In vitro enamel surface roughness analysis of 4 methods for removal of remaining orthodontic adhesive after bracket debonding.

OBJECTIVES: To perform an in vitro qualitative and quantitative evaluation of the enamel surface (by scanning electronic microscopy [SEM] and measuring polishing time and roughness analysis, respectively) among four methods to remove remaining orthodontic adhesive after bracket debonding. MATERIALS AND METHODS: Forty-one human premolars were randomly divided into four groups (n = 10) according to the adhesive remnant removal method and one tooth was used as control: Group 1 (G1): Enhance (Dentsply, Milford, USA); Group 2 (G2): Fiberglass (TDV, Pomerode, Brazil); Group 3 (G3): DU10CA-Ortho (Dian Fong Industrial, Shenzhen, China); Group 4 (G4): Sof-Lex Pop-On (3M ESPE, Seefeld, Germany). Roughness was measured before bonding and after complete removal of the remaining adhesive (Ra2). SEM analysis was performed on one sample of each group after adhesive removal and polishing. The time required for adhesive remnant removal and polishing was measured in all groups. Analysis of variance and Tukey post hoc for pairwise comparison was applied to compare polishing times among groups and analysis of covariance was used to compare Ra2 means. RESULTS: Comparison between groups show that G4 presented the lowest Ra2 mean (0.43 µm)c followed by G3 (0.71 µm)ac, G1 (1.06 µm)ab, and G2 (1.21 µm)b - different letters, statistically different at P ≤ 0,05. In addition, Fiberglass was more time-consuming for adhesive remnant removal than other methods (P ≤ .05). SEM analysis showed that some enamel damage occurred for all methods. CONCLUSIONS: All methods were able to remove the remaining adhesive and polish the enamel. The DU10CA-Ortho and Sof-Lex methods promoted better polishing of the enamel surface and exhibited a similar time-consuming process.

Há diferença entre as alterações na amplitude da cavidade nasal após expansão maxilar rápida e lenta? / Is there any difference between alterations in the nasal cavity amplitude after slow and rapid maxillary expansion?

Resumo Introdução: O objetivo deste estudo clínico retrospectivo foi verificar os efeitos da Expansão Maxilar Rápida (EMR) e Expansão Maxilar Lenta (EML) na cavidade nasal e seio maxilar em pacientes com dentição mista, por meio de Tomografia Computadorizada de Feixe Cônico (TCFC). Material e Métodos: Trinta e nove crianças entre 7 e 10 anos foram divididas em dois grupos: EMR (n=20) e EML (n=19). Ambos os grupos tiveram a mesma quantidade de expansão maxilar (8mm), mas com diferentes protocolos (EMR=0.4mm/dia, EML=0.4mm/semana). Três diferentes áreas da cavidade nasal foram avaliadas: Anterior (CNA), Intermediária (CNI) e Posterior (CNP), bem como o seio maxilar na região mais anterior (SN). As alterações em cada grupo foram avaliadas através do test t pareado. Teste t student foi utilizado para verificar a diferença entre os grupos. O teste de Scheffé post hoc e ANOVA two-way foram utilizados para comparações múltiplas dentro de cada grupo. Resultados: A expansão maxilar promoveu aumento da largura da cavidade nasal nos dois grupos. Embora não significativa, a cavidade nasal apresentou maiores expansões de anterior para posterior (CNA= 2.23mm, CNI=1.73mm e CNP=1.54mm) no grupo EMR. Nenhum dos dois grupos apresentaram alterações significativas na amplitude do seio maxilar. Conclusões: A expansão maxilar promove aumento na amplitude da cavidade nasal na expansão maxilar rápida e lenta.(AU)

