Unusual case of prolonged breastfeeding in an orthodontic patient: clinical and psychosocial implications / Amamentação prolongada em paciente ortodôntico: implicações clínicas e psicossociais

Case report: This article presents the case of an 11-year-old patient who sought orthodontic treatment, complaining of crooked teeth. In anamnesis, an emotional and physical dependence was reported regarding the act of breastfeeding. Considerations on the diagnosis, psychological implications, and clinical approach in this rare case were addressed. An orthodontic treatment and myofunctional therapy were performed to resolve the occlusal and functional aspects of the patient. Psychological therapy for the child and her mother was required to handle emotional sequelae. Conclusion: Multidisciplinary treatment was prescribed. Dentists should be aware of this need in cases of patients with special characteristics for treatment beyond oral problems. In orthodontics, this may be the difference between effective treatment outcomes or not.

Relato de caso: Este artigo apresenta o caso de uma paciente de 11 anos que procurou tratamento ortodôntico com queixa de "dentes tortos". Na anamnese, foi relatada dependência emocional e física da criança em relação ao ato de amamentar. Considerações sobre diagnóstico, implicações psicológicas, abordagem clínica neste raro caso foram abordadas. Foi realizado tratamento ortodôntico e terapia miofuncional para resolução dos aspectos oclusais e funcionais do paciente. Um acompanhamento psicológico para crianças e sua mãe foi necessária para abordar sequelas emocionais inerentes. Conclusão: Um tratamento multiprofissional foi instituído e o dentista deve estar atento a essa necessidade nos casos de pacientes com características especiais, visando uma abordagem além dos problemas bucais. Na Ortodontia, essa pode ser a diferença entre os resultados eficazes do tratamento ou não.

Impaction of mandibular third molars after orthodontic treatment by the edgewise method: a retrospective study

Abstract This study aimed to determine the incidence of mandibular third molar (M3) impaction after orthodontic treatment by edgewise appliances, and identify possible determinant factors of M3 impaction. A retrospective cohort study was conducted with 1154 patients. Complete orthodontic records were analyzed pretreatment and posttreatment, considering the following variables: type of Angle malocclusion, treatment with or without extraction of first premolars, overbite, stage of dentition, M3 prior angulation and duration of orthodontic treatment. Impaction was determined after radiographic evidence of total closure of the root apex. The chi-square test and Poisson regression (p < 0.05) were used for statistical analysis with a hierarchical approach. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Mandibular M3 impaction incidence was 17%. Overbite equal to or greater than 4 mm (RR = 1.23, 95%CI: 1.11-1.26, p < 0.001), prior mesial angulation of M3 (RR = 0.59, 95%CI: 0.52-0.68, p < 0.001), non-extraction of first premolars (RR=1.06, 95%CI: 1.01-1.12, P=0.019) and orthodontic treatment time equal to or less than three years (RR = 0.94. 95%CI: 0.90-0.99, p < 0.014) were significantly associated with impacted M3. There was no correlation between the type of Angle malocclusion and the risk of impaction. In conclusion, the incidence of mandibular M3 impaction was considered low. The main pretreatment factors directly involved in impaction were mesioangulation of M3 and overbite equal to or greater than 4 mm. Orthodontic treatment with extraction of first premolars and treatment time greater than 3 years reduce the risk of impaction.