Effect of rapid maxillary expansion on masticatory and swallowing functions in children with posterior crossbite

Abstract Objective: Investigate the influence of posterior crossbite on masticatory and swallowing functions by videofluoroscopy examination and to analyze the effects of Rapid Maxillary Expansion (RME) on the same functions. Methods: A prospective longitudinal study was conducted on 32 children, 21 of them with posterior crossbite (10 girls and 11 boys, mean age 9.2 years, study group) and 11 children with no occlusal changes (6 girls and 5 boys, mean age 9.3 years, control group). The children were evaluated by an orthodontist for diagnosis, group characterization and occlusal treatment, by the otorhinolaryngology team for the assessment of respiratory symptoms, and by a speech therapist for videofluoroscopic evaluation of masticatory and swallowing parameters. The children with posterior crossbite were treated orthodontic ally using the Haas disjunctor for approximately six months and re-evaluated 5-months after removal of the appliance. Data were analyzed statistically by the Studentt-test for independent samples for comparison of the crossbite and control groups before and after treatment. Results: There was no significant difference in oral preparatory and oral transit times, nor in cycles and masticatory frequency, between the pre and post orthodontic treatment groups and the control group. Conclusion: Rapid maxillary expansion did not influence the masticatory and swallowing variables studied by videofluoroscopy. However, the data require caution in interpretation.

Effect of rapid maxillary expansion on masticatory and swallowing functions in children with posterior crossbite.

OBJECTIVE: Investigate the influence of posterior crossbite on masticatory and swallowing functions by videofluoroscopy examination and to analyze the effects of Rapid Maxillary Expansion (RME) on the same functions. METHODS: A prospective longitudinal study was conducted on 32 children, 21 of them with posterior crossbite (10 girls and 11 boys, mean age 9.2 years, study group) and 11 children with no occlusal changes (6 girls and 5 boys, mean age 9.3 years, control group). The children were evaluated by an orthodontist for diagnosis, group characterization and occlusal treatment, by the otorhinolaryngology team for the assessment of respiratory symptoms, and by a speech therapist for videofluoroscopic evaluation of masticatory and swallowing parameters. The children with posterior crossbite were treated orthodontic ally using the Haas disjunctor for approximately six months and re-evaluated 5-months after removal of the appliance. Data were analyzed statistically by the Studentt-test for independent samples for comparison of the crossbite and control groups before and after treatment. RESULTS: There was no significant difference in oral preparatory and oral transit times, nor in cycles and masticatory frequency, between the pre and post orthodontic treatment groups and the control group. CONCLUSION: Rapid maxillary expansion did not influence the masticatory and swallowing variables studied by videofluoroscopy. However, the data require caution in interpretation.

Comparison of nasal cavity changes between the expander with differential opening and the fan-type expander: a secondary data analysis from an RCT.

INTRODUCTION: The aim of this study was to compare the nasal cavity skeletal changes between the expander with differential opening (EDO) and the fan-type expander (FE). METHODS: This study was a secondary analysis of a previous randomized clinical trial. Forty-eight patients with posterior crossbite were randomly allocated into two study groups. Twenty-four patients (11 male, 13 female) with a mean initial age of 7.6 ± 0.9 years were treated with rapid maxillary expansion (RME) using the EDO. Twenty-four patients (10 male, 14 female) with a mean initial age of 7.8 ± 0.9 years were treated with the FE. Cone-beam computed tomography (CBCT) was performed before treatment and 1 to 6 months after the active phase of RME. Using frontal CBCT slices passing at the level of maxillary permanent first molars and maxillary deciduous canines, the width of the nasal cavity was measured in the lower, middle and upper thirds. Nasal cavity height was also evaluated in both slices. Intergroup comparisons of interphase changes were performed using t or Mann-Whitney tests (P < 0.05). RESULTS: The two groups were similar regarding baseline data. EDO showed a greater transverse increase in the lower third of the nasal cavity in both canine (P = 0.007) and molar regions (P < 0.001). No intergroup difference was observed for changes in middle and upper widths and height of the nasal cavity. CONCLUSIONS: Both expanders are effective in promoting an increase of the nasal cavity skeletal dimensions. The expander with differential opening produced a greater transverse increase in the lower third of the nasal cavity compared to the fan-type expander, both at the anterior and posterior regions of the maxilla. CLINICAL RELEVANCE: EDO might be more beneficial to pediatric patients with oral breathing and obstructive sleep apnea compared to FE.

Comportamiento de la maloclusión funcional e interferencias oclusales en niños con dentición mixta