Abstract Introduction: The purpose of this retrospective clinical study was to evaluate the effects in nasal cavity and maxillary sinus of the Rapid Maxillary Expansion (RME) and the Slow Maxillary Expansion (SME) in mixed dentition patients using Cone Beam Computed Tomography (CBCT). Material and Methods: Thirty-nine children between 7-10 years old were allocated into two groups: RME (n=20) and SME (n=19). Both groups received the same amount of expansion (8mm), but with different protocols (RME=0.4mm/day and SME=0.4mm/week). Three different areas of the nasal cavity were evaluated: Anterior (ANC), Intermediate (INC), and Posterior (PNC). Student t-test and paired t-test were applied to comparison between and within group changes. Scheffé post hoc test and two-way ANOVA were used for multiple comparisons within each group. Results:Both Rapid Maxillary Expansion (RME) and Slow Maxillary Expansion (SME) promoted widening of the nasal cavity. Although not significant, RME presented larger widening from anterior to posterior areas of the nasal cavity (ANC=2.23mm, INC=1.73mm, e PNC=1.54mm). None of the groups showed significant alterations in the maxillary sinus amplitude. Conclusions: Maxillary expansion promotes widening in the nasal cavity amplitude in Rapid Maxillary Expansion (RME) and Slow Maxillary Expansion (SME). (AU)

A 3-D evaluation of transverse dentoalveolar changes and maxillary first molar root length after rapid or slow maxillary expansion in children.

OBJECTIVE: The objective of the present study was to conduct a randomized clinical trial comparing the effects of rapid maxillary expansion (RME) and slow maxillary expansion (SME). Maxillary permanent first molar root length and tooth movement through the alveolus were studied using cone-beam computed tomography (CBCT). METHODS: Subjects with maxillary transverse deficiencies between 7 and 10 years of age were included. Using Haas-type expanders, children were randomly assigned to two groups: RME (19 subjects, mean age of 8.60 years) and SME (13 subjects, mean age of 8.70 years). RESULTS: Buccal cortical, buccal bone thicknesses and dentoalveolar width decreased in both groups. In the RME group the greatest decrease was related to distal bone thickness (1.26 mm), followed by mesial bone thickness (1.09 mm), alveolar width (0.57 mm), and the buccal cortical (0.19 mm). In the SME group the mesial bone thickness decreased the most (0.87 mm) and the buccal cortical decreased the least (0.22 mm). The lingual bone thickness increased in the RME and SME groups (0.56 mm and 0.42 mm, respectively). The mesial root significantly increased in the RME group (0.52 mm) and in the SME group (0.40 mm), possibly due to incomplete root apex formation at T1 (prior to installation of expanders). CONCLUSIONS: Maxillary expansion (RME and SME) does not interrupt root formation neither shows first molar apical root resorption in juvenile patients. Although slightly larger in the RME group than SME group, both activation protocols showed similar buccal bone thickness and lingual bone thickness changes, without significant difference; and RME presented similar buccal cortical bone changes to SME.

A 3-D evaluation of transverse dentoalveolar changes and maxillary first molar root length after rapid or slow maxillary expansion in children

ABSTRACT Objective: The objective of the present study was to conduct a randomized clinical trial comparing the effects of rapid maxillary expansion (RME) and slow maxillary expansion (SME). Maxillary permanent first molar root length and tooth movement through the alveolus were studied using cone-beam computed tomography (CBCT). Methods: Subjects with maxillary transverse deficiencies between 7 and 10 years of age were included. Using Haas-type expanders, children were randomly assigned to two groups: RME (19 subjects, mean age of 8.60 years) and SME (13 subjects, mean age of 8.70 years). Results: Buccal cortical, buccal bone thicknesses and dentoalveolar width decreased in both groups. In the RME group the greatest decrease was related to distal bone thickness (1.26 mm), followed by mesial bone thickness (1.09 mm), alveolar width (0.57 mm), and the buccal cortical (0.19 mm). In the SME group the mesial bone thickness decreased the most (0.87 mm) and the buccal cortical decreased the least (0.22 mm). The lingual bone thickness increased in the RME and SME groups (0.56 mm and 0.42 mm, respectively). The mesial root significantly increased in the RME group (0.52 mm) and in the SME group (0.40 mm), possibly due to incomplete root apex formation at T1 (prior to installation of expanders). Conclusions: Maxillary expansion (RME and SME) does not interrupt root formation neither shows first molar apical root resorption in juvenile patients. Although slightly larger in the RME group than SME group, both activation protocols showed similar buccal bone thickness and lingual bone thickness changes, without significant difference; and RME presented similar buccal cortical bone changes to SME.

