Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Evaluation of Head and Cervical Spine Posture after Therapy with Maxillary Protraction Appliances / Evaluación de la Postura de la Cabeza y la Columna Cervical Después de la Terapia con Aparatos de Protracción Maxilar

SUMMARY: The objective of this study was to evaluate the changes of head and cervical spine posture of skeletal class malocclusion in adolescent with maxillary protraction. Thirty cases of skeletal class malocclusion were randomly selected from the Stomatological Hospital of Shanxi Medical University. High-quality lateral cephalograms were collected including pre- and posttreatment to compare the changes of head and cervical spine posture. Data were processed using SPSS 26.0 statistical software. The paired-t test was used to compare pre- and posttreatment mean angular measurements.A significant difference in the SNA(p<0.001), SNB(p<0.01), and ANB(p<0.001) between T1 and T2 showed an improvement in the sagittal relationships. A significant change was observed in middle cervical spine posture, while upper cervical spine posture variables showed no significant difference after treatment. Skeletal class with maxillary protraction appliance not only led to the improvement of sagittal relationship, but also changed the middle cervical spine posture.

El objetivo de este estudio fue evaluar los cambios en la postura de la cabeza y la columna cervical debido a la maloclusión clase esquelética en adolescentes con protracción maxilar. Treinta casos de maloclusión de clase esquelética fueron seleccionados al azar del Hospital Estomatológico de la Universidad Médica de Shanxi. Se recogieron cefalogramas laterales de alta calidad, incluidos el tratamiento previo y posterior, para comparar los cambios en la postura de la cabeza y la columna cervical. Los datos se procesaron con el software estadístico SPSS 26.0. Se utilizó la prueba t pareada para comparar las medidas angulares medias antes y después del tratamiento. Una diferencia significativa en SNA (p <0,001), SNB (p <0,01) y ANB (p <0,001) entre T1 y T2 mostró una mejora en las relaciones sagitales. Se observó un cambio significativo en la postura de la columna cervical media, mientras que las variables de postura de la columna cervical superior no mostraron diferencias significativas después del tratamiento. La clase esquelética con aparato de protracción maxilar no solo condujo a la mejora de la relación sagital, sino que también cambió la postura de la columna cervical media.

Odontoma mandibular inusual y su resolución: reporte de un caso / Unusual mandibular odontoma and its resolution: report of a case

Objetivo: El odontoma es una lesión hamartomatosa benigna formada por tejido dentario (cemento, esmalte, pul­ pa). Según su grado de diferenciación podrá ser clasificado en sus dos variantes: compuesto y complejo en una relación 2:1. El objetivo de este artículo es presentar un odontoma mixto de gran tamaño de localización mandibular y su resolución quirúrgica. Caso clínico: Se describe el caso de un paciente mascu­ lino de 16 años de edad, portador de ortodoncia, que presenta un odontoma mixto de gran tamaño de localización mandibular y su resolución quirúrgica utilizando planificación 3D y confección de placa de titanio customizada (AU)

Aim: Odontoma is a benign hamartomatous lesion formed by dental tissue (cementum, enamel, pulp). According to its degree of differentiation, it can be classified in its two variants: compound and complex in a 2:1 ratio. The objective of this article is to present a large mixed odontoma of mandi­ bular location and its surgical resolution. Clinical case: A 16-year-old male patient with ortho­ dontics, who presents a large mixed odontoma with mandibu­ lar location and its surgical resolution using 3D planning and customized titanium plate fabrication (AU)

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.

Diagnóstico e tratamento precoce da má oclusão de Classe III com Aparelho Disjuntor Hyrax e Máscara Facial de Petit com avaliação do tempo de uso com micro-sensor: relato de caso clínico / Early diagnosis and treatment of Class III occlusion with Hyrax Isolating Appliance and Petit Face Mask with evaluation of the time of use with micro-sensor: a clinical case report

O sucesso do tratamento precoce da classe III depende de um bom diagnóstico e da cooperação do paciente na utilização do aparelho extrabucal. Neste trabalho, por meio de um chip (Theramon) instalado na Máscara Facial de Petit da paciente, foi possível monitorar a quantidade de horas que a paciente utilizou o aparelho por dia, durante um período de quatro meses. Paciente do sexo feminino, 7 anos e 11 meses de idade portadora da má oclusão de classe III, utilizou o aparelho de disjunção da maxila (Hyrax) modificado, seguido da Máscara Facial de Petit com chip (Theramon) instalado. A média de uso foi maior do que 11 horas de uso diário. O uso deste dispositivo auxilia no monitoramento do tempo de uso do aparelho, cujo sucesso do tratamento depende da utilização deste pelo paciente(AU)