Introducción: las interferencias oclusales no controladas precozmente pueden producir desviación de la mandíbula en sentido anteroposterior o transversal. El manejo de las mordidas cruzadas se debe iniciar en el momento del diagnóstico, preferiblemente en edades tempranas, con el fin de tratarlas en el nivel primario de prevención. Objetivo: determinar el comportamiento de la maloclusión funcional causada por interferencias oclusales en niños con dentición mixta de la Escuela Primaria Mártires del Corynthia, entre octubre de 2019 y junio de 2021. Materiales y métodos: se realizó un estudio observacional descriptivo de corte transversal en la Escuela Primaria Mártires del Corynthia, del Área de Salud José Jacinto Milanés, del municipio de Matanzas, entre octubre de 2019 y junio de 2021. El universo estuvo conformado por 66 niños. Se utilizó una planilla de recolección de datos y se solicitó el consentimiento informado a los tutores de los niños. Resultados: las edades donde los niños presentaron mayor afectación fueron de 6 a 7 años y de 8 a 9 años, ambos rangos con un 10,6 %. El 27,3 % presentó interferencias oclusales y mordida cruzada posterior unilateral. El 48,5 % fue del sexo femenino y el 30,3 % tenían edades de 6 a 7 años. El 71,2 % eran simétricos y presentaron mordida cruzada posterior unilateral. Los simétricos y con línea media coincidente representaron un 36,4 %. Conclusiones: la maloclusión funcional más frecuente en niños con dentición mixta fue la mordida cruzada posterior unilateral, que se relacionó de manera directa con las interferencias oclusales. Las asimetrías faciales y la línea media desviada estuvieron asociadas a dicha maloclusión.

Introduction: early uncontrolled occlusal interferences can produce anterior-posterior jaw deflection. Management of cross-bites should be initiated at the time of diagnosis, preferably at early ages, in order to treat them at the primary level of prevention. Objective: to determine the behavior of functional malocclusion caused by occlusal interferences in children with mixed dentition from the Martires del Corynthia primary school between October 2019 and June 2021. Materials and methods: a cross-sectional, observational, descriptive study was carried out at the Martires del Corynthia Primary School, of the Jose Jacinto Milanes Health Area, Matanzas municipality, between October 2019 and June 2021. The universe consisted of 66 children. A data collection form was used and informed consent was requested from the children's guardians. Results: the ages where the children presented more affectation were from 6 to 7 years and from 8 to 9 years, both ranges with 10.6%. 27.3% presented occlusal interferences and posterior unilateral cross-bite. 48.5% were female and 30.3% were 6 to 7 years old. 71.2% were symmetrical and presented unilateral posterior cross-bite. Symmetric patients and with a coincident midline represented 36.4%. Conclusions: the most frequent functional malocclusion in children with mixed dentition was the unilateral posterior cross-bite, which was related to occlusal interferences in a direct way. Facial asymmetries and a deviated midline were associated with the before mentioned malocclusion.

Evaluation of the three-dimensional (3D) position of cervical vertebrae in individuals with unilateral posterior crossbite.

OBJECTIVE: To evaluate the three-dimensional (3D) position of the cervical vertebrae of growing subjects with unilateral posterior crossbite (UPC). MATERIALS AND METHODS: In this cross-sectional study, cone beam computed tomography (CBCT) scans of 1455 patients were screened, and ultimately 58 scans (26 patients with UPC and 32 controls with normal occlusion) were included after imposing inclusion/exclusion criteria. Roll, yaw, and deviation of the geometric center of C1, C2, and C3 vertebrae were measured and compared between groups. A correlation between these parameters and different variables on mandibular positioning was also carried out. RESULTS: A statistically significant difference (p < 0.05) was observed between groups for the deviation of pogonium (Pog), mandibular plane roll, and C3 roll, and patients with UPC showed higher cant or deviation. A significant correlation was reported for the roll of C2 and C3 with the deviation of Pog, a roll of the occlusal plane, and roll of the mandibular plane (p < 0.05). The greater the deviation of the Pog to one side, the greater the roll of the vertebrae with this same side up. The same tendency was observed between the roll of the occlusal plane or the mandibular plane with the roll of these cervical vertebrae. CONCLUSIONS: There is a positive correlation between transverse occlusal changes and positional deviations of the cervical vertebrae, especially C2 and C3. CLINICAL RELEVANCE: The study results do not allow us to infer the clinical/functional consequences of these deviations, as well as if malocclusion's treatment would result in an improvement of intervertebral relationships.

Root resorption pattern in panoramic radiographs of pediatric patients with unilateral posterior crossbite: a cross-sectional and retrospective study / Patrón de reabsorción radicular en radiografías panorámicas de pacientes pediátricos con mordida cruzada posterior unilateral: estudio transversal y retrospectivo

SUMMARY: temporary mandibular molars in panoramic radiographs of pediatric patients with unilateral posterior crossbite (UPCB). This cross-sectional and retrospective study analyzed 114 orthopantomograms of patients between 6 - 9 years of age with unilateral posterior crossbite diagnosis. The first and second mandibular molars were analyzed. Their root resorption stage was typified, and the root lengths were measured; to later compare the data obtained depending on the malocclusion side. 86.4 % of molars showed a linear resorption pattern, and atypical resorption prevalence in patients with UPCB was 13.5 %. The total length average of the first molars on the side of the malocclusion was 8.20 mm, while the contralateral exhibited a mean of 9.29 mm. Lastly, the second molars had a mean length of 11.12 mm in crossbite side and 12.30 mm in the normal occlusion side. UPCB could affect physiological resorption by observing a resorption alteration in those mandibular molars located on the malocclusion side.

