Uso do laser em cruz como método auxiliar no diagnóstico e planejamento de tratamento de pacientes padrão III / Use of the cross laser as an auxiliary method in Class III patients diagnosis and treatment planning

O posicionamento espacial do complexo crânio-maxilo-mandibular está relacionado com a posição natural da cabeça, que nem sempre é obtida facilmente, devido à compensação postural viciosa e inconsciente. O laser em cruz permite a fixação de certos parâmetros na face, que ensejam o posicionamento natural e adequado da cabeça, para a realização da telerradiografia lateral em conjunto com a análise facial. A severidade da discrepância esquelética do Padrão III é mascarada pelos tecidos moles, e é melhor averiguada e quantificada com o paciente em perfil sorrindo, em relação à vertical verdadeira e pode ser comparada com a análise cefalométrica. O tratamento dessa discrepância está diretamente ligado a sua severidade. Esse artigo tem como objetivo demonstrar a relevância do laser em cruz, como ferramenta auxiliar na análise da severidade facial de pacientes Padrão III. São apresentados três casos clínicos com diferentes severidades para o Padrão III e suas respectivas abordagens de tratamento. (AU)

The spatial positioning of the cranio-maxillary-mandibular complex is related to the natural position of the head, which is not always easily obtained due to the vicious and unconscious postural compensation. The cross-laser allows the fixation of certain face parameters, which lead to natural and adequate positioning of the head for lateral teleradiography in conjunction with facial analysis. The severity of Pattern III skeletal discrepancy is masked by soft tissues, and is best investigated and quantified with the patient in smiling profile, relative to true vertical and can be compared with the cephalometric analysis. The treatment of this discrepancy is directly related to its severity. This article aims to demonstrate the relevance of the cross-laser, as an auxiliary tool in the analysis of the facial severity of patients Pattern III. Three clinical cases with different severities for Pattern III and their respective treatment approaches are presented. (AU)

A Novel Analysis via Micro-CT Imaging Indicates That Chemically Modified Tetracycline-3 (CMT-3) Inhibits Tooth Relapse after Orthodontic Movement: A Pilot Experimental Study.

OBJECTIVE: To evaluate the effect of chemically modified tetracycline-3 (CMT-3) and simvastatin on tooth relapse after orthodontic movement in rats using a novel analysis method employing high-resolution micro-CT (Micro-CT) images. In addition, the correlation between bone density and orthodontic relapse was also evaluated for each experimental group. METHODS: Forty adult male Wistar rats had stainless steel springs installed on their left upper first molars in order to generate tooth movement for 18 days. After this initial period, the animals were divided into three groups: (1) 30 mg/kg of CMT-3; (2) 5 mg/kg of simvastatin; and (3) 0.5% carboxymethylcellulose, and each group was treated for 20 days. Micro-CT images were analyzed (conventional method and 3D reconstruction) on the 7th and 18th days following spring fixation and finally, 20 days after treatment either with CMT-3 or simvastatin (38th day). Bone mineral density (BMD) of the mesial and distal roots of the upper first molar was also analyzed. RESULTS: The difference was statistically significant between the groups as to recurrence (p=0.048), and the post hoc test identified the value of p=0.007 between the control group and the CMT-3 group. Simvastatin was not able to inhibit tooth relapse. The bone mineral densities of both the mesial and distal roots were different between the three groups, after the 20th day of drug use (p=0001 and p < 0001). CONCLUSION: Our findings support the initial evidence that CMT-3 is able to prevent relapse after tooth movement. Future trials in humans should evaluate such treatment as a promising approach to preventing this common phenomenon. CLINICAL RELEVANCE: Considering the results obtained, CMT-3 can be used to avoid relapse after tooth movement.

Lesions of the Parotid Gland and Buccal Artery After Buccal Fat Pad Reduction.