RESUMO Objetivo: o objetivo do presente trabalho foi realizar um estudo clínico randomizado comparando os efeitos da expansão rápida da maxila (ERM) e da expansão lenta da maxila (ELM). O comprimento radicular do primeiro molar superior permanente e o deslocamento dentro do alvéolo foram estudados por meio de imagens de tomografia computadorizada de feixe cônico (TCFC). Métodos: pacientes com deficiência maxilar transversal e faixa etária entre 7 e 10 anos foram incluídos no estudo. As crianças foram distribuídas em dois grupos: ERM (19 indivíduos com idade média de 8,60 anos) e ELM (13 indivíduos com idade média de 8,70 anos). Em ambos os grupos foi utilizado o aparelho expansor tipo Haas. Resultados: a cortical vestibular, a espessura do osso vestibular e a largura dentoalveolar sofreram redução nos dois grupos. No grupo ERM, a maior redução foi relacionada com a espessura do osso distal (1,26 mm), seguida pela espessura do osso mesial (1,09 mm), largura alveolar (0,57 mm) e, finalmente, pela cortical vestibular (0,19 mm). Já no grupo ELM, a espessura do osso mesial apresentou maiores valores de redução (0,87 mm), enquanto a cortical vestibular teve a menor redução (0,22 mm). A espessura do osso lingual aumentou nos dois grupos, sendo 0,56 mm no grupo ERM e 0,42 mm no grupo ELM. A raiz mesial aumentou significativamente nos grupos ERM (0,52 mm) e ELM (0,40 mm) - possivelmente, em função da rizogênese incompleta ainda em T1 (antes da instalação do aparelho). Conclusões: a expansão maxilar (ERM e ELM) não interrompe a formação ou leva à reabsorção radicular nos primeiros molares permanentes de pacientes jovens. Embora discretamente maiores no grupo ERM, as modificações na espessura do osso vestibular e lingual demonstradas pelos protocolos de ativação não apresentam diferenças significativas. O grupo ERM apresentou alterações semelhantes ao grupo ELM, em relação à cortical óssea vestibular.

Understanding the basis of space closure in Orthodontics for a more efficient orthodontic treatment.

INTRODUCTION: Space closure is one of the most challenging processes in Orthodontics and requires a solid comprehension of biomechanics in order to avoid undesirable side effects. Understanding the biomechanical basis of space closure better enables clinicians to determine anchorage and treatment options. In spite of the variety of appliance designs, space closure can be performed by means of friction or frictionless mechanics, and each technique has its advantages and disadvantages. Friction mechanics or sliding mechanics is attractive because of its simplicity; the space site is closed by means of elastics or coil springs to provide force, and the brackets slide on the orthodontic archwire. On the other hand, frictionless mechanics uses loop bends to generate force to close the space site, allowing differential moments in the active and reactive units, leading to a less or more anchorage control, depending on the situation. OBJECTIVE: This article will discuss various theoretical aspects and methods of space closure based on biomechanical concepts.

Understanding the basis of space closure in Orthodontics for a more efficient orthodontic treatment

ABSTRACT Introduction: Space closure is one of the most challenging processes in Orthodontics and requires a solid comprehension of biomechanics in order to avoid undesirable side effects. Understanding the biomechanical basis of space closure better enables clinicians to determine anchorage and treatment options. In spite of the variety of appliance designs, space closure can be performed by means of friction or frictionless mechanics, and each technique has its advantages and disadvantages. Friction mechanics or sliding mechanics is attractive because of its simplicity; the space site is closed by means of elastics or coil springs to provide force, and the brackets slide on the orthodontic archwire. On the other hand, frictionless mechanics uses loop bends to generate force to close the space site, allowing differential moments in the active and reactive units, leading to a less or more anchorage control, depending on the situation. Objective: This article will discuss various theoretical aspects and methods of space closure based on biomechanical concepts.

