Tratamiento Rehabilitador Estético-Oclusal con Resinas Compuestas en una Paciente con Mordida Profunda y Desgaste Severo / Aesthetic-Occlusal Rehabilitation Treatment with Composite Resins in a Patient with Deep Bite and Dental Wear

RESUMEN: La rehabilitación oral tradicional del paciente con mordida profunda y braquifacial puede ser muy compleja e invasiva, sin embargo, podría involucrar muchas especialidades para su resolución ideal. Un análisis integral estético-oclusal es necesario antes de empezar el tratamiento para hacer propuestas con el menor costo biológico, de tiempo y económico. La odontología adhesiva permite una propuesta aditiva y no invasiva como un tratamiento de mediano plazo o transitorio. Este artículo presenta un caso de una paciente de 46años de edad con mordida profunda anterior y desgaste dental severo en las caras palatinas de los dientes antero-superiores, sin disfunción temporomandibular, ni compromisos sistémicos. Se destaca la rehabilitación estética- oclusal con el mínimo compromiso biológico (ultra-conservadora), mediante restauraciones adhesivas semi-indirectas de resina compuesta con acompañamiento de 12meses. Esta propuesta rehabilitadora con resinas compuestas representa una alternativa de tratamiento para el manejo del paciente con mordida profunda anterior. El control a un año de tratamiento demostró que se siguió una secuencia y resolución que aseguró los principios de la rehabilitación oral, al mismo tiempo, se procedió de la manera menos invasiva posible.

ABSTRACT: The traditional oral rehabilitation of the patient with deep bite and brachifacial can be very complex and invasive, however, a number of treatments could be considered to improve rehabilitation. A comprehensive aesthetic-occlusal analysis is necessary prior to starting treatment in order to consider the best procedure, time involved, and economic cost. Adhesive dentistry allows an additive and non-invasive proposal as a medium-term or transitory treatment. A case of a 46-year-old patient is presented, with anterior deep bite and severe dental wear on palatal surfaces of the antero-superior teeth, without temporomandibular dysfunction, or systemic compromises. The objective was to emphasize the aesthetic and occlusal rehabilitation with the least biological commitment (ultraconservative), through semi-indirect adhesive restorations of composite resin with 12 months follow-up. This restorative proposal with composite resins represents an alternative treatment for patient management with anterior deep bite. Control at one year of treatment showed that a sequence and resolution was followed, that ensured adequate oral rehabilitation in the least invasive manner possible.

Early vertical correction of the deep curve of Spee

ABSTRACT Even though few technological advancements have occurred in Orthodontics recently, the search for more efficient treatments continues. This paper analyses how to accelerate and improve one of the most arduous phases of orthodontic treatment, i.e., correction of the curve of Spee. The leveling of a deep curve of Spee can happen simultaneously with the alignment phase through a method called Early Vertical Correction (EVC). This technique uses two cantilevers affixed to the initial flexible archwire. This paper describes the force system produced by EVC and how to control its side effects. The EVC can reduce treatment time in malocclusions with deep curves of Spee, by combining two phases of the therapy, which clinicians ordinarily pursue sequentially.

RESUMO Apesar de haver poucos desenvolvimentos tecnológicos nos últimos anos dentro da Ortodontia, a busca por tratamentos mais eficientes não cessou. Assim, o presente artigo visa analisar, de maneira lógica, como otimizar uma das fases do tratamento ortodôntico que mais demandam tempo: a correção da sobremordida exagerada. Pretende-se demonstrar como realizá-la concomitantemente ao alinhamento inicial, por meio de uma técnica denominada correção vertical precoce (CVP). Essa técnica utiliza dois cantilevers associados ao primeiro fio de alinhamento ortodôntico, mas não restritos a ele, a fim de iniciar a planificação da curva de Spee o mais cedo possível. Assim, o tempo de tratamento pode ser diminuído, já que duas fases do tratamento, normalmente realizadas de forma independente, podem ser realizadas ao mesmo tempo. Além disso, tanto o sistema de forças quanto os efeitos colaterais e os passos da execução da técnica serão devidamente apresentados e discutidos.