The success of early treatment of class III depends on a good diagnosis and the cooperation of the patient in the use of the extra oral appliance. In this study, the patient was able to monitor the number of hours the patient used the device per day during a period of four months using a Theramon chip installed in the Patient's Facial Mask. A 7-year, 11-month-old male with Class III malocclusion used the modified maxillary disjunction (Hyrax), followed by the Petit Facial Mask with a Theramon chip installed. The average use was greater than 11 hours of daily use. The use of this device assists in the monitoring of the time of use of the device, whose success of the treatment depends on the use of this by the patient(AU)

A cone-beam computed tomography evaluation of three-dimensional changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions / 北京大学学报(医学版)

OBJECTIVE@#To assess three-dimensional (3D) changes of circummaxillary sutures following maxillary protraction with alternate rapid palatal expansions and constrictions (RPE/C) facemask protocol in maxillary retrusive children, and to investigate the relationship between the changes of circum-maxillary sutures and zygomaticomaxillary suture (ZMS) maturation, and to explore the factors of maxilla forward movement with RPE/C and facemask.@*METHODS@#In the study (clinical trial registration No: ChiCTR2000034909), 36 maxillary retrusive patients were recruited and block randomized to either the rapid palatal expansion (RPE) group or the RPE/C group. Patients aged 7 to 13 years, Class Ⅲ malocclusion, anterior crossbite, ANB less than 0°, Wits appraisal less than -2 mm, and A-Np less than 0 mm were included in the study. The RPE group received rapid palatal expansion, whereas the RPE/C group received alternate rapid palatal expansions and constrictions, and both with facemask protraction. Head orientations of cone-beam computed tomography (CBCT) images were implemented by Dolphin 11.7. 3D measurements of circummaxillary sutures on CBCT images were evaluated using Mimics 10.01 before (T0) and after treatment (T1). The changes were analyzed with independent t test, two-way ANOVA, Pearson correlation and regression analysis.@*RESULTS@#Two subjects in the RPE/C group were lost to follow-up. A total of 34 patients reached the completion criteria and were analyzed. Compared with the RPE group, sagittal changes of circummaxillary sutures were significantly increased in the RPE/C group with 1.21 mm advancement of zygomaticotemporal suture, 2.20 mm of ZMS, 1.43 mm of zygoma-ticofrontal suture (P < 0.05, respectively). Except for the zygomaticotemporal suture, the rest forward sagittal changes of other circummaxillary sutures showed no major difference in terms of the ZMS maturation. The Spearman's correlation in RPE/C indicated a strong positive correlation of sagittal changes between ZMS and point A (P < 0.01) with a regression analysis R2=42.5%.@*CONCLUSION@#RPE/C might be more effective on the treatment of maxillary retrusive children. As one of the major mechanical loading sutures during orthopedic therapy, ZMS showed a strong positive correlation with point A on sagittal changes.

Revisión de los principales manejos ortodónticos interceptivos y correctivos no quirúrgicos de la maloclusión clase III / Review of the main non-surgical interceptive and corrective orthodontic management of Class III malocclusion

La maloclusión clase III se considera un reto en la práctica de todo ortodoncista. Una de las principales dudas al respecto reside en ¿cuándo es el mejor momento para intervenir? Exis- ten dos enfoques en el manejo ortodóntico del paciente: 1) la ortodoncia interceptiva; y 2) la ortodoncia correctiva. La or- todoncia interceptiva busca la prevención del establecimiento de la malolcusión. En este grupo, se encuentra el uso de más- cara facial con disyunción maxilar y el de aparatología fija (2x4 o 2x6). Por otro lado, la intervención correctiva hace re- ferencia al camuflaje de las características que trae consigo la maloclusión clase III ya establecida; dentro de este enfoque se encuentran las extracciones de piezas, el uso de minitornillos extraalveolares y la filosofía MEAW. Se puede concluir que el adecuado manejo de la maloclusión clase III radica en el oportuno y correcto diagnóstico, que debe realizarse a través de la minuciosa inspección de las características y hallazgos intra y extraorales de los pacientes (AU)

