Evaluación del aparato funcional postratamiento de Waveney como alternativa en la contención del avance mandibular

Fundamento: Para la contención del avance mandibular es necesario utilizar un aparato que mantenga la mandíbula en la posición lograda por los aparatos activos y que su diseño no provoque movimientos dentarios indeseados. Objetivo: Describir los cambios clínicos y cefalométricos del aparato funcional postratamiento de Waveney como alternativa en la contención del avance mandibular. Metodología: Se realizó una investigación descriptiva observacional de corte transversal en el servicio Ortodoncia de la Clínica Estomatológica Docente Provincial Dr. Justo Ortelio Pestana Lorenzo de la provincia Sancti Spíritus, desde septiembre 2019 a febrero 2022. Se seleccionaron 20 pacientes que iniciaron su etapa de contención en este período y cumplieron los criterios de inclusión. Se utilizaron métodos del nivel empírico y estadístico. Se analizaron las variables: edad, sexo, variables morfológicas clínicas y cefalométricas, así como resultado de la contención. Resultados: Se constató una edad promedio de 15.6; el 65 % de los escolares pertenecían al sexo femenino. Al año de iniciada la contención se mantuvo el sobrepase incisivo en 2.95 mm, la relación molar de neutroclusión en el 65 %, ángulo SNB en 79°, el ángulo ANB en 2.80°, la posición del incisivo superior 2.45 mm, la posición del incisivo inferior en 1.90 mm y el perfil estético en 0.55 mm. Solo existió incremento en el valor promedio del resalte incisivo de 2.70 mm a 2.75 mm. Conclusiones: Al año de iniciada la contención con el aparato funcional postratamiento de Waveney no se observó modificación de las variables estudiadas, excepto el resalte incisivo con incremento de su valor promedio.

Background: For mandibular advancement containment, it is necessary to use an appliance that holds the jaw in the achieved position by active appliances and that its design does not provoke undesired dental movements. Objective: To describe the clinical and cephalometric changes of the Orthodontic Appliances after the Waveney treatment as an alternative in the mandibular advancement containment. Methodology: A descriptive observational cross-sectional research was conducted at the Dr. Justo Ortelio Pestana Lorenzo Provincial Teaching Stomatology Clinic orthodontic service in Sancti Spíritus province, from September 2019 to February 2022. 20 patients who started their containment stage in this period and fulfilled the inclusion criteria were selected. Empirical and statistical methods were used. The following variables were analyzed: age, sex, clinical morphological and cephalometric variables, as well as the containment result. Results: An average age of 15.6 was found; 65% of the schoolchildren were female. One year after the containment was started, the incisive overpass was maintained at 2.95 mm, the neutroclusion molar rate at 65%, SNB angle at 79°, the ANB angle at 2.80°, the upper incisor position 2.45 mm, the lower incisor position by 1.90 mm and the esthetic profile by 0.55 mm. There was only an average increase in the incisor protrusion value from 2.70 mm to 2.75 mm. Conclusions: One year after containment with the Waveney post-treatment Orthodontic Appliances was initiated no changes were observed in the studied variables, except for incisor protrusion with an increase in its average value.

Cambios dento-esqueléticos de un paciente con síndrome clase III de Moyers tratado con bloques gemelos

La finalidad de la ortopedia dentofacial consiste en modificar el patrón de crecimiento facial y de las estructuras óseas subyacentes de la cara, como la de los pacientes con síndrome clase III de Moyers. El objetivo de este trabajo es dar a conocer los cambios dento-esqueléticos de un paciente con síndrome clase III de Moyers tratado con bloques gemelos. Se presenta el caso de un paciente masculino de 9 años de edad que acudió a consulta de Ortodoncia de la Clínica Universitaria de Especialidades Estomatológicas "Manuel Cedeño" en abril de 2019, preocupado su papá por la estética del paciente. Mediante el análisis de modelos de estudio, las mediciones cefalométricas y los hallazgos del examen físico se clasificó al paciente como síndrome clase III de Moyers. Se empleó los bloques gemelos clase III como aparato de ortopedia funcional de los maxilares. Los resultados dento-esqueléticos se determinaron a los cuatro meses de iniciada la terapia funcional. Luego del tratamiento se concluyó que con el uso de los bloques gemelos clase III los resultados fueron favorables pues se corrigió la relación de oclusión dentaria y se logró una clase I esquelética máxilo-mandibular.

The purpose of dentofacial orthopedics is to modify the pattern of facial growth and the underlying bone structures of the face, such as that of patients with Moyers class III syndrome. The objective of this work is to present the dento-skeletal changes of a patient with Moyers class III syndrome treated with twin blocks. The case of a 9-year-old male patient who attended the orthodontic consultation of the University Clinic of Stomatological Specialties "Manuel Cedeño" in April 2019 is presented, his father worried about the aesthetics of the patient. By analyzing study models, cephalometric measurements and physical examination findings, the patient was classified as Moyers class III syndrome. Class III twin blocks were used as a functional maxillary orthopedic device. Dento-skeletal results were determined four months after the start of functional therapy. After the treatment, it was concluded that with the use of the class III twin blocks, the results were favorable because the dental occlusion relationship was corrected and a skeletal maxillo-mandibular class I was achieved.

O objetivo da ortopedia dentofacial é modificar o padrão de crescimento facial e as estruturas ósseas subjacentes da face, como a de pacientes com síndrome de Moyers classe III. O objetivo deste trabalho é apresentar as alterações dentoesqueléticas de um paciente com síndrome de Moyers classe III tratado com blocos gêmeos. É apresentado o caso de um paciente do sexo masculino de 9 anos que compareceu à consulta de Ortodontia da Clínica Universitária de Especialidades Estomatológicas "Manuel Cedeño" em abril de 2019, seu pai preocupado com a estética do paciente. Analisando modelos de estudo, medidas cefalométricas e achados do exame físico, o paciente foi classificado como síndrome de Moyers classe III. Blocos gêmeos Classe III foram usados ​​como um dispositivo ortopédico funcional para os maxilares. Os resultados dentoesqueléticos foram determinados quatro meses após o início da terapia funcional. Após o tratamento concluiu-se que com o uso de blocos gêmeos classe III os resultados foram favoráveis, pois a relação de oclusão dentária foi corrigida e uma classe I esquelética maxilomandibular foi alcançada.

