Distal movement of upper permanent molars using midpalatal mini-implant

OBJECTIVE: To assess whether palatal mini-implants are effective as direct anchorage for distal movement of the upper molars. METHODS: It was used an acrylic model of the upper dental arch. After making a groove in the region corresponding to dental alveolus, acrylic teeth were fixed in groove with #7 wax, with the roots being previously immersed in adhesive wax. The orthodontic appliance was placed according to the Edgewise technique and then a mini-implant (SIN, São Paulo, Brazil) was inserted at the site corresponding to the palatal raphe. A 0.019 x 0.025-in stainless steel archwire was made and attached to the upper arch with elastics. A transpalatal arch bar (0.019 x 0.025in) was mounted and two hooks were soldered to it in order to retain chain elastics (Unitek, Brazil) to be connected to the mini-implant under a force of 1.5 N on each side. The maxillary model was immersed in water 40 times and photographed after each immersion, for observation of dental movements. Analysis of variance (ANOVA) and Tukey's test were employed for analyzing the obtained data. RESULTS: Molars displaced distally 3.1 mm, in average, with distal inclination ranging from 3 to 5 mm. CONCLUSIONS: Molar movements occurred due to distal inclination, with a slight rotation and no extrusive effect.

OBJETIVO: verificar se o mini-implante no palato é eficaz como ancoragem direta para distalização dos molares superiores. MÉTODOS: foi utilizado um modelo em acrílico da arcada superior. Após a confecção da canaleta na região correspondente aos alvéolos dentários, os dentes em acrílico foram fixados com cera #7, montado aparelho ortodôntico com a técnica Edgewise e inserido um mini-implante (SIN, São Paulo) no local correspondente à rafe palatina. Foram colocados arco 0,19" x 0,25" e barra transpalatina, soldados na barra dois ganchos para retenção de dois elásticos em cadeia de dois elos, a uma carga de 150g/f de cada lado (Unitek), que se estenderam dos ganchos até o mini-implante. O modelo da maxila foi mergulhado 40 vezes em banheira e fotografado após cada mergulho para observação da movimentação dentária. Os dados foram analisados pela análise da variânçia (ANOVA) e teste de Tukey. RESULTADOS: os molares deslocaram-se distalmente 3,1mm, em média, com inclinação distal entre 3 e 5mm. CONCLUÕES: a movimentação dos molares ocorreu pela inclinação distal, com leve rotação, mas sem efeito extrusivo.

Anteroposterior dentoalveolar effects with cervical headgear and pendulum appliance: a systematic review

Aim: The aim of this systematic review was to compare the maxillary dental effects of cervical headgear and pendulum appliance during distalization of permanent maxillary first molars.Methods: A literature survey from databases covering the period from 1956 to August 2008 was carried out. Randomized controlled trials (RCT) and controlled clinical trials (CCT) were included. Two reviewers selected and extracted the data independently, and also assessed the quality of the retrieved studies. Results: The search strategy resulted in 48 articles, of which 3 met the inclusion criteria. Distal molar movement with headgear versus pendulum appliance was identified.In all studies selected, the methods used to detect and analyze the distal molar movement were valid and generally well know. All articles included an error analysis method and considered the risk for confounding factors, but only one study used blinding in measurements. Conclusions: The studies showed that both cervical headgear with patient compliance and a non-compliance pendulum appliance are very effective in distalizing maxillary molars. However, additional RCTs with larger samples of both molar distalizing appliances are needed to confirm this result andprovide further reliable scientific evidence.

Adenoid hypertrophy and open bite

Aim: To evaluate if the constricted airway passage, measured by the nasopharyngeal (NP) and oropharyngeal (OP) width, has a correlation to anterior open bite. Methods: Lateral cephalometric radiographs of 43 patients with anterior open bite (26 with mixed dentition and 17 with permanent dentition) and 30 patients with overbite (15 with mixed dentition and 15 with permanent dentition) were obtained from de Department of Pediatric Dentistry and Orthodontics of the Federal University of Rio de Janeiro for examination. Eight patients with syndromes were excluded from study. Cephalometric measurements were carried out using Dolphin Imaging & Management SolutionsTM software (Chatsworth, CA, USA). Measures of NP and OP were evaluated according to the McNamara’s soft tissue analysis and were correlated with the presence of open bite or overbite. Student’s t test and chi-square were used to assess statistical differences in continuous and dichotomic variables, respectively. Kruskal-Wallis test was employed to compare multiple variables. Results: Open bite patients showed significant decreased mean NP and OP values compared to overbite patients. Lack of labial seal was observed in all open bite patients. When patients with mixed and permanent dentitions were analyzed separately, the mean NP value was still significantly smaller in the open bite group. However, the mean OP values were smaller in the open bite group in both dentitions analysis, but were not statistically different. Conclusions: All patients with anterior open bite had reduced NP and OP measures compared to overbite patients, in spite of dentition.