Class III malocclusion is considered a challenge in the practice of every orthodontist. One of the main questions is: when is the best time to intervene? There are 2 approaches to the orthodontic management of the patient: 1) interceptive orthodontics, and 2) corrective orthodontics. Interceptive or- thodontics seeks to prevent the establishment of malocclusion by means of the use of a facial mask with maxillary disjunc- tion, or the use of fixed appliances (2x4 or 2x6). Corrective intervention refers to camouflaging the characteristics of a Class III malocclusion that is already established. This ap- proach uses tooth extraction, extra-alveolar mini screws or the MEAW philosophy. To conclude, proper management of Class III malocclu- sion is based on timely, correct diagnosis, which must be made through careful inspection of the characteristics and intraoral and extraoral findings in patients (AU)

Caracterización morfológica de caninos en premolares, un caso de anodoncia parcial de caninos maxilares / Morphological characterization of canine teeth done in first bicuspid, a maxillary canine partial anodontia case report

En este informe de caso clínico se muestra el tratamiento exitoso de un paciente con anodoncia parcial de órganos dentales 13 y 23 debido a que fueron extraídos por presentar impactación y mal pronóstico de tracción. En este artículo se presenta un paciente masculino de 29 años clase I esquelética con un perfil convexo, maloclusión de clase III, overjet disminuido, ausencia de guías funcionales, discrepancia oseodentaria positiva en arcada superior y negativa en arcada inferior. El tratamiento se realizó con extracciones de los órganos dentales 34 y 44 para nivelar las discrepancias óseo dentarias interarcadas, se llevó a cabo mediante un cierre de espacios recíproco por medio de cadenas elásticas para ambas arcadas, con lo que se logró crear un overjet y overbite adecuados. La creación de las guías caninas funcionales se consiguió mediante el cambio de morfología de los órganos dentales 14 y 24, los cuales fueron llevados a la posición de los caninos ausentes. El tiempo total de tratamiento para este paciente fue de 24 meses. Se realizaron ameloplastias positivas, la aplicación de agregados de resina para mejorar la funcionalidad y proveer salud articular. Se sugiere que ante casos de anodoncia de caninos en la arcada superior, un tratamiento favorable se puede llevar a cabo mediante el cierre de espacios, la caracterización morfológica de los caninos ausentes mediante ameloplastias positivas en premolares (AU)

This case report shows the successful treatment of a patient with partial anodontia of dental organs 13 and 23 because they have been extracted due to present impactation and poor traction prognosis. This article presents a 29-year-old male class I skeletal patient with convex profile, class III malocclusion, overjet reduction, absence of functional guidance, positive bone-teeth discrepancy in the upper arch and negative in the lower arch. The treatment was carried out with the extractions of the dental organs 34 and 44 for correcting oral dental discrepancies between upper and lower arches; it was done using reciprocal closing of spaces by using elastic chains for both arches in order to achieve a suitable overjet and overbite. The creation of the canine guides was achieved by changing the morphology of the dental organs 14 and 24, which were taken to the position of the absent canines. The total treatment timing for this patient was 24 months. Positive ameloplasties were performed by application of resin aggregates to improve functionality and provide joint health. A favorable treatment for these kinds of cases of canine anodontics in the upper arch is carried out by closing spaces and the morphological characterization of the absent canines by positive in-premolar ameloplasties (AU)

Orthodontic camouflage as a treatment alternative for skeletal Class III

ABSTRACT Introduction: Skeletal Class III malocclusion is a deformity of complex treatment, with few intervention alternatives, which are further limited in nongrowing patients. In most cases, orthognathic surgery is the ideal treatment for adults, an option often refused by patients. Mild to moderate skeletal Class III malocclusions and acceptable facial esthetics can benefit from a course of treatment in which dental movements are used to compensate for the skeletal discrepancy. Objective: This study aimed to discuss orthodontic camouflage as an option for adult patients with Class III malocclusion, emphasizing its indications, implications and expected results.

RESUMO Introdução: A má oclusão esquelética de Classe III é uma deformidade de difícil tratamento e com poucas alternativas de intervenção, que ficam ainda mais limitadas em pacientes sem crescimento. Na maior parte dos casos, o tratamento ideal para adultos é a cirurgia ortognática, opção muitas vezes recusada pelo paciente. As más oclusões esqueléticas de Classe III leve a moderada e com estética facial aceitável podem se beneficiar de um plano de tratamento no qual movimentações dentárias são realizadas para compensar a discrepância esquelética. Objetivo: O objetivo do presente estudo foi discutir a camuflagem ortodôntica como opção para pacientes adultos com má oclusão de Classe III, ressaltando suas indicações, implicações e resultados esperados.