Combining Circumvestibular Corticotomy with Maxillary Protraction as a Conservative Approach to Treatment in an Adolescent with Maxillary Deficiency: A Case Report with Long Term Follow-up.

Maxillary protraction with a face mask is an effective treatment for class III children with maxillary hypoplasia. However, in late adolescence, orthopedic approaches are not very effective for treatment of maxillary deficiency. The aim of this study was to report a minimally invasive technique to orthopedically treat a 16-year-old female adolescent with mild to moderate maxillary deficiency, before the cessation of growth. A circumvestibular corticotomy technique was performed followed by a regimen of rapid maxillary expansion and application of heavy extra-oral forces. After termination of the orthopedic and orthodontic phases, the patient was monitored for ten years. The dental and skeletal results immediately after treatment were compared with the results ten years after termination of treatment. A noticeable anterior displacement of "A" point was observed after the orthopedic phase and this remained unchanged for ten years.

Efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares / Effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders

RESUMEN Fundamento: Existen modalidades de tratamiento para los trastornos temporomandibulares, una de ellas es la Ortopedia funcional de los maxilares. Objetivo: Evaluar la efectividad del Bionator de California en la disminución del grado de severidad de los trastornos temporomandibulares. Metodología: Se realizó estudio experimental, abierto, controlado y aleatorizado en el servicio de Prótesis Estomatológica de la Clínica Estomatológica de Fomento en el período de septiembre de 2019 a septiembre de 2021. Se seleccionaron 60 pacientes con trastornos temporomandibulares que cumplieron los criterios de selección, mediante asignación aleatoria se establecieron los grupos: Estudio (tratado con Bionator de California) y control (tratado con férula neuromiorrelajante). Se utilizaron métodos del nivel teórico, empírico y estadístico. La variable de respuesta principal fue: Efectividad del Bionator de California en el grado de severidad del trastorno temporomandibular. Resultados: Al inicio del estudio predominó la severidad moderada de trastornos temporomandibulares en ambos grupos, pero a los 6 meses de tratamiento predominaron los asintomáticos (66.7 %) en el grupo estudio y 36.7 % en el grupo control, con diferencia estadísticamente significativa entre ambos grupos. Conclusiones: El tratamiento con el Bionator de California fue efectivo porque se logró disminuir el grado de severidad de los trastornos temporomandibulares.

ABSTRACT Background: There are treatment modalities for temporomandibular disorders, one of them is functional orthopedics of the jaws. Objective: To evaluate the effectiveness of the California Bionator in reducing the degree of severity of temporomandibular disorders. Methodology: An experimental, open, controlled and randomized study was carried out in the Dental Prosthesis service at Fomento Dental Clinic from September 2019 to September 2021. 60 patients with temporomandibular disorders who met the selection criteria were selected. The groups were established by random assignment: Study (treated with Bionator from California) and control (treated with a neuromyorelaxant splint). Method theoretical, empirical and statistical levels were used. The main response variable was: Effectiveness of the California Bionator in the degree of severity of the temporomandibular disorder. Results: At the beginning of the study moderate severity of temporomandibular disorders prevailed in both groups, but after 6 months of treatment asymptomatic predominated (66.7%) in the study group and 36.7% in the control group, with a statistically significant difference between both groups. Conclusions: The treatment with the California Bionator was effective because the degree of severity of temporomandibular disorders was reduced.

Utilización del botón de Nance modificado para la propulsión mandibular / Utilization of the modified Nance button for mandibular propulsion

RESUMEN Introducción: En sus inicios la mayoría de los aparatos funcionales fueron removibles, pero cada día más se incrementan los fijos. Su combinación puede incrementar la eficacia en el tratamiento del retrognatimo mandibular. Objetivo: Presentar los resultados del tratamiento con el botón de Nance modificado en una paciente con retrognatismo mandibular. Caso clínico: Paciente femenina de 13 años de edad, que presenta perfil convexo, disfunción neuromuscular, dentición permanente en ambos maxilares con presencia de ligero apiñamiento anterior, relación molar bilateral de distoclusión de ½ unidad, resalte y sobrepase incisivos de 6 mm, mala relación intermaxilar causada por retrognatismo de la mandíbula y escaso remanente de crecimiento mandibular activo. La primera etapa del tratamiento, incluyó psicoterapia, mioterapia y avance mandibular con un aparato funcional fijo (botón de Nance modificado para la propulsión mandibular). A los nueve meses de iniciar el tratamiento se comprobó el cambio en las relaciones intermaxilares en sentido antero-posterior, con disminución del ángulo ANB hasta 20 e incremento del SNB a 78, como reflejo de una buena relación de las bases ósea por crecimiento mandibular. Conclusiones: El tratamiento realizado a la paciente con el botón de Nance modificado para la propulsión mandibular, permitió la obtención de relaciones intermaxilares favorables.

ABSTRACT Introduction: In the beginning, most of the functional appliances were removable, but the fixed ones are increasing every day. Their combination can increase the effectiveness in the treatment of mandibular retrognathymus. Objective: To present the results of the treatment of a patient with mandibular retrognathism treated with the modified Nance button. Case report: A 13-year-old female patient with convex profile, neuromuscular dysfunction, permanent dentition in both jaws with the presence of slight anterior crowding, bilateral distoclusion molar ratio of ½ unit, incisor protrusion and overhang of 6 mm, poor intermaxillary relationship caused by retrognathism of the mandible and little remnant of active mandibular growth. The first stage of treatment included psychotherapy, myotherapy and mandibular advancement with a fixed functional appliance (modified Nance button for mandibular propulsion). Nine months after starting the treatment, the change in the intermaxillary relationships in the anteroposterior direction was verified, with a decrease in the ANB angle to 20 and an increase in the SNB to 78, as a reflection of a good relationship of the bone bases due to mandibular growth. Conclusions: One year after treatment with the modified Nance button for mandibular propulsion, a correct relationship of the patient's bone bases was achieved.

