mental and social well-being. Our goal, as health agents, will be to be able to meet the explicit or covert demand with the greatest aesthetics and functionality (AU)

Resolución de clase II mordida profunda con distalamiento molar mini-iimplantoasistida: reporte de caso clínico / Resolution of a class II deep bite with mini-implant-assisted molar distal movement; report of a clinical case

En todos los tratamientos ortodónticos, el primer objetivo a cumplir es alinear y nivelar las piezas dentales. Para tal fin, deberíamos generar espacio dentro del arco dentario. Existen tres procedimientos diferentes para lograr este objetivo, según el grado de apiñamiento dental o Índice de nance, que son los siguientes: a) stripping o desgaste interproximal, b) exodoncia de piezas dentales y c) distalamiento. La distalización de los molares es una de las técnicas más antiguas de la terapéutica ortodóntica y se han empleado distintos recursos terapéuticos para tal fin, como pendulum, jig de jans, first class, entre otros; cada uno con sus ventajas y desventajas. La introducción de los mini-implantes dentro de nuestra especialidad ha revolucionado en forma drástica los conceptos de anclaje, brindándonos movimientos dentarios sin generar efectos colaterales indeseables. El objetivo de este caso clínico, es mostrar la utilización de un Orthorama modificado y mini-implantes como distaladores de los molares superiores (AU)

Interdisciplinary planning as a landmark for treatment: Case report with a 2-years follow-up

Abstract Case report: young adult woman with esthetic complaints regarding her smile and frontal teeth aspect. At first glance, the problem seemed to be only the shape of the lateral upper incisors and a small diastema between the central incisors. The diagnosis shared between the orthodontist and the prosthetist led us to consider some other important aspects, such as the deep bite, the teeth inclination and the lips support. All these findings led us to consider that the right way to improve the esthetics of the patient's smile was to plan an orthodontic treatment. This would serve not only for the distribution of the spaces, but mostly it would improve all other problems, before the restoration of the upper lateral teeth with two ceramic veneers. Results: the treatment plan achieved the right distribution of spaces for upper lateral incisors, significant correction of the incisors inclination with important reduction of overbite and better lip support, upper laterals restorations with ceramic feldspathic veneers, obtaining a good integration with natural teeth satisfying patient complaint. Conclusion: in cases which involve interdisciplinary approach, the fundamental step comes from the beginning, when only an initial diagnosis shared among the team of specialists can define the patient problems from different points of view. In this way, we can better understand the competency fields and plan the right treatment and time sequence.

Resumo Relato de caso: paciente adulta jovem, sexo feminino, buscou tratamento devido à queixa com a estética do sorriso e o aspecto dos dentes anteriores. À primeira vista, o problema parecia ser apenas o formato dos incisivos laterais superiores e um pequeno diastema entre os incisivos centrais. O diagnóstico conjunto do ortodontista e do protesista fez com que considerássemos outros aspectos importantes, tais como mordida profunda, inclinação dentária e suporte labial. A partir de todas essas constatações, consideramos que a maneira mais adequada de melhorar a estética do sorriso seria planejar o tratamento ortodôntico. Assim, o tratamento serviria não apenas para melhor distribuição dos espaços, mas também melhoraria todos os outros problemas antes da restauração dos dentes laterais superiores ser realizada com duas facetas de cerâmica. Resultados: o tratamento planejado levou à correta distribuição dos espaços nos incisivos laterais superiores, com correção significativa da inclinação dos incisivos, importante redução da sobremordida e um melhor suporte labial, com restauração dos laterais superiores usando facetas de cerâmica feldspática, obtendo-se uma integração ideal com os dentes naturais, resolvendo as reclamações da paciente. Conclusão: em casos envolvendo abordagem multidisciplinar, as etapas iniciais são fundamentais, e apenas um diagnóstico inicial discutido entre a equipe de especialistas pode determinar os problemas do paciente sob diferentes perspectivas. Dessa forma, podemos compreender melhor os campos de competência e planejar a sequência e o tempo de tratamento mais adequados.

Tratamiento de Clase II con Ortodoncia Sistema Damon y gomas intermaxilares en etapas tempranas de tratamiento / Treatment of Class II with Orthodontics Damon System and elastics in early stages of treatment

