Efficacy of the combination of myofunctional therapy (lip exercises) and activator high-pull headgear in the closure of interlabial gap in long-face skeletal class II patients with lip incompetence: A 6-8-month longitudinal randomized clinical trial.

Background: Lip incompetence is an important issue in orthodontics. No study has evaluated the effects of the combination of headgear + lip exercises on lip incompetence. Therefore, this study was conducted. Materials and Methods: This was a longitudinal randomized clinical trial on 29 subjects (16 controls and 13 experimental subjects). Both groups were treated with standardized activator high-pull headgear (and followed up monthly) for 6-8 months. In the experimental group, patients were also instructed to practice certain lip exercises 3 sessions a day, 5 times per session. Pre-/post-treatment interlabial gap, upper lip length and vermilion height, lower lip length and vermilion height, nasolabial angle, and profile convexity angle were measured clinically and photographically, immediately before treatment and after it. Data were analyzed using paired/unpaired t-tests (α = 0.025) and partial correlation coefficient controlling for the intervention type (α = 0.05). Results: Lip exercise plus activator headgear significantly changed/improved all parameters (P ≤ 0.006) over the 6-8-month course of treatment. Activator headgear alone changed/improved only 4 parameters: interlabial gap, upper and lower lip lengths, the lower lip vermilion height, and profile convexity (P ≤ 0.008). Compared to the control (activator headgear alone), in the experimental group, the changes observed in the interlabial gap closure (P = 0.011), upper lip lengthening (P = 0.002), and upper lip vermilion lengthening (P = 0.017) were significantly greater. Convexity angle corrections were more successful in cooperative patients (R = 0.469, P = 0.012). Cases with smaller pretreatment nasolabial angles may experience more changes in this angle after treatment (R = 0.581, P = 0.001). Conclusion: The addition of lip exercises to activator high-pull headgear can boost activator headgear's efficacy in treating lip incompetence.

Does Early Treatment Improve Clinical Outcome of Class II Patients? A Retrospective Study.

The present study was carried out to evaluate the benefits from one-phase Class II Early Treatment (ET) using extraoral forces and functional appliances but without intermaxillary forces and eventual lower leeway space preservation compared to two-phase Class II Late Treatment (LT) with the need for extractions and full fixed appliances as well as lower incisor proclination. The ET group (n = 239, 115 M, 124 F, mean age 10.6 ± 1.2 years), with first premolars not in contact and the second deciduous lower molars preserved, was compared to the LT group (n = 288, 137 M, 151 F, mean age 12.4 ± 1.5 years). The ET group was first treated with headgears, growth guide appliances, or Teuscher activators and, in borderline crowding cases, with lower space maintenance by a lingual arch, lip bumper, or fixed utility arch. The LT group and the second phase of ET were treated with full fixed appliances including intermaxillary forces such as Class II elastics or noncompliance devices; headgear and a growth guide appliance were also used. Cephalograms and plaster models were taken before (T1) and after treatment (T2) to calculate cephalometric changes and space balance discrepancies. The differences between T1 and T2 were analyzed by a t-test for normally distributed data and by the Mann-Whitney Test for nonnormally distributed data at a level of p < 0.05. The groups were defined as statistically homogeneous at T1. A statistical analysis showed that the ET group (mean treatment time 35.3 ± 13.3 months) was significantly associated with a 22.2% lower extraction rate, 15.9% less need for a full fixed appliance, and more than 5° less incisor proclination in the nonextraction cases compared to the LT group (mean treatment time 25.9 ± 8.1 months); treatment time significantly increased in the ET group compared to the LT group. Early Class II treatment resulted in a significant treatment effort reduction in more than one third of the patients and less lower incisor proclination, even if it clinically increased treatment time.

Tratamiento ortodóncicoquirúrgico de canino inferior derechotransmigrado / Orthodontic-surgical approach in the treatment of a transmigrated lower right canine

RESUMEN Introducción: Si un canino impactado cruza la línea media desde su posición normal al lado contrario, se denomina transmigración. Esta presenta bajos rangos de prevalencia por lo que se le considera una condición rara. El tratamiento ortodóncico quirúrgico es una de sus opciones terapéuticas. Objetivo: Describir los resultados del tratamientoortodóncico quirúrgico en un pacientecon canino inferior derecho transmigrado. Caso clínico: Paciente masculino de 11 años de edad con antecedentes de salud que acudió a consulta de Estomatología General Integral por tener los dientes botados y por la falta de uno que mudó y el sucesor aún no ha brotado. El caso se refiere al servicio de Ortodoncia. Al examen bucal destacó la ausencia clínica del 43, sin espacio necesario para su ubicación en la arcada. El paciente clasificó como síndrome de clase II división 1 de Moyers. Se indicó estudio radiográfico y se confirmó el diagnóstico de canino incluido, transmigrado y mesioangular en región mentoniana. Se decidió realizar tratamiento ortodóncico quirúrgico para colocar el canino en su posición. Conclusiones: El tratamiento ortodóncico quirúrgico devolvió al paciente la función y la estética, mediante la correcta ubicación del canino en la arcada. Este puede ser considerado como una alternativa terapéutica en el caso de canino mandibular transmigrado que presenta patrón tipo 1.