Estudo exploratório dos efeitos das terapias com eletroestimulação neuromuscular e dispositivos biomecânicos intraoral na saliva em pacientes com síndrome de Down e apneia obstrutiva do sono / Exploratory study of the effects of therapies with neuromuscular electrostimulation and intraoral biomechanical devices on saliva in patients with Down syndrome and obstructive sleep apnea

Este estudo tem como objetivo avaliar os efeitos das terapias com eletroestimulação neuromuscular e dispositivos biomecânicos intraorais sobre as propriedades físicoquímica e microbiológica da saliva em pacientes com síndrome de Down (SD) e apneia obstrutiva do sono (AOS). Ainda investigamos a morfologia das glândulas salivares maiores: parótidas, submandibulares e sublinguais para verificar possíveis desordens estruturais nesses indivíduos. Vinte e três pacientes adultos com SD e AOS, com idade entre 18 e 31 anos, de ambos os gêneros, foram convidados para participar deste estudo. Dentre esses pacientes, 18 concluíram as terapias propostas e foram divididos em três grupos: EENMs (n=7; terapia com eletroestimulação neuromuscular de superfície), DMHB (n=4; terapia com dispositivo mastigatório com hiperboloide) e AIOm (n=7; terapia com aparelho intraoral de avanço mandibular). A EENMs foi aplicada sobre os músculos masseter (porção superficial) e temporal (porção anterior), em ambos os lados. O DMHB foi posicionado entre as faces oclusais dos dentes posteriores e o paciente mordeu suas pontas ativas com hiperboloide. O AIOm foi utilizado somente no período de sono. Esse aparelho foi ativado lentamente, de 0,5 mm a 1,0 mm a cada 1 ou 2 semanas, respeitando as limitações fisiológicas do paciente. Todas as terapias foram realizadas durante 2 meses consecutivos. Antes e após as terapias propostas, testes de saliva foram realizados, incluindo taxa de fluxo salivar (TFS), valor de pH, capacidade tampão (CT), cortisol salivar matinal (CSmatinal) e noturno (CSnoturno) e identificação de Pseudomonas aeruginosas (P. aeruginosas). A seguir, a morfologia das glândulas salivares maiores, foram investigadas através do exame de ultrassonografia. Na análise estatística, teste de Wilcoxon (signed-rank test) para análise de correlação e teste de Kruskal-Wallis com o teste de Dunn para comparações múltiplas não paramétricas foram feitos. O nível de significância foi de p < 0,05. Embora a TFS tenha permanecido reduzida, a produção de saliva aumentou em todas as terapias. A TFS mostrou diferença estatística apenas no AIOm (p<0,0225). Houve diferença estatística no valor de pH apenas no EENMs (p < 0,0346). Nenhuma diferença estatística no CT foi encontrada; entretanto, os valores de normalidade foram alcançados (valores de limítrofe para normal) em 50% para DMHB e em 29% para EENMs e AIOm. Os valores normais de CSn não foram afetados, embora os níveis de CSn tenham aumentado estatisticamente na EENM (p < 0,0360) e entre as terapias EENM e AIOm (p < 0,0058). Nenhuma espécie de P. aeruginosa foi identificada em nossos pacientes antes das terapias. Neste estudo, pudemos concluir que a redução de fluxo salivar permaneceu nos pacientes com SD e AOS após as terapias propostas; entretanto, o AIOm seguido do DMHB mitigaram a severidade dessa alteração. A EENMs teve melhor desempenho em relação a qualidade da saliva quando comparado com as demais terapias. Dentre as terapias, os pacientes tratados com AIOm mostraram alta susceptibilidade ao estresse no período noturno. Nenhum paciente tinha risco de pneumonia por aspiração, antes das terapias. Nenhuma anomalia congênita de glândulas salivares maiores foi evidenciada, todavia alterações adquiridas foram observadas em alguns pacientes com SD e AOS (AU).

This study aims to evaluate the effects of neuromuscular electrostimulation therapies and intraoral biomechanical devices on the physicochemical and microbiological properties of saliva in patients with Down syndrome (DS) and obstructive sleep apnea (OSA). In addition, we investigated the major salivary glands' morphology: the glands of parotid, submandibular and sublingual to verify possible structural disorders in these individuals. Twenty-three adult patients with DS and OSA, with age range from 18 to 31 years old, of both genders, were invited to participate in this study. Among these patients, 18 patients completed the proposed therapies, and they were divided into three groups of therapy: sNME (n=7; therapy with surface neuromuscular electrostimulation), MDHB (n=4; therapy with masticatory device with hyperboloid) and mIOA (n= 7; therapy with mandibular advancement intraoral appliance). The sNME was applied on the masseter (superficial portion) and temporal (anterior portion) muscles on both the sides. The MDHB was positioned between the occlusal surfaces of the posterior teeth and the patient bit the active tips with hyperboloid. The mIOA was used only during the sleep. This appliance was activated slowly, from 0.5 mm to 1.0 mm per 1 to 2 weeks, respecting the patient's physiological limitations. All therapies were performed for 2 consecutive months. Before and after the proposed therapies, saliva tests were done, including salivary flow rate (SFR), pH value, buffering capacity (BC), morning (morningSC) and night (nightSC) salivary cortisol, and identification of Pseudomonas aeruginosa (P. aeruginosa). Furthermore, the major salivary glands' morphology, were investigated by means of ultrasound examination. For statistical analysis, Wilcoxon signed-rank test for correlation analysis and Kruskal-Wallis test with Dunn's test for nonparametric multiple comparisons were done. The level of significance was p < 0.05. Although SFR remained reduced, the saliva production increased in all therapies. The SFR showed a statistical difference only in the mIOA (p<0.0225). Despite the few variations in the pH value, there was a statistical difference only in the sNME (p<0.0346). No statistical difference was found in BC; however, the normality values were reached (borderline to normal values) in 50% for MDHB and in 29% for sNME and mIOA. The normal values of nSC were not affected, even though the nSC levels have increased statistically in NMES (p < 0.0360) and between the NMES and mIOA therapies (p <0.0058). No P. aeruginosa species was identified in our patients before the therapies. In this study, we concluded that the reduction in salivary flow remained in DS patients with DS and OSA after the proposed therapies; however, mIOA followed by MDHB mitigated the severity of this alteration. sNME showed better performance in relation to saliva quality when compared to other therapies. Among the therapies, patients treated with mIOA showed high susceptibility to stress, particularly at night. No patient had risk of aspiration pneumonia before the therapies. No congenital anomalies of major salivary glands were evidenced, but acquired alterations were observed in some patients with DS and OSA. (AU)

