Comparisons of soft tissue changes after Herbst appliance treatment in three different growth phases.

BACKGROUND: This study aimed to compare the soft tissue effects of Herbst appliance in Class II malocclusion patients treated in three different craniofacial growth phases: prepubertal (PRE), circumpubertal (CIR), and postpubertal (POS). METHODS: In total, 95 patients with Class II Division 1 malocclusion previously treated with a Herbst appliance were analyzed. Through the cervical vertebral maturation stages method, patients were allocated into three groups depending on the growth craniofacial phase at the beginning of treatment: PRE, CIR, and POS. Seventeen cephalometric measures were evaluated from each lateral radiograph before and after Herbst therapy using the Radiocef 2 software (Radio Memory, Belo Horizonte). Intragroup and intergroup treatment changes were compared statistically using a paired t test and MANOVA test, respectively. RESULTS: Soft tissue thickness changes were related only to mandible; all three mandibular measurements (L1_LL, B_B', and Pog_Pog') showed thickening for the PRE group ranging from 0.92 mm (Pog_Pog') to 2.02 mm (B_B'), and only lower lip thickened overtime for the POS group (L1_LL = 0.99 mm). Soft and hard tissue pogonion displaced anteriorly, but only the soft tissue showed differences among groups; PRE group presented more anterior displacement than POS group (3.61 mm and 1.39 mm, respectively). Hard and soft tissue facial convexity decreased more in the PRE and CIR groups than in the POS group. Mentolabial sulcus depth reduced more in the PRE (1.07 mm) and CIR (1.29 mm) groups than in the POS (0.55 mm) group. Horizontal movement of the skeletal and soft pogonion presented a moderate-high positive correlation (r = 0.783), and hard and soft facial convexity showed a moderate-low positive correlation (r = 0.403). CONCLUSIONS: Herbst appliance therapy produces soft tissue improvements in the three phases of craniofacial growth, being greater in patients in the PRE and CIR phases.

Má oclusão de Classe III, subdivisão associada à mordida cruzada posterior unilateral e à biprotrusão dentoalveolar ­ tratamento corretivo do Padrão I em adulto jovem / Class III subdivision malocclusion associated to unilateral posterior crossbite and dentoalveolar biprotrusion ­ corrective treatment of Pattern I in young adult

Resumo Indivíduos adultos com má oclusão de mordida cruzada posterior apresentam prognóstico ruim para Expansão Rápida da Maxila (ERM), quando não associada aos dispositivos de ancoragem esquelética temporários ou cirurgia. O objetivo deste estudo foi analisar os efeitos do tratamento ortodôntico corretivo em indivíduo Padrão I com má oclusão de Classe III, subdivisão esquerda associada à mordida cruzada posterior unilateral esquerda e à biprotrusão dentoalveolar em paciente adulto jovem. A correção da mordida cruzada posterior ocorreu pela abertura da sutura palatina mediana, sendo utilizado o disjuntor Haas, o qual ocasionou ulcerações na mucosa palatina e foi substituído pelo disjuntor Hyrax. Imediatamente após a remoção do expansor, instalou-se aparelho ortodôntico pré-ajustado para o alinhamento e nivelamento. Obteve-se a correção da biprotrusão dentoalveolar por meio da extração dos quatro primeiros pré-molares, utilizando-se mecânica ortodôntica para retração dos dentes anteriores e fechamento dos espaços. Foram avaliados os resultados cefalométricos, oclusão e face. O resultado do tratamento propiciou uma relação de Classe I normal tratada com sobressaliência horizontal e vertical corretas, assim como melhora do perfil facial do paciente. Conclui-se que a ERM, sem dispositivos de ancoragem esquelética ou cirurgia, foi efetiva na correção da mordida cruzada posterior no adulto jovem, assim como o aparelho ortodôntico pré-ajustado associado à extração dos quatro primeiros pré-molares para o tratamento da biprotrusão. O correto diagnóstico, plano de tratamento, mecânica ortodôntica e contenção favoreceram a obtenção de uma relação de Classe I, oclusão normal tratada ao final do tratamento, assim como a estabilidade do tratamento dois anos após o término.(AU)