ABSTRACT Introduction: If an impacted canine tooth crosses the midline towards the opposite side, it is considered as dental transmigration. It is a rare condition with low ranges of prevalence. The surgical-orthodontic treatment is one of the therapeutic options. Objective: To describe the orthodontic-surgical treatment results, in a patient, with transmigrated lower right canine. Case report: An 11-year-old male patient attended the general practitioner for dental evaluation, his chief complaint was the absence of one deciduous tooth and the permanent still un-erupted and the tipping of the upper incisors. During the orthodontic examination was noted insufficient space to tooth 43 in the arch. The patient was diagnosed with Moyers' class II malocclusion division 1 syndrome. The radiographic examination confirmed the diagnosis of impacted and transmigrated lower right canine, mesioangular position across the midline within the chin area. Orthodontic-surgical treatment was carried out to bring the canine tooth to its functional position. Conclusions: Orthodontic-surgical treatment restored the function and aesthetics to the patient, through the right positioning of the canine in the arch. It could be considered as a therapeutic alternative in the case of transmigrated mandibular canine with type 1 pattern.

Facemask therapy with skeletal anchorage: A possible alternative to orthognathic surgery.

Treatment of skeletal Class III malocclusion in young patients is very challenging. Facemask therapy has been proven to be effective in early correction of Class III malocclusion. With the aid of skeletal anchorage, the orthopaedic effects are expected to be greater than the effects with conventional facemask with tooth-borne anchorage. However, only a few studies have reported on the long-term stability of facemask therapy combined with skeletal anchorage. This report examines two patients with skeletal Class III malocclusion who were treated with facemask and skeletal anchorage followed by orthodontic treatment using fixed orthodontic appliances. The long-term effects of facemask therapy with skeletal anchorage are discussed and compared with the conventional facemask therapy.

Tratamiento de mordida cruzada anterior con aparato de tracción extraoral Máscara Delaire en paciente con estrabismo: Reporte de caso / Anterior crossbite treatment with headgear: Delaire mask in a patient with strabismus: Case reportCitaciónAriza JA, Flórez AP, Hurtado ME. Tratamiento de mordida cruzada anterior con aparato de tracción extraoral Máscara Delaire en paciente con estrabismo: Reportede caso

In Class III malocclusion with anterior crossbite exist an altered relationship between maxilla and mandible: maxillary retrognathism, mandibular prognathism or a combination of these; this disharmony can alter facial aesthetics. The etiology is multifactorial; hereditary and environmental (habits, enlarged tonsils and mandibular posture). Considering the etiological factor is crucial to establish an adequate treatment plan and achieve long-term stability.An intervention at an early age can achieve a normal function and harmony in the relationship of the jaws, thus improving the aesthetics of the patient. There are several treatment options depending on age such as maxillary orthopedics, orthodontics and orthognathic surgery. This case report depictsa 9-year-old and 7-month-old female patient, with strabismus,whose mother consults because "her jaw is getting out";the clinical and cephalometric findings determine a class III malocclusion with maxillary retrognathism, anterior cross bite, vertical growth, mixed breathing with nasal predominance, atypical swallowingand sigmatism. The treatment was developed in 2 phases: first mechanical orthopedics with Hyrax and Delaire's facial mask for 11 months, in the second phase SN3 functional orthopedic appliance (small lower fins). The changes obtained with Delaire's facial mask are evidenced at the facial, dental and skeletal level, without compromising the strabismus alteration that the patient presents and handles with glasses.

En la maloclusión clase III con mordida cruzada anterior existe una alteración en la relación máxilo-mandibular: retrognatismo maxilar, prognatismo mandibular o combinada, esta desarmonía puede alterar la estética facial. Si se interviene a una edad temprana se puede lograr la normalidad de la funciones y armonía en la relación de los maxilares, llevando a mejorar la estética del paciente. Es importante tener en cuenta el factor etiológico para establecer un adecuado plan de tratamiento y lograr estabilidada largo plazo. La etiología es multifactorial; hereditaria y ambiental (hábitos, agrandamiento de las amígdalas y postura mandibular). Existen varias opciones de tratamiento dependiendo de la edad como ortopedia maxilar, ortodoncia y cirugía ortognática.Este reporte de caso,presenta una paciente de 9 años y 7 meses de edad, género femenino, con estrabismo, cuya madre consulta porque "se le está saliendo la mandíbula"; los hallazgos clínicos y cefalométricos determinan una maloclusión clase III con retrognatismo maxilar, mordida cruzada anterior, crecimiento vertical, respiración mixta con predominio nasal, deglución atípica y sigmatismo. El tratamiento que se realizó en este paciente fue en 2 fases: en la primera ortopedia mecánica con Hyrax y máscara facial de Delaire por 11meses y en la segunda fase aparato de ortopedia funcional SN3 (pequeñas aletas inferiores). Los cambios obtenidos con máscara facial de Delaire se evidencian a nivel facial, dental y esquelético, sin comprometer la alteración de estrabismo que la pacientepresenta y maneja con gafas.