RESUMEN: El trabajo de este estudio se realizó en molares mandibulares temporales en radiografías panorámicas de pacientes pediátricos con mordida cruzada posterior unilateral (MCPU). Este estudio transversal y retrospectivo analizó 114 ortopantomografías de pacientes entre 6 - 9 años de edad con diagnóstico de mordida cruzada posterior unilateral. Se analizaron los primeros y segundos molares mandibulares. Se tipificó su estado de reabsorción radicular y se midió la longitud de las raíces; para luego comparar los datos obtenidos según el lado de la maloclusión. El 86,4 % de los molares mostró un patrón de reabsorción lineal y la prevalencia de reabsorción atípica en pacientes con MCPU fue del 13,5 %. El promedio de longitud total de los primeros molares del lado de la maloclusión fue de 8,20 mm, mientras que el contralateral exhibió una media de 9,29 mm. Por último, los segundos molares tenían una longitud media de 11,12 mm en el lado de mordida cruzada y de 12,30 mm en el lado de oclusión normal. La MCPU podría afectar la reabsorción fisiológica al observar una alteración de la reabsorción en aquellos molares mandibulares ubicados en el lado de la maloclusión.

Discrepancia negativa transversal del maxilar y diferencias cefalométricas laterales según el ancho de la arcada superior / Negative maxillary transverse discrepancy and cephalometric lateral differences according to the width of upper arch

Introduction: Negative maxillary transverse discrepancy is not exclusive to narrow upper arch. The transverse discrepancy due to maxillary deficiency is well described, but this is not the case when the maxilla displays adequate dimensions and the origin of the problem is an excess of mandibular width. Objective: To describe the cephalometric characteristics of negative maxillary transverse discrepancy present in narrow upper arches with those of normal or increased width. Methods: An observational and cross-sectional study was carried out in records of patients with negative maxillary transverse discrepancy. The cases referred to the maxillofacial surgery department at Hospital Clínico Quirúrgico "Hermanos Ameijeiras" between January 2016 and January 2020 were selected. The initial study models were measured and two groups were formed: those with a distance between central fossae of 16 to 26, less than 47 mm and the other with equal or greater values. Lateral cephalometric analysis of Ricketts, McNamara, Björk & Jarabak, Burstone and soft profile were performed on the initial teleradiographs. Using the Mann Whitney U test of independent samples, measurements with statistically significant differences between both groups were selected. (p <0.05). Results: Significant differences were found regarding the cranial-mandibular relationship, mandibular anatomy, maxillo-mandibular relationship and occlusal relationship. The most important differences observed in each group were respectively: S-Ar / Ar-Go ratio (p = 0.033), mandibular body length (p = 0.01), mandibular-maxillary difference (p = 0.003) and overjet (p = 0.043). Conclusions: In the studied patients, negative maxillary transverse discrepancy has the same probability of presenting a wide or in norm upper arch, as well as a narrow arch. In the first case, it is more likely to find jaws with increased body length, a skeletal class III pattern and a concave profile; in the second case, the tendency is to present small jaws with increased articular angle and dental overjet(AU)

Introducción: La discrepancia negativa transversal del maxilar no es exclusiva de una arcada superior angosta. La discrepancia transversal por deficiencia maxilar está bien descrita, pero no ocurre así cuando el maxilar se presenta con dimensiones adecuadas y el origen del problema es un exceso del ancho mandibular. Objetivo: Describir las diferencias cefalométricas de la discrepancia negativa transversal del maxilar que presentan arcadas superiores estrechas con aquellas de ancho normal o incrementado. Métodos: Se realizó un estudio observacional, de corte transversal, en expedientes de pacientes con discrepancia negativa transversal del maxilar. Se seleccionaron los casos que acudieron entre enero del 2016 y enero del 2020 a la consulta de cirugía maxilofacial del Hospital Clínico Quirúrgico "Hermanos Ameijeiras". Se midieron los modelos de estudio iniciales y se conformaron dos grupos: aquellos con distancia entre fosas centrales de 16-26, menor de 47 mm y el otro con valores iguales o superiores. Se realizaron análisis cefalométricos laterales en las telerradiografías iniciales de Ricketts, McNamara, Björk & Jarabak, Burstone y perfil blando. Por medio de la prueba U de Mann Whitney de muestras independientes, se seleccionaron las mediciones con diferencias estadísticas significativas entre ambos grupos (p < 0.05). Resultados: Se encontraron diferencias significativas concernientes a la relación cráneo mandibular, anatomía mandibular, relación máxilo mandibular y relación oclusal. Las diferencias observadas más importantes de cada grupo fueron respectivamente: relación S-Ar/Ar-Go (p = 0,033), longitud del cuerpo mandibular (p = 0,01), diferencia mandibular-maxilar (p = 0,003) y resalte (p = 0,043). Conclusiones: En los pacientes estudiados, las discrepancias negativas transversales tienen la misma probabilidad de presentarse con la arcada superior ancha o en norma, que angosta. En los primeros es más probable encontrar mandíbulas con longitud del cuerpo incrementada, patrón de clase III esquelética y perfil cóncavo; en los segundos, la tendencia es a presentar mandíbulas pequeñas con ángulo articular y resalte dentario aumentados(AU)

Mini Hyrax vs Hyrax expanders in the rapid palatal expansion in adolescents with posterior crossbite: a randomized controlled clinical trial.

