Distracción maxilar con dispositivos internos en pacientes fisurados: Planificación virtual y transferencia de datos al campo quirúrgico / Maxillary distraction with internal devices in cleft patients: virtual planing and transference of dates to surgical field

Objetivo. Los dispositivos internos de distracción maxilar han sido poco utilizados debido a la dificultad que supone su colocación precisa. Esto se debe a que pequeñas imprecisiones en su orientación dan lugar a grandes imprecisiones en la posición final del hueso distraído. En este sentido, la cirugía asistida por ordenador es una herramienta de gran ayuda para alcanzar la máxima precisión. El objetivo de este trabajo es presentar nuestro protocolo de planificación de la posición de distractores internos, así como un nuevo objeto CAD/CAM para transferir los datos al campo quirúrgico. Material y método. Se planifica de forma virtual el avance maxilar de 2 pacientes fisurados y los vectores de movimiento virtual. Para la transferencia de datos al campo quirúrgico se utiliza una férula especial con acoples laterales que orientan el vector de distracción. Resultados. Dos pacientes fueron intervenidos con resultados satisfactorios. Conclusión. Tanto el protocolo de planificación virtual del vector de distracción como el objeto CAD/CAM para transferencia de datos al campo quirúrgico presentado son útiles para aumentar la precisión en la posición final del maxilar. De esta forma el uso de distractores internos para avances menores de 12 mm resulta una técnica predecible (AU)

Objetive. Maxillary internal distractors have not been widely used since the accurate positioning is challenging. This is because a small deviation in the positioning results in a great deviation in the final position of the distracted maxilla. Computer assisted surgery is a powerful tool to reach accurate results. The authors report a protocol for internal distractor positioning as well as a new object for transferring dates from virtual planning to surgical field. Material and method. Virtual planning was performed to plan the maxillary advance in 2 cleft patients. A wafer with 2 lateral attachments was used to transfer the vector of distraction from virtual planning to surgical field. Results. Satisfactory result was achieved in both patients. Conclusion. This virtual planning protocol as well as the CAD/CAM objet to transfer dates from computer to surgical field are useful in order to achieve a suitable final position of the maxilla. These tools facilitate the positioning of internal distractors, leaving the use of external distractors for advancement greater than 12 mm (AU)

Randomized controlled study of a mandibular advancement appliance for the treatment of obstructive sleep apnea in children: A pilot study

BACKGROUND: The current limited evidence may be suggestive that mandibular advancement appliance (MAAs) result in improvements in AHI scores, but it is not possible to conclude that MAAs are effective to treat paediatric OSA. There are significant weaknesses in the existing evidence due primarily to absence of control groups, small sample sizes, lack of randomization and short-term results. AIM: the objective of the present study was to evaluate MAAs in children with OSA. MATERIAL AND METHODS: Children presenting an apnea-hypopnea index (AHI) greater than or equal to one event per hour were considered to be apneic. This group of children with AHI greater than or equal to one was randomly divided through a draw into two subgroups: half of them in an experimental subgroup and half of them in a control subgroup. In the experimental subgroup, molds of each of these children's maxillary and mandibular arches were taken using standard molds and molding material. The control group did not use any intraoral device and did not undergo any type of treatment for OSAS. The MAAs used in this study had the aim of achieving mandibular advancement, thereby correcting the mandibular position and dental occlusion, and perhaps increasing the airway and treating OSAS. After 12 consecutive months of use of the mandibular advancement devices, polysomnography examinations using the same parameters as in the initial examinations were requested for both the experimental and the control subgroup. RESULTS: There was a decrease in AHI in the experimental group and an increase in the control group, with statistical significance. These data were used to calculate the sample size, which was 28 children in total in the groups. CONCLUSIONS: There was a decrease in AHI one year after implementing use of mandibular advancement devices, in comparison with the group that did not use these devices

Rapid maxillary expansion and obstructive sleep apnea: A review and meta-analysis

