Evaluation of facial pleasantness in patients with complete and unilateral cleft lip and palate rehabilitated and submitted to orofacial harmonization.

OBJECTIVE: The objective of the present prospective case control study was to evaluate the facial pleasantness of patients with complete and unilateral cleft lip and palate at the end of interdisciplinary rehabilitation, submitted to facial fillers based on hyaluronic acid. METHODS: The study group consisted of 18 individuals with complete unilateral cleft lip and palate, aged between 18 and 40 years (mean age 29 years) of both sexes. The patients presented a concave profile with mild to moderate maxillary deficiency, with completed orthodontic treatment and conducted by means of dentoalveolar compensations without orthognathic surgery. Participants underwent facial filling procedures with hyaluronic acid (HA) in the midface, inserted by a single operator. Standard photographs in frontal norm at rest, right profile at rest, and left profile at rest were obtained from each patient at the following operative times: (T1) pre-filler and (T2) and one-month post-filler. The photographs in T1 and T2 were randomly placed on a page of a virtual album. A 5-point Likert scale was used to assess facial pleasantness. The photographs were evaluated by two groups of evaluators consisting of 18 individuals with cleft lip and palate (CLPG=18) and 18 orthodontists with experience in the treatment of clefts (OG=18). For comparison between phases T1 and T2, and between evaluators with orofacial clefts and orthodontists, the Wilcoxon test was used (p<0,05). RESULTS: People with cleft lip and palate rated their face as more pleasant after the midface filling procedure. In the perception of the orthodontists, on the other hand, the facial pleasantness remained similar after the facial filling procedure. CONCLUSIONS: The filling of the middle third of the face in patients with cleft lip and palate treated without orthognathic surgery increased the pleasantness of the face in the opinion of laypeople with cleft lip and palate.

Evaluation of facial pleasantness in patients with complete and unilateral cleft lip and palate rehabilitated and submitted to orofacial harmonization

ABSTRACT Objective: The objective of the present prospective case control study was to evaluate the facial pleasantness of patients with complete and unilateral cleft lip and palate at the end of interdisciplinary rehabilitation, submitted to facial fillers based on hyaluronic acid. Methods: The study group consisted of 18 individuals with complete unilateral cleft lip and palate, aged between 18 and 40 years (mean age 29 years) of both sexes. The patients presented a concave profile with mild to moderate maxillary deficiency, with completed orthodontic treatment and conducted by means of dentoalveolar compensations without orthognathic surgery. Participants underwent facial filling procedures with hyaluronic acid (HA) in the midface, inserted by a single operator. Standard photographs in frontal norm at rest, right profile at rest, and left profile at rest were obtained from each patient at the following operative times: (T1) pre-filler and (T2) and one-month post-filler. The photographs in T1 and T2 were randomly placed on a page of a virtual album. A 5-point Likert scale was used to assess facial pleasantness. The photographs were evaluated by two groups of evaluators consisting of 18 individuals with cleft lip and palate (CLPG=18) and 18 orthodontists with experience in the treatment of clefts (OG=18). For comparison between phases T1 and T2, and between evaluators with orofacial clefts and orthodontists, the Wilcoxon test was used (p<0,05). Results: People with cleft lip and palate rated their face as more pleasant after the midface filling procedure. In the perception of the orthodontists, on the other hand, the facial pleasantness remained similar after the facial filling procedure. Conclusions: The filling of the middle third of the face in patients with cleft lip and palate treated without orthognathic surgery increased the pleasantness of the face in the opinion of laypeople with cleft lip and palate.

RESUMO Objetivo: O objetivo do presente estudo caso-controle prospectivo foi avaliar a agradabilidade facial de pacientes com fissura labiopalatina completa e unilateral ao final da reabilitação interdisciplinar, submetidos a preenchimentos faciais à base de ácido hialurônico. Métodos: O grupo de estudo foi composto por 18 indivíduos com fissura labiopalatina unilateral completa, com idade entre 18 e 40 anos (média de 29 anos), de ambos os sexos. Os pacientes apresentavam perfil côncavo com deficiência maxilar leve a moderada, com tratamento ortodôntico concluído e realizado por meio de compensações dentoalveolares sem cirurgia ortognática. Os participantes foram submetidos a procedimentos de preenchimento facial com ácido hialurônico (AH) no terço médio da face, implantado por um único operador. Fotografias padrão em norma frontal em repouso, perfil direito em repouso e perfil esquerdo em repouso foram obtidas de cada paciente nos seguintes tempos operatórios: (T1) pré-preenchimento e (T2) um mês pós-preenchimento. As fotografias em T1 e T2 foram inseridas aleatoriamente em uma página de um álbum virtual. Uma escala Likert de 5 pontos foi utilizada para avaliar a agradabilidade facial. As fotografias foram avaliadas por dois grupos de avaliadores formados por 18 indivíduos com fissura labiopalatina (GFLP=18) e 18 ortodontistas com experiência no tratamento de fissuras (GO=18). Para comparação entre as fases T1 e T2, e entre avaliadores com fissura labiopalatina e ortodontistas, foi utilizado o teste de Wilcoxon (p<0,05). Resultados: As pessoas com fissura labiopalatina avaliaram seu rosto como mais agradável após o preenchimento do terço médio da face. Já na percepção do ortodontista, a agradabilidade facial permaneceu semelhante após o procedimento de preenchimento facial. Conclusões: O preenchimento do terço médio da face em pacientes com fissura labiopalatina tratados sem cirurgia ortognática aumentou a agradabilidade da face na opinião dos leigos com fissura labiopalatina.