PURPOSE: The aim of this study was to compare the dental effects, impact on quality of life, and pain perception of adolescents wearing Mini Hyrax and Hyrax expanders in rapid palatal expansion. METHODS: Thirty-four adolescents aged 11 to 16 years, with maxillary transverse deficiency (unilateral or bilateral posterior crossbite), were randomly allocated into two groups, Mini Hyrax group and Hyrax group (1:1 ratio). Dental effects were evaluated by digitally superimposed pretreatment and postretention three-dimensional intraoral scans on the palatal rugaes using the software 3DSlicer. Impact on quality of life was assessed with the OHIP-14 questionnaire applied in the pretreatment, posttreatment and postretention. Visual analog scale was applied 24, 48, and 72 h and 7 days after the first activation of the expander. RESULTS: Thirty of the 34 adolescents recruited completed the study. There were no statistically significant differences in dentoalveolar effects between groups. OHIP-14 scores across time among Mini Hyrax wearers were similar to those of the Hyrax wearers. The inter-group comparisons showed no difference between groups with respect to the OHIP-14 scores in posttreatment and postretention (p > 0.05). There were no differences in pain perception between groups. Considering intra-group comparison, the reduction in pain perception among adolescents in the Mini Hyrax group was gradual. Among adolescents in the Hyrax group, a statistically significant reduction between 48 and 72 h was observed. CONCLUSION: There were no significant differences in dental effects, impact on quality of life and pain perception between adolescents wearing Mini Hyrax and Hyrax expanders in rapid palatal expansion.

Correção da mordida cruzada posterior bilateral em paciente classe III por compensação dentoalveolar ­ relato de caso / Bilateral posterior crossbite correction in a class III patient by dentoalveolar compensation ­ case report

Resumo A busca pelo tratamento ortodôntico por pacientes adultos tem aumentado nos consultórios. A demanda estética é um fator contribuinte para esse aumento. Ao tratar de um paciente adulto pode-se encontrar vários tipos de problemas oclusais. Como exemplo, pode-se citar a deficiência transversal da maxila. Esse caso clínico trata-se do tratamento compensatório de um paciente Padrão I com mordida cruzada posterior bilateral, relação molar de Classe III, atresia do arco superior e expansão do arco inferior. Para realizar o tratamento foram utilizados aparelho fixo autoligado, fios Cooper NiTi com diagrama expandido arcada superior e NiTi convencional na arcada inferior associados a levantes de mordida e uso de elásticos (1/8") intermaxilares para descruzar a mordida. O resultado satisfatório foi obtido com a correção da relação de mordida cruzada posterior, obtenção de uma oclusão satisfatória em Classe I, melhora do sorriso, overbite e overjet dentro dos padrões e resolução da queixa do paciente. (AU)

Abstract The search for orthodontic treatment by adult patients has increased in the offices. Aesthetic demand is a contributing factor for this increase. When treating an adult patient, many types of occlusal problems can be found. As an example, we can mention the transverse deficiency of the maxilla. This clinical case is the compensatory treatment of a Pattern I patient with bilateral posterior crossbite, Class III molar relationship, upper arch atresia, and expansion of the lower arch. To perform the treatment self-ligating fixed appliance, Cooper NiTi wires with expanded diagram in the upper arch and conventional NiTi in the lower arch were used in conjunction with the bite lifters and the use of intermaxillary elastics (1/8 ") to uncross the bite. A satisfactory result was obtained by correcting the posterior crossbite ratio, obtaining a satisfactory Class I occlusion, improving the smile, overbite, and overjet within the standards, and resolving the patient's complaint.

Comparison Between Removable and Fixed Devices for Nonskeletal Anterior Crossbite Correction in Children and Adolescents: A Systematic Review.

OBJECTIVE: To compare removable and fixed orthodontic devices in the correction of non-skeletal anterior crossbite in children and adolescents in the mixed dentition. MATERIALS AND METHODS: Electronic searches were conducted in the following databases: PubMed, Web of Science, Scopus, Medline Ovid, Lilacs, US Clinical Trials, and Proquest. A hand search of the reference lists of the included articles and a Google Scholar search were also conducted. References were evaluated by 2 review authors. Articles that met the eligibility criteria were included. Data extraction, methodological quality assessment (Cochrane tool), and strength of the evidence evaluation (GRADE) were also carried out. RESULTS: Seven articles were included. The results showed that removable and fixed devices were equally efficacious for overjet correction. Removable and fixed devices can also present inconveniences regarding pain and discomfort levels, the accomplishment of everyday activities (leisure and school), and the performance of functions, such as chewing and speech. However, treatment time and costs were significantly lower in orthodontic therapy with fixed appliances. Sequence generation, allocation concealment, and complete outcome data were not a concern. Blinding of participants or personnel was not reported in any article, and blinding of the assessor was a concern in 2 articles. Selective reporting was a concern in 2 articles. The certainty of the evidence for overjet correction was very low. CONCLUSION: Removable and fixed orthodontic devices are efficacious for overjet correction in non-skeletal anterior crossbite. However, treatment time and costs are lower for cases treated with fixed devices.

Is there association between dental malocclusion and bruxism? A systematic review and meta-analysis.