BACKGROUND: OSAS during childhood leads to significant physical and neuropsychomotor impairment. Thus, it needs to be recognized and treated early in order to avoid or attenuate the chronic problems associated with OSAS, which are deleterious to a child's development. Adenotonsillectomy and, in select cases, continuous positive airway pressure (CPAP) have been the preferred treatments for OSAS in children, and yet they are ineffective at fully ameliorating the disease. Minimally invasive treatments have recently been proposed, comprising intra-oral and extra-oral devices as well as speech therapy. OBJECTIVE: to conduct a meta-analysis on studies from around the world that used rapid maxillary expansion (RME) to treat OSAS in children. MATERIAL AND METHODS: We performed a meta-analysis of studies using RME for OSA treatment in children. A literature survey was conducted using PubMed and Medline for English articles published up to December 2014 with the following descriptors: Sleep Apnea, Obstructive, Children, Treatment, Orthodontic, Othopaedic, Maxillary expansion. Studies were included in the meta-analysis if they were case-controlled studies, randomized, and involved non-syndromic children aged 0 to 12years old diagnosed with OSA by the polysomnography apnea hypopnea index (AHI) before and after the intervention, submitted RME only. RESULTS: In all, 10 articles conformed to the inclusion criteria and were included in this meta-analysis. The total sample size across all these articles was 215 children, having a mean age of 6.7 years, of whom58.6%were male. The mean AHI during the follow-up was -6.86 (p< 0.0001). CONCLUSIONS: We concluded that rapid maxillary expansion (RME) in children with OSAS appears to be an effective treatment for this syndrome. Further randomized clinical studies are needed to determine the effectiveness of RME in adults

Masseter function and skeletal malocclusion.

The aim of this work is to review the relationship between the function of the masseter muscle and the occurrence of malocclusions. An analysis was made of the masseter muscle samples from subjects who underwent mandibular osteotomies. The size and proportion of type-II fibers (fast) decreases as facial height increases. Patients with mandibular asymmetry have more type-II fibers on the side of their deviation. The insulin-like growth factor and myostatin are expressed differently depending on the sex and fiber diameter. These differences in the distribution of fiber types and gene expression of this growth factor may be involved in long-term postoperative stability and require additional investigations. Muscle strength and bone length are two genetically determined factors in facial growth. Myosin 1H (MYOH1) is associated with prognathia in Caucasians. As future objectives, we propose to characterize genetic variations using "Genome Wide Association Studies" data and their relationships with malocclusions.

[Comprehensive approach to treatment of patients with teeth-jaws anomalies accompanied by nose functional disturbances and esthetic deformations].

Problem of medical rehabilitation of patients with teeth-jaws anomalies accompanied by nose functional disturbances and esthetic deformations was viewed. Method of comprehensive reconstructive intervention on facial cranium was presented allowing to restore correct jaws relationship to cranium base. Correction of nasal and endonasal structures was performed, functions of nasal breathing and esthetic face parameters as a whole were restored. Comprehensive approach to planning and carrying out surgical treatment let to receive high esthetic and functional results.

Functional results after condylectomy in active laterognathia.

INTRODUCTION: Mandibular asymmetry due to overgrowth has two main forms, hemimandibular hyperplasia and hemimandibular elongation. It is necessary to distinguish between inactive and active forms, since surgical treatment of the latter, with a solely morphological aim, could lead to recurrence of further condylar growth. In these cases orthognathic surgery is performed in association with high condylectomy to interrupt the hyperactivity of the condyle. Condylectomy alone in growing patients stops the progression of deformities and sometimes achieves facial symmetry at the end of growth. Some authors have viewed condylectomy as a dangerous procedure, with the possibility of compromising articular function. We aimed to verify immediate and long-term results of condylar function after high condylectomy. MATERIALS AND METHODS: Between 1998 and 2007, 15 patients underwent high condylectomy for active laterognathia. All but one patient underwent postoperative Delaire functional rehabilitation. Long-term articular function was evaluated using subjective and objective criteria. RESULTS: In 14 patients, articular function was subjectively satisfactory. In one case, this did not occur because the patient refused postoperative functional rehabilitation. DISCUSSION AND CONCLUSIONS: Some authors have advised against condylectomy because of the possibility of temporomandibular joint dysfunction. High condylectomy in active laterognathia seems to be the procedure of choice in both adults and growing patients. In our experience, functional alterations of practical relevance are rare if the operation is followed by successful functional rehabilitation.

Prosthodontic treatment of a patient with hemimandibular elongation: a clinical report.