The significant increase in esthetic surgery, especially buccal fat pad reduction, has led to a corresponding increase in lesions and postoperatory after-effects from this surgical procedure. The aim of this study is to discuss the immediate and mediate risks of removing the Bichat ball, as well as describing a clinical study in which this surgical procedure resulted in lesions of the parotid gland and buccal artery, which was confirmed via nuclear magnetic resonance. The facial lesions were remedied via exploratory surgery by opening a new orifice of the glandular duct in the buccal cavity followed by drainage and compressive surgical bandages.

Fusão de imagem 3D do complexo craniomaxilofacial – ferramenta para simulação virtual do tratamento ortodôntico-ortognático / Fusion of 3D image of cranio-maxillofacial complex: tool for virtual simulation of orthodontic-orthognathic treatment

O objetivo deste estudo foi analisar, através de um relato de caso, a contribuição da técnica de fusão de imagem para o planejamento cirúrgico e a realização das goteiras prototipadas aplicadas à cirurgia ortognática. Paciente do gênero masculino, CML, 19 anos de idade, com Classe III esquelética e assimetria facial com subdesenvolvimento maxilar e deficiência vertical da maxila, teve o plano de tratamento estabelecido após moldagem intraoral. Os modelos foram enviados para a digitalização a laser 3D que contém duas câmeras e sistema de movimento tri-axial. A tomografia computadorizada cone beam CT, as imagens em 3D faciais e os modelos 3D digitais fundiram-se para fazer uma cirurgia virtual 3D, que simulou o tratamento proposto. A simulação cirúrgica 3D com fusão de imagem visa não somente aumentar a precisão da cirurgia em si e sua previsibilidade, mas também reduzir as complicações cirúrgicas.

The aim of this study was to examine, through a case report, the contribution of image fusion technique for the surgical planning and production of prototype trays applied to orthognathic surgery. A male patient, CML, 19 years old, with skeletal Class III and facial asymmetry by maxillary underdevelopment assisted by a vertical height of the maxilla. The treatment plan was established after intraoral molding. The models were sent to the digital scanning laser 3D that it contains 2 cameras and tri-axial movement system. The cone beam computed tomography, facial 3D images and digital 3D models were merged to make a virtual 3D surgery, which simulated the proposed treatment. The surgical simulation 3D with image fusion aims not only to increase the accuracy of the surgery itself and its predictability, but also to reduce surgical complications.

The effect of simvastatin on relapse of tooth movement and bone mineral density in rats measured by a new method using microtomography.

PURPOSE: To evaluate the effect of simvastatin on relapse of tooth movement in rats using microtomography (micro CT), as well as the correlation of bone density with the orthodontic relapse. METHODS: Twenty-five adult male Wistar rats, divided into two groups, had stainless steel springs installed on left maxillary first molar. The molars were moved for 18 days, and after removing the springs, were applied by oral gavage, 5mg/kg of simvastatin in the experimental group for 20 days. Tooth relapse was assessed with a micro CT scanner, and the images chosen through the Data Viewer software 1.5.0.0 had their measurement guides made and checked by the software Image ProR plus 5.1, and compared by Mann-Whitney test. After rats were sacrificed, bone mineral density was evaluated by micro CT through the software CT Analyzer 1.13 and compared by independent T-test, as well as by Spearman correlation test. RESULTS: Relapse and bone mineral density (BMD) was lower in the experimental group than in the control group, however without a statistically significant difference. CONCLUSION: Simvastatin did not inhibit the relapse of tooth movement in rats, and there was no correlation between bone density and orthodontic relapse.