Nuevas opciones de aparatos funcionales para tratar pacientes con retrognatismo mandibular / New functional appliance options for treating patients with mandibular retrognathia

RESUMEN Fundamento: El estudio sobre los aparatos actuales de la ortopedia funcional de los maxilares puede aportar nuevos conocimientos para el perfeccionamiento del tratamiento de pacientes con retrognatismo mandibular. Objetivo: Profundizar en los nuevos aparatos de la ortopedia funcional de los maxilares para el tratamiento de pacientes con retrognatismo mandibular. Desarrollo: Se realizó una revisión bibliográfica en las bases de datos SciELO, PubMed, Ebsco, Cumed y Lilacs. En la búsqueda se revisaron 37 artículos, de ellos más del 80 % son de los últimos cinco años. Se identificaron bases teóricas de la ortopedia funcional de los maxilares en el tratamiento de pacientes con retrognatismo mandibular y los aparatos que se utilizan en la actualidad. Conclusiones: Existen nuevas opciones de aparatos funcionales, en su mayoría fijos y clasificados como dentosoportados pasivos, para el tratamiento de pacientes con retrognatismo mandibular.

ABSTRACT Background: The study of the current jaw functional orthopedic appliances can provide new knowledge for the improvement of the patients' treatment with mandibular retrognathia. Objective: To study deeply the current jaw functional orthopedic appliances for the patients' treatment with mandibular retrognathia. Development: A bibliographic review was conducted in the SciELO, PubMed, Ebsco, Cumed and Lilacs databases. A total of 37 articles were reviewed, more than 80 % from the last five years. Theoretical bases on the jaw functional orthopedics in the patients' treatment with mandibular retrognathia and current appliances in use were identified. Conclusions: New functional appliance options, mostly fixed and classified as passive dent supportive, are available for the patients' treatment with mandibular retrognathia.

Modificaciones esqueletales y de autoestima con bloques gemelos / Skeletal and self-esteem modifications with twin blocks

RESUMEN Las anomalías de clase II y III esqueletales son una afección del desarrollo, en la mayoría de los casos, no se debe a procesos patológicos, sino a una moderada distorsión del desarrollo normal, ello provoca alteración de la estética que influye en los niveles de autoestima de los pacientes. El objetivo del estudio fue evaluar las modificaciones esqueletales y de autoestima con bloques gemelos. Se realizó un estudio cuasi-experimental modalidad antes y después sin grupo control, en 35 pacientes con clase II y III esqueletal, ingresados en la Consulta de Ortodoncia de la Clínica Universitaria de Especialidades Estomatológicas "Manuel Cedeño", en el período comprendido entre enero a noviembre de 2018. Como medio de diagnóstico se empleó el examen clínico, la cefalometría y el Inventario de Autoestima elaborado por Cooper smith. Se obtuvo como resultado que el 71,42 % pertenecen a las edades de 12 y 13 años, y el 54,28 % son del sexo femenino; el 65,71 % de los pacientes presentó clase II esqueletal y el 34,28 % clase III antes del tratamiento, luego de éste, la anomalía esqueletal se corrigió en el 91,42 % de los casos; al caracterizar la población objeto de estudio se reveló que la autoestima fue baja en el 60,00 % antes del tratamiento, y luego fue de alta en el 74,28 %. Se concluye que la población de estudio presentó anomalías esqueletales y baja autoestima al inicio del tratamiento que se corrigió y mejoró, respectivamente, en la mayoría de los pacientes mediante el tratamiento con los bloques gemelos estándar y clase III.

ABSTRACT Skeletal class II and III anomalies are a developmental condition, in most cases, not due to pathological processes, but to a moderate distortion of normal development, this causes alteration of the aesthetic that influences the levels of self-esteem of the patients. The objective of the study was to evaluate the skeletal and self-esteem modifications with twin blocks. We performed a quasi-experimental modality before and after without a control group, in 35 patients with skeletal class II and III, admitted to the Orthodontic Consultation of the University Clinic of Stomatological Specialties "Manuel Cedeño", in the period from January to November 2018.The clinical examination, the cephalometry and the Self-esteem Inventory prepared by Coppersmiths were used as diagnostic means. It was obtained as a result that 71,42% belong to the ages of 12 and 13 years, and 54,28 % are female; 65,71% of patients presented class II skeletal and 34,28% class III before treatment, after this, the skeletal anomaly was corrected in 91,42% of cases; When characterizing the population under study it was revealed that self-esteem was low in 60,00% before treatment, and then it was high in 74,28%. It was concluded that the population studied presented skeletal anomalies and low self-esteem at the beginning of the treatment, which was corrected and improved, respectively, in the majority of patients by treatment with the standard twin and class III twin blocks.

Utilización del Neville Bass en el tratamiento del retrognatismo mandibular. Reporte de caso / Using of Neville Bass in the treatment of mandibular retrognathism. Case report

RESUMEN Fundamento: El uso de placas de acrílico superior retentiva y extensión de elementos linguales para el tratamiento del retrognatismo mandibular, constituye una opción novedosa en Cuba. Objetivo: Ilustrar el resultado en una paciente con retrognatismo mandibular tratado con el aparato Neville Bass. Presentación de caso: Paciente femenino de 9 años de edad, mestiza, con disfunción neuromuscular, mala relación intermaxilar, causado por retrognatismo mandibular, se le realizó tratamiento a la paciente con el aparato Neville Bass. Conclusiones: El tratamiento a la paciente con el aparato Neville Bass permitió la obtención de una correcta relación de sus bases óseas.