OBJECTIVES: Given that current literature largely dissociates dental malocclusion and bruxism, the objective of this study was to gather, through a systematic review, scientific evidence to support their relationship. METHODOLOGY: This study was performed according to the PECO strategy (where P = general population; E = dental malocclusion; C = no dental malocclusion; and O = bruxism). Literature searches were conducted without language or date restrictions in the following databases: PubMed, Scopus, the Web of Science, the Cochrane Library, LILACS/BBO via VHL and the grey literature. The search strategy included Medical Subject Headings/DECs, synonyms and free terms relevant to each database, with no age restrictions applied. Once the relevant data were extracted from the articles, the Fowkes and Fulton guidelines were followed to assess the quality and risk of bias. For quantitative analysis, dental malocclusions were divided into groups according to their type in order to perform odds ratio (OR) meta-analyses with 95% confidence intervals (CI) using the Review Manager software program (Cochrane, London, UK). The level of certainty of evidence was demonstrated through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS: After 1,502 studies found, 10 studies were included for qualitative analysis and nine for quantitative synthesis. Four studies presented high methodological quality. Five meta-analyses suggested a non-association between bruxism and Angle class I (OR: 1.05, 95% CI: 0.41-2.69; P = .92; I2  = 84%), Angle class II (OR: 1.49, 95% CI: 0.77-2.87; P = .23; I2  = 71%) or Angle class III (OR: 0.77, 95% CI: 0.31-1.93; P = .58; I2  = 0%). Bruxism was associated with children who did not present with a posterior crossbite (OR: 0.70, 95% CI: 0.51-0.96; P = .03; I2  = 27%) and present crowding (OR: 1.53, 95% CI: 1.03-2.26; P = .03; I2  = 0%). The GRADE analysis presented a very low quality of evidence. CONCLUSION: Individuals who present with bruxism have a greater chance of crowding. However, bruxism is not associated with the presence of any of the other malocclusions evaluated.

Three-dimensional assessment of craniofacial asymmetry in children with transverse maxillary deficiency after rapid maxillary expansion: A prospective study.

OBJECTIVE: The aim of this study was to evaluate craniofacial asymmetry in children with transverse maxillary deficiency, with or without functional unilateral posterior crossbite (UPC), before and after rapid maxillary expansion (RME). SETTING AND SAMPLE POPULATION: A sample of 51 children with cone beam computed tomography scans obtained before RME (T1) and a year after RME (T2). MATERIAL AND METHODS: This prospective study consisted of 2 groups: 25 children with functional UPC (6.77 ± 1.5 years) and 26 children without UPC (7.41 ± 1.31 years). Linear and angular measurements were obtained from zygomatic, maxilla, glenoid fossa and mandible, using original and mirrored 3D overlapped models. All right and left side comparisons in both groups and intergroups asymmetries were compared using MANOVA and t test for independent samples, respectively, statistically significant at P < .05. RESULTS: The UPC group showed no side differences, but mandibular horizontal rotation at T1, and this asymmetry was improved in T2. The non-UPC group showed at baseline significant lateral asymmetry in orbitale, position of palatine foramen, respectively, in average 2.95 mm and 1.16 mm, and 0.49 mm of average asymmetry in condylar height. The glenoid fossa was symmetric in both groups at T1 and T2. CONCLUSIONS: Children with transverse maxillary deficiency showed slight morphological asymmetry, located in the mandible position in cases of UPC, and in the orbital and maxillary regions in cases without UPC. One year after RME, patients improved their craniofacial asymmetry, with significant changes in the mandible and correction of the mandibular rotation in patients who presented UPC.

El quad-hélix, un aparato versátil / The quad-hélix, a versatile appliance

El quad-hélix (QH) es un aparato de expansión maxilar, fabricado con alambre de acero inoxidable soldado a bandas en molares, que dispone de espirales o hélices que aumentan la longitud de alambre del aparato, lo que lo hace muy elástico y aligera la magnitud de la fuerza sobre los dientes, es ampliamente usado tanto en dentición mixta como en permanente temprana, fácil de fabricar, higiénico y bien tolerado por los pacientes. Su principal acción es mover hacia vestibular los procesos dentoalveolares de la arcada maxilar, influyendo secundariamente en la expansión de la sutura palatina media en pacientes con dentición mixta o permanente temprana. El QH es muy práctico y tiene muchos usos y adaptaciones y se puede utilizar como auxiliar en el tratamiento de problemas de hábito de dedo o lengua, para abrir mordida, rotar y dar torque a molares permanentes o para mover sólo un diente en particular. En este artículo describimos una nueva aplicación del QH que consiste en la tracción, de dientes anteriores superiores permanentes retenidos, después del abordaje quirúrgico para localizarlos. También revisaremos las indicaciones, contraindicaciones, ventajas y desventajas del aparato QH soldado a bandas en molares así como su elaboración, variantes y forma de activación (AU)

The quad-helix (QH) is a maxillary expansion appliance, manufactured with stainless steel wire welded to bands in molars, which has spirals or helix to increase the length of wire of the device, which makes it very elastic and lightens the magnitude of the force on the teeth, is widely used both in mixed and in early permanent dentition, is easy to manufacture, hygienic and well tolerated by patients. Its major action is to move towards the dentoalveolar process of the maxillary arcade, secondarily influencing the expansion of the middle palatal suture in young patients with mixed or permanent early dentition. The QH is very practical and has many uses and adaptations as an aid in the treatment of problem of thumb sucking or tongue habit, to open bite, to rotate and torque permanent molars or to move only one particular tooth. In this article we describe a new application of the QH that consist of the traction or retained permanent upper teeth, after surgical approach to locate them. We will also review the indications, contraindications, advantages and disadvantages of the QH welded to molar bands, as well as its construction, variants and activation form (AU)

