Early orthognathic surgery with postsurgical bone-anchored retention in unilateral cleft lip and palate: A case report.

We present a case report of early Le Fort I osteotomy with maxillary advancement retained postoperatively by Class III elastics anchored on miniplates in a growing patient with complete unilateral cleft lip and palate (UCLP). A 14-year-old boy who underwent orthognathic surgery at the pubertal growth spurt was presented. During surgery, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics anchored on miniplates were used at night (8-10 h) starting 60 days after surgery. The force of the elastics progressively increased from 100 g to 250 g. The elastics were replaced daily. The positive overjet remained stable over 15 months of postoperative follow-up. Maxillary advancement was adequately retained using Bollard miniplates and the facial profile remained stable until the end of facial growth.

Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults.

INTRODUCTION: This study aimed to compare the dentoskeletal and periodontal changes after miniscrew-assisted rapid palatal expansion (MARPE) in patients aged 18-29 and 30-45 years. METHODS: The sample comprised 28 subjects with transverse maxillary discrepancy successfully treated with MARPE. The young adult (YA) group comprised 14 subjects (mean age, 22.8 years; 3 male, 11 female). The middle adult (MA) group comprised 14 subjects (mean age, 36.8 years; 6 male, 8 female). All patients were treated with a 4-miniscrew MARPE expander. The activation protocol was one quarter turn twice a day until the midline diastema opening, followed by one quarter turn a day until overcorrection. Cone-beam computed tomography (CBCT) scans taken before and immediately after the expansion was analyzed using OnDemand3D Dental software. Using CBCT coronal images, transversal dentoskeletal and periodontal variables were measured in the preexpansion and postexpansion. Intergroup comparisons of expansion changes were performed using t and Mann-Whitney tests (P <0.05). RESULTS: Groups were compatible at preexpansion for most CBCT measurements. A success rate of midpalatal suture opening of 100% and 81% was observed for YA and MA groups, respectively. No intergroup differences were found for the maxillary and dental arch widths increases. The buccal tip of anchorage teeth was observed similarly in both groups. The buccal bone thickness of posterior teeth decreased, and the palatal bone thickness increased after expansion with no difference between groups. CONCLUSIONS: After MARPE, the MA group showed similar dentoskeletal and periodontal changes compared to the YA group.

Pain and discomfort perception during miniscrew-anchored maxillary protraction: secondary data analysis of a randomized clinical trial.

OBJECTIVES: To compare the perception of pain and discomfort of patients and guardians during treatment between miniscrew-anchored maxillary protraction (MAMP) therapy using Hybrid (HH) and Conventional Hyrax (CH) expanders. MATERIALS AND METHODS: Group HH was composed of 18 subjects (8 female, 10 male; initial age: 10.80 years) with Class III malocclusion treated with a hybrid expander in the maxilla and two miniscrews in the anterior region of the mandible. Class III elastics were used from maxillary first molar to mandibular miniscrews. Group CH was composed of 14 subjects (6 female, 8 male; initial age: 11.44 years) treated with a similar protocol except for conventional Hyrax expander. Pain and discomfort of patients and guardians were assessed using a visual analog scale immediately after placement (T1), after 24 hours (T2), and 1 month after appliance installation (T3). Mean differences (MD) were obtained. Intergroup and intragroup timepoint comparisons were performed using independent t-tests, analysis of variance for repeated measures and Friedman test (P < 5%). RESULTS: Both groups demonstrated similar levels of pain and discomfort with a significant decrease after 1 month of appliance placement (MD: 4.21; P = .608). Compared to patient perceptions, guardians reported a higher level of pain and discomfort at all timepoints (MD, T1: 13.91, P < .001; T2: 23.15, P < .001; T3: 9.35, P = .008). CONCLUSIONS: MAMP therapy with HH and CH produced similar levels of pain and discomfort after appliance installation until 1 month after treatment. Pain and discomfort may not influence the choice between HH and CH expanders.

Upper airway changes in Class III patients using miniscrew-anchored maxillary protraction with hybrid and hyrax expanders: a randomized controlled trial.