ABSTRACT Background: The use of retentive upper acrylic plates and extension of lingual elements for the treatment of mandibular retrognathism is a novel option in Cuba. Objective: To illustrate the result in a patient with mandibular retrognathism treated with the Neville Bass device. Case Report: A 9 year-old, half blood, female patient, with neuromuscular dysfunction, having poor intermaxillary relationship, caused by mandibular retrognathism, the patient was treated with the Neville Bass device. Conclusions: The treatment using the Neville Bass device allowed obtaining a correct relation of their bone bases.

Utilización del Neville Bass en el tratamiento del retrognatismo mandibular. Reporte de caso / Using of Neville Bass in the treatment of mandibular retrognathism. Case report

RESUMEN Fundamento: El uso de placas de acrílico superior retentiva y extensión de elementos linguales para el tratamiento del retrognatismo mandibular, constituye una opción novedosa en Cuba. Objetivo: Ilustrar el resultado en una paciente con retrognatismo mandibular tratado con el aparato Neville Bass. Presentación de caso: Paciente femenino de 9 años de edad, mestiza, con disfunción neuromuscular, mala relación intermaxilar, causado por retrognatismo mandibular, se le realizó tratamiento a la paciente con el aparato Neville Bass. Conclusiones: El tratamiento a la paciente con el aparato Neville Bass permitió la obtención de una correcta relación de sus bases óseas.

ABSTRACT Background: The use of retentive upper acrylic plates and extension of lingual elements for the treatment of mandibular retrognathism is a novel option in Cuba. Objective: To illustrate the result in a patient with mandibular retrognathism treated with the Neville Bass device. Case Report: A 9 year-old, half blood, female patient, with neuromuscular dysfunction, having poor intermaxillary relationship, caused by mandibular retrognathism, the patient was treated with the Neville Bass device. Conclusions: The treatment using the Neville Bass device allowed obtaining a correct relation of their bone bases.

Corrección de maloclusión de mordida abierta anterior con aparatología híbrida de FLOWJAC® system con antecedente de reabsorción ósea en mentón. Reporte de caso / Anterior open bite correction with hybrid FLOWJAC® system devices, patient with previous Chin bone resorption. Case report

The orthodontic minitubes system (FLOWJAC ® System, Bogotá, Colombia) is an innovating system that blend the selfligating philosophy techniques and a lowprofile appliance. The FLOWJAC® System works with low orthodontic forces, same as selfligation devices. The system uses heat-treated wires with better physical properties such as hysteresis when is compare with traditional wires. However, the FLOWJAC® technique doesn´t use a wire sequence to get a "working wire", just a 0,014 Copper NiTi. The clinician in each appointment must modify the minitube location to the clinical desire teeth position. The present report blend FLOWJAC® devices in the upper arch and clear selfligation in the lower arch. The patient treated has mandibular bone resorption due a alloplastic chin augmentation. The root apex from first right premolar to the first left premolar seen to be near to the resorption area using Cone Beam Computer Tomography. That´s the reason why we use a pre-adjust devices in the lower arch, to avoid pulpar and periodontal counter effects. This case was finished with proper functional and aesthetics objectives; such as molar and canine class I, anterior open bite closure with 20% of overbite, coincidence of dental smile arch with lower lip, and without root and pulpar counter effects. The porpoise of this report is to present an orthodontic case with bone resorption on right premolar and incisors area of the mandible. The case was treated with selfligation orthodontics system; FLOWJAC® System in the upper arch and Empower Clear® (American Orthodontics Shebboyiang, USA) in the lower arch and could be done with a precise diagnosis and adequate treatment planning.

El sistema de ortodoncia con Minitubos (FLOWJAC® System, Bogotá, Colombia) es un sistema innovador que combina la filosofía de trabajo de las técnicas de autoligado con una aparatología de perfil bajo. El sistema de FLOWJAC® trabaja con fuerzas leves, al igual que la aparatología de autoligado, con arcos de características físicas de histéresis mayor que los arcos tradicionales. Sin embargo, el sistema FLOWJAC® no presenta una secuencia de arcos hasta llegar a un arco de trabajo, dado que trabaja con un único arco de calibre 0,014 CuNiTi y el clínico lo que realiza son modificaciones de la posición de los minitubos en cada cita hasta llegar al objetivo clínico deseado. En el siguiente reporte se observa una combinación de aparatología, FLOWJAC® en el arco superior y autoligado estético en la arcada inferior. La paciente tratada presenta reabsorción ósea en zona de mentón debido a un procedimiento de mentoplastía de aumento con injerto aloplástico. Se observa tomográficamente cercanía de los ápices radiculares de premolar a premolar y por tal motivo se escoge aparatología pre-ajustada para evitar detrimento del estado pulpar y periodontal de dichos dientes. Se finaliza el caso con adecuados objetivos estéticos y funcionales; Clase I molar y canina, cierre de la mordida abierta anterior con un resalte vertical del 20%, arco dental concordante al arco de sonrisa, y evitando detrimento en los dientes circundantes de la zona de lesión. El propósito del presente artículo es ambientar al clínico sobre el tratamiento en paciente con antecedente de reabsorción ósea en zona de incisivos hasta premolares derechos inferiores, con Sistema de Ortodoncia de Autoligado; FLOWJAC® en la arcada superior y Empower Clear® en la arcada inferior. El caso pudo finalizar de forma adecuada gracias a un diagnóstico asertivo y un plan de tratamiento adecuado.