Reabilitação neuroclusal em paciente odontopediátrico com mordida cruzada posterior unilateral: relato de caso clínico / Neuro-occlusal rehabilitation in pediatric dental patient with unilateral posterior crossbite: clinical case report

Objetivo: relatar a sequência clínica de tratamento para descruzar uma mordida cruzada posterior unilateral na dentição decídua por meio da reabilitação neuroclusal. Relato de caso: o caso clínico foi realizado em um paciente do sexo masculino, com 5 anos de idade, diagnosticado com mordida cruzada posterior unilateral funcional do lado direito. Após a verificação de interferências dentais nos caninos e molares em oclusão cêntrica, realizaram-se os ajustes oclusais. Seguiu-se então o protocolo para confecção de pistas diretas de Planas, utilizando resina composta em planos inclinados na metade vestibular da face oclusal dos dentes 84 e 85 e na face vestibular dos dentes 53, 54 e 55. Logo após a confecção das pistas, observou-se a correção da mordida cruzada e a estabilidade na mudança postural da mandíbula. Considerações finais: a reabilitação neuroclusal por meio de pistas diretas de Planas apresenta grande eficácia na correção da mordida cruzada posterior, proporcionando estabilidade mandibular e estímulo para o crescimento e desenvolvimento crânio-maxilo-facial. (AU)

Objective: To report the clinical treatment sequence to uncross a unilateral posterior crossbite in deciduous dentition using neuro-occlusal rehabilitation. Case report: The clinical case was performed in a 5-year-old male patient diagnosed with a functional unilateral posterior crossbite on the right side. After verifying dental interferences with canines and molars in centric occlusion, the occlusal adjustments were performed. The protocol for producing Planas direct tracks was followed using composite resin in inclined planes in the buccal half of the occlusal surface of teeth 84 and 85 and in the buccal surface of teeth 53, 54, and 55. After the preparation of tracks, the crossbite correction and the stability in postural mandibular change were observed. Final considerations: Neuro-occlusal rehabilitation using Planas direct tracks is highly effective in correcting posterior crossbite, providing mandibular stability and stimulus for the growth and development of the maxillofacial skull. (AU)

Rapid maxillary expansion in the treatment of the functional posterior crossbite: joint noise and electromyographic activity analysis / Expansão rápida da maxila no tratamento da mordida cruzada posterior: análise de ruídos articulares e atividade eletromiográfica

Abstract Introduction The rapid maxillary expansion (RME) reduces the risk of developing structural and functional disorders in the stomatognathic system. Objective To examine the effects of the RME as a treatment for the posterior crossbite, related with the electromyographic activity of the masticatory muscles and the TMJ noises in a population of children. Material and method 13 girls and 7 boys, regardless of the type of malocclusion, with a mean age of 9 years old (± 3), were treated with RME. The electrovibratography analyzed the TMJ noise, and the electromyography analyzed the masticatory muscles before treatment (T0) and after three months of a short-term follow-up (T1). The comparisons of the affected and unaffected sides by the crossbite were performed using Mann-Whitney's test, and to compare data before and after treatment the Wilcoxon's test was used (level of significance: 5%). Result No significant differences were found in the parameters of joint noise in comparison to the sides affected and unaffected by the crossbite, in both T0 and T1 (p>0.05); only the side without the crossbite observed decrease in the peak amplitude of the joint noises after treatment. In the static electromyographic analysis, inter-side differences were observed before and after treatment, since the deliberate unilateral chewing showed greater asymmetry activity in T0 for both sides, which has been corrected after treatment, improving the functional chewing. Conclusion The proposed treatment did not lead to the occurrence of joint noises and improved the functional pattern of electromyographic activity during chewing at the end of treatment.

Resumo Introdução A expansão rápida da maxila (RME) reduz o risco de desenvolvimento de distúrbios estruturais e funcionais no sistema estomatognático. Objetivo Analisar os efeitos desta intervenção como tratamento para a mordida cruzada posterior, relacionados à ocorrência de ruídos nas articulações temporomandibulares e à atividade eletromiográfica dos músculos masseter e temporal anterior. Material e método 13 meninas e 7 meninos, independentemente do tipo de maloclusão, com idade média de 9 anos (±3), foram tratadas com RME. Por meio de eletrovibratografia analisou-se ruídos nas articulações temporomandibulares, e de eletromiografia de superfície a atividade dos músculos mastigatórios antes (T0) e após 3 meses do final do tratamento proposto (T1). As comparações entre os lados afetado e não afetado pela mordida cruzada foram realizadas utilizando-se o teste de Mann-Withney. As comparações de antes e após o tratamento foram realizadas pelo teste de Wilcoxon (nível de significância: 5%). Resultado Não houve diferença significativa na eletrovibratografia entre os lados afetado e não afetado pela mordida cruzada, tanto em T0 como em T1 (p>0.05); do lado sem mordida cruzada observou-se diminuição do pico de amplitude dos ruídos articulares após a expansão rápida da maxila (p<0.05). Na análise da eletromiografia estática foram observadas diferenças inter-lados antes e após o tratamento, uma vez que a mastigação deliberada unilateral apresentou maior atividade de assimetria em T0 para ambos os lados, o que foi corrigido após o tratamento (p<0.05), melhorando a mastigação funcional padrão. Conclusão O tratamento proposto para mordida cruzada posterior funcional não levou à ocorrência de ruídos articulares e melhorou o padrão funcional da atividade eletromiográfica durante a mastigação ao final do tratamento.