Gonial Angle Characteristics of Class III Malocclusion in Javanese Ethnic

ABSTRACT Objective: To describe the gonial angle characteristics in class III skeletal malocclusion in Javanese ethnic. Material and Methods: Pretreatment lateral cephalometric radiographs of 43 Javanese ethnic patients were measured: upper (Go1) and lower gonial angle (Go2), anterior (AFH) and posterior face height ratio (PFH), maxilla-mandibular length difference, mandibular plane angle (FMA), Y axis, ramus position, ANB angle, posterior cranial base/ramus height and mandibular body length/anterior cranial base. The relation between Go1, Go2 and other variables were analysed using correlation and regression analysis. Results: The total gonial angle is within normal range, but Go1 is below normal and Go2 is above normal. There is no difference between male and female gonial angle measurements (p=0.939 and p=0.861, respectively). Ramus position is positively correlated to Go1 (p=0.003), while AFH (p=0.000), maxilla-mandibular length difference (p=0.000), FMA (p=0.000), Y axis (p=0.000), and posterior cranial base/ramus height (p=0.018) are positively correlated to Go2. PFH is negatively correlated to Go2 (p=0.018). Conclusion: The upper gonial angle is influenced by the position of mandibular ramus, while the lower gonial angle is affected by the posterior and anterior lower facial height and mandibular size and rotation. Javanese with class III malocclusion tends to have hypodivergent facial type, with more posteriorly located mandibular ramus and excess mandibular length.

Importance of orthodontic intervention of the Class III malocclusion in mixed dentition

ABSTRACT Introduction: Supervising the development of occlusion, managing problems during the transition from mixed to permanent dentition, as well as controlling environmental factors that contribute to establishing malocclusion, are important actions to achieve a Class I occlusion with facial balance. Among these problems, the malocclusions associated with dysfunctions such as mouth breathing or obstructive sleep apnea syndrome (OSAS), atypical swallowing and abnormal tongue position, open bites, crossbites and maxillomandibular discrepancies, and especially the Class III malocclusion can be listed. Objective: The purpose of this article is to present and discuss the main aspects relevant to the benefits of performing the treatment of Class III malocclusion in patients with growth.

RESUMO Introdução: A supervisão do desenvolvimento da oclusão e o gerenciamento de problemas durante a transição da dentição mista para a permanente, bem como o controle de fatores ambientais que contribuem para estabelecer a má oclusão, são importantes ações para se obter uma oclusão de Classe I com equilíbrio facial. Entre esses problemas, pode-se considerar más oclusões associadas às disfunções como respiração bucal ou síndrome da apneia obstrutiva do sono (SAOS), deglutição atípica, posição anormal da língua, mordidas abertas e mordidas cruzadas e discrepâncias maxilomandibulares, especialmente, a má oclusão de Classe III. Objetivo: O objetivo do presente artigo é apresentar e discutir os principais aspectos pertinentes aos benefícios de se realizar o tratamento da má oclusão de Classe III em pacientes com crescimento.

Cephalometric and occlusal changes of Class III malocclusion treated with or without extractions

ABSTRACT Objective: The aim of this retrospective study was to evaluate the cephalometric and occlusal changes of orthodontically treated Class III malocclusion patients. Methods: The experimental groups comprised 37 Class III patients treated: G1) without (n=19) and G2) with extractions (n=18) . The control group (G3), matched by age and sex with the experimental groups, consisted of 18 subjects with untreated Class III malocclusion. Cephalometric (radiographs) and occlusal (study models) changes were assessed between the beginning (T1) and the end (T2) of treatment. Intergroup comparisons were performed with one-way ANOVA followed by Kruskal-Wallis tests (p< 0.05). Occlusal changes were evaluated by the peer assessment rating (PAR) index (ANOVA and Kruskal-Wallis tests), and the treatment outcomes were evaluated by the Objective Grading System (OGS) (t-tests). Results: The experimental groups showed a restrictive effect on mandibular anterior displacement and a discrete improvement in the maxillomandibular relationship. Extraction treatment resulted in a greater retrusive movement of the incisors and significant improvements in the overjet and molar relationship in both groups. The PAR indexes were significantly reduced with treatment, and the OGS scores were 25.6 (G1) and 28.6 (G2), with no significant intergroup difference. Conclusions: Orthodontic treatment of Class III malocclusion patients with fixed appliances improved the sagittal relationships, with greater incisor retrusion in the extraction group. Both the extraction and non-extraction treatments significantly decreased the initial malocclusion severity, with adequate and similar occlusal outcomes of treatment.