RESUMO Introdução: O fechamento de espaços é um dos processos mais desafiadores na Ortodontia e requer uma compreensão sólida de conceitos biomecânicos, a fim de se evitar efeitos colaterais indesejáveis. Compreender o fundamento biomecânico do fechamento de espaços possibilita uma melhor definição das opções de ancoragem e tratamento, por parte dos clínicos. Apesar de haver uma variedade de desenhos de aparelhos ortodônticos, o fechamento de espaços pode ser realizado por meio da mecânica com atrito ou sem atrito, e cada técnica apresenta vantagens e desvantagens. A mecânica com atrito, ou mecânica de deslizamento, é atraente em virtude de sua facilidade, o espaço é fechado por meio do uso de elásticos ou molas helicoidais, que produzem força, fazendo com que os braquetes deslizem no arco ortodôntico. Por outro lado, a mecânica sem atrito se utiliza de dobras em alças para gerar força para fechar o espaço, possibilitando momentos diferenciais nas unidades ativa e reativa, induzindo a uma ancoragem mais ou menos controlada, dependendo da situação. Objetivo: o presente artigo discutirá vários aspectos teóricos e métodos de fechamento de espaços, baseando-se em conceitos biomecânicos.

Fissuras labiopalatinas – diagnóstico e tratamento contemporâneos / Cleft Lip and Palate – contemporary diagnosis and treatment

As deformidades dentofaciais acentuadas, entre as quais estão as fissuras labiopalatais, são as que mais dificuldade impõem ao cirurgião dentista no seu reconhecimento, diagnóstico e planejamento do tratamento. Este artigo objetiva reunir informações atuais sobre as fissuras labiopalatais, servindo como fonte para pesquisa, auxiliando no diagnóstico e propiciando noções básicas sobre o plano de tratamento

Severe dentofacial deformities, among which are the Cleft Lip and Palate are the most demanding to the dentist in recognition, diagnosis and treatment planning. This article aims to gather current information about the Cleft Lip and Palate, serving as a source for research, aiding in the diagnosis and providing basics of the treatment plan.

Avaliação longitudinal em pacientes com má oclusão de Classe II Divisão 1 submetidos ao tratamento ortodôntico sem extrações – análise de modelos / Long-term evaluation in Class II Division 1 patients after nonextraction orthodontic treatment – Dental cast analysis

O objetivo deste estudo longitudinal foi avaliar as alterações dentárias pós-tratamento e em longo prazo em pacientes Classe II Divisão 1 de Angle tratados com aparelho extrabucal cervical e aparelho ortodôntico fixo sem extrações dentárias. Os modelos dentários de 33 pacientes foram avaliados no pré-tratamento (T1), pós-tratamento (T2) e pós-contenção (T3). Os pacientes apresentavam em média 10,7 anos em T1, 15,1 anos em T2, e 26,2 anos no T3. As larguras intermolares e intercaninos, comprimento do arco, perímetro do arco, overjet, overbite e irregularidade dos incisivos inferiores foram avaliados nos modelos do arco maxilar e mandibular. Para identificar mudanças estatisticamente significativas em curto prazo (T1-T2) e longo prazo (T2-T3) foi utilizado o teste t de Student. Os resultados mostraram que, durante o tratamento, as larguras do arco maxilar e mandibular foram significativamente aumentadas, tanto nas regiões de molares quanto de caninos, e reduzidas no período pós-contenção. Durante o tratamento apenas o comprimento do arco mandibular reduziu, no entanto, em T3, o perímetro e o comprimento diminuíram em ambos os arcos. Overjet e overbite diminuíram em média 5,5 mm e 2,1 mm, respectivamente, no pós-tratamento e ambos aumentaram (média de 0,5 mm e 0,4 mm) na avaliação pós-contenção. A irregularidade dos incisivos inferiores diminuiu em média de 1,9 mm durante o tratamento e aumentou em média 1,1 mm depois do tratamento. Concluiu-se que a terapia utilizada foi eficaz para a correção da má oclusão de Classe II Divisão 1. Após o período de contenção, mínimas alterações dentárias podem ser esperadas na largura intercanino e intermolar, perímetro e comprimento dos arcos, irregularidade dos incisivos e overjet.