Virtual orthodontic setup in orthodontic camouflage planning for skeletal Class III malocclusion

ABSTRACT The purpose of this paper was to emphasize the importance of the orthodontic setup in treatment planning for skeletal Class III malocclusion correction in an adult patient with moderate lower anterior crowding and anterior crossbite associated with two supernumerary lower incisors.

RESUMO O objetivo desse artigo é enfatizar a importância do setup ortodôntico no planejamento do tratamento da má oclusão de Classe III esquelética de uma paciente adulta com apinhamento anteroinferior moderado e mordida cruzada anterior associada à presença de dois incisivos inferiores supranumerários.

Impact of two early treatment protocols for anterior dental crossbite on children's quality of life

ABSTRACT Objective: To assess the impact of two early treatment protocols for anterior dental crossbite on children's quality of life. Methods: Thirty children, 8 to 10 years of age, with anterior dental crossbite, participated in this study. Individuals were divided into two groups: Group 1 - 15 children undergoing treatment with an upper removable appliance with digital springs; Group 2 - 15 children undergoing treatment with resin-reinforced glass ionomer cement bite pads on the lower first molars. Quality of life was evaluated using the Brazilian version of the Child Perceptions Questionnaire (CPQ8-10), which contains four subscales: oral symptoms (OS), functional limitations (FL), emotional well-being (EW), and social well-being (SW). A higher score denotes a greater negative impact on children's quality of life. Children answered the questionnaire before treatment (T1) and twelve months after orthodontic treatment onset (T2). Descriptive statistics, the Wilcoxon test and analysis of covariance (ANCOVA) were performed. Results: Children's mean age was 9.07 ± 0.79 years in Group 1 and 9.00 ± 0.84 years in Group 2. For Group 1, the FL and EW subscale scores and the overall CPQ8-10 were significantly higher in T1 as compared to T2 (p= 0.004, p= 0.012 and p= 0.015, respectively). For Group 2, there were no statistically significant differences. The ANCOVA showed no significant difference regarding quality of life at T2 between groups, after controlling for quality of life measures at T1. Conclusions: The difference regarding the impact on quality of life between groups is not related to the protocol used.

RESUMO Objetivo: avaliar o impacto de dois protocolos de tratamento precoce para a mordida cruzada anterior dentária na qualidade de vida de crianças. Métodos: trinta crianças de 8 a 10 anos de idade com mordida cruzada anterior dentária participaram desse estudo. Os indivíduos foram divididos em dois grupos: Grupo 1 - 15 crianças em tratamento com aparelho removível superior com molas digitais; Grupo 2 - 15 crianças em tratamento com batentes de cimento de ionômero de vidro resinoso nos primeiros molares permanentes inferiores. A qualidade de vida foi avaliada por meio da versão brasileira do Child Perceptions Questionnaire (CPQ8-10), o qual contém quatro subescalas: sintomas bucais (SB), limitações funcionais (LF), bem-estar emocional (BE) e bem-estar social (BS). Um escore mais alto indica um impacto mais negativo na qualidade de vida. As crianças responderam ao questionário antes do tratamento (T1) e 12 meses após o início do tratamento ortodôntico (T2). Estatística descritiva, o teste Wilcoxon e análise de covariância (ANCOVA) foram realizados. Resultados: a média de idade das crianças foi de 9,07 ± 0,79 anos no Grupo 1 e de 9,00 ± 0,84 no Grupo 2. Para o Grupo 1, os escores das subescalas LF e BE e o escore total do CPQ8-10 foram significativamente maiores em T1 do que em T2 (p= 0,004, p= 0,012 e p= 0,015, respectivamente). Para o Grupo 2, não houve diferença estatisticamente significativa. A ANCOVA não mostrou diferença significativa entre os grupos em relação à qualidade de vida em T2, após o controle para as medidas de qualidade de vida em T1. Conclusões: a diferença em relação ao impacto na qualidade de vida entre os grupos não foi relacionada ao protocolo de tratamento utilizado.

Prevalencia de mordida cruzada en pacientes de la Clínica Estomatológica Artemio Mastrapa / Prevalence of Crossbite in Patients of Artemio Mastrapa Dental Clinic