RESUMO Objetivos: O objetivo desse estudo retrospectivo foi avaliar as alterações cefalométricas e oclusais de pacientes com má oclusão de Classe III tratados ortodonticamente. Método: Os grupos experimentais compreenderam 37 pacientes Classe III tratados: 19 com extrações dentárias (G1) e 18 sem (G2). O grupo controle (G3), compatibilizado em idade e sexo com os grupos experimentais, consistiu de 18 indivíduos com má oclusão de Classe III não tratada. Alterações cefalométricas (radiografias) e oclusais (modelos de estudo) foram avaliadas ao início (T1) e ao fim (T2) do tratamento. Comparações intergrupos foram realizadas com testes ANOVA a um critério e Kruskal-Wallis (p< 0,05). As alterações oclusais foram avaliadas pelo índice PAR (testes ANOVA e Kruskal-Wallis) e os resultados oclusais dos tratamentos, pelo índice Objective Grading System (OGS) (testes t). Resultados: Os grupos experimentais apresentaram um efeito restritivo no posicionamento anterior da mandíbula e uma discreta melhora na relação maxilomandibular. Os tratamentos com extrações resultaram em um maior movimento retrusivo dos incisivos e melhoras significativas no trespasse horizontal e na relação molar em ambos os grupos. Os índices PAR foram reduzidos significativamente com o tratamento, e os índices OGS foram iguais a 25,6 (G1) e 28,6 (G2), sem diferença significativa entre os grupos. Conclusões: O tratamento ortodôntico de pacientes com má oclusão de Classe III com aparelhos corretivos fixos melhorou as relações sagitais, com maior retrusão dos incisivos no grupo com extrações. Ambos os tratamentos, com e sem extrações dentárias, diminuíram significativamente a severidade inicial da má oclusão, com resultados oclusais do tratamento adequados e similares.

Morphological changes of frankel functional regulator III in mixed dentition with class III malocclusion / Cambios morfológicos del regulador funcional frankel III en dentición mixta con maloclusión clase III

The aim of this study was to evaluate the hard and soft tissue profile changes following treatment of functional and mild skeletal class III malocclusion in mixed dentition by means of the Frankel functional regulator (FR-3) appliance, and to reveal the mechanism and effectiveness of treatment with FR-3 appliance. Twenty-six patients (chronological mean age, 8.7±1.4 years; mean treatment duration, 10.3±1.3 months) with functional and mild skeletal class III malocclusion were selected and treated with FR-3 appliances. Lateral cephalogram was taken pre- and post-treatment, and the data was analyzed by paired-samples t test with SPSS22.0 software package. Differences were considered statistically significant at P < 0.05. The results demonstrated that the FR-3 appliance produced a statistically significant decrease in L1-NB, L1-MP, U1-L1 (P<0.01) and an increase greatly in ANB, MP-FH, Y axis, ANSMe, ANS-Me/N-Me and overjet (P<0.01). SNA, SNB were increased significantly (P<0.05). Meanwhile, N'-Sn-Pog', ULSn-SN, LLSiSN increased, S-N'-Si, LL-EP decreased with significant difference (P<0.01). S-N'-Sn, Cm-Sn-UL, UL-EP, Sn-Mes and Ns-Mes increased with significant difference (P<0.05). Therefore it was concluded that after FR-3 treatment, the position of mandible may rotate clockwise backwards and downwards, with the labioversion of upper incisors and linguoversion of lower incisors. Although point A moved mesially, the length and position of the maxilla did not change significantly. With the protrusion of upper lip and the retrusion of lower lip, the relationship among nose, upper lip, lower lip and chin become harmonious, the profile of soft tissue is more coordinated and attractive.