Correção da má oclusão de Classe II empregando ancoragem intrabucal / Correction of Class II malocclusion using intraoral ancorage

Este relato de caso descreveu o tratamento ortodôntico de uma jovem de 12 anos que possuía relação molar de Classe II, falta de espaço para os caninos superiores, discreto apinhamento anteriorinferior, relação de topo de pré-molar e caninos superiores, desvio da linha média superio e para o lado direito, sobremordida normal e harmonia facial. Ela foi tratada com aparelho fixo e técnica Edwise em ambas as arcadas, associado à mecânica de sliding-jig e elásticos de Classe II, com finalidade de movimentar os molares distalmente e conseguir espaço para o correto posicionamento dos caninos. Com o tratamento ortodôntico, as corretas relações oclusais foram alcançadas, com manutenção da estética facial, correção da linha média e do discreto apinhamento anteroinferior.

Tratamento da maloclusão de Classe II com a extração de 4 premolares superiores: relato de caso / Treatment of Class II malocclusion with four upper bicuspids extractions: clinical report

Este relato de caso descreve o tratamento ortodôntico de uma mulher de 32 anos de idade que tinha uma relação molar de Classe II, apinhamento ântero-posterior em ambos os arcos, sobremordida e sobressaliência acentuadas, perda precoce dos primeiros molares inferiores e segundo premolar inferior direito, com desvio de linha média inferior para o lado direito e hiperdivergência facial. Os primeiros e segundos premolares superiores foram extraídos, porque a ancoragem extraoral associada à barra transpalatina e exodontia dos segundos premolares superiores não foram suficientes para correção da sobressaliência e da relação dos caninos, pois não houve a colaboração da paciente no uso do aparelho extrabucal. Depois do tratamento ortodôntico, boa oclusão e estética facial foram obtidas com resultados mantidos 10 anos pós-contenção. Conclui-se que o planejamento deverá ser individualizado de acordo com as características da maloclusão e possibilidades de tratamento, analisando-se criteriosamente as limitações de cada caso.

This clinical report describe the orthodontic treatment of a 32 years female Who shows Class II dental and skeletal relationship, anterior and posterior crowding in the upper and lower archs, excessive overbite, large overjet, lower first molar and right second bicuspid extrated, midline deviation to right side and hiper divergent profile. The upper first and second bicuspids were extracted because extraoral ancorage with transpalatal arch and upper second bicuspid extraction were not enough to correct overjet and canines positions, because there was not patient cooperation on use of extraoral appliance. After treatment, good occlusion and estetics were obtained, remainning tem years after retention. The conclusion is that the planing should be personal based on malocclusion characterization and treatment possibilities, analyzing with judiciousness the limitations of each case.

Tratamento ortocirúrgico da classe III e mordida aberta severa / Ortho-surgical treatment of class III with severe open-bite

Relato de caso ortocirúrgico de uma paciente classe III com mordida aberta total. A cirurgia consistiu em recuo de 6 mm da mandíbula, avanço e elevação posterior de 4 mm da maxila, pelas técnicas de osteotomia sagital do ramo mandibular e Le Fort I, associadas à fixação interna rígida. Após a obtenção da harmonia facial e dentoesquelética observou-se leve recidiva dentária, com diastema na distal dos caninos inferiores, na fase de contenção. Esse caso demonstra que a cirurgia ortognática é um valioso recurso no tratamento das má-oclusões esqueléticas, em especial, a Classe III.

A case report of a Class III ortho-surgical treatment with a full open bite. The surgery of choice was 6 mm mandibular setback, and anterior displacement and posterior elevation of the maxilla in 4 millimeters, by the sagital split technique for the mandibular ramus and Le Fort I, associated to internal rigid fixation. After facial, skeletal and tooth harmonies were acquired, slight dental relapse in orthodontic treatment long-term was observed. This case report elucidates that orthognatic surgery is a valuable resource in treatment of skeletal malocclusions, especially in Class III cases.