Comparison of the dentoskeletal and soft tissue changes with the cervical headgear and Jones Jig followed by fixed appliances in Class II malocclusion patients: A retrospective study.

OBJECTIVE: To retrospectively compare the dentoskeletal and soft tissue changes of patients with Class II malocclusion treated with cervical headgear and Jones Jig appliances, followed by fixed appliances. MATERIAL AND METHODS: The sample comprised 46 Class II malocclusion patients divided into two groups. Patients with Class II malocclusion based on the ANB angle and plaster model analyses, needing non-extraction orthodontic treatment, absence of mandibular crowding and no previous orthodontic treatment were eligible to be selected. Group 1 consisted of 25 patients treated with cervical headgear (CH) followed by fixed appliances for a mean period of 3.26 years and group 2 consisted of 21 patients treated with the Jones Jig (JJ) appliance for a mean of 4.29 years. Lateral cephalograms were evaluated at the beginning and at the end of orthodontic treatment. For intergroup comparisons, t and Mann-Whitney tests were performed. RESULTS: The cervical headgear group produced significantly greater maxillary anterior displacement restriction (SNA; CH: -0.97°±1.33; JJ: 0.07°±1.73; P=0.025), apical base discrepancy improvement (ANB; CH: -1.52°±1.25; JJ: 0.36°±1.46; P=0.006), FMA reduction (CH: -0.78°±2.68; JJ: 1.07°±2.84; P=0.028) and distal mandibular molar angulation (Md6.PM; CH: 6.97°±3.66; JJ: 2.77°±6.87; P=0.013) than the Jones Jig group. CONCLUSIONS: Both distalizers followed by fixed appliances were effective to correct Class II malocclusion. The cervical headgear group presented skeletal effects with less treatment time and there were no significant intergroup differences regarding soft tissue changes.

Effects of the cervical headgear in growing Angle Class II malocclusion patients: a prospective study

ABSTRACT Objective: Evaluate dental and skeletal changes resulting from the exclusive use of the cervical headgear for 15 ± 4 months in the treatment of patients with Class II division 1 malocclusion. Methods: Differences between the beginning (T1) and immediately after the end of the therapy (T2) with the cervical headgear in growing patients (Experimental Group, EG, n = 23) were examined and compared, during compatible periods, with those presented by a group of untreated individuals (Control Group, CG, n =22) with similar malocclusions and chronological age. The cephalometric variables evaluated were: ANB, GoGn.SN, AO-BO, S'-ANS, S'-A, S'-B, S'-Pog and S'-U6 (maxillary first molar). The Shapiro-Wilk and Levene tests were used to evaluate the results. Results: Significant differences were found relative to the ANB, S'-U6, AO-BO, S'-ANS, S'-A, S'-B and S'-Pog variables between T1 and T2 when comparing both groups. No statistically significant variation was found regarding the GoGn.SN angle. Conclusions: The use of cervical headgear promoted distal movement of the maxillary first molars and restricted the anterior displacement of the maxilla, without significantly affecting the GoGn.SN angle.

RESUMO Objetivo: Avaliar as alterações dentárias e esqueléticas decorrentes do uso exclusivo do aparelho extrabucal durante 15 ± 4 meses para tratamento de pacientes com má oclusão de Classe II divisão 1 (Grupo Experimental, GE). Métodos: As diferenças entre o início (T1) e imediatamente após o término da terapia (T2) com o aparelho extrabucal de tração cervical (Grupo Experimental, GE, n = 23) foram comparadas àquelas apresentadas por um grupo composto por indivíduos não tratados (Grupo Controle, GC, n = 22), com má oclusão e faixa etária cronológica compatíveis. As variáveis cefalométricas avaliadas foram: ANB, GoGn.SN, AO-BO, S'-ENA, S'-A, S'-B, S'-Pog e S'-U6 (primeiro molar superior). Os testes de Shapiro-Wilk e Levene foram aplicados para avaliar os resultados. Resultados: Diferenças significativas entre T1 e T2 foram encontradas para as variáveis ANB, S'-U6, AO-BO, S'-ENA, S'-A, S'-B e S'-Pog, quando comparados os dois grupos. Nenhuma diferença estatisticamente significativa foi encontrada em relação ao ângulo GoGn.SN. Conclusão: O uso do aparelho extrabucal com tração cervical promoveu movimento para distal do primeiro molar superior e restringiu o deslocamento anterior da maxila, sem afetar significativamente o ângulo GoGn.SN.