OBJECTIVES: The aim of this study was to compare the upper airway space changes after miniscrew-anchored maxillary protraction with hybrid (HH) and conventional hyrax (CH) expanders. MATERIAL AND METHODS: The sample comprised Class III malocclusion growing patients that were randomized into two groups of miniscrew-anchored maxillary protraction. The group HH was treated with a hybrid hyrax appliance in the maxilla and two miniscrews distally to the canines in the mandible. Class III elastics were used from the maxillary first molar to the mandibular miniscrews until anterior crossbite correction. The group CH was treated with a similar protocol except for the conventional hyrax expander in the maxilla. Cone-beam computed tomography was obtained before (T1) and after 12 months of therapy (T2). The shape and size of upper airway were assessed. Intergroup comparisons were performed using Mann-Whitney U test (p < 0.05). RESULTS: The group HH was composed of 20 patients (8 female, 12 male) with a mean age of 10.76 years. The group CH was composed of 15 patients (6 female, 9 male) with a mean age of 11.52 years. Anteroposterior and transverse increases of the upper airway were found for both groups. The oropharynx and the most constricted area increased similarly in both groups. CONCLUSIONS: No differences in upper airway changes were observed using protraction anchored on hybrid or conventional hyrax expanders. CLINICAL RELEVANCE: Maxillary protraction anchored on hybrid or conventional hyrax expanders may benefit patients with breathing disorders due to the increase of the upper airway volume and most constricted area. Registration: ClinicalTrials.gov (NCT03712007).

Dentoskeletal comparison of miniscrew-anchored maxillary protraction with hybrid and conventional hyrax expanders: A randomized clinical trial.

INTRODUCTION: This randomized clinical trial aimed to compare the skeletal and dental effects of miniscrew-anchored maxillary protraction (MAMP) using hybrid hyrax (HH) and conventional hyrax (CH) expanders in growing patients with Class III malocclusion. METHODS: This was a randomized, parallel, controlled trial. Forty growing patients with Class III malocclusion and maxillary deficiency (Wits appraisal of less than -1 mm) were randomized into 2 groups. Patients were recruited at the Orthodontic Clinic of Bauru Dental School, University of São Paulo, Brazil. The HH group was composed of patients with Class III malocclusions in the late mixed or early permanent dentition treated with a HH expander with 2 miniscrews in the maxilla and 2 miniscrews in the anterior region of the mandible. Class III elastics were used from the maxillary first molars to the mandibular miniscrews placed between permanent canines and first premolars. The CH group was composed of patients treated with a similar protocol except for the use of a CH expander in the maxilla. The primary outcomes included the frequency of overjet correction and sagittal skeletal effects produced with treatment. Allocation was performed with a simple randomization process. Blinding was performed only during assessments. Data were analyzed blindly on an intention-to-treat basis. Intergroup comparison was performed using analysis of covariance. Mean differences (MD) and 95% confidence interval (CI) were obtained for all variables. RESULTS: The final sample for the HH group was 20 subjects (8 female, 12 male; initial age of 10.7 years), whereas the final sample for the CH group was 15 subjects (6 female, 9 male; initial age of 11.5 years). The frequency of overjet correction observed in the HH and CH groups was 94.4% and 71.4% (risk ratio, 1.32; 95% CI, 0.93-1.88), respectively. Both groups presented similar skeletal sagittal and vertical outcomes after maxillary protraction. The maxillary length (CoA) showed a similar increase in both groups (MD, 1.12 mm; 95% CI, -0.03 to 2.27). The CH group demonstrated a greater mesial displacement of maxillary first molars after treatment than the HH group (MD, 1.22 mm; 95% CI, 0.33-2.11). HH and CH groups produced 2.88 and 1.97 overjet corrections (MD, 0.53 mm; 95% CI, -0.52 to 1.59), respectively. CONCLUSIONS: MAMP using HH and CH expanders produced a frequency of overjet correction of 94.4% and 71.4%, respectively. Similar skeletal effects were observed between MAMP using HH and CH expanders. Greater control of the mesial displacement of maxillary first molar during maxillary protraction using hybrid expanders was observed. REGISTRATION: The trial was registered at http://ClinicalTrials.gov, under the identifier NCT03712007. PROTOCOL: This trial protocol was not published. FUNDING: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES) - Finance Code 001, and by the São Paulo Research Foundation (FAPESP) - Grants nos. 2017/04141-9, 2017/24115-2, and 2019/03175-2.