Influence of fixed appliances on two-phase orthopedic-orthodontic treatment

Aim: The purpose of this retrospective study was to investigate the effects of phase 2 with fixed appliances, after phase 1 Bionator treatment of Class II division 1 malocclusion, as compared to a matching control group. Methods: The experimental group consisted of 20 patients who were evaluated after orthodontic treatment with fixed appliances subsequently to functional therapy with the Bionator in phase 1. A control group consisting of 20 Class II, division 1 individuals. Results: During phase 1 there was significant forward growth restriction in the maxillary complex, improvement of the maxillomandibular relationship and decrease in facial convexity. There was also significant reduction of the maxillary incisor proclination and protrusion, protrusion of the mandibular incisors, and vertical development of the mandibular molars. The overjet was significantly reduced and the molar relationship was significantly improved. Treatment during phase 2, with fixed appliances, resulted in significant maxillary forward growth restriction and facial convexity reduction. Conclusion: Major Class II skeletal and dentoalveolar anteroposterior correction was obtained during phase 1, with the Bionator. Phase 2, with fixed appliances only produced a significant maxillary forward growth restriction and facial convexity reduction, without any significant dentoalveolar change

Castillo Morales Appliance Therapy in the treatment of drooling children.

OBJECTIVE: To evaluate the efficacy of Castillo Morales Appliance Therapy (CMAT) in reducing the severity and frequency of problematic drooling in children. METHODS: A de-identified extraction of all hospital morbidity records belonging to patients with drooling who underwent treatment with CMAT was performed between June 22, 2000 and April 12, 2016. Data were obtained from Starship Children's Hospital clinical records department. Demographic, diagnostic, and procedural data were included. Severity and frequency of drooling was quantified using the Thomas-Stonell and Greenberg classification method. RESULTS: There were fifty-three children less than 17 years of age who were treated with CMAT for the indication of problematic drooling between June 22, 2000 and April 12, 2016. 72% (n = 38) of patients had a reduction in the severity and frequency of drooling with CMAT. Mean follow up was 51 months. These patients did not require further treatment for drooling with botulinum toxin or surgery. Within this group, 63% (n = 24) of patients had significant improvement in drooling as per the Thomas-Stonell and Greenberg classification method (p = 0.024). CONCLUSIONS: Children who underwent CMAT for drooling were less likely to require further treatment with botulinum toxin or surgery. This result suggests that the use of CMAT in children with problematic drooling confers benefit.

Herbst appliance with skeletal anchorage versus dental anchorage in adolescents with Class II malocclusion: study protocol for a randomised controlled trial.

BACKGROUND: The Herbst appliance is an orthodontic appliance that is used for the correction of class II malocclusion with skeletal discrepancies. Research has shown that this is effective. However, a potential harm is excessive protrusion of the lower front teeth. This is associated with gingival recession, loss of tooth support, and root resorption. This trial evaluates a method of reducing this problem. METHODS/DESIGN: The study is a single-center, randomised, assessor-blinded, superiority clinical trial with parallel 1:1 allocation. Male and female young people (10-14 years old) with prominent front teeth (class II, division 1) will be treated in one orthodontic clinic. Group 1 will be treated with the conventional Herbst appliance with dental anchorage and group 2 with the Herbst appliance with indirect skeletal anchorage for 12 months. The primary objective will be to compare the proclination of the lower incisors between the Herbst appliance with dental anchorage and skeletal anchorage. Secondary objectives will be to evaluate the changes occurring between the groups in the mandible, maxilla, lower and upper molars, and in gingival recession and root resorption at the end of the treatment. Additionally, the young patient's experience using the appliances will be assessed. The primary outcome measure will be the amount of lower incisor proclination at the end of treatment. This will be assessed by cone-beam computed tomography (CBCT) superimposition. Secondary outcome measures will be the changes in the mandible, maxilla, lower and upper molars at the end of treatment assessed by tomography superimposition and the young patient's experience using the appliances assessed by self-reported questionnaires and semi-structured interviews. The randomisation method will be blocked randomisation, using software to generate a randomised list. The allocation concealment will be done in opaque envelopes numbered from 1 to 40 containing the treatment modality. The randomisation will be implemented by the secretary of the Department of Orthodontics of Rio de Janeiro State University before the beginning of the study. The patients and the orthodontists who will treat the patients cannot be blinded, as they will know the type of appliance used. The technician who will take the CBCT image and the data analyst will be blinded to patients' group allocation. DISCUSSION: If this new intervention is effective, the findings can change orthodontic practice and may also be relevant to other forms of treatment in which appliances are fixed to the bones of the jaws. However, if the bone anchoring is not effective, the trial will provide much needed information on the use of this comparatively new development. TRIAL REGISTRATION: ClinicalTrials.gov, protocol ID: NCT0241812 . Registered on 26 March 2015.

Resultados del tratamiento de maloclusión clase II división 1 con activador abierto elástico de Klammt / Results of type II division 1 malocclusion treatment, with Klammt elastic open activator

Fundamento: El activador abierto elástico de Klammt ha sido utilizado en Cuba en los últimos años. Es un aparato funcional que se encuentra entre las opciones de tratamiento de la maloclusión clase II división 1.Objetivo: describir los resultados del tratamiento ortopédico para la corrección de maloclusión clase II división 1 con activador abierto elástico de Klammt.Métodos: se realizó un estudio de intervención, cuasiexperimental, que incluyó a 20 niños de la escuela primaria Antonio Maceo, del Área de Salud II del municipio Cienfuegos. Para el diagnóstico se tomaron telerradiografías laterales de cráneo al inicio y al año de tratamiento, a las cuales se aplicaron mediciones lineales y/o angulares de Steiner, Ricketts y McNamara. Se evaluaron los cambios cefalométricos esqueletales y de tejidos blandos antes y después del tratamiento.Resultados: se observaron cambios en las mediciones de las radiografías laterales del cráneo, con variaciones cefalométricas cráneofaciales de significación estadística importante; lo mismo ocurrió en los tejidos blandos, que denotaron en general un mejoramiento del perfil, sobre todo del ángulo nasolabial, esencialmente originado en su componente labial.Conclusión: se constató la efectividad del activador abierto elástico de Klammt en el tratamiento de las maloclusiones clase II división 1, ya que se logró la corrección de estas en pacientes de edades tempranas, lo cual se evidenció en las variaciones resultantes en el biotipo facial hacia patrones más favorables.

