Aggressive unicystic ameloblastoma affecting the posterior mandible: late diagnosis during orthodontic treatment

Maxillofacial images must be examined to find pathologies not identified during clinical examination. Unicystic ameloblastoma (UA) extending to the mandibular body and ramus was neglected on initial panoramic radiographic examination. After orthodontic therapy, a huge lesion was observed clinically and through imaging exams. After the conservative surgery, no recurrence was observed during five years of follow-up. This case emphasized the need for careful evaluation of patient images focusing on the oral diagnosis before any dental treatment planning, including orthodontic therapy.

Periodontal health in patients under conventional and lingual orthodontic therapies / Saúde periodontal em pacientes sob tratamentos ortodônticos convencional e lingual

Objective: Some clinical periodontal health parameters were assessed comparatively in patients using conventional and lingual brackets. Material and method: A trained examiner registered the frequencies of visible plaque (VP), bleeding on probing (BOP), as well as the simplified oral hygiene (OHI-S) and modified gingival (MGI) indices in 83 subjects from two clinics. The effects of orthodontic treatments on periodontal health were analyzed using logistic regression (alfa= 0.05). Result: In the conventional group, the frequency of visible plaque was significantly higher on the buccal surfaces of anterior (OR = 12.5) and maxillary posterior (OR = 3.6) teeth, p < 0.01. BOP in posterior teeth was also more frequent in this group, p < 0.05. The lingual group presented higher frequency of visible plaque on the lingual surfaces of anterior teeth (OR = 4.3; p = 0.0034). The conventional group had significantly higher frequencies of mild gingivitis in the buccal regions of anterior (OR = 9.0) and maxillary posterior (OR = 16.7) teeth, p < 0.05, and anterior papillae (OR = 9.0; p = 0.0003). On the other hand, the lingual group evidenced mild gingivitis more often in the lingual regions of anterior teeth (OR = 54.5), p <0.01. Conclusion: Based on the results of this study, the clinical periodontal health conditions may be considered acceptable for patients using both conventional and lingual brackets.

Objetivo: Alguns parâmetros clínicos de saúde periodontal foram avaliados comparativamente em pacientes que utilizavam braquetes convencionais e linguais. Material e método: Um examinador treinado registrou as frequências de placa bacteriana visível (PB) e sangramento à sondagem (SS), bem como dos índices higiene oral simplificado (IHO-S) e gengival modificado (IGM), em 83 pacientes de duas clínicas. Os efeitos dos tratamentos ortodônticos na saúde periodontal foram analisados por regressão logística (alfa=0,05). Resultado: No grupo convencional, a frequência de placa bacteriana foi significativamente mais elevada nas superfícies vestibulares dos dentes anteriores (OR = 12,5) e posteriores superiores (OR = 3,6), p <0,01. O SS nos dentes posteriores também foi mais frequente neste grupo, p < 0,05. O grupo lingual apresentou frequência mais alta de placa bacteriana nas superfícies linguais dos dentes anteriores (OR = 4,3; p = 0,0034). O grupo convencional apresentou frequências significativamente elevadas de gengivite leve nas regiões vestibulares dos dentes anteriores (OR = 9,0) e posteriores superiores (OR = 16,7), p < 0,05, e de papilas anteriores (OR = 9,0 p = 0,0003). Por outro lado, o grupo lingual evidenciou gengivite leve mais frequentemente nas superfícies linguais dos dentes anteriores (OR = 54,5), p < 0,01. Conclusão: Com base nos resultados deste estudo, as condições clínicas de saúde periodontal podem ser consideradas razoáveis em pacientes que utilizavam braquetes convencionais e linguais.

Tratamiento no quirúrgico de las mordidas abierta esqueletales: utilización adecuada del anclaje con mini-implantes / Nonsurgical treatment of open bites skeletal: anchor with proper use mini-implants

En este estudio se estableció de acuerdo a diferentes investigaciones el método más eficaz y que nos produce menos recidiva en las mordidas abiertas anteriores con un patrón de crecimiento vertical. El método utilizado fue el de los mini-implantes. Es recomendable que las mordidas abiertas anteriores esqueléticas, en pacientes portadores de crecimiento vertical, sean corregidas preferencialmente por la intrusión de los dientes posteriores y no por la extrusión de los dientes anteriores, para evitar perjuicios estéticos. Los mini-implantes proporcionan anclaje absoluto en los molares y muestran mejores resultados. La recidiva de los dientes posteriores intruidos y la extrusión de los elementos anteriores son efectos indeseables generalmente relatados, con mayor frecuencia para otros tipos de aparatología como son magnetos, bite-blocks y aparatos removibles. Pero, ocurre con menor frecuencia en tratamientos con mini-implantes. Con el propósito de demostrar la indicación de estos dispositivos de anclaje absoluto, será relatado un caso clínico de un paciente con mordida cruzada posterior, mordida abierta esquelética y crecimiento vertical, de 17 años de edad, que no quería someterse a tratamiento quirúrgico, al cual se realizó disyunción con una aparatología de Haas, elásticas de 4 onzas de 3/16 para ayudar a realizar la rotación anti-horaria de la maxila y mini-implantes ortodóncicos auto-perforantes de titanio, con perfil transmucoso corto de 1mm de 1,6mm y una longitud de 8,0mm, tipo de cabezal de alta utilidad Pot™.

In this study the most effective method was established in agreement to different investigations and the one that produced less relapse to the anterior open bites with a pattern of vertical growth. The method used was the mini- implant. It is recommendable that skeletal anterior open bites, in patients with vertical growth pattern, are corrected preferentially by the intrusion of posterior teeth and not by the extrusion of anterior teeth to avoid aesthetic damages. The mini-implants provide absolute anchorage in molars and yield better results. Relapse of the anterior teeth with intrusion and the extrusion of the posterior teeth are generally undesirable effects related, with greater frequency for other types of orthodontic devices such as magnets, bite-blocks and removable devises. However, it happens with smaller frequency in treatments with mini-implant. To demonstrate the indication of these adjuncts for absolute anchorage, a clinical case report of a 17-year-old patient with posterior crossbite, skeletal anterior open bite and vertical growth pattern, who did not want to undergo surgical treatment, will be presented. Orthodontic treatment consisted of a disjunction with Haas expander, elastic of 4 ounces of 3/16 to help making the anti-clockwise rotation of the maxilla and self-drilling titanium orthodontic mini-implants, with short transmucosal profile of 1mm of 1,6mm and 8,0mm in length, type of head High Utility Pot™.