ABSTRACT
OBJECTIVE: This cross-sectional study evaluated the bone thickness on mini-implants insertion site, the factors that influence the digital planning of MARPE appliance (miniscrew-assisted rapid palatal expansion), and its different designs. METHODS: A total of 135 plannings were assessed regarding the size of the expander screw used, the positioning and the type of the mini-implant rings, and their location in relation to the teeth. Bone thickness measurements were assessed in the region of the mini-implants' trajectory. Differences between the sexes was verified using the ANOVA test (5% significance). RESULTS: 73 cases were planned with 4 mini-implants and 62 cases, with 6 mini-implants. In 90% of cases, teeth #16 and #26 were used as supports, and the most used expander screw was 13mm (64.1% of cases). The anterior mini-implants of conventional MARPE showed more pronounced insertion in bone in males (5.9 ± 2mm; p= 0.025). The extra mini-implants (anterior region) were inserted with greater bone thickness in males (11.1 ± 2.3mm) compared to females (9.9 ± 1.8mm; p=0.041). A greater bone thickness was observed in males (10.1 ± 2.1 mm) when using mini-implants in the paramedian region. CONCLUSION: Additional rings allow more pronounced bone insertion. Male patients had greater bone thickness, which may be related to greater difficulty in opening the sutures. The alveolar process region seems to be a satisfactory site for mini-implants to those patients with reduced bone thickness in the paramedian posterior region. MARPE appliance must be customized for each patient, due to bone thickness and anatomical variations.
Subject(s)
Bone Screws , Orthodontic Anchorage Procedures , Orthodontic Appliance Design , Palatal Expansion Technique , Humans , Palatal Expansion Technique/instrumentation , Male , Female , Cross-Sectional Studies , Orthodontic Anchorage Procedures/instrumentation , Orthodontic Anchorage Procedures/methods , Adolescent , Sex Factors , Young Adult , Patient Care Planning , Child , AdultABSTRACT
OBJECTIVE: The aim of this randomized clinical trial was to evaluate and compare, during the first week of rapid maxillary expansion (RME), the impact caused by two types of appliances: Hyrax and Hybrid Hyrax. METHODS: Forty-two patients who met the eligibility criteria (aged 11-14 years, with transverse maxillary deficiency, posterior crossbite, and presence of maxillary first premolars and first permanent molars) were selected and randomly divided into two groups: TBB GROUP (tooth-bone-borne expander), treated with Hybrid Hyrax (12 females and 9 males, mean age 13.3 ± 1.3 years), and TB GROUP (tooth-borne expander), treated with Hyrax (5 females and 16 males, mean age 13.3 ± 1.4 years). Pain and discomfort were assessed in two times: after the first day of activation (T1) and four days after, by means of the numerical rate scale and the instrument MFIQ (Mandibular Functional Impairment Questionnaire). Descriptive statistics and the Mann-Whitney test were used for comparison between groups and between sexes. A 5% significance level was adopted. RESULTS: Both appliances had a negative impact, generating pain and discomfort, and reducing functional capacity. However, the scores obtained were of low intensity and no significant differences were observed between the groups. Considering sexes, there were statistically significant differences, with the female sex presenting higher scores for pain and functional limitation. CONCLUSIONS: Despite causing impact in pain and increase in the functional limitation, these changes were of low intensity, with no statistical difference between the groups. Females were more sensitive to the impact caused by the RME.