Mandibular behavior in the treatment of skeletal class II malocclusion: a 5-year post-retention analysis

Aim: This study aimed to assess mandibular behavior in Class II subjects subjected to full orthodontic treatment with standard edgewise appliance and cervical headgear (Kloehn appliance) during the pubertal growth spurt period. Methods: Lateral cephalometric radiographs of 40 patients (21 females and 19 males) were performed at the beginning of the treatment (T0), at its end (T1) and at 5-year post-retention phase (T2) in order to quantify the cephalometric measurements (8 angular and 3 linear), representing the mandibular behavior in the anteroposterior and vertical senses. The mean age of female patients at T0, T1 and T2 was 11.4, 15 and 26 years, respectively, and for male patients it was 12.2, 16.7 and 28 years, respectively. All patients were treated in just one phase without extractions and not associating Class II intermaxillary elastics. Results: The effective treatment of skeletal Class II malocclusion with conventional Edgewise fixed appliance and Kloehn cervical headgear did not interfere in the direction and amount of mandibular growth as well as remodeling at it is inferior border, with no influence in anti-clockwise rotation of the mandible. Themandibular growth was also observed after the orthodontic treatment, suggesting that it is influenced bygenetic factors. Conclusion: These observations may lead to the peculation that growing patients with skeletal Class II malocclusion and low mandibular plane are conducive to a good treatment and long-term stability.

Perioperative administration of probiotics: effects on immune response, anastomotic resistance and colonic mucosal trophism

PURPOSE: To investigate the effects of perioperative administration of diet containing probiotics on the immune response, anastomotic resistance, and colonic mucosal trophism in rats underwent left-sided colonic anastomosis. METHODS: Sixty adults Wistar rats were randomized to two groups (A and B) with 30 animals each to receive or not a diet supplemented with probiotics (Streptococcus thermophilus e Lactobacillus helveticus) during pre- and postoperative period. They underwent laparotomy followed by left colon section and immediate anastomosis. Groups of 15 animals were killed either on the 4th (groups A1 and B1) or 7th PO (groups A2 and B2) days. The outcome variables were serum proteins, albumin, globulins and IgA, lenght and weight of the colon, mucosal weight, DNA content and anastomotic bursting pressure. RESULTS: Colonic weight was greater in probiotic group compared to controls (1,69±0,34g vs 1,48±0,26g; p<0.05). Total serum proteins and globulin were higher in probiotic animals (proteins = 7,05±0,97g/dl vs 6,57±0,66g/dl e globulins = 5,1±0,62g/dl vs 4,68±1,1g/dl; p<0.05). Serum IgA increased from basal to post-operative days only in the probiotic group (p<0.01). CONCLUSIONS: Perioperative probiotics enhanced the immune response and colonic weight. Probiotics failed to increase anastomotic resistance.

OBJETIVO: Investigar os efeitos da administração peroperatória de dieta acrescida de probióticos sobre a resposta imunológica, resistência anástomótica e trofismo da mucosa colônica em ratos submetidos a anastomose do cólon esquerdo. MÉTODOS: 60 ratos Wistar adultos foram randomizados em dois grupos (A e B), cada um com 30 animais, de acordo com o uso ou não de suplementação pré e pós-operatória de probióticos (Streptococcus thermophilus e Lactobacillus helveticus). Foram submetidos a laparotomia com secção e anastomose imediata do cólon esquerdo, e sacrificados em grupos de 15 animais no 4° (grupos A1 e B1) ou 7° dia de pós-operatório (grupos A2 e B2). As variáveis estudadas foram concentração plasmática de proteínas totais, albumina, globulinas e IgA; peso e comprimento do cólon sem fezes, peso da mucosa, conteúdo de DNA da mucosa e pressão anastomótica de ruptura. RESULTADOS: Observou-se aumento do peso do intestino grosso sem fezes no grupo A (probiótico) quando comparado ao controle (1,69±0,34g vs 1,48±0,26g; p<0.05). Houve aumento de proteínas totais e globulinas no grupo probiótico (proteínas = 7,05±0,97g/dl vs 6,57±0,66g/dl e globulinas = 5,1±0,62g/dl vs 4,68±1,1g/dl; p<0.05). A IgA aumentou entre os níveis basais e o pós-operatório apenas no grupo probiótico (p<0.01). As demais variáveis não apresentaram diferenças entre diversos grupos estudados. CONCLUSÃO: O uso peri-operatório de probióticos melhorou a resposta imunológica e o peso do cólon. Não houve diferença na resistência anastomotica.