Bone stress and strain after use of a miniplate for molar protraction and uprighting: a 3-dimensional finite element analysis.

INTRODUCTION: The aim of this study was to use the finite element method to evaluate the distribution of stresses and strains on the local bone tissue adjacent to the miniplate used for anchorage of orthodontic forces. METHODS: A 3-dimensional model composed of a hemimandible and teeth was constructed using dental computed tomographic images, in which we assembled a miniplate with fixation screws. The uprighting and mesial movements of the mandibular second molar that was anchored with the miniplate were simulated. The miniplate was loaded with horizontal forces of 2, 5, and 15 N. A moment of 11.77 N·mm was also applied. The stress and strain distributions were analyzed, and their correlations with the bone remodeling criteria and miniplate stability were assessed. RESULTS: When orthodontic loads were applied, peak bone strain remained within the range of bone homeostasis (100-1500 µ strain) with a balance between bone formation and resorption. The maximum deformation was found to be 1035 µ strain with a force of 5 N. At a force of 15 N, bone resorption was observed in the region of the screws. CONCLUSIONS: We observed more stress concentration around the screws than in the cancellous bone. The levels of stress and strain increased when the force was increased but remained within physiologic levels. The anchorage system of miniplate and screws could withstand the orthodontic forces, which did not affect the stability of the miniplate.

Arco duplo helicoide palatino fixo: O arco indesejável para o hábito de sucção do polegar / Double helicoidal palatal arch. The undesirable arch for thumb sucking habit

A mordida aberta anterior é a má oclusão mais freqüente dentre as consequências do hábito de sucção do polegar. No presente relato de caso clínico, na fase de dentição mista com má oclusão Classe II divisão 1 subdivisão direita, mordida aberta anterior e palato profundo, preconizou-se um aparelho fixo com uma configuração diferenciada na região da curvatura anterior do palato constituída de duplo helicoide para impedir, de forma mecânica, o hábito de sucção do polegar da mão direita e interceptar a mordida aberta anterior. Após três meses de tratamento ocorreu a eliminação do hábito, correção da mordida aberta anterior e normalização do overjet. A estabilidade da conduta clínica empregada foi constatada após três anos de remoção do hábito de sucção.

Anterior open bite is the most frequent malocclusion among the consequences for thumb sucking habit. In this Angle Class II, 1 malocclusion, in mixed dentition and na open bite, it was used a fixed appliance with a differentiated configuration in the anterior curvature of the palate. This device consisted in a allow double helix to prevent sucking the thumb and the anterior open bite to close. After three months of treatment it was observed the correction of anterior open bite and normalization of overjet. The stability of treatment was found after three years of removing the sucking habit. The main reason was the elimination of the thumb sucking habit.

Upper molar intrusion in rehabilitation patients with the aid of microscrews.

BACKGROUND: Overeruption of an upper molar following loss of the opposing tooth is a common clinical finding. Rehabilitation can be difficult when the interocclusal space is reduced. AIM: To intrude an overerupted upper first molar and replace the missing lower first molar. METHODS: Buccal and palatal microscrews and a transpalatal bar were placed. The palatal miniscrew loosened shortly after implantation and was not replaced. A short length of elastomeric chain from the buccal miniscrew applied 30 g of force to the overerupted molar. The elastomeric chain was replaced every four weeks. RESULTS: Sufficient intrusion of the upper molar was obtained in 4 months. CONCLUSION: A single buccal microscrew and transpalatal arch can be used to intrude an overerupted upper molar.

Remoçäo cirúrgica de mucocele / Mucoceles: a clinical case report

Mucocele é um termo utilizado para diagnosticar clinicamente dois fenômenos que podem acometer as glândulas salivares menores, sendo eles: o fenômeno de extravasamento e o cisto de retençäo mucoso. Embora essas lesöes sejam muito freqüentes na cavidade bucal, existe ainda certa confusäo em relaçäo a esses termos. Os autores relatam um caso clínico de mucocele, discutindo a etiopatogenia e as características clínicas que levaram ao diagnóstico clínico da lesäo, bem como o prognóstico, o tratamento e as características histológicas da mesma