Foundation: Klammt elastic open activator has been used in Cuba in the last years. It is a fuctional aparathus whis is found among the treatment options for type II division 1 maloclussion. Objective: To describe Klammt elastic open activator for correcting type II division 1 maloclussion with Klammt elastic open activator.Methods: A quasi-experimental intervention was carried out, including 20 children from the Antonio Maceo elementary school, from the Cienfuegos municipality Health Area II. For the diagnosis skull lateral cephalograms were taken at the beginning and at a year time from treatment beginning, to which linear and/or angular measurements of Steiner, Ricketts and McNamara were applied. Changes in measurements of skull lateral radiographs were observed, with cephalometric variations of craniofacial of important statistical significance; the same occurred in soft tissues, which generally denoted an improvement of the profile, especially of the nasolabial angle, essentially originating in its labial component. Skeletal and soft tissue cephalometric changes were evaluated before and after treatment.Results: Changes in measurements of skull lateral radiographs were observed, with cephalometric variations of craniofacial of important statistical significance; The same occurred in soft tissues, which generally denoted a profile improvement, especially of the nasolabial angle, essentially originating in its labial component.Conclusion: The effectiveness of Klammt elastic open activator in the treatment of class II malocclusions division 1 was verified, as it was corrected in patients of early age, which was evidenced in the resulting variations in the facial biotype towards more favorable patterns.

Discomfort, expectations, and experiences during treatment of large overjet with Andresen Activator or Prefabricated Functional Appliance: a questionnaire survey.

BACKGROUND: The purpose of this study was to investigate the amount of functional and social discomfort experienced after 1 and 6 months of appliance wear, comparing a slightly modified Andresen Activator (AA) and a Prefabricated Functional Appliance (PFA). METHODS: Ninety-seven patients randomly selected by lottery in an AA (40 subjects), and a PFA (57 subjects) group, with an Angle Class II, Division 1 malocclusion, were eligible for the study. One month and 6 months after start of treatment, a questionnaire, addressing discomfort, perception of treatment need and outcome, was used. RESULTS: The response rate was 69% after 1 month, and 45% after 6 months. The most common discomfort reported was the 'appliance falling out during sleep' followed by 'difficulties in remembering it'. The only difference was for pain, which was experienced more extensively in the AA group after 1 month of treatment. The dentist appeared to have the greatest impact on the decision to initiate treatment. Teasing, because of appearance, occurred in 13% of the cases. CONCLUSIONS: No difference could be seen between groups for the experience of functional or social discomfort after 6 months of appliance use. Adequate time should be allowed for clarifying treatment difficulties, using treatment need as motivation. PRACTICAL IMPLICATIONS: The PFA eliminates the need for taking impressions. Furthermore, it can be economically advantageous to both patients and clinicians.

Skeletal and dental changes induced by bionator in early treatment of class II / Alterações esqueléticas e dentárias induzidas pelo bionator no tratamento precoce da classe II

The purpose was to investigate the amount of skeletal and dentoalveolar changes after early treatment of Class II, Division 1 malocclusion with bionator appliance in prepubertal growing patients. Forty Class II patients were divided in two groups. Treated group consisted of 20 subjects treated consecutively with bionator. Mean age at the start of treatment (T0) was 9.1 years, while it was 10.6 years at the end of treatment (T1). Mean treatment time was 17.7 months. Pretreatment and post-treatment cephalometric records of treated group were evaluated and compared with a control group consisted of 20 patients with untreated Class II malocclusion. Intergroup comparisons were performed using Student's t-tests and chi-square test with Yates' correction at a significance level of 5 per cent. Bionator appliance was effective in generating differential growth between the jaws. Cephalometric skeletal measurements ANB, WITS, Lafh, Co-A and dental L6-Mp, U1.Pp, IsIi, OB, OJ showed statistically significantly different from the control. Bionator induced more dentoalveolar changes than skeletal during treatment in prepubertal stage.

Este estudo quantificou as alterações esqueléticas e dentoalveolares no período pré-puberal de crescimento após o tratamento da má oclusão de classe II, divisão 1 com bionator. Quarenta pacientes classe II foram divididos em dois grupos. Um grupo com 20 pacientes tratados consecutivamente com bionator. A média de idade no início do tratamento (T0) foi de 9,1 anos, enquanto ao final (T1) foi de 10,6 anos. O tempo médio de tratamento foi de 17,7 meses. Os dados cefalométricos antes e após o tratamento foram avaliados e comparados com um grupo controle de 20 pacientes com má oclusão de classe II, divisão 1 não tratada. A comparação intergrupo foi realizada pelo teste t de Student e teste qui-quadrado com correção de Yates para um nível de significância de 5 por cento. O aparelho foi efetivo em gerar diferencial de crescimento entre os arcos dentários. As medidas cefalométricas esqueléticas ANB, WITS, Lafh, Co-A e as dentárias L6-Mp, U1.Pp, IsIi, OB, OJ demonstraram diferença estatística significante entre os grupos. O bionator induziu maiores alterações dentoalveolares que esqueléticas no tratamento da classe II, divisão 1 durante o período pré-puberal.

Changes in alveolar bone support induced by the Herbst appliance: a tomographic evaluation

ABSTRACT Objective: This study evaluated alveolar bone loss around mandibular incisors, induced by the Herbst appliance. Methods: The sample consisted of 23 patients (11 men, 12 women; mean age of 15.76 ± 1.75 years), Class II, Division 1 malocclusion, treated with the Herbst appliance. CBCT scans were obtained before treatment (T0) and after Herbst treatment (T1). Vertical alveolar bone level and alveolar bone thickness of mandibular incisors were assessed. Buccal (B), lingual (L) and total (T) bone thicknesses were assessed at crestal (1), midroot (2) and apical (3) levels of mandibular incisors. Student's t-test and Wilcoxon t-test were used to compare dependent samples in parametric and nonparametric cases, respectively. Pearson's and Spearman's rank correlation analyses were performed to determine the relationship of changes in alveolar bone thickness. Results were considered at a significance level of 5%. Results: Mandibular incisors showed no statistical significance for vertical alveolar bone level. Alveolar bone thickness of mandibular incisors significantly reduced after treatment at B1, B2, B3, T1 and significantly increased at L2. The magnitude of the statistically significant changes was less than 0.2 mm. The changes in alveolar bone thickness showed no statistical significance with incisor inclination degree. Conclusions: CBCT scans showed an association between the Herbst appliance and alveolar bone loss on the buccal surface of mandibular incisors; however, without clinical significance.