Different approaches to the treatment of skeletal Class II malocclusion during growth: Bionator versus extraoral appliance

ABSTRACT Introduction: Class II malocclusion, which has a significant incidence in the population, may compromise facial esthetics and the smile, as well as the masticatory and respiratory functions. Often associated with skeletal abnormalities, it severely affects and compromises quality of life. An accurate diagnosis is fundamental to prepare a treatment plan to correct dental and skeletal anomalies. Objectives: This study discusses treatment alternatives to the correction of Class II division 1 and 2 malocclusion in growing patients, using a Bionator and an extraoral appliance.

RESUMO Introdução: A má oclusão de Classe II apresenta uma incidência significativa na população, podendo comprometer a estética facial, o sorriso e as funções mastigatória e respiratória. Frequentemente está associada à alteração esquelética, o que aumenta a repercussão desse comprometimento, interferindo ainda mais na qualidade de vida das pessoas afetadas. O correto diagnóstico dessa condição é fundamental para a elaboração de um plano de tratamento que permita a correção dentária e esquelética. Objetivos: O objetivo do presente artigo é discutir as alternativas terapêuticas para correção da Classe II divisão 1 e 2 em pacientes em fase de crescimento, utilizando-se o Bionator de Balters ou o aparelho extrabucal.

Tratamiento de la hipoplasia anteroposterior maxilar / Treatment of anteroposterior maxillary hypoplasia

RESUMEN Los pacientes con hipoplasia anteroposterior del maxilar superior deben ser detectados durante la atención odontológica temprana, o sea, cuando todavía están en período de crecimiento, con la finalidad de poder inducir cambios de tipo alveolar, esqueléticos y estéticos. La paciente tenía 12 años de edad, contaba con potencial remanente de crecimiento y presentaba Síndrome de Clase III esqueletal, por retrusión del maxilar superior. La caracterizaba una mandíbula de tamaño normal y una mordida cruzada anterior; en su tratamiento se utilizó la máscara facial ortopédica de Petit, para la tracción anterior del maxilar, y el tornillo Hyrax, para la expansión dentoalveolar. Estos instrumentos se emplearon con el fin de corregir la mordida cruzada posterior simple del lado izquierdo. Se observaron resultados satisfactorios desde el punto de vista esqueletal, oclusal, faciales y del perfil.

ABSTRAC Patients with anteroposterior hypoplasia of the upper jaw should be detected during early dental care, that is, when they are still growing, in order to be able to induce alveolar, skeletal and aesthetic changes. The patient was 12 years old, had residual growth potential and presented skeletal Class III Syndrome due to retrusion of the upper jaw. She was characterized by a normal sized jaw and an anterior crossbite; a Petit orthopedic face mask was used as a treatment for anterior maxillary traction and a Hyrax screw for dentoalveolar expansion. These instruments were used in order to correct the simple posterior crossbite on the left side. Satisfactory results were observed from the skeletal, occlusal, facial and profile points of view.

Comparison of two asymmetric headgear force systems: A finite element analysis

Abstract Objective: The aim of this study was to evaluate the effect of displacement patterns of the molar teeth in response to different asymmetric headgear loading using 3D finite element method. Methods: A series of twenty-five facebow with different left vs. right outer bow length and different expansion of left vs. right were designed. The non-favored side (right side) was shortened at intervals of 10 mm, and favored side (left side) was expanded 10 degree greater than right side and 5 degree expansion were successively added. At the first phase, each side received 200-g load, implying the neck strap to displace toward shorter arm. At the second phase, a total of 400-g load was applied to the ends of the outer bow. Because of the neck strap displacement, the shorter arm received greater load than the left side, the magnitude of the applied force to each side depended on difference of left vs. right outer bow length and expansion. Results: All systems were effective in promoting asymmetric distal movement of the molars. However, the asymmetrical facebow with the 40 mm shortening and 25 degree expansion outer bow when unequal force applied could be used in asymmetric mechanics. Medial and occlusal displacing forces were observed in all systems. Conclusions: Both equal and unequal force application is effective for molar distalization. Expansion of the outer bow in the affected side and shortening of the outer bow in the normal side were effective to produced differential distal molar movement.