El objetivo de este estudio fue evaluar los cambios en el perfil de los tejidos duros y blandos después del tratamiento de la maloclusión funcional y leve de la clase III esquelética en la dentición mixta mediante el aparato regulador funcional Frankel (FR-3), y revelar el mecanismo y efectividad del tratamiento con el aparato FR-3. Veintiseis pacientes (edad media 8,7 ± 1,4 años; duración media del tratamiento, 10,3 ± 1,3 meses) con maloclusión funcional y leve de clase esquelética III fueron seleccionados y tratados con aparatos FR-3. El cefalograma lateral se tomó antes y después del tratamiento, y los datos se analizaron mediante la prueba t de muestras con el software SPSS22.0. Las diferencias se consideraron estadísticamente significativas a P <0,05. Los resultados demostraron que el dispositivo FR-3 produjo una disminución estadísticamente significativa en L1-NB, L1MP, U1-L1 (P <0,01) y un gran aumento en ANB, MP-FH, eje Y, ANS-Me, ANS -Me / N-Me y overjet (P <0,01). SNA, SNB se incrementaron significativamente (P <0,05). Mientras tanto, N'Sn-Pog', ULSn-SN, LLSi-SN aumentaron, S-N'-Si, LL-EP disminuyeron con una diferencia significativa (P <0,01). S-N'-Sn, Cm-Sn-UL, UL-EP, Sn-Mes y Ns-Mes aumentaron con una diferencia significativa (P <0,05). Por lo tanto, se concluyó que después del tratamiento con FR-3, la posición de la mandíbula puede girar en sentido reloj hacia atrás y hacia abajo, con labioversión de los incisivos superiores y linguoversión de los incisivos inferiores. Aunque el punto A se movió mesialmente, la longitud y la posición del maxilar no cambiaron significativamente. Con la protuberancia del labio superior y la retrusión del labio inferior, la relación entre la nariz, el labio superior, el labio inferior y el mentón se armoniza, el perfil del tejido blando es más coordinado y atractivo.

Efectividad de la Expansión Maxilar en la Corrección de Apiñamiento en Dentición Mixta. Revisión Sistemática / Effectiveness of the Maxillary Expansion in the Correction of Crowding and Mixed Dentition. Systematic Review

RESUMEN: El apiñamiento en edades tempranas, se refleja cuando el tamaño dental no coincide con la longitud de arco. De este modo, resulta importante determinar si la expansión del maxilar podría solucionar por sí solo el problema de apiñamiento en el sector anterior, teniendo en cuenta que este tratamiento es uno de los más antiguos y que comúnmente se ha enfocado en la resolución de alteraciones transversales en dientes posteriores empleándose a edades tempranas. El objetivo fue determinar si la expansión maxilar es efectiva o no, en la corrección del apiñamiento en dentición mixta mediante el análisis de la evidencia disponible. Se realizó una revisión sistemática en español e inglés, para establecer la máxima evidencia posible, con las indicaciones de la guía PRISMA. Dos artículos cumplieron con la calidad de la revisión. En el primero se estableció que el apiñamiento mejoro despues del tratamiento de expansion maxilar, con una recidiva menor en la dentición permanente. En el segundo, se encontró que el apiñamiento en los incisivos permanentes superiores fue corregido cuando se retiró el aparato expansor. Se concluyó que la evidencia actual no tiene la suficiente calidad metodológica para llevar a una toma de decisión. Se recomienda hacer ensayos clínicos aleatorizados en este tema.

ABSTRACT: Crowding at early ages is reflected when tooth size does not coincide with arch length. Thus, it is important to determine whether maxillary expansion alone could solve the problem of crowding in the anterior sector, bearing in mind that this treatment is one of the oldest and has commonly focused on solving transverse alterations in posterior teeth used at an early age. The objective was to determine whether or not maxillary expansion is effective in correcting crowding in the mixed dentition by analysing the available evidence. A systematic review was carried out in Spanish and English, to establish the maximum possible evidence, with the indications of the PRISMA guide. Two articles met the quality of the review. The first established that crowding improved after the treatment of maxillary expansion, with a minor recurrence in the permanent dentition. In the second, it was found that crowding in the upper permanent incisors was corrected when the expanding appliance was removed. The current evidence is not of sufficient methodological quality to lead to a decision. Randomized clinical trials are recommended in this area.