Subject(s)
Hyraxes , Male , Animals , Humans , Female , Child , Adolescent , Pain Measurement , Palatal Expansion Technique , Molar , PainABSTRACT
ABSTRACT Objective: The aim of this randomized clinical trial was to evaluate and compare, during the first week of rapid maxillary expansion (RME), the impact caused by two types of appliances: Hyrax and Hybrid Hyrax. Methods: Forty-two patients who met the eligibility criteria (aged 11-14 years, with transverse maxillary deficiency, posterior crossbite, and presence of maxillary first premolars and first permanent molars) were selected and randomly divided into two groups: TBB GROUP (tooth-bone-borne expander), treated with Hybrid Hyrax (12 females and 9 males, mean age 13.3 ± 1.3 years), and TB GROUP (tooth-borne expander), treated with Hyrax (5 females and 16 males, mean age 13.3 ± 1.4 years). Pain and discomfort were assessed in two times: after the first day of activation (T1) and four days after, by means of the numerical rate scale and the instrument MFIQ (Mandibular Functional Impairment Questionnaire). Descriptive statistics and the Mann-Whitney test were used for comparison between groups and between sexes. A 5% significance level was adopted. Results: Both appliances had a negative impact, generating pain and discomfort, and reducing functional capacity. However, the scores obtained were of low intensity and no significant differences were observed between the groups. Considering sexes, there were statistically significant differences, with the female sex presenting higher scores for pain and functional limitation. Conclusions: Despite causing impact in pain and increase in the functional limitation, these changes were of low intensity, with no statistical difference between the groups. Females were more sensitive to the impact caused by the RME.
RESUMO Objetivo: O objetivo deste ensaio clínico randomizado foi avaliar e comparar, durante a primeira semana de expansão rápida da maxila (ERM), o impacto causado por dois tipos de aparelhos: Hyrax e Hyrax Híbrido. Métodos: Quarenta e dois pacientes que atendiam aos critérios de seleção (idade de 11 a 14 anos, com deficiência transversal da maxila, mordida cruzada posterior e presença de primeiros pré-molares e primeiros molares permanentes superiores) foram selecionados e divididos aleatoriamente em dois grupos: Grupo DOS (expansor dento-osseossuportado), tratado com Hyrax Híbrido (12 mulheres e 9 homens, idade média 13,3 ± 1,3 anos), e Grupo DS (expansor dentossuportado), tratado com Hyrax (5 mulheres e 16 homens, idade média de 13,3 ± 1,4 anos). A dor e o desconforto foram avaliados em dois momentos: após o primeiro dia de ativação (T1) e após quatro dias, por meio da escala de frequência numérica e do instrumento MFIQ (Questionário de Limitação Funcional Mandibular). A estatística descritiva e o teste de Mann-Whitney foram utilizados para comparação entre os grupos e entre os sexos. Adotou-se nível de significância de 5%. Resultados: Ambos os aparelhos tiveram impacto negativo, gerando dor e desconforto e reduzindo a capacidade funcional. No entanto, os escores obtidos foram de baixa intensidade e não foram observadas diferenças significativas entre os grupos. Considerando os sexos, houve diferenças estatisticamente significativas, com o sexo feminino apresentando maiores escores para dor e limitação funcional. Conclusões: Apesar de causar impacto na dor e aumento na limitação funcional, essas alterações foram de baixa intensidade, sem diferença estatística entre os grupos. As mulheres foram mais sensíveis ao impacto causado pela ERM.
ABSTRACT
OBJECTIVES: To compare, using cone-beam computed tomography, the dentoskeletal changes in rapid maxillary expansion with tooth-bone-borne (Hybrid Hyrax) and tooth-borne (Hyrax) appliances. SETTING AND SAMPLE POPULATION: Forty-two patients who met the eligibility criteria (aged 11-14 years; transverse maxillary deficiency, posterior crossbite, and presence of upper first premolars and molars) were screened and allocated into two groups: HHG (treatment with Hybrid Hyrax) and HG (treatment with Hyrax). MAIN OUTCOME MEASURES: The primary outcomes included nasomaxillary dimensional changes. CBCT was performed before and 3 months after the activation phase. Measurements were performed using Dolphin® . Baseline data were compared using one-way ANOVA. For intergroup comparison, ANCOVA was used to analyze the initial age, appliance activations (mm), and mid-palatal suture maturation data as covariates. Statistical significance was set at 5%. RESULTS: The premolar region in HHG showed increased skeletal changes than in HG, with the difference being 1.5 mm (0.5; 2.6) in the nasal cavity (P = .004), 1.4 mm (0.3; 2.5) in the nasal floor (P = .019), and 1.1 mm (0.2; 2.1) in the maxilla (P = .022). The molar region in HHG showed increased skeletal changes with the difference being 0.9 mm (0.2; 1.5) in the nasal cavity (P = .005), and 0.9 mm (0; 1.8) in the maxilla (P = .042) than in HG. Premolar inclination was higher in HG. CONCLUSION: Hybrid Hyrax showed more skeletal changes and fewer dental side effects, especially in the first premolar region. The amount of activation influenced the higher nasal skeletal changes in the Hybrid hyrax group.