Resumo Objetivo: o objetivo desse estudo foi usar o método de elementos finitos 3D para avaliar o efeito no padrão de deslocamento dos molares em resposta ao uso de aparelhos extrabucais com diferentes forças assimétricas. Métodos: foram confeccionados 25 aparelhos extrabucais (AEB) com diferenças, entre os lados direito e esquerdo, quanto ao comprimento e ao grau de abertura do braço externo. O lado não favorecido (lado direito) foi encurtado em intervalos de 10 mm e o lado favorecido (lado esquerdo) foi aberto 10 graus a mais do que o lado direito, sendo adicionados 5 graus de abertura sucessivamente. Na primeira fase, cada lado recebeu carga de 200 g, causando o deslocamento da tala cervical em direção ao braço mais curto. Na segunda fase, foi aplicada carga total de 400 g às extremidades dos braços externos dos AEB. Devido ao deslocamento da tala cervical, o braço mais curto recebeu uma força maior do que o lado oposto; a magnitude da força aplicada em cada lado dependeu da diferença no comprimento e na abertura dos braços externos do AEB. Resultados: todos os sistemas foram efetivos em promover movimentação distal assimétrica dos molares. Porém, o AEB assimétrico com 40 mm de encurtamento e 25 graus de abertura do braço externo poderia ser usado na mecânica assimétrica, com aplicação diferenciada de força. Foram observadas forças mediais e oclusais de deslocamento em todos os sistemas. Conclusões: tanto a aplicação de forças simétricas quanto assimétricas são efetivas para a distalização dos molares. A expansão do braço externo do AEB no lado afetado e o encurtamento no lado normal foram efetivos na produção de movimento distal assimétrico dos molares.

Tratamento da Classe III esquelética associada à mordida aberta ­ relato de caso / Treatment of skeletal Class III associated with open bite ­ case report

A Classe III esquelética, apesar de baixa prevalência na população, representa um grande desafio ao ortodontista em virtude da imprevisibilidade do padrão de crescimento da mandíbula que é determinado geneticamente. Pode ser causada por uma retrusão maxilar, protrusão mandibular ou uma combinação de ambas. Sua associação à mordida aberta esquelética constitui um desafio adicional. Entre os tratamentos preconizados para a Classe III, encontram-se a protração maxilar, a camuflagem ortodôntica e a correção orto-cirúrgica. Este trabalho objetiva apresentar um caso clínico de um paciente do sexo masculino em fase de crescimento. Foi diagnosticada Classe III esquelética por retrognatismo maxilar, hipoplasia da região zigomática, perfil facial convexo e leve padrão dolicofacial; incisivos superiores vestibularizados e incisivos inferiores levemente retruídos, mordida aberta anterior e posterior associada à postura alterada da língua. A terapia escolhida foi a disjunção com aparelho Hyrax e tração reversa da maxila com máscara de Petit, seguida de Ortodontia fixa com exodontia dos primeiros pré-molares para correção da mordida aberta; também foi utilizado arco lingual com esporões para correção da postura da língua. A oclusão normal foi obtida de acordo com os princípios funcionais e estéticos, com correção da Classe III e da mordida aberta. Houve melhora no relacionamento entre a maxila e a mandíbula sem alterações significativas no padrão vertical. A limitação facial foi plenamente aceita pelo paciente que havia recusado a opção pelo tratamento cirúrgico.(AU)

Skeletal Class III malocclusion, despite low prevalence in the population, represents a great challenge to the orthodontist due to the unpredictability of the jaw growth pattern, which is genetically determined. It can be caused by a maxillary retrusion, mandibular protrusion or a combination of both. Its association with skeletal open bite consists in an additional challenge. Among the treatment options recommended for Class III, there are maxillary protraction, orthodontic camouflage, and orthodontic-surgical correction. This article aims to present a case report of a male patient, in growth phase. It was diagnosed skeletal Class III due to maxillary retrognathism, zygomatic hypoplasia, convex facial profile, mild dolichofacial pattern; proclined upper incisors and slightly retruded lower incisors, anterior and posterior open bite associated with altered tongue posture. The therapy chosen was the disjunction with Hyrax appliance and reverse traction of the maxilla with Petit facemask, followed by fixed orthodontics with first premolars extraction for correction of open bite; and lingual arch with spurs was also used for tongue posture correction. Normal occlusion was obtained according to functional and aesthetic principles, with Class III and open bite correction. There was improvement in the relationship between the maxilla and the mandible without significant changes in the vertical pattern. The facial limitation was fully accepted by the patient who had refused the option for surgical treatment.(AU)

Tratamento compensatório da Classe III em adulto com expansão cirúrgica da maxila e uso de máscara facial / Compensatory Class iii treatment in adult with surgical maxillary expansion and facial mask use

A má oclusão de Classe III, apesar de ser menos prevalente na população mundial, gera preocupação clínica devido ao seu difícil tratamento e grande comprometimento estético. Em adultos, devido à impossibilidade de abordagem ortopédica, o tratamento pode seguir dois caminhos: ortodôntico, com compensação dentoalveolar ou orto-cirúrgico, com preparo para cirurgia ortognática. Para pacientes adultos diagnosticados com má oclusão esquelética de Classe III, mas que relutam em se submeter ao procedimento cirúrgico, a camuflagem ortodôntica consiste em uma opção viável de tratamento. O objetivo deste trabalho foi relatar a compensação de uma má oclusão de Classe III em um paciente adulto, com utilização de mecânica corretiva fixa, realização de Expansão Rápida da Maxila Assistida Cirurgicamente (ERMAC) e utilização de máscara facial de Petit. Os resultados obtidos neste caso demonstraram que a abordagem terapêutica proporcionou melhora oclusal, funcional e estética para o paciente. (AU)