Abstract Adult individuals with posterior crossbite malocclusion show poor prognostic for Rapid Palatal Expansion (RPE), when not associated to temporary skeletal anchorage devices or surgery. This study aimed to analyze the effects of orthodontic corrective treatment of Pattern I individual with Class III left subdivision malocclusion associated to unilateral posterior left side crossbite and dentoalveolar biprotrusion in young adult patient. The correction of unilateral posterior left side crossbite was obtained by midpalatal suture opening, being performed the RPE with Haas appliance, that caused palatal ulceration and was replaced by Hyrax appliance. Immediately after the expander appliance removal, pre-adjusted orthodontic appliance was installed for alignment and leveling. The correction of dentoalveolar biprotrusion was performed by extraction of four first premolars, using orthodontic mechanics for retraction of anterior teeth and spaces closure. The cephalometric, occlusion and face results were evaluated. The correction of Class III left subdivision malocclusion, unilateral posterior left side crossbite and dentoalveolar biprotrusion provided Class I normal occlusal relationship with normal overjet and overbite, as well as improvement of patient facial profile. Therefore, it was concluded that RPE, without temporary skeletal anchorage devices or surgery, was effective in correcting posterior crossbite malocclusion in young adult, as well as the pre-adjusted orthodontic appliance associated to the extraction of four first premolars for the treatment of dentoalveolar biprotrusion. The accurate diagnostic, treatment plan, orthodontic mechanic and retention allowed a Class I relationship, treated normal occlusal at the end of the treatment, as well as stability two years after the end. (AU)

Effects of Herbst Appliance Treatment on the Mandibular Incisor Segment: a ThreeDimensionally Analysis / Efeitos do Tratamento com Aparelho Herbst no Segmento Incisivo Inferior: uma Análise Tridimesional

Abstract Three-dimensionally evaluation of the treatment changes of a Herbst appliance using a lower anchorage unit not touching the lingual surface of the lower incisors. The sample consisted of 23 Class II:1 patients (12 males, 11 females) with a mean age of 15.7±1.7 years treated with a Flip-Lock Herbst® appliance (TP Orthodontics, Inc., La Porte, IN, USA). The lower anchorage unit for the Herbst appliance consisted of two anchor bands connected by a lingual arch with 3mm distance from the incisor's lingual surface. Treatment changes in mandibular incisor inclination, overjet and overbite were evaluated by means of cone beam computed tomography images (i-CAT® Classic unit, Imaging Sciences International, Hatfield, PA, USA) obtained before and after treatment with the Herbst appliance. On average, there was a statistically significant increase in mandibular incisor inclination (2.6+1.8°) and a reduction in overjet (3.2+2.2mm) and overbite (1.3+0.9mm). Genders did not differ significantly. Incisor proclination was however only seen in 74% of the patients. The changes in mandibular incisor inclination were associated with the changes in overjet (/r/ = 0.1 to 0.5) and overbite (/r/ = 0.3 to 0.7). A Herbst appliance with a mandibular anchorage unit distant from the incisor's lingual surface results in smaller amounts of mandibular incisor proclination compared to literature. However, as it induces canine anchorage loss, the decreased amount of proclination may not prevail after multibracket treatment.(AU)

Resumo Avaliação tridimensional das alterações induzidas pelo aparelho Herbst utilizando a unidade de ancoragem inferior afastada da superfície lingual dos incisivos. A amostra incluiu 23 pacientes Classe II:1 (12 masculino, 11 feminino), média de idade 15,7 ± 1,7, tratados com aparelho Herbst Flip-Lock® (TP Orthodontics, Inc., La Porte, IN, EUA). A unidade de ancoragem inferior do aparelho Herbst consistiu-se de duas bandas conectadas por um arco lingual afastado 3mm da superfície lingual do incisivo. As alterações induzidas pelo tratamento na inclinação dos incisivos inferiores, trespasse horizontal e trespasse vertical foram avaliadas por meio de imagens de tomografias computadorizadas de feixe cônico (i-CAT® Classic unit, Imaging Sciences International, Hatfield, PA, USA) obtidas antes e após o tratamento com aparelho Herbst. Na média, houve diferença significativa com aumento da inclinação dos incisivos inferiores (2,6+1,8°) e diminuição do trespasse horizontal (3,2+2,2mm) e do trespasse vertical (1,3+0,9mm). Não houve diferença estatística entre os sexos. No entanto, a vestibularização do incisivo ocorreu em apenas 74% dos pacientes. As alterações na inclinação dos incisivos inferiores apresentam correlação estatisticamente significativa com as alterações no trepasse horizontal (/r/ = 0,1 a 0,5) e no trespasse vertical (/r/ = 0,3 a 0,7). O aparelho Herbst com uma unidade de ancoragem inferior afastada da superfície lingual dos incisivos resulta em menor quantidade de vestibularização do incisivo inferior em comparação com a literatura. Entretanto, como isto induz perda de ancoragem do canino, a diminuição da vestibularização pode não prevalecer ao final tratamento ortodôntico com braquetes. (AU)

Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment.