Manejo ortodóncico de la clase III: presentación de un caso clínico / Orthodontic management of class III: presentation of a clinical case

Introducción: La maloclusión clase III es considerada como severa y en la mayoría de los pacientes la etiología suele estar combinada entre componentes esqueléticos y dentoalveolares. Las posibilidades terapéuticas dependerán de la edad biológica del paciente y del tipo de maloclusión. Conforme va aumentando la edad del paciente va menguando la capacidad de crecimiento y se va asentando la relación de clase III esquelética. Las maloclusiones de clase III esqueléticas se pueden corregir mediante extracciones dentales y cirugía ortognática. Caso clínico: Paciente masculino de 13 años de edad con protrusión mandibular, discrepancia óseo dentaria negativa, convexidad facial disminuida y clase III dental y esqueletal. Resultados: Se resolvió la discrepancia óseo dentaria negativa del paciente, se logró la clase I Molar y canina con una sobremordida adecuada (AU)

Introduction: Class III malocclusion is considered severe and in most patients the etiology is usually combined between skeletal and dentoalveolar components. The therapeutic possibilities depend on the biological age of the patient and the type of malocclusion. As it increases the age of the patient wanes growth capacity and Will settled the relationship skeletal class III. The skeletal class III malocclusion can be corrected by tooth extractions and orthognathic surgery. Case report: Male patient 13 years old with mandibular protrusion, negative tooth bone discrepancy, decreased facial convexity and dental and skeletal class III. Results: Dental patient refusal bone discrepancy was resolved, I molar and canine class and adequate overbite was achieved (AU)

Frenectomía lingual láser asistida como coadyuvante del tratamiento de ortopedia maxilar / Laser-assissted lingual frenectomy as a coadjuvant to maxillary orthopedic treatment

La aplicación del LÁSER (light amplification of stimulation emision of radiation) en las áreas de la medicina y la odontología viene demostrando una constante evolución, brindándonos alternativas a los tratamientos convencionales. Los láseres quirúrgicos de tejidos blandos muestran grandes ventajas comparados a los procedimientos habituales de corte, ya sea con bisturí frío o electrobisturí. La mínima necesidad de anestesia, la analgesia intra y postoperatoria, la coagulación inmediata, la cicatrización por segunda, el efecto bactericida, la ausencia de puntos de sutura, el confort postoperatorio, son algunas de las ventajas que hacen que la cirugía con láser sea una opción indiscutible que está ganando terreno entre los profesionales de la salud (AU)

Quick correction of a skeletal class III maloclussion in primary dentition with face mask plus rapid maxillary expansion therapy / Corrección rápida de una maloclusión esquelética clase III en dentición primaria con máscara facial más terapia rápida de expansión maxilar

Abstract Skeletal Class III is a malocclusion characterized by anterior crossbite as a result of an abnormal skeletal maxillary and mandibular base discrepancy, which involves disharmony of craneofacial skeleton and profile. The preferred management for children having skeletal Class III malocclusion with retruded maxilla and/or prognathic mandible is the use of devices that encourage the growth and anterior movement of the maxilla bone and/or restrict the exessive mandible growth. The orthopedic treatment consisting of a face mask with rapid maxillary expansion (RME) produces the most dramatic results in the shortest period of time. The purpose of this article is to review a quick correction of skeletal class III maloclussion in the primary dentition through a case example with use of a face mask plus rapid maxillary expansion therapy in a 5 year-old male patient due to a combination of retruded maxilla and protruded mandible, in primary dentition, who was treated with a Petit face mask in conjunction with a bonded RME intraoral appliance added with bite blocks. The first evident occlusal outcomes were a clockwise rotation of the mandible, a positive overjet of 3 mm, a correct overbite, a canine Class I relationship, and a bilateral flush terminal plane. After discussing the present clinical case report and the related published literature, we concluded that skeletal class III malocclusions should be treated as soon as the first clinical signs of abnormal craniofacial growth are recognized, during the first years of life.

Resumen La clase III esquelética es una maloclusión caracterizada por mordida cruzada anterior como resultado de una discrepancia esquelética de la base maxilar y mandibular, que implica desarmonía craneofacial y del perfil. El tratamiento de elección para niños con maloclusión clase III esquelética con mandíbula maxilar y/o prognática es el uso de dispositivos que estimulan el crecimiento y el movimiento anterior del hueso maxilar y/o restringen el crecimiento excesivo de la mandíbula. El tratamiento ortopédico que consiste en una máscara facial con expansión maxilar rápida (EMR) produce resultados en un período de tiempo más corto. El propósito de este artículo es revisar una corrección rápida de la maloclusión de clase III esquelética en la dentición primaria mediante el uso de una máscara facial más terapia de expansión maxilar rápida en un paciente masculino de 5 años debido a una combinación de maxilar retruido y mandíbula prominente, en dentición primaria, que fue tratada con una mascarilla Petit junto con un dispositivo intraoral unido con bloques de mordida. Los primeros resultados evidentes fueron una rotación en sentido horario de la mandíbula, un overjet positivo de 3 mm, una sobremordida correcta, una relación canina de Clase I y un plano terminal de descarga bilateral. Después de discutir el presente informe de caso clínico y la literatura publicada relacionada, concluimos que las maloclusiones de clase III esqueléticas deberían tratarse tan pronto como se reconozcan los primeros signos clínicos de crecimiento craneofacial anormal, durante los primeros años de vida.