Class III malocclusion, although less prevalent in the world population, generates clinical concern, due to difficulty to treat it and great aesthetic impairment. In adults, due to the impossibility of orthopedic approach, treatment can follow two paths: orthodontic, with dentoalveolar compensation or orthosurgical, with preparation for orthognathic surgery. For adult patients diagnosed with malocclusion Class III, but who are reluctant to go through surgery, orthodontic camouflage consists of a viable treatment option. The purpose of this article was to report the compensation of a Class III malocclusion in an adult patient, with fixed corrective mechanics, rapid maxillary expansion surgically assisted (SARME) and use of Petit facial mask. The results obtained in this case showed that the therapeutic approach provided occlusal, functional and aesthetic improvement for the patient. (AU)

Tratamiento de la maloclusión Clase III con protracción maxilar: Reporte de Caso / Treatment of Class III malocclusion with maxillary protraction: Case Report

La maloclusión Clase III es un problema esquelético anteroposterior en la que se puede observar relaciones alteradas de los componentes óseos, dentarios y musculares; siendo el componente esquelético alterado con mayor frecuencia la deficiencia maxilar en sentido sagital y transversal. La intervención temprana de esta anomalía es reportada con un mayor porcentaje de éxito. Con la utilización de la máscara de protracción asociada a una disyunción maxilar se producen cambios beneficiosos en la arquitectura facial. La edad del paciente, la colaboración y el manejo adecuado del sistema son los factores que conducen a resultados exitosos y estables. El objetivo de este reporte es describir el tratamiento de un paciente en etapa de la dentición mixta con el uso de este dispositivo. Consideraciones finales: El uso de la máscara facial de Petit, asociado con expansión maxilar, fue útil en la corrección de la deficiencia maxilar y la maloclusión Clase III.

Class III malocclusion is an anteroposterior skeletal problem in which altered relationships of the bones, teeth and muscular components can be observed; the skeletal component being most frequently altered in the sagittal and transverse maxillary deficiency. Early treatment of this anomaly is reported with a higher success rate. The protraction mask associated with a maxillary disjunction produces beneficial changes in the facial architecture. The patient's age, collaboration and proper management of the system are the factors that lead to successful and stable results. The purpose of this report is to describe the treatment of a patient in the stage of the mixed dentition with the use of this device. Final considerations: The use of the Petit facial mask, associated with maxillary expansion, was useful in the correction of maxillary deficiency and class III malocclusion

Tridimensional finite element analysis of teeth movement induced by different headgear forces.

BACKGROUND: This study aimed to simulate the actions of low-pull (LP), high-pull (HP), and combined pull (CP) headgears (HGs) and to analyze tooth movement tendencies through finite element analysis. METHODS: Tomographic slices of a human maxilla with complete permanent dentition were processed by reconstruction software, and the triangular surface mesh was converted into non-uniform rational B-spline (NURBS) curves. An HG facial bow was also modulated in 3D. The teeth and bone were considered to have isotropic and linear behavior, whereas the periodontal ligament was considered to have non-linear and hyperelastic behavior. Data regarding the application points, directions and magnitudes of forces were obtained from the literature and from a dolichofacial patient with class II, division 1 malocclusion, who was treated with a CP HG. RESULTS: The CP HG promoted 37.1 to 41.1 %, and the HP HG promoted 19.1 to 31.9 % of LP distalization. The HP HG presented the highest intrusion, and the LP HG presented the highest extrusion of the first molar. The LP HG contracted the distal side, and the HP and CP HGs contracted the lingual and distobuccal roots of the second molar to a lesser degree. CONCLUSIONS: The LP HG promotes the greatest distalization, followed by the CP and HP HGs; the LP HG causes greater extrusion of the first molar, and the HP HG causes greater intrusion of the first molar. The LP HG causes greater contraction of the second molar than the HP HG.

Outcomes of different Class II treatments : Comparisons using the American Board of Orthodontics Model Grading System.

OBJECTIVE: The aim of this study was to evaluate the clinical outcomes of three different Class II treatment modalities followed by fixed orthodontic therapy, using the American Board of Orthodontics Model Grading System (ABO-MGS). MATERIALS AND METHODS: As a retrospective study, files of patients treated at postgraduate orthodontic  clinics in different cities in Turkey was randomly selected. From 1684 posttreatment records, 669 patients were divided into three groups: 269 patients treated with extraction of two upper premolars, 198 patients treated with cervical headgear, and 202 patients treated with functional appliances. All the cases were evaluated by one researcher using ABO-MGS. The χ (2), Z test, and multivariate analysis of variance were used for statistical evaluation (p < 0.05). RESULTS: No significant differences were found among the groups in buccolingual inclination, overjet, occlusal relationship, and root angulation. However, there were significant differences in alignment, marginal ridge height, occlusal contact, interproximal contact measurements, and overall MGS average scores. The mean treatment time between the extraction and functional appliance groups was significantly different (p = 0.017). CONCLUSION: According to total ABO-MGS scores, headgear treatment had better results than functional appliances. The headgear group had better tooth alignment than the extraction group. Headgear treatment resulted in better occlusal contacts than the functional appliances and had lower average scores for interproximal contact measurements. Functional appliances had the worst average scores for marginal ridge height. Finally, the functional appliance group had the longest treatment times.