Comparative cephalometric study of Class II malocclusion treatment with Pendulum and Jones jig appliances followed by fixed corrective orthodontics

OBJECTIVE: The purpose of this study was to cephalometrically compare the skeletal and dentoalveolar effects in the treatment of Class II malocclusion with Pendulum and Jones jig appliances, followed by fixed corrective orthodontics, and to compare such effects to a control group. METHODS: The sample was divided into three groups. Group 1: 18 patients treated with Pendulum, Group 2: 25 patients treated with Jones jig, and Group 3: 19 young subjects with untreated Class II malocclusions and initial mean age of 12.88 years. The chi-square test was applied to assess severity and gender distribution. Groups 1 and 2 were compared to the control group by means of the one-way ANOVA and Tukey tests in order to differentiate treatment changes from those occurred by craniofacial growth. RESULTS: There were no significant changes among the three groups with regard to the components of the maxilla and the mandible, maxillomandibular relationship, cephalometric and tegumental pattern. Buccal tipping of mandibular incisors was significantly greater in the experimental groups and increased mesial angulation of the maxillary second molars was found in the Jones jig group. In the experimental groups, dental relationship, overbite and overjet were corrected. CONCLUSION: It can be stated that the distalization achieved its purpose of correcting the Class II.

OBJETIVO: a proposta desse estudo foi comparar, cefalometricamente, os efeitos esqueléticos e dentoalveolares no tratamento da má oclusão de Classe II com os distalizadores Pendulum e Jones jig, seguidos de aparelho fixo corretivo, e compará-los ao grupo controle. MÉTODOS: a amostra foi dividida em três grupos. Grupo 1: 18 pacientes tratados com o Pendulum; grupo 2: 25 pacientes tratados com o Jones jig; e grupo 3: 19 jovens com má oclusão de Classe II não tratada. Empregou-se o teste qui-quadrado para avaliar a distribuição da severidade e do sexo. Os grupos 1 e 2 foram comparados ao controle pela ANOVA a um critério; também empregou-se o teste de Tukey com o intuito de diferenciar as alterações do tratamento daquelas ocorridas pelo crescimento craniofacial. RESULTADOS: não foram observadas alterações significativas entre os três grupos quanto aos componentes da maxila, mandíbula, relação maxilomandibular, padrão cefálico e tegumentar. Verificou-se uma vestibularização significativamente maior dos incisivos inferiores nos grupos experimentais e maior angulação mesial dos segundos molares superiores no grupo 2 (Jones jig). Nos grupos experimentais, a relação dentária e os trespasses horizontal e vertical foram corrigidos. CONCLUSÃO: pode-se afirmar que os distalizadores alcançaram seus objetivos de correção da Classe II.

Comparative evaluation of condylar position in symptomatic (TMJ dysfunction) and asymptomatic individuals.

Context: The etiopathogenesis of temporomandibular joint (TMJ) disorders has been attributed to multiple factors and, while the importance of centric relation (CR) has been acknowledged in dental literature, the role of condylar position and CR-CO (CO-centric occlusion) discrepancy in TMJ dysfunction (TMD) has been a source of controversy. Aim: To establish the relationship between condyle position and TMD. Setting and Design: This was a case-control study to evaluate condylar displacement and interarch CR-CO discrepancy in symptomatic subjects (with TMD) and compare them with asymptomatic subjects. Materials and Methods: Forty subjects were screened for TMD based on Helkimo index and grouped into asymptomatic and symptomatic groups. CR was registered using the modified Roth power centric bite registration after neuromuscular deprogramming. Models thus mounted on an Advanced Dental Design (AD2) articulator were evaluated for interarch CR-CO discrepancy. The condylar position discrepancy was recorded on a device MCD (measured condylar deviation). Statistical Analysis: The Student's t test was used to test statistical significance. The paired t test and the unpaired t test were used for comparing results within and between the groups. Pearson correlation coefficient was used to find out the correlation between MCD measurements and dental three-dimensional (3D) model analysis measurements. The Chi-square test was used to evaluate the qualitative data. Results: The average vertical and horizontal condylar displacements were significantly greater in the symptomatic group than in the asymptomatic group. There were significant deviations at the level of the occlusion in both groups. Conclusion: Condyle position may play a significant role in the etiopathogenesis of TMJ disorders.