The effect of simvastatin on relapse of tooth movement and bone mineral density in rats measured by a new method using microtomography

PURPOSE: To evaluate the effect of simvastatin on relapse of tooth movement in rats using microtomography (micro CT), as well as the correlation of bone density with the orthodontic relapse. METHODS: Twenty-five adult male Wistar rats, divided into two groups, had stainless steel springs installed on left maxillary first molar. The molars were moved for 18 days, and after removing the springs, were applied by oral gavage, 5mg/kg of simvastatin in the experimental group for 20 days. Tooth relapse was assessed with a micro CT scanner, and the images chosen through the Data Viewer software 1.5.0.0 had their measurement guides made and checked by the software Image ProR plus 5.1, and compared by Mann-Whitney test. After rats were sacrificed, bone mineral density was evaluated by micro CT through the software CT Analyzer 1.13 and compared by independent T-test, as well as by Spearman correlation test. RESULTS: Relapse and bone mineral density (BMD) was lower in the experimental group than in the control group, however without a statistically significant difference. CONCLUSION: Simvastatin did not inhibit the relapse of tooth movement in rats, and there was no correlation between bone density and orthodontic relapse. .

Alternative treatment for open bite Class III malocclusion in a child with Williams-Beuren syndrome.

Williams-Beuren syndrome (WBS) is a rare genetic condition that affects approximately 1 in every 20,000 - 50,000 live births. WBS children have specific skeletal deformities, dental malformations and rare lingual muscle dysfunction. The need for orthodontic and orthognathic therapy has arisen and has been considered a real clinical challenge even for experienced professionals, once it requires a complex and individualized treatment plan. This study reports a case of orthopedic expansion of the maxilla, in which a modified facial mask was used for protraction of the maxillary complex associated with clockwise rotation of the maxilla. In addition, special considerations about treatment time and orthopedic outcomes are discussed.

Alternative treatment for open bite Class III malocclusion in a child with Williams-Beuren syndrome

Williams-Beuren syndrome (WBS) is a rare genetic condition that affects approximately 1 in every 20,000 - 50,000 live births. WBS children have specific skeletal deformities, dental malformations and rare lingual muscle dysfunction. The need for orthodontic and orthognathic therapy has arisen and has been considered a real clinical challenge even for experienced professionals, once it requires a complex and individualized treatment plan. This study reports a case of orthopedic expansion of the maxilla, in which a modified facial mask was used for protraction of the maxillary complex associated with clockwise rotation of the maxilla. In addition, special considerations about treatment time and orthopedic outcomes are discussed.

A síndrome de Williams-Beuren (WBS) é uma doença genética rara, acometendo, aproximadamente, de 1:20.000 a 1:50.000 crianças nascidas. As crianças com WBS têm deformidades esqueléticas específicas, má formações dentárias e, algumas vezes, disfunção muscular da língua. As necessidades ortodônticas e ortognáticas têm sido consideradas um verdadeiro desafio clínico, até mesmo para aqueles profissionais com vasta experiência, uma vez que requerem um plano de tratamento individualizado e complexo. Esse relato de caso aborda uma expansão ortopédica da maxila, em que foi utilizada uma máscara facial modificada para protração do complexo maxilar, acompanhada de uma rotação horária da maxila. Além disso, considerações especiais sobre o tempo de tratamento e resultados ortopédicos são discutidas.

Protein biomarkers of external root resorption: A new protein extraction protocol. Are we going in the right direction?

OBJECTIVE: The aim of this study is to determine a protocol of gingival crevicular fluid protein extraction used for the first dimension of 2-DE gels. It also aims at conducting a review on the current candidates for protein markers of this pathology, all of which may be used to prevent the disease. METHODS: Gingival crevicular fluid was collected from two groups of 60 patients each, with and without external root resorption. Samples were extracted by means of various methods of protein extraction. SDS-PAGE gels were used to assess the quality of the method which was subsequently tested during isoelectric focusing of 2-DE gels taken from samples of patients with and without the disease. RESULTS: Milli-Q ultrapure ice cold water, without precipitation for gingival crevicular fluid protein extraction, proved the method with greatest sharpness to detect protein bands. Additionally, it allowed two-dimensional electrophoresis to be performed. CONCLUSION: The new protein extraction protocol does not interfere in isoeletric focusing of 2-DE gels. Furthermore, it provides the greatest sharpness in detecting protein bands of SDS-PAGE gels. This will allow mapping and searching of new external root resorption markers, particularly due to the difficulty in carrying out molecular tests with the current candidates for protein markers. .