The aim of this longitudinal study was to evaluate the post-treatment and long-term dental changes in Class II Division 1 malocclusion patients treated with cervical headgear in conjunction with full-fixed appliance in nonextraction therapy. Dental casts of 33 patients were evaluated at: pretreatment (T1), post-treatment (T2), and postretention (T3). The mean ages were 10.7 years at T1, 15.1 years at T2, and 26.2 years at T3. Molars and canines transversal widths, arch length, arch perimeter, overjet, overbite and lower incisor irregularity were assessed on maxillary and mandibular dental casts. To identify statistically significant changes in short term (T1-T2) and long-term (T2-T3) was used the Student paired t test. The results showed that, during treatment, maxillary and mandibular widths have increased significantly, at both, molar and canine regions and reduced in postretention period. During treatment only mandibular arch length showed reduction, however at T3 perimeter and length, decreased for maxillary and mandibular arches. Overjet and overbite had a mean decreased, during treatment of 5.5 mm and 2.1 mm, respectively, and both increased (mean of 0.5 mm and 0.4mm) in postretention evaluation. Lower incisor irregularity decreased mean was 1.9 mm during treatment and increased mean of 1.1 mm after. The therapy used was effective for Class II Division 1 malocclusion correction. After the retention period small dental changes can be expected in intercanine and intermolar width, arch perimeter and length, incisor irregularity and overjet.

Considerações sobre recessão gengival e sua resolução através da Ortodontia e Periodontia / Considerations about gingival recession and its resolution through Orthodontics and Periodontics

A recessão gengival pode ser definida como a perda de inserção do periodonto de proteção, com consequente aumento de coroa clínica e exposição radicular. Na grande maioria dos casos, fatores como acúmulo de placa bacteriana, seguido de inflamação gengival, trauma, deficiência de espessura de gengiva queratinizada e o tipo de mecânica ortodôntica empregada podem, de maneira isolada ou conjuntamente, causar ou agravar o problema. Uma vez estabelecido este quadro, resta ao ortodontista recorrer ao auxílio da terapia periodontal. Contudo, alguns detalhes, como o momento oportuno para a interação entre as terapias ortodôntica e periodontal, ainda geram dúvidas ao clínico. Desta forma, o presente artigo tem por objetivo promover a discussão sobre os fatores etiológicos da recessão gengival, bem como a validade científica, viabilidade, necessidade e o momento oportuno para emprego da terapia periodontal cirúrgica em pacientes submetidos ao tratamento ortodôntico.

Loss of insertion of periodontium followed by increased display of clinical crown and exposition of the root defines gingival recession. Factors as gingivitis, trauma, thin keratinized gingiva and the type of orthodontic mechanics, aisolated or combined may cause or increase gingival recession. Once established, the problem demands attention of orthodontists and probably requires assistance of periodontal surgical therapy. However, some details such as the timing for interaction between orthodontic and periodontal therapies still raise questions to the clinician. Thus, the purpose of this study is to discuss the etiological factors of gingival recession and the scientific value, feasibility, necessity and the convenient time for periodontal surgical therapy in orthodontic patients.

An interview with Peter H. Buschang.