Introducción: las anomalías de la oclusión no constituyen una enfermedad específica, sino que, son consecutivas a irregularidades de las partes blandas, los maxilares, los dientes y las articulaciones temporomandibulares. El tratamiento temprano evita graves consecuencias en la salud del aparato masticatorio. Objetivo: determinar la prevalencia de las mordidas cruzadas en nuestros pacientes en cuanto a sexo, etiología, tipo y localización. Método: se realizó un estudio transversal durante el período de enero a mayo de 2015. El universo estuvo constituido por 715 pacientes con edades comprendidas entre 7 y 11 años de uno u otro sexo procedentes de la Consulta de Ortodoncia de la Clínica Estomatológica Artemio Mastrapa en la ciudad de Holguín. La muestra quedó constituida por 141 pacientes portadores de mordida cruzada, dentición mixta y sin pérdida de dientes permanentes como criterio de inclusión. Se utilizó la anamnesis, examen clínico y análisis funcional. Resultados: la prevalencia de la mordida cruzada fue de 19,72%, en el sexo femenino se obtuvo el 19,95%. Las causas que más contribuyeron a que se produjera dicha alteración fueron los hábitos bucales deformantes, la persistencia de dientes temporales y los traumatismos; el tipo simple predominó en ambos sectores, en cuanto a su ubicación la mordida cruzada posterior fue la más frecuente (68,7%). Conclusiones: las mordidas cruzadas fueron las anomalías más frecuentes en la población infantil que acude a consultas de ortodoncia, sin diferencias significativas intersexo, la posterior simple fue la más frecuente. Las causas locales estuvieron asociadas a la etiología, por lo que es necesario continuar realizando actividades encaminadas a su prevención y tratamiento precoz.

Introduction: occlusion anomalies do not constitute a specific disease but they are consecutive to irregularities of the soft tissue, maxilar bones, teeth and the temporomandibular joints. The early treatment avoids serious consequences in the health of the oral apparatus. Objective: determine the prevalence of the crossbites in our patient according to sex, etiology, type and location. Method: a descriptive, cross-sectional study was performed during the period of January and May of 2015. The universe was constituted by 715 patients with ages between 7 and 11 years old of one or other sex coming from Artemio Mastrapa Dental Clinic in Holguín city. The sample was constituted by 141 carrying patients of crossbite, mixed teething and without loss of permanent teeth like inclusion criterion. Anamnesis, clinical examination and functional analysis were used. Results: the prevalence of crossbite was of 19.72%, female sex was affected in a 19.95%. The main causes of the alteration were the deforming buccal habits, persistence of temporary teeth and the traumatisms, single type predominated in both sectors, according location the posterior crossbite was the most frecuent (68.7%). Conclusions: crossbites continue being very frequent anomalies in the infantile population that assist to orthodontics consultation, without significant sex differences, single posterior crossbite was more frecuent; local factors were associate to etiology reason why it is necessary to continue developing activities directed to its prevention and early treatment.

Retention period after treatment of posterior crossbite with maxillary expansion: a systematic review

ABSTRACT OBJECTIVE: The aim of this systematic review was to evaluate the duration of the retention period in growing patients undergoing maxillary expansion and its relation with posterior crossbite stability. METHODS: Search strategies were executed for electronic databases Cochrane Library, Web of Science, PubMed and Scopus, which were completed on January 15, 2016. The inclusion criteria included randomized, prospective or retrospective controlled trials in growing subjects with posterior crossbite; treated with maxillary expanders; retention phase after expansion; post-retention phase of at least 6 months. The exclusion criteria were anterior crossbite, craniofacial anomalies, surgery or another orthodontic intervention; case reports; author’s opinions articles, thesis, literature reviews and systematic reviews. The risk of bias of selected articles was assessed with Cochrane risk of bias tool for RCTs and Downs and Black checklist for non-RCTs. RESULTS: A total of 156 titles/abstracts was retrieved, 44 full-texts were examined, and 6 articles were selected and assessed for their methodological quality. The retention period after maxillary expansion ranged between 4 weeks and 16 months. Fixed (acrylic plate, Haas, Hyrax and quad-helix) or removable (Hawley and Hawley expander) appliances were used for retention. CONCLUSIONS: Six months of retention with either fixed or removable appliances seem to be enough to avoid relapse or to guarantee minimal changes in a short-term follow-up.

RESUMO OBJETIVO: o objetivo da presente revisão sistemática foi avaliar a duração do período de contenção e a estabilidade do tratamento ortodôntico com expansão maxilar em pacientes em crescimento com mordida cruzada posterior. MÉTODOS: foram realizadas buscas estratégicas nas bases eletrônicas: Cochrane Library, Web of Science, PubMed e Scopus, até 15 de janeiro de 2016. Os critérios de inclusão foram: estudos clínicos controlados e randomizados, prospectivos ou retrospectivos, de pacientes em crescimento com mordida cruzada; tratados com aparelhos expansores maxilares, com fase de contenção pós-expansão e no mínimo seis meses de fase de pós-contenção. Os critérios de exclusão foram: mordida cruzada anterior, anomalias craniofaciais, cirurgia ou outro tratamento ortodôntico; relato de casos; artigos de opinião; teses; revisões de literatura e revisões sistemáticas. O risco de viés dos artigos selecionados foi avaliado a partir do Cochrane risk of bias tool para ensaios clínicos randomizados e Downs and Black checklist para ensaios clínicos não randomizados. RESULTADOS: a busca resultou em 156 títulos/resumos, sendo 44 textos examinados na íntegra. Foram selecionados 6 artigos para o acesso à qualidade metodológica. A duração do período de contenção ocorreu entre 4 semanas e 6 meses. Aparelhos fixos (aparelho em acrílico, Haas, Hyrax e quad-helix) ou removíveis (Hawley e Hawley com expansor) foram utilizados na fase de contenção. CONCLUSÃO: parece que seis meses de contenção com aparelhos fixos ou removíveis são suficientes para evitar a recidiva ou garantir mudanças mínimas em um curto período de acompanhamento pós-contenção.