OBJETIVO: o objetivo desse trabalho foi determinar o protocolo de extração proteica do fluido crevicular gengival, que pudesse ser utilizado para a realização da primeira dimensão dos géis 2-DE, bem como fazer uma revisão dos atuais candidatos a marcadores proteicos dessa patologia que podem ser utilizados na prevenção dessa doença. MÉTODOS: foi coletado o fluido crevicular gengival de dois grupos de 60 pacientes, com e sem a reabsorção radicular externa. As amostras foram extraídas por diversos métodos de extração proteica e utilizados géis SDS-PAGE para aferir a qualidade do método, que posteriormente foi testado durante a realização da focalização isoelétrica dos géis 2-DE, de amostras de pacientes com e sem a patologia. RESULTADOS: a utilização de água Milli-Q gelada ultrapura, sem nenhuma precipitação para a extração proteica do fluido crevicular gengival, foi o método com maior nitidez das bandas proteicas, além de permitir a realização da eletroforese bidimensional. CONCLUSÕES: o novo protocolo de extração proteica não interfere na focalização durante a realização dos géis 2-DE, além de maior nitidez na resolução das bandas proteicas dos géis SDS-PAGE. Isso permitirá o mapeamento e busca de novos marcadores da reabsorção radicular externa, tendo em vista a dificuldade de realização de testes moleculares com os atuais candidatos a marcadores proteicos. .

Protein biomarkers of external root resorption: a new protein extraction protocol. Are we going in the right direction?

OBJECTIVE: The aim of this study is to determine a protocol of gingival crevicular fluid protein extraction used for the first dimension of 2-DE gels. It also aims at conducting a review on the current candidates for protein markers of this pathology, all of which may be used to prevent the disease. METHODS: Gingival crevicular fluid was collected from two groups of 60 patients each, with and without external root resorption. Samples were extracted by means of various methods of protein extraction. SDS-PAGE gels were used to assess the quality of the method which was subsequently tested during isoelectric focusing of 2-DE gels taken from samples of patients with and without the disease. RESULTS: Milli-Q ultrapure ice cold water, without precipitation for gingival crevicular fluid protein extraction, proved the method with greatest sharpness to detect protein bands. Additionally, it allowed two-dimensional electrophoresis to be performed. CONCLUSION: The new protein extraction protocol does not interfere in isoeletric focusing of 2-DE gels. Furthermore, it provides the greatest sharpness in detecting protein bands of SDS-PAGE gels. This will allow mapping and searching of new external root resorption markers, particularly due to the difficulty in carrying out molecular tests with the current candidates for protein markers.

Expansor palatal de níquel titânio como alternativa para correção de atresia maxilar e mordida cruzada posterior em adultos jovens - relato de caso / Nickel titanium palatal expander as an alternative for correction of maxillary atresia and posterior crossbite in young adults - case report

As deficiências transversais da maxila constituem problemas clínicos comuns encontrados por ortodontistas. A correção dessas más oclusões deve ser realizada na primeira etapa do tratamento ortodôntico, para tanto é imprescindível realizar o diagnóstico diferencial e conhecer os métodos de tratamento para indicar o mais adequado. Este trabalho tem como objetivo apresentar o expansor palatal de níquel titânio termoativado como alternativa para correção de atresia maxilar e mordida cruzada posterior em adultos jovens através do relato de um caso clínico, ressaltando as vantagens desse aparelho.

Maxillary transverse discrepancies are common clinical problems encountered by orthodontists. The correction of malocclusion should be performed in the first phase of orthodontic treatment therefore it is essential to perform a differential diagnosis and know the treatment methods in order to choose the most appropriate method. This paper aimed to present the thermal nickel titanium palatal expander as an alternative for correction of narrow maxilla and posterior crossbite in young adults through the report of a clinical case, presenting the advantages and disadvantages of this device.