Dr. Peter Buschang is regent professor and director of orthodontic research. He has been at Texas A&M University Baylor College of Dentistry since 1988. Dr. Buschang received his PhD in 1980 from the University of Texas at Austin; he spent 3 years as a NIDR postdoctoral fellow at the University of Connecticut, and five years as a FRSQ scholar at the University of Montreal. Every year, Dr. Buschang teaches in 16 different courses, 7 of which he directs. In addition to more than 100 lecture hours per year, he spends hundreds of hours mentoring students. For his teaching efforts, Dr. Buschang was awarded the Robert E. Gaylord Award of Excellence in Orthodontic education in 1992, 1998, 2004, and 2010. He also gives 1-2 day evidence-based CE courses throughout the world. The residents he has taught recently honored him by pledging to fund the Peter H. Buschang Endowed Professorship of Orthodontics. His research interests pertain to craniofacial growth and assessment of treatment effects. Dr. Buschang has been funded regularly over the years by the Medical Research Council of Canada, Fonds de le Recherche en Santé du Québec, the NIH, and the American Association of Orthodontics Foundation. He has mentored over 140 Master's and PhD students, and 49 dental students. Dr. Buschang has published over 250 peer-reviewed articles, 15 book chapters and 198 abstracts. He has given over 150 invited talks and lectures in 14 different countries. For his work with the American Board of Orthodontics, Dr. Buschang was awarded the Earl E. and Wilma S. Shepard Award. Dr. Buschang is the only non-orthodontist ever to have been made an honorary member of both the American Association of Orthodontics (2005) and the Edward H. Angle Society of Orthodontics (2009), the two most prestigious orthodontic groups.

Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: a clinical trial study.

INTRODUCTION: The purposes of this study were to analyze and compare the immediate effects of rapid and slow maxillary expansion protocols, accomplished by Haas-type palatal expanders activated in different frequencies of activation on the positioning of the maxillary first permanent molars and on the buccal alveolar bones of these teeth with cone-beam computerized tomography. METHODS: The sample consisted of 33 children (18 girls, 15 boys; mean age, 9 years) randomly distributed into 2 groups: rapid maxillary expansion (n = 17) and slow maxillary expansion (n = 16). Patients in the rapid maxillary expansion group received 2 turns of activation (0.4 mm) per day, and those in the slow maxillary expansion group received 2 turns of activation (0.4 mm) per week until 8 mm of expansion was achieved in both groups. Cone-beam computerized tomography images were taken before treatment and after stabilization of the jackscrews. Data were gathered through a standardized analysis of cone-beam computerized tomography images. Intragroup statistical analysis was accomplished with the Wilcoxon matched-pairs test, and intergroup statistical analysis was accomplished with analysis of variance. Linear relationships, among all variables, were determined by Spearman correlation. RESULTS AND CONCLUSIONS: Both protocols caused buccal displacement of the maxillary first permanent molars, which had more bodily displacement in the slow maxillary expansion group, whereas more inclination was observed in the rapid maxillary expansion group. Vertical and horizontal bone losses were found in both groups; however, the slow maxillary expansion group had major bone loss. Periodontal modifications in both groups should be carefully considered because of the reduction of spatial resolution in the cone-beam computerized tomography examinations after stabilization of the jackscrews. Modifications in the frequency of activation of the palatal expander might influence the dental and periodontal effects of palatal expansion.

Evaluation of the lower incisor inclination during alignment and leveling using superelastic NiTi archwires: a laboratory study

OBJECTIVE: The aim of this laboratory study is to evaluate the influence of the shape and the length limitation of superelastic nickel-titanium (NiTi) archwires on lower incisors inclination during alignment and leveling. METHODS: Metal teeth mounted on a typodont articulator device were used to simulate a malocclusion of the mandibular arch (-3.5 mm model discrepancy). Three different shapes (Standard, Accuform and Ideal) of superelastic NiTi archwires (Sentalloy, GAC, USA) were tested. Specimens were divided in two groups: Group I, with no limitation of the archwire length; and Group II, with distal limitation. Each group had thirty specimens divided into three subgroups differentiated by the archwire shape. All groups used round wires with diameters of 0.014-in, 0.016-in, 0.018-in and 0.020-in. The recording of all intervals was accomplished using standardized digital photographs with orthogonal norm in relation to median sagittal plane. The buccolingual inclination of the incisor was registered using photographs and software CorelDraw. RESULTS: The results were obtained using ANOVA and Tukey's test at a significant level of 5%. The inclination of the lower incisor increased in both groups and subgroups. The shape of the archwire had statistically significant influence only in Group I - Standard (11.76º), Ideal (5.88º) and Accuform (1.93º). Analyzing the influence of the length limitation, despite the mean incisor tipping in Group II (3.91º) had been smaller than Group I (6.52º), no statistically significant difference was found, except for Standard, 3.89º with limitation and 11.76º without limitation. The greatest incisor tipping occurred with the 0.014-in archwires.