Orthopedic outcomes of hybrid and conventional Hyrax expanders.

OBJECTIVES: To compare the effects of a hybrid miniscrew-supported expander versus a conventional Hyrax (CH) expander in growing patients. MATERIALS AND METHODS: Forty patients were randomized into two groups: a hybrid Hyrax (HH) expander group using a Hyrax expander with two miniscrews and a CH expander group. The final sample had 18 subjects (8 female, 10 male; initial age of 10.8 years) in the HH group and 14 subjects (6 female, 8 male; initial age of 11.4 years) in the CH group. Cone-beam computed tomography examinations and digital dental models were obtained before expansion and 11 months postexpansion. The primary outcomes included the orthopedic transverse effects of expansion. Intergroup comparison was performed using analysis of covariance (P < .05). RESULTS: Significantly greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width were found for the HH group. No intergroup differences were observed for dental arch width or shape changes. CONCLUSIONS: The HH group showed greater increases in the nasal cavity width, maxillary width, and buccal alveolar crest width. No differences were observed for intermolar, interpremolar, or intercanine widths; arch length; or arch perimeter. Arch size and shape showed similar changes in both groups.

Miniscrew-anchored maxillary protraction in growing Class III patients.

The aim of this article is to report a case series of a miniscrew-anchored maxillary protraction therapy (MAMP). Two male patients presenting with Class III malocclusion were included in this report. The treatment consisted of a hybrid expander and two miniscrews at the anterior region of the mandible anchoring Class III elastics for maxillary protraction. Effective maxillary length, ANB angle and Wits appraisal increased after treatment. Slight dental effects were observed. MAMP therapy produced substantial skeletal effects and might be a good treatment option for Class III growing patients.

Outcomes of Alveolar Graft With Rhbmp-2 in CLP: Influence of Cleft Type and Width, Canine Eruption, and Surgeon.

OBJECTIVE: To evaluate the influence of cleft type and width, canine eruption stage, and surgeon on the outcomes of alveolar graft with rhBMP-2. DESIGN: Cross-sectional. SETTING: Tertiary craniofacial center. PARTICIPANTS: Ninety individuals submitted to alveolar graft in late mixed or early permanent dentition. INTERVENTIONS: The 90 individuals (mean age: 16.8 years) were submitted to alveolar graft with rhBMP-2. Periapical radiographs were obtained before and 6 months after surgery. Surgeries were performed by 4 experienced maxillofacial surgeons. The alveolar grafts were assigned as success or failure by 3 blinded raters based on the modified Bergland and Chelsea scales. Permanent canines adjacent to the defect were assigned as erupted and not erupted. The greatest cleft width was measured on preoperative periapical radiographs. MAIN OUTCOME MEASURES: The influence of 4 independent variables (cleft type, cleft width, canine eruption phase, and surgeon) on the outcome of alveolar graft was analyzed by multivariate logistic regression ( P < .05). RESULTS: All independent variables presented significant influence on alveolar graft outcome. The subgroup of unerupted maxillary canines demonstrated better outcomes than erupted canines ( P = .001). The group with cleft lip and alveolus (CL/A) demonstrated better outcomes than complete cleft lip and palate (CLP; P < .001). The greater the alveolar cleft width, the less favorable were the graft outcomes ( P = .027). The surgeon also had a significant influence on the surgery success ( P = .003 and .001). CONCLUSION: The type and width of CLP, the eruption of permanent canines, and the surgeon influenced the outcome of alveolar graft surgeries performed with rhBMP-2.

Evaluation of secondary alveolar bone grafting outcomes performed after canine eruption in complete unilateral cleft lip and palate.