O princípio do V assimétrico: otimizando a biomecânica retracional / The principle of V asymmetrical. Optimizing a biomechanics

A retração é uma fase específica do tratamento ortodôntico que necessita de uma logística peculiar para a sua realização. O presente artigo aborda o princípio do V assimétrico em arcos auxiliares durante o período retracional, explorando as suas nuanças terapêuticas com relação aos aspectos biomecânicos de ancoragem, controle vertical e inclinação axial dos incisivos, com vistas à individualização da mecânica retracional baseado em um diagnóstico e tratamento também individualizados.

The retraction is a specific phase of orthodontic treatment that requires a peculiar logistics for its implementation. This article discusses the principle of asymmetrical V auxiliary arches during retracional, exploring their therapeutic nuances with respect to the biomechanical aspects anchor, controlling the vertical and axial inclination of the incisors, with a view to the individualization of mechanical retracional based on a diagnosis and treatment is also individualized.

Alinhadores invisíveis: indicações, limitações biomecânicas e a problemática da mensuração das forças aplicadas / Invisible aligners: indications, biomechanical limitations and the problem of measuring the forces applied

Os alinhadores invisíveis ganharam o seu espaço no arsenal do ortodontista moderno, mas, como toda nova tecnologia, o uso indiscriminado sem atentar-se para as suas indicações e limitações é preocupante. Os anseios por uma estética adequada não podem sobrepujar os resultados clínicos alcançados. O presente artigo realiza uma breve revisão da literatura dos alinhadores invisíveis, com finalidade de discutir a sua problemática biomecânica, assim como as indicações e limitações da mensuração da força aplicada. Dessa maneira, serão apresentados dois casos clínicos com essa proposta de tratamento como alternativa no cotidiano do ortodontista.

Multifuncionalidade do aparelho expansor de Haas 3D preconizado por Franco / 3D multifunctional Haas expander appliance preconized by Franco

Introdução: o tratamento precoce das discrepâncias transversais da maxila é utilizado desde a década de 60, assim como são bem conhecidos os efeitos da expansão rápida maxilar no complexo craniofacial, evidenciados de maneira significativa pela literatura pertinente. Muitas variações clínicas do aparelho Haas foram idealizadas em função das diferentes más oclusões apresentadas nas dentições decíduas, mista e permanente. Entretanto, nenhuma dessas alterações supre a necessidade de correção simultânea das más oclusões sagitais, verticais e transversais, o que implicou no surgimento do expansor Haas 3D proposto pelos autores, que tem como objetivo principal a correção transversal da maxila. Objetivo: o presente trabalho tem por objetivo apresentar um caso clínico com a utilização do aparelho tipo Haas multifunção 3D para o tratamento precoce e simultâneo das más oclusões de mordida cruzada posterior, Classe II e mordica aberta anterior. Conclusões: até a presente data, essas modificações têm sido utilizadas com sucesso na clínica de ortodontia pelos autores, respeitando suas indicações e limitações intrínsecas da aparatologia em evidência.

Emprego racional da Biomecânica em Ortodontia: "arcos inteligentes" / Biomechanics in Orthodontics

A versatilidade biomecânica propiciada pelos "arcos inteligentes" ("smart archwires") permite estratégias para cada tipo de má oclusão, diferenciada por nuances terapêuticas, que por sua vez geram um melhor controle do caso clínico. Os arcos multifuncionais (Arco de intrusão de nitinol CIA® e arco de retração Mushroom Loop®) foram idealizados no intuito de simplificar o atendimento clínico do ortodontista que, municiado de recursos diagnósticos apropriados e sólidos, os utiliza como uma ótima alternativa entre as disponíveis para a resolução dos problemas e expectativas dos pacientes. Com o presente artigo procurou-se demonstrar que os arcos de intrusão de nitinol (CIA®) e o arco de retração Mushroom Loop® são ferramentas poderosas no tratamento de pacientes com extrações dentárias que requerem um controle de ancoragem mais apropriado, bem como uma retração mais eficaz.