Asymmetric Outer Bow Length and Cervical Headgear Force System: 3D Analysis Using Finite Element Method.

OBJECTIVES: This study sought to assess distal and lateral forces and moments of asymmetric headgears by variable outer bow lengths. MATERIALS AND METHODS: Four 3D finite element method (FEM) models of a cervical headgear attached to the maxillary first molars were designed in SolidWorks 2010 software and transferred to ANSYS Workbench ver. 11 software. Models contained the first molars, their periodontal ligament (PDL), cancellous and cortical bones, a mesiodistal slice of the maxillae and the headgear. Models were the same except for the outer bow length in headgears. The headgear was symmetric in model 1. In models 2 to 4, the headgears were asymmetric in length with differences of 5mm, 10mm and 15mm, respectively. A 2.5 N force in horizontal plane was applied and the loading manner of each side of the outer bow was calculated trigonometrically using data from a volunteer. RESULTS: The 15mm difference in outer bow length caused the greatest difference in lateral (=0.21 N) and distal (= 1.008 N) forces and also generated moments (5.044 N.mm). CONCLUSION: As the difference in outer bow length became greater, asymmetric effects increased. Greater distal force in the longer arm side was associated with greater lateral force towards the shorter arm side and more net yawing moment. CLINICAL RELEVANCE: A difference range of 1mm to 15 mm of length in cervical headgear can be considered as a safe length of outer bow shortening in clinical use.

Unilateral Outer Bow Expanded Cervical Headgear Force System: 3D Analysis Using Finite Element Method.

OBJECTIVES: Headgears are among the effective orthodontic appliances to achieve treatment goals. Unilateral molar distal movement is sometimes needed during an orthodontic treatment, which can be achieved by an asymmetric headgear. Different unilateral headgears have been introduced. The main goal of this study was to analyze the force system of unilateral expanded outer bow asymmetric headgears by the finite element method (FEM). MATERIALS AND METHODS: Six 3D finite element models of a mesiodistal slice of the maxilla containing upper first molars, their periodontal ligaments (PDLs), cancellous bone, cortical bone, and a cervical headgear with expanded outer bow attached to maxillary first molars were designed in SolidWorks 2010 and meshed in ANSYS Workbench ver. 12.1. The models were the same except for the degree of outer bow expansion. The outer bow ends were loaded with 2 N force. The distal driving force and the net moment were evaluated. RESULTS: A decrease in the distalizing force in the normal side molar from 1.69 N to 1.37 N was shown by increasing the degree of unilateral expansion. At the same time, the force increased from 2.19 N to 2.49 N in the expanded side molar. A net moment increasing from 2.26 N.mm to 4.64 N.mm was also shown. CONCLUSION: Unilateral outer bow expansion can produce different distalizing forces in molars, which increase by increasing the expansion.

Effects of cervical headgear appliance: a systematic review

OBJECTIVE: Although much has been investigated about the effects of cervical headgear, there remains some controversy. Therefore, the objective of this systematic review is to disclose the actual effects of the cervical headgear appliance, based on articles of relevant quality.METHODS: A literature review was conducted using PubMed, Web of Science, Embase, Scopus and Cochrane databases. Inclusion criteria consisted of human studies written in English; published between 1970 and 2014; in which only the cervical headgear was used to correct Class II malocclusion; prospective or retrospective; with a clear description of cervical headgear effects; with a sample size of at least 15 individuals. No comparative studies, clinical cases or cases with dental extractions were included and the sample should be homogeneous.RESULTS: Initially, 267 articles were found. A total of 42 articles were selected by title and had their abstracts read. Finally, 12 articles were classified as with high quality and were used in this systematic review.CONCLUSIONS: The cervical headgear appliance proved efficient to correct Class II, Division 1 malocclusion. Its effects consisted in correction of the maxillomandibular relationship by restriction of maxillary anterior displacement; distalization and extrusion of maxillary molars; and slight maxillary expansion.