Expansão maxilar rápida X expansão maxilar lenta: considerações clínicas / Rapid maxillary expansion X Slow maxillary: clinical considerations

A recuperação da discrepância transversal da maxila mostra-se indispensável para o tratamento adequado de diversos tipos de má oclusão. Diferentes aparelhos expansores têm sido descritos na literatura com a finalidade de expandir a maxila, sendo que esses podem resultar em expansão maxilar lenta (EML) ou rápida (EMR). O objetivo deste trabalho é discutir as considerações clínicas da EML e da EMR. Os dois pacientes avaliados utilizaram expansor fixo como preconizado por Haas, porém, foram submetidos a diferentes protocolos de ativação. Apesar das diferenças clínicas apresentadas, tanto a EMR quanto a EML mostraram-se eficientes na correção da mordida cruzada posterior na dentição mista.

Análise da expansão rápida da maxila por meio da tomografia computadorizada Cone-Beam / Analysis of rapid maxillary expansion using Cone-Beam computed tomography

Diante do diagnóstico de uma arcada maxilar esqueleticamente atrésica, o tratamento de escolha geralmente é a expansão ortopédica da maxila, envolvendo a separação da sutura palatina mediana. A avaliação dessa sutura era basicamente realizada por meio da radiografia oclusal superior, limitando sua análise em norma frontal. Da mesma forma, quantificar essa atresia radiograficamente nas telerradiografias cefalométricas sempre foi um obstáculo para o clínico, devido à grande sobreposição das estruturas faciais. O advento da tomografia computadorizada na Odontologia tem transformado a forma de diagnóstico devido à alta precisão na avaliação das dimensões das estruturas faciais, possibilitando quantificar de maneira fiel o comportamento das hemimaxilas, a inclinação dentária, a formação óssea na sutura nos três planos do espaço, assim como a reabsorção óssea alveolar e demais consequências da expansão palatina.

Whenever a maxillary arch is diagnosed as skeletally atresic the treatment of choice is usually maxillary orthopedic expansion, involving separation of the midpalatal suture. Basically, this suture used to be assessed with the aid of a maxillary occlusal radiograph, which limited its posteroanterior evaluation. Similarly, quantifying this atresia in cephalometric x-rays always posed an obstacle for clinicians owing to considerable superimposition of facial structures. With the advent of computed tomography, this technology has revolutionized diagnostic methods in dentistry because it provides high dimensional accuracy of the facial structures and a reliable method for quantifying the behavior of the maxillary halves, tooth inclination, bone formation at the suture in the three planes of space, as well as alveolar bone resorption and other consequences of palatal expansion.

Palatal expansion in a patient with solitary median maxillary central incisor syndrome.

The objective of this article was to report a clinical case of a patient with solitary median maxillary central incisor syndrome. He was treated with rapid maxillary expansion and evaluated with computed tomography. The boy, aged 6 years 7 months, had a single maxillary central incisor in the midline, posterior crossbite, prominent midpalatal ridge, indistinct philtrum, no incisive papilla, and no labial frenulum. No other systemic anomalies were found. Posteroanterior cephalometric radiography showed skeletal atresia of the maxilla that was corrected with rapid maxillary expansion. A Haas expander was used and activated twice per day (quarter turn per activation) for 15 days. The procedure was monitored with computed tomography to evaluate any effect on the intermaxillary suture and tooth. Although the crossbite was clinically corrected after the expansion, radiographs and tomographs showed no opening of the midpalatal suture. Rapid maxillary expansion resulted in neither midpalatal suture opening nor transverse increase of the maxillary skeletal base in this patient.

Multiloop edgewise archwire in the treatment of a patient with an anterior open bite and a long face.

An adolescent girl with an Angle Class III malocclusion, excessive lower facial height, and anterior open bite sought nonsurgical treatment. She was treated with a multiloop edgewise archwire (MEAW). In association with a chincup, MEAW mechanics allowed the successful correction of the anterior open bite and the molar relationship, without major alterations of the patient's profile. Combined orthodontic and surgical treatment should be considered for patients with skeletal anterior open-bite malocclusion. For patients who do not want surgery, however, MEAW treatment is an alternative that can have excellent results.