INTRODUCTION: This study compared the skeletal and dental changes of microimplant assisted rapid palatal expansion (MARPE) with those produced by surgically assisted rapid maxillary expansion (SARPE) in postpeak adolescents and adults. METHODS: The sample comprised 17 patients (mean age, 26 ± 11 years) selected for the MARPE group and 15 (mean age, 28.5 ± 10.5 years) selected for the SARPE group. Cone-beam computed tomography scans taken just before and after the expansion were used to assess dental and skeletal changes and compare the changes between the groups. RESULTS: MARPE showed greater transversal skeletal changes in the midface and posterior and anterior maxillary base measurements. The transverse displacement of the alveolar process was greater but not significant for the SARPE group than the MARPE group. Regarding dental effects, the root distance measurements did not differ between the groups, but SARPE produced a significantly greater increase in intermolar and interpremolar distance and a greater buccal inclination of the alveolar process and supporting teeth than MARPE. CONCLUSIONS: The MARPE technique showed an increase in skeletal transverse maxillary expansion at the midface and basal bone compared with SARPE, especially at the posterior palatal region; however, no difference was found in the expansion of the alveolar process between the 2 methods. MARPE presented a more parallel expansion in both a coronal and axial view, whereas SARPE led to a V-shaped opening. The greater buccal inclination of the alveolar process and supporting teeth was observed in the SARPE group.

As diferentes formas de ancoragem para o aparelho Herbst / Different forms of anchorage for Herbst appliance

Introdução: O aparelho ortopédico mecânico Herbst destaca-se entre os aparelhos que estimulam o avanço mandibular. Objetivo: Esse artigo demonstra diferentes formas de ancoragem para o aparelho Herbst. Método: Descrevem-se formas distintas de ancoragem, variando desde ancoragem com banda ortodôntica, com esplinte acrílico, com esplinte metálico, associadas ou não ao parafuso expansor. Conclusão: A escolha do tipo de ancoragem para o aparelho Herbst é dependente do plano de tratamento ortodôntico e definida de forma individual para cada paciente.

Introduction: Herbst mechanical orthopedic device stands out among the devices that stimulate the mandibular advancement. Objective: This paper describes different forms of Herbst appliance anchorage. Method: Distinct forms of Herbst appliance anchorage are described varying from orthodontic band, acrylic splint, metallic splint ancorage associated or not with expansion screw. Conclusions: The choice of Herbst appliance anchorage is dependent of orthodontic treatment planning and defined individually for each patient.

Analysis of the smile photograph.

Optimal facial esthetics is one of the objectives in orthodontic treatment and an important issue in modern society. In this context, orthodontic treatment permits individuals with dental malpositions to achieve improved dentofacial esthetics. To reach this result, the orthodontist needs to recognize the characteristics considered normal and pleasant in dental arches and smiles. The objective of this article is to review and discuss criterion adopted by dental literature to technically analyze the smile, such as dental midline, smile line, dental exposure, negative space, dental proportion, and symmetry. This article proposes a way to visualize an ideal smile for each patient.

Comparação entre endoscopia nasofaringeana e telerradiografia cefalométrica lateral no diagnóstico da obstrução do espaço aéreo nasofaringeano / A comparison of nasopharyngeal endoscopy and lateral cephalometric rediography in the diagnosis of nasopharyngeal airway obstruction

Foram comparados dois métodos auxiliares de diagnóstico das obstruções nasofaringianas: telerradiografia cefalométrica lateral e videoendoscopia nasofaringiana, para avaliar a eficácia dos mesmos através do estudo de reprodutibilidade e validade. Trinta pacientes ortodônticos, idade entre 7 e 12 anos, com um padrão de respiração predominantemente bucal ou mista, persistente a tratamento otorrinolaringológico, realizaram, no mesmo dia, exames radiográfico e endoscópico nasofaringiano. Dois médicos otorrinolaringologistas analisaram os exames e emitiram o diagnóstico. Os resultados evidenciaram que a endoscopia nasal foi mais confiável ao diagnosticar os diversos processos obstrutivos nasofaringianos. Utilizando o índice Kappa, a endoscopia mostrou nível de concordância diagnóstica quase perfeito para o diagnóstico do desvio de septo posterior, substancial para o desvio de septo anterior e para hipertrofia do cometo inferior e moderado para a hipertrofia do cometo médio. A telerradiografia cefalométrica lateral apresentou concordância perfeita para o diagnóstico da imagem do cometo médio; quase perfeita para a cauda do cometo inferior e substancial para a imagem do cometo inferior. O estudo de validade mostrou alta sensibilidade e baixa especificidade da radiografia ao diagnosticar a hipertrofia dos cometos nasais inferior e médio, quando comparada ao diagnóstico endoscópico verdade