OBJETIVO: embora muitos estudos investiguem os efeitos do AEB cervical, ainda há algumas controvérsias sobre os seus efeitos. Portanto, o objetivo desta revisão sistemática é divulgar os efeitos reais do aparelho extrabucal cervical, com base em artigos com qualidade.MÉTODOS: os artigos foram pesquisados por meio das bases de dados PubMed, Web of Science, Embase, Scopus e Cochrane. Os critérios de inclusão consistiram em: estudos em humanos escritos em inglês; publicados entre 1970 e 2014; apenas o AEB cervical foi utilizado para corrigir má oclusão de Classe II; prospectivos ou retrospectivos; com uma descrição clara dos efeitos do aparelho; com um tamanho de amostra de pelo menos 15 indivíduos. Estudos comparativos, relatos de caso ou casos com extrações não foram incluídos e a amostra deveria ser homogênea.RESULTADOS: inicialmente, 267 artigos foram encontrados; e 42 artigos desses foram selecionados pelo título, tendo seus resumos lidos. Por fim, 12 artigos foram classificados como de alta qualidade e foram utilizados na presente revisão sistemática.CONCLUSÕES: o aparelho extrabucal cervical foi eficiente para corrigir a má oclusão de Classe II divisão 1. Seus efeitos são correção da relação maxilomandibular, com restrição do deslocamento anterior da maxila; distalização e extrusão dos molares superiores e ligeira expansão maxilar.

Treating Class II malocclusion in children. Vertical skeletal effects of high-pull or low-pull headgear during comprehensive orthodontic treatment and retention.

OBJECTIVES: To evaluate, in Class II malocclusion children, vertical skeletal changes occurring with high- and low-pull headgear during non-extraction comprehensive orthodontic treatment, and retention. SETTING AND SAMPLE POPULATION: Two groups of thirty Class II malocclusion children (mean age 10.8 years) who had undergone non-extraction comprehensive orthodontic treatment with either high- or low-pull headgear and fixed appliances. MATERIAL AND METHODS: Retrospective longitudinal study, where pre-treatment, post-treatment and at least 2 year post-retention lateral cephalometric radiographs were analyzed. Comparisons were made concerning changes during treatment and retention in high- or low-pull headgear-treated children. Correlation analyses were carried out investigating changes in vertical cephalometric parameters and pre-treatment vertical facial pattern or type of headgear used. RESULTS: During treatment, sagittal relationships improved in all children and remained stable during retention. Vertically, in both high- and low-pull headgear groups, the intermaxillary angle as well as the maxillary and mandibular plane angles did not show statistically significant changes during treatment or retention, and large variation was seen between patients. When pooling the whole patient sample, change in the vertical facial pattern was independent of the pre-treatment vertical facial pattern or type of headgear used. CONCLUSION: When treating Class II malocclusion children non-extraction with high- or low-pull headgear and fixed appliances, changes in vertical skeletal relationships demonstrate wide variation, both during treatment and retention. Dentoalveolar changes brought about by these appliances may not be able to make a predictable difference in vertical skeletal patterns of growing patients.

Tratamento da mordida aberta anterior com a utilização do gancho J / Treatment of open bite using J hook

O presente artigo tem a finalidade de relatar um caso clínico de uma paciente afro-brasileira, dolicofacial, 18 anos de idade, com mordida aberta anterior (MAA) dentoalveolar associada ao hábito de sucção digital. O tratamento ortodôntico consistiu na colocação de um aparelho ortodôntico fixo com bráquetes Edgewise e controle vertical com o uso do Gancho J com puxada alta somente na arcada inferior, com a finalidade de rotação anti-horária da mandíbula e o consequente fechamento da mordida. Simultaneamente, a paciente foi encaminhada para tratamento fonoaudiológico. O tratamento foi finalizado com êxito ao final de 36 meses com a correção da MAA havendo melhora das relações vertical e sagital entre a maxila e a mandíbula, obtenção de estética, equilíbrio e harmonia facial, além das características oclusais e funcionais. Assim, foi possível concluir que após a remoção do hábito de sucção digital é necessário que seja feita uma intervenção multidisciplinar que, neste caso, consistiu numa intervenção ortodôntica associada a um acompanhamento fonoaudiológico. Além disto, o uso de um extrabucal, colocado diretamente no aparelho ortodôntico na arcada inferior (Gancho J) foi primordial no fechamento da mordida, pois houve um controle vertical, o que proporcionou uma rotação mandibular no sentido anti-horário e o consequente fechamento da mordida.

This article aims to report a case of an Afro-Brazilian patient, dolicofacial, 18 years of age, with open bite dentoalveolar associated with digit sucking habit. Orthodontic treatment consisted on a fixed orthodontic appliance with edgewise brackets and vertical control using the J hook with high pull only in the lower jaw for the purpose of anti-clockwise rotation of the mandible and the consequent closing of the bite. Simultaneously, the patient was referred for speech therapy. The treatment was completed successfully at the end of 36 months with the correction of open bite with an improvement of vertical and sagittal relations between the maxilla and the mandible obtaining facial aesthetics and harmony besides the occlusal and functional characteristics. Thus, it was concluded that after breaking digit habit, a multidisciplinary intervention is required.In this case it consisted on an orthodontic intervention associated with a speech therapist. In addition, the use of a headgear placed directly on the archwire, the lower arch in the case was the J hook, was paramount in closing the bite because there was a vertical control which provided a mandibular rotation in a counterclockwise direction and the consequent closing of the bite