This clinical report describes prosthodontic treatment of a patient with hemimandibular elongation that resulted in significant dentofacial asymmetry. A maxillary metal-ceramic fixed dental prosthesis and crowns were fabricated. To eliminate the negative horizontal overlap, 3 mandibular teeth were reduced to the gingival level. The mandibular prosthetic restoration was completed with metal and composite resin using an electroforming technique.

Surgical and prosthodontic treatment alternatives for children and adolescents with ectodermal dysplasia: a clinical report.

Ectodermal dysplasia with oligodontia and anodontia is characterized by absence or deficiency of the alveolar ridges. The optimal surgical and prosthetic approach varies in relation to patient age and the amount of bone that is present. This clinical report presents rehabilitation alternatives for ectodermal dysplasia in children and adolescents.

Consideraciones prácticas para la construcción de pistas planas / Practical considerations for the construction of planas appliances

Se recopilan las experiencias prácticas sobre la construcción de pistas planas en la Facultad de Estomatología de La Habana, las cuales se fundamentan con referencias bibliográficas de este tipo de aparato para brindar una información que pueda facilitar su confección en los diferentes Servicios de Ortodoncia del país. Se describen los tipos de pistas con ilustraciones en dependencia de la maloclusión a tratar(AU)

Reabilitaçäo dinâmica e funcional dos maxilares (sem extraçöes) - Tratamento das más oclusöes de classe II, divisäo 1, com mordidas construtivas posturais / Dynamic and functional rehabilitation of the jaws (non-extraction) - Treatment of class II, division 1 malocclusions with constructive postural bites

No sentido de impedir a continuaçäo da má oclusäo e instalaçäo do padräo oclusal com alteraçöes dentárias, esqueléticas e faciais em pacientes de classe II, divisäo 1, a técnica da reabilitaçäo dinâmica e funcional dos maxilares preconiza, como opçäo de tratamento, com vistas a conservar os elementos dentários, importantes para estabilidade oclusal, as mordidas construtivas posturais

[The psychological rehabilitation of patients following reconstructive operations in congenital deformities of the jaw bones]. / Psikhologicheskaia reabilitatsiia bol'nykh posle rekonstruktivnykh operatsii pri vrozhdennykh deformatsiiakh cheliustnykh kostei.

Various methods of psychotherapeutic correction, used in patients with congenital deformations of the jaw bones, are described. Individual and group psychotherapy before, immediately and in late periods after surgery was used. Good results were achieved, confirmed by objective psychologic tests.

[Mastication rehabilitation via dysgnathia surgery and simultaneous implantation]. / Kaufunktionelle Rehabilitation durch Dysgnathieoperation und simultane Implantation.

Within the last 2 years 26 endosseous implants have been used in combination with orthognathic surgery in the maxilla and mandible. The results show, that endosseous implants can be used simultaneously with orthognathic surgery. This helps to treat dysfunctions often seen in partially edentulous patients that undergo orthognathic surgery and at the same time reduce the risk of relapse by achieving stable occlusion.

[A global approach to the dental care of children and young adults with trisomy 21. I. The dental and orofacial characteristics of Down's syndrome]. / Un approccio globale all'assistenza odontostomatologica nei bambini e nei giovani adulti con trisomia 21. Parte I. Caratteristiche dentali ed orofacciali della sindrome di Down.

On the basis of a full analysis of recently reported data, it is shown that manifold and quite characteristic problems of dental and orofacial nature requiring global consideration coexist in Down's syndrome. These are addressed one by one in order to stress the need for dental treatment and to provide for correct planning of interventions right from the early months of life in the case of a patient with Down's syndrome.

[Possibilities and limitations for the correction of bony, dental and mucosal tissue loss in children using a maxillofacial prosthesis]. / Possibilités et limites de la correction des pertes de substance osseuse, dentaire et muqueuse chez l'enfant par la prothèse maxillo-faciale.

The maxillofacial prosthesis for surgical treatment of loss of bony, dental or mucosal substance in children has the advantage of allowing postponement of therapy until growth is terminated or any other favorable period. In addition, the temporary reconstitutions possible by their use often provide, apart from esthetic results, an effective action physically and mentally on the mainly labile growth.