Subject(s)
Hyraxes , Palatal Expansion Technique , Animals , Bicuspid/diagnostic imaging , Cone-Beam Computed Tomography/methods , Maxilla/diagnostic imaging , Orthodontic Appliance DesignABSTRACT
Com o surgimento dos dispositivos de ancoragem temporária (DATs), especialmente os mini-implantes, vislumbrou-se que o controle de todos os movimentos desejados pela ortodontia seria alcançado. Entretanto, para suprir as reais necessidades biomecânicas muitas vezes o desenho da aparatologia necessária deve ser desenvolvida laboratorialmente. Assim, este artigo fornece orientações em relação aos aspectos biomecânicos e como proceder durante o planejamento de aparatologia associada aos DATs
Subject(s)
Biomechanical Phenomena , Dental Implants , Orthodontic Anchorage Procedures , OrthodonticsABSTRACT
É consenso entre os especialistas que a Classe III é a desordem sagital mais difícil de ser tratada. Também é concordante entre os clínicos e a literatura que o tratamento ainda em fase de crescimento favorece o prognóstico neste tipo de má oclusão. Entretanto, as soluções descritas até o momento como padrão ouro de tratamento da retrusão de maxila dificultam a aderência ao tratamento. Este trabalho descreve uma máscara facial individualizada modificada com o propósito de aumentar o conforto e aceitação do paciente e como isso afeta sua aderência ao tratamento, tornando essa terapia ainda mais efetiva
Subject(s)
Humans , Growth and Development , Malocclusion, Angle Class III , Orthodontics , Orthopedic ProceduresABSTRACT
As Disfunções temporomandibulares (DTM) têm sua etiologia e abordagem multifatorial, sendo assim esse artigo se propõe a descrever os procedimentos para se obter o sucesso em mais uma modalidade terapêutica, a placa oclusal. Desmitificando os materiais, as arcadas, os tipos de placas, sua tomada de registro interoclusal, os requisitos básicos e seu mecanismo de ação
Subject(s)
Occlusal Splints , Oral Health , Quality of Life , Temporomandibular Joint Dysfunction SyndromeABSTRACT
Com o advento da ancoragem esquelética a ortodontia alcançou um novo patamar em seus resultados. Entretanto, é possível aumentar o nível de excelência em seus resultados com o auxílio de dispositivos com design especifico para cada movimentação desejada. Isso é conquistado com a parceria ortodontista e ortotécnico. O presente artigo é a primeira parte de uma série na qual discutiremos algumas destas possibilidades. A parte I apresenta a região PENA como sítio preferencial de instalação, devido à grande segurança de instalação e estabilidade
Subject(s)
Dental Implants , Dental Occlusion , Orthodontic Anchorage Procedures , OrthodonticsABSTRACT
O objetivo desse trabalho é mostrar um novo sistema de distalização de molares superiores no tratamento de más oclusões de Classe II dentoalveolar, com ancoragem esquelética por meio de dois mini-implantes ou DATs no palato, na região paramediana em direção à espinha nasal anterior. Descrever conceitos básicos dos mini-implantes, sítios de instalação, confecção laboratorial (posicionamento do torno, braço de conexão, ganchos anteriores e soldagem), instalação dos mini-implantes e do aparelho SCREW-DIS. A ancoragem óssea reduzirá os efeitos adversos previstos nos sistemas convencionais de distalização, possibilitando um controle maior da distalização e diminuindo o tempo de tratamento