Surgery-first approach with 3D customized passive self-ligating brackets and 3D surgical planning: Case report

ABSTRACT It is possible to unify three-dimensional customized orthodontic techniques and three-dimensional surgical technology. In this case report, it is introduced a treatment scheme consisting of passive self-ligation customized brackets and virtual surgical planning combined with the orthognathic surgery-first approach in a Class III malocclusion patient. Excellent facial and occlusal outcomes were obtained in a reduced treatment time of five months.

RESUMO É possível unificar técnicas ortodônticas personalizadas e tecnologia de planejamento cirúrgico 3D. No presente relato de caso, apresenta-se um plano de tratamento envolvendo o uso de braquetes autoligáveis passivos personalizados e planejamento cirúrgico virtual, combinado com cirurgia ortognática de benefício antecipado, em um paciente com má oclusão de Classe III. Foram obtidos excelentes resultados faciais e oclusais em um tempo reduzido de tratamento, de 5 meses.

Morphological changes of skeletal class III malocclusion in mixed dentition with protraction combined activities / Cambios morfológicos en maloclusión de la clase esquelética III en dentición mixta con actividades combinadas de protracción

The objective of the study was to investigate the morphological changes of skeletal class III malocclusion in mixed dentition with light force protraction combined activities. Randomly selected 30 cases of orthodontics in Shanxi Medical University orthodontics patients (ages: 6-10 years) of the lateral cephalograms. Using the oral maxillary casting type of pre-traction device, according to the condition of maxillary dentition to select the corresponding activities of the movable expansion appliance, each side of the force of about 150-200 g, requiring patients to wear 10-12 hours a day, the appliance should be removed after reaching normal occlusion. The correlation cephalometric profile of the cranial lateral radiographs before and after orthodontic treatment was measured. All patients with skeletal class III malocclusion were improved, concave type became direct type, measurements SNA, ANB, A-Ptm, MP-SN, ANS-Me/N-Me increased, maxillary advancement and reconstruction are more obvious; mandible rotates clockwise; the increase of lip inclination of anterior teeth compensatory changes, lower anterior tooth inclination changes smaller; upper lip forward, nasolabial angle decreased, improved appearance significantly. Light force protraction combined activities can make the mixed dentition of skeletal class III malocclusion in patients with significant improvement in profile appearance.

El objetivo de este estudio fue investigar los cambios morfológicos de la maloclusión clase esquelética III, en la dentición mixta, con actividades combinadas de protracción de la fuerza ligera. Se seleccionaron aleatoriamente 30 casos de ortodoncia en pacientes de ortodoncia de la Universidad Médica de Shanxi (edades: 6-10 años) a partir de cefalogramas laterales, utilizando el tipo de dispositivo de pretracción de vaciado maxilar oral, de acuerdo con la condición de la dentición maxilar para seleccionar las actividades correspondientes del dispositivo de expansión móvil, cada lado con fuerza de alrededor de 150-200 g, requiriendo que los pacientes los utilizaran de 10 a 12 horas al día. El dispositivo debía ser retirado después de alcanzar la oclusión normal. Se midió el perfil cefalométrico de correlación de las radiografías laterales craneales, antes y después del tratamiento ortodóncico. Se observó mejoramiento en todos los pacientes con maloclusión de clase esquelética. Las mediciones SNA, ANB, APtm, MP-SN, ANS-Me / N-Me aumentaron, el avance y la reconstrucción maxilar fueron los cambios más significativos; la mandíbula giró en el sentido de las agujas del reloj, se observó un aumento de la inclinación labial de los dientes anteriores. Fue reducida la inclinación anterior del diente inferior, el ángulo nasolabial disminuyó y en general mejoró significativamente la apariencia. Las actividades combinadas de protrusión de la fuerza radiante pueden llevar a una mejora signficativa en el perfil de pacientes con dentición mixta de maloclusión clase III.