RESUMO Introdução: este estudo avaliou a perda óssea alveolar ao redor dos incisivos inferiores induzida pelo aparelho de Herbst. Métodos: a amostra foi composta por 23 pacientes (11 homens e 12 mulheres; média de idade 15,76 ± 1,75 anos), má oclusão de Classe II, divisão 1, tratados com aparelho de Herbst. TCFCs foram realizadas antes do tratamento (T0) e após o tratamento (T1) com o Herbst. A altura e a espessura óssea alveolar dos incisivos inferiores foram avaliadas. As espessuras ósseas vestibular (V), lingual (L) e total (T) foram mensuradas nos terços cervical (1), médio (2) e apical (3) dos incisivos inferiores. O teste t de Student e o teste t de Wilcoxon compararam as amostras dependentes nos casos paramétricos e não paramétricos, respectivamente. As análises de Pearson e Spearman determinaram a correlação entre as alterações na espessura do osso alveolar. Os resultados foram considerados para um nível de significância de 5%. Resultados: os incisivos inferiores não apresentaram significância estatística para a altura óssea alveolar. Após o tratamento, a espessura óssea alveolar dos incisivos inferiores reduziu-se significativamente em V1, V2, V3 e T1 e aumentou significativamente em L2. A quantidade da alteração óssea significativa foi menor que 0,2mm. As alterações na espessura óssea alveolar não apresentam correlação estatisticamente significativa com o grau de inclinação do incisivo. Conclusões: as imagens de TCFC demonstram associação entre o uso do aparelho de Herbst e a perda óssea alveolar no lado vestibular dos incisivos inferiores; entretanto, sem significância clínica.

Cone beam computed tomography study of apical root resorption induced by Herbst appliance

Objective This study evaluated the frequency of root resorption during the orthodontic treatment with Herbst appliance by Cone Beam Computed Tomography (CBCT).Material and Methods The sample comprised 23 patients (11 men, 12 women; mean ages 15.76±1.75 years) with Class II division 1 malocclusion, treated with Herbst appliance. CBCT was obtained before treatment (T0) and after Herbst treatment (T1). All the dental roots, except third molars, were evaluated, and apical root resorption was determined using the axial guided navigation method. Paired t-tests and Wilcoxon T Test were used to compare the dependent samples in parametric and nonparametric cases, respectively. Chi-Square Test with Yates’ correction was used to evaluate the relationship between apical root resorption and gender. Results were considered at a significance level of 5%.Results Apical resorption was detected by CBCT in 57.96% of 980 roots that underwent Herbst appliance treatment. All patients had minimal resorption and there was no statistical significance between the genders.Conclusion CBCT three-dimensional evaluation showed association between Herbst appliance and minimal apical root resorption, mostly in the anchoring teeth, without clinical significance.

Degradación de fuerzas en cadenas elastoméricas de dos marcas diferentes. Estudio in vitro / Degradation of forces in elastomeric chains of two different brands. In vitro study

Determinar la cantidad de degradación de fuerzas en cadenas elastoméricas de dos marcas diferentes. Materiales y métodos. Se elaboraron quince muestras de cada marca comercial de cadenas elastoméricas (American Orthodontics y Denstply GAC) de cuatro eslabones cada una, transparentes y de tipo short. Se confeccionaron bases acrílicas en las cuales se insertaron y fijaron pines metálicos que tuvieron como finalidad mantener las muestras permanentemente traccionadas a una distancia de 15 mm. Se midió la fuerza de tracción inicial utilizando un dinamómetro calibrado. Las muestras fueron sumergidas en saliva artificial. Un solo investigador realizó el mismo procedimiento en intervalos de 1 día, 7 días, 14 días y 21 días. Resultados. Para comparar la degradación de fuerzas de ambos grupos se emplearon las pruebas U de Mann-Whitney y t de Student a un nivel de significancia de 5%. Al inicio del estudio hubo una diferencia muy significativa (p<0,001). A las 24 h se mantuvo la diferencia significativa (p<0,024). A los 7 días no hubo diferencia significativa (p<0,299). Pero, a los 14 días hubo una diferencia muy significativa (p<0,001) y a los 21 días hubo diferencia altamente significativa (p<0,001). Conclusiones. Se encontró que ambas marcas comerciales mostraron una alta degradación de fuerzas al primer día. Posteriormente, la degradación de fuerzas de cada muestra disminuyó en intensidady fue más estable. La marca Denstply GAC frente a la marca American Orthodontics, mostró mayor cantidad de fuerza remanente al final del estudio...

To determine the amount of degradation force in elastomeric chains of two different brands. Materials and methods. Fifteen samples of each brand of elastomeric chains (American Orthodontics y Denstply GAC) of four brands each, transparent and short type were manufactured. Acrylic bases in which metal pins were inserted and fixed that had the objective to keep the samples permanently drivable at a distance of 15 mm were prepared. Initial tensile strength was measured using a calibrated dynamometer. Samples were immersed in artificial saliva. A single investigator performed the same procedure in 1 day, 7 days, 14 days and 21 days. Results. To compare the degradation of forces of both groups U Mann-Whitney test and Student t test at a significance level of 5% were used. At baseline there was a significant difference (p <0,001). At 24 h the significant difference (p <0,024) remained. At 7 days, there was no significant difference (p <0,299). But, at 14 days there was a highly significant difference (p <0,001) and 21 days there were highly significant (p <0,001). Conclusions. It was found that both brands showed high force degradation the first day. Subsequently, force degradation of each sample was decreased in intensity and was more stable. The brand Denstply GAC in comparison to the mark American Orthodontics showed greater amount of force remaining at the end of the study...