OBJECTIVES: Evaluate the results of secondary alveolar bone grafting (SABG) in patients with complete unilateral cleft lip and palate (UCLP), operated after permanent canine eruption (CE). MATERIALS AND METHODS: Seventy-four periapical radiographs from patients with complete UCLP (mean age 14 years) submitted to SABG were retrospectively analyzed for the amount of bone in the cleft site through the Bergland and Chelsea scales. RESULTS: Of the cases, 47.3 % was classified as Bergland type I and Chelsea type A, 35.2 % as type II/C, 6.7 % as type III/D, and 10.8 % as type IV/failure. When the canine was moved into the grafted area, the success rate (type I/A) was 56.8 %; for cases in which the space was maintained for an implant or prosthetic finishing, the index was 45.8 %; however, this difference was not statistically significant. CONCLUSION: Even in advanced ages, after permanent canine eruption, SABG can be considered a highly successful procedure. CLINICAL RELEVANCE: This research shows good results of secondary alveolar bone grafting performed in patients with unilateral complete cleft lip and palate, even when it was performed after eruption of the permanent canine in the cleft area.

Cleft lip and palate: recommendations for dental anesthetic procedure based on anatomic evidences.

Patients with cleft lip and palate usually present dental anomalies of number, shape, structure and position in the cleft area and the general dentist is frequently asked to restore or extract those teeth. Considering that several anatomic variations are expected in teeth adjacent to cleft areas and that knowledge of these variations by general dentists is required for optimal treatment, the objectives of this paper are: 1) to describe changes in the innervation pattern of anterior teeth and soft tissue caused by the presence of a cleft, 2) to describe a local anesthetic procedure in unilateral and bilateral clefts, and 3) to provide recommendations to improve anesthetic procedures in patients with cleft lip and palate. The cases of 2 patients are presented: one with complete unilateral cleft lip and palate, and the other with complete bilateral cleft lip and palate. The patients underwent local anesthesia in the cleft area in order to extract teeth with poor bone support. The modified anesthetic procedure, respecting the altered course of nerves in the cleft maxilla and soft tissue alterations at the cleft site, was accomplished successfully and the tooth extraction was performed with no pain to the patients. General dentists should be aware of the anatomic variations in nerve courses in the cleft area to offer high quality treatment to patients with cleft lip and palate.

Cleft lip and palate: recommendations for dental anesthetic procedure based on anatomic evidences

Patients with cleft lip and palate usually present dental anomalies of number, shape, structure and position in the cleft area and the general dentist is frequently asked to restore or extract those teeth. Considering that several anatomic variations are expected in teeth adjacent to cleft areas and that knowledge of these variations by general dentists is required for optimal treatment, the objectives of this paper are: 1) to describe changes in the innervation pattern of anterior teeth and soft tissue caused by the presence of a cleft, 2) to describe a local anesthetic procedure in unilateral and bilateral clefts, and 3) to provide recommendations to improve anesthetic procedures in patients with cleft lip and palate. The cases of 2 patients are presented: one with complete unilateral cleft lip and palate, and the other with complete bilateral cleft lip and palate. The patients underwent local anesthesia in the cleft area in order to extract teeth with poor bone support. The modified anesthetic procedure, respecting the altered course of nerves in the cleft maxilla and soft tissue alterations at the cleft site, was accomplished successfully and the tooth extraction was performed with no pain to the patients. General dentists should be aware of the anatomic variations in nerve courses in the cleft area to offer high quality treatment to patients with cleft lip and palate.

O uso tópico de rifamicina como antibiótico: profilaxia em implantodontia / The topical use of rifamicina as antibiotic prophylaxis in implants

Este estudo avaliou o uso tópico de Rifocina M 150mg, como antibiótico, profilaxia em 187 implantes ósseos, em um período de dois anos. Os resultados sugerem que este antibiótico realiza uma eficiente proteçäo contra processos infecciosos no trans-operatório de cirurgias para colocaçäo de implantes nos maxilares, bem como näo produz efeitos indesejáveis no processo de integraçäo óssea dos implantes