La técnica ortodóncica de baja fricción utiliza brackets pasivos de autoligado con una serie de arcos superelásticos que mantienen las fuerzas aplicadas sobre las piezas dentarias a nivel de la "biozona o zona fuerza óptima". La utilización de gomas intermaxilares ligeras (2 onzas o 56,68 g) en estos tratamientos, desde etapas iniciales, sobre todo en pacientes en crecimiento, permite obtener resultados muy favorables en cuanto a la resolución de la maloclusión de Clase II. Objetivo: evaluar el tratamiento de Ortodoncia de un paciente Clase II esqueletal con sobremordida, sin realizar exodoncias de premolares y utilizando elásticos intermaxilares en fases iniciales de tratamiento. Materiales y método: se presenta el caso clínico de un paciente de sexo masculino de 11 años, de Clase II esqueletal con sobremordida y apiñamiento dentario anterior superior e inferior moderado, con su diagnóstico y evaluación completos pre y post tratamiento y control y seguimiento al año. El tratamiento se realiza con brackets autoligantes (técnica de Damon). Resultados: se obtiene la corrección completa de la Clase II y la sobremordida, alcanzando los objetivos deseados de estética facial y función, en oclusión y desoclusiones, con buen desarrollo de las basales y conservación de la altura de las corticales alveolares a nivel de los caninos. Conclusión: Mediante los recursos terapéuticos disponibles en la actualidad y evaluando al niño en etapas tempranas, podremos combinar diferentes tratamientos para alcanzar los objetivos propuestos en menor tiempo y con óptimos resultados en una maloclusión de Clase II con sobremordida con biotipo mesofacial (AU)

The low friction orthodontic technique uses passive self-ligating brackets with a series of superelastic arches that maintain the forces applied to the dental pieces at the "Biozone or Optimal Force Zone". The use of inter maxillary light elastics (2 ounces or 56.68 yr.) from the initial stages in growing patients, yields very favorable results in terms of correction of Class II malocclusion. Objective: To assess the orthodontic treatment of a skeletal Class II patient with overbite, without extraction of premolars and using elastic in the early stages of treatment. Materials and methods: an 11 year old male skeletal Class II patient with overbite and moderate crowding in upper and lower anterior teeth, with complete diagnostic and evaluation before and after treatment and with annual control. For the treatment, self-ligating brackets (Damon technique) were employed. The results: Total correction of Class II condition and overbite was obtained. The desired goals of facial aesthetics and correct function were attained in occlusion and desocclusion, as well as development of the osseous basis and conservation of the canine alveolar cortical height. Conclusion: Through the employment of therapeutic resources available at present and following up the child through his developmental stages, it is possible to combine different treatments to achieve the proposed objectives in a shorter time with excellent results in mesofacial type patients with Class II malocclusion and deep overbite (AU)

Comparative effects of the Mandibular Protraction Appliance in adolescents and adults

ABSTRACT Objective: The aim of this study was to compare the skeletal, dental, and soft tissue effects of the Mandibular Protraction Appliance (MPA) application in adolescent and adult Class II malocclusion patients. Methods: The sample comprised the pretreatment and posttreatment lateral cephalograms of 39 subjects presenting Class II malocclusion treated with the MPA and fixed appliances. Sample was divided into two groups: Group 1 comprised 23 subjects (10 male; 13 female), at a mean pretreatment age of 11.75 years, with a mean treatment time of 3.32 years; Group 2 included 16 subjects (7 male; 9 female), at a mean pretreatment age of 22.41 years, with a mean treatment time of 4.24 years. Intergroup comparison of the initial and final stages and treatment changes between the groups was performed with t tests, at p< 0.05. Results: The adults showed less significant amounts of skeletal, dentoalveolar and soft tissue changes than the adolescents. There was significantly greater palatal tipping of the maxillary incisors and retrusion of the upper lip in the adolescents. The adult group showed greater mandibular incisor proclination in the posttreatment stage. Conclusion: Adult patients treated with MPA showed less significant amounts of skeletal, dentoalveolar and soft tissue changes than adolescents.

RESUMO Objetivo: o objetivo do presente estudo foi comparar os efeitos esqueléticos, dentários e em tecidos moles do Aparelho de Protração Mandibular (APM) em pacientes adolescentes e adultos com má oclusão de Classe II. Métodos: a amostra consistiu das telerradiografias pré- e pós-tratamento de 39 indivíduos com má oclusão de Classe II tratados com APM e aparelhos fixos. A amostra foi dividida em dois grupos: o Grupo 1 compreendeu 23 indivíduos (10 homens e 13 mulheres), com idade inicial de 11,75 anos, com um tempo médio de tratamento de 3,32 anos; o Grupo 2 incluiu 16 pacientes (7 do sexo masculino e 9 do sexo feminino), com idade média inicial de 22,41 anos, com um tempo médio de tratamento de 4,24 anos. A comparação intergrupos dos estágios inicial e final e das alterações com o tratamento foi realizada com testes t, considerando-se um nível de significância de p< 0,05. Resultados: os adultos apresentaram quantidades menos significativas de alterações esqueléticas, dentoalveolares e de tecidos moles do que os adolescentes. Houve uma inclinação palatina significativamente maior dos incisivos superiores e retrusão do lábio superior nos adolescentes. O grupo de adultos apresentou maior proclinação dos incisivos inferiores no estágio pós-tratamento. Conclusão: pacientes adultos tratados com APM apresentaram quantidades menos significativas de alterações esqueléticas, dentoalveolares e de tecidos moles do que os adolescentes.