Solitary median maxillary central incisor.

Solitary median maxillary central incisor syndrome (SMMCIS) is a rare abnormality characterized by the presence of a central incisor positioned at the maxillary mid-axis. This morphologic defect also can be associated with other diseases. The purpose of this paper was to present a case report of a 4-year-old twin child with SMMCIS. The patient showed a symmetrical primary maxillary central incisor located at the midline, with an absence of labial frenulum, an indistinct philtrum, and an incisive papilla. Radiographic examination confirmed the presence of only a maxillary central incisor in both dentitions. The patient was referred for a genetic and otolaryngological assessment, however, no other abnormality than the ones reported were detected.

Palatal expansion with six bands: an alternative for young adults / Expansão palatina com seis bandas: uma alternativa para adultos jovens

OBJECTIVE: To presente a case of correction of transverse maxillary deficiencies with posterior crossbite. METHOD: Opening of the midpalatal suture using a tooth-and-tissue-borne expander. RESULTS AND DISCUSSION: Rapid maxillary expansion (RME) is the preferred procedure in growing patients because it allows stability with respect to the amount of bone expansion and it avoids teeth expansion. In adults it is frequently associated with failure. However, in individuals past their growth spurt where the midpalatal suture and adjacent circumaxillary articulations have become more rigid, surgically assisted rapid maxillary expansion is recommended. The original Haas expander appliance consists of bands fitted to the first molars. Increased anchorage with bands on the second premolars enhances the orthodontic effect and can be used successfully in patients beyond their skeletal growth spurt. CONCLUSION: A non surgical alternative for treating transverse maxillary deficiency with skeletal crossbite in patients after their growth spurt, using a modified Haas palatal expander with six bands is presented.

OBJETIVO: Apresentar um caso de correção de deficiência transversa maxilar com cruzamento posterior. MÉTODO: Abertura da sutura mediana palatina utilizando-se expansores dento-muco suportados. RESULTADO E DISCUSSÃO: A expansão rápida da maxila é o procedimento nos pacientes em crescimento porque proporciona estabilidade com relação ao montante de expansão óssea, evitando expansão dentária. Em adultos, o procedimento é frequentemente falho. Entretanto, em indivíduos que já terminaram o crescimento, onde a sutura palatina mediana e as articulações adjacentes relacionadas com os maxilares tornaram-se mais rígidas, a expansão rápida assistida cirurgicamente está indicada. O expansor Haas original consiste de bandas adaptadas aos primeiros molares. CONCLUSÃO: O aumento da ancoragem com bandas nos segundos pré-molares proporciona o efeito ortodôntico e pode ser usado com sucesso em pacientes após o estirão de crescimento, com a utilização de um expansor palatino Haas com seis bandas.

The dilemma of the open gingival embrasure between maxillary central incisors.

AIM: The aim of this report is to present the etiology, diagnosis, and treatment planning strategy in the presence of an open gingival embrasure between the maxillary central incisors. BACKGROUND: The open gingival embrasure or "black triangle" is a visible triangular space in the cervical region of the maxillary incisors. It appears when the gingival papilla does not completely fill in the interdental space. The space may occur due to: (1) disease or surgery with periodontal attachment loss resulting in gingival recession; (2) severely malaligned maxillary incisors; (3) divergent roots; or (4) triangular-shaped crowns associated with or without periodontal problems and alveolar bone resorptions. REPORT: The post-treatment prevalence in adult orthodontic patients is estimated to be around 40% compromising the esthetic result. CONCLUSION: Several methods of managing patients with open gingival embrasure exist, but the interdisciplinary aspects of treatment must be emphasized to achieve the best possible result. The orthodontist can play a significant role in helping to manage these cases. CLINICAL SIGNIFICANCE: Various treatment strategies are available to treat cases of an undesirable black triangle and are dependent on the etiology of the condition.