Anterior open bite and its relationship with dental arch dimensions and tongue position during swallowing and phonation in individuals aged 8-16 years: A retrospective case-control study.

OBJECTIVE: To determine the relationship between AOB and factors such as dental arch dimensions and tongue position during swallowing and phonation. MATERIAL AND METHODS: A case-control study was performed in two groups: 132 children with Anterior Open Bite (AOB) and 132 with normal vertical overbite (NVO), aged 8-16 years selected from the records taken by a previous study from five public schools. Dental arch dimensions were assessed through digitalized study models. Swallowing was evaluated using the Payne technique, and phoniatric assessment included an adaptation of the articulation test used to describe phonemes. STATISTICAL ANALYSIS: Chi-Square or Fisher's exact test for comparisons between qualitative variables and the Mann Whitney or T-student were applied to compare the dental arch dimensions according to bite type. A logistic regression model was applied to control the effect of confusion between independent variables and to describe its simultaneous effect on the type of bite. RESULTS: Intercanine, interpremolar and intermolar widths showed higher values in AOB patients with a mean deviation (MD) of 0.536 (P=0.031), 0.60 (P=0.043) and 1.15, (P<0.001) respectively. Distortions caused by tongue interposition and thrust, tongue protrusion during swallowing, mandibular arch intermolar width, total maxillary arch length, maxillary arch perimeter, and posterior arch depth accounted for 64.6% of AOB and allowed for correct predictions in 83.8% of the cases observed in the study population. CONCLUSIONS: A significant association between tongue position and function, as well as alterations such as tongue interposition and thrust during swallowing and phonation in individuals with AOB, were observed. There is a relationship between AOB and the presence of a wider mandibular arch and a narrower, longer, and deeper maxillary arch.

Cervical Extraoral Traction Therapy in Early Treatment of Class II Malocclusion. A systematic review / Terapia de tracción extraoral cervical en el tratamiento temprano de la maloclusión de clase II. Una revisión sistemática / Terapia de Tração Extraoral Cervical no Tratamento Precoce da Maloclusão Classe II. Uma revisão sistemática

Abstract Introduction and objective: Cervical headgear has been used for decades as a treatment of class II malocclusion. Although the effects have been reported previously they are somewhat contradictory. The objective was to determine the available scientific evidence that supports the parameters of clinical use for therapy with cervical extraoral traction in early treatment for class II malocclusion. Materials and methods: A systematic search was conducted using Medline, Google Scholar, Cochrane, and Lilacs data-bases. The search involved articles in English, Spanish, Portuguese, and German using previously selected MeSH terms and free-text terms. The search included articles dealing with cervical extraoral traction treatment, systematic reviews, meta-analysis, clinical trials, and cohort, case-control, and cross-sectional studies. Methodological quality was evaluated using various scales according to the type of study. Results: The search generated 334 articles, 259 were eliminated because they were duplicates, and 34 were eliminated because they did not meet the inclusion criteria. 41 articles were evaluated in full text, 21 were excluded because they did not meet the inclusion criteria, leaving a total of 20 articles. Conclusions: The articles offered varied, yet clear, recommendations. According to the literature and clinical judgment, treatment timing is recommended during the pubertal growth spurt. The most efficient force is 450 to 500g per side for 12 to 14 hours per day. A long outer bow bent 15o degrees upward should be used in patients with normal and hypodivergent patterns. Maxillary growth control depends on age, force, treatment duration, etc. Changes in overjet can be expected due to changes in dental inclination, growth, or the use of additional appliances; an average molar distalization of 1 mm to 2 mm can be achieved.

Resumen Introducción y objetivo: La Tracción cervical se ha utilizado durante décadas como tratamiento para la maloclusión de clase II. Aunque los efectos se han informado previamente, son algo contradictorios. El objetivo fué determinar la evidencia científica disponible que respalde los parámetros de uso clínico para la terapia con tracción extraoral cervical en el tratamiento temprano de la maloclusión de clase II. Materiales y métodos: Se realizó una búsqueda sistemática utilizando las bases de datos Medline, Google Scholar, Cochrane y Lilacs. La búsqueda incluyó artículos en inglés, español, portugués y alemán utilizando términos MeSH previamente seleccionados y términos de texto libre. La búsqueda incluyó artículos relacionados con el tratamiento de tracción extraoral cervical, revisiones sistemáticas, metanálisis, ensayos clínicos y estudios de cohortes, casos y controles y estudios transversales. La calidad metodológica se evaluó utilizando varias escalas según el tipo de estudio. Resultados: La búsqueda generó 334 artículos, 259 fueron eliminados porque eran duplicados y 34 fueron eliminados porque no cumplían con los criterios de inclusión. Se evaluaron 41 artículos en texto completo, se excluyeron 21 porque no cumplían con los criterios de inclusión, dejando un total de 20 artículos. Conclusiones: Los artículos ofrecieron recomendaciones variadas, pero claras. De acuerdo con la literatura y el juicio clínico, se recomienda el momento del tratamiento durante el período de crecimiento puberal. La fuerza más eficiente es de 450 a 500 g por lado durante 12 a 14 horas por día. Se debe usar un arco externo largo doblado 15 grados hacia arriba en pacientes con patrones normales e hipodivergentes. El control del crecimiento maxilar depende de la edad, la fuerza, la duración del tratamiento, etc. Se pueden esperar cambios en la sobrecarga debido a cambios en la inclinación dental, el crecimiento o el uso de aparatos adicionales. Se puede lograr una distalización molar promedio de 1 mm a 2 mm.

Resumo Introdução e objetivo: A tração cervical tem sido utilizada como tratamento da má oclsão de classe II. Embora os efeitos tenham sido relatados anteriormente, eles são contraditórios. O objetivo foi determinar as evidências científicas disponíveis que suportamos parâmetros de uso clínico para terapia com tração extraoral cervical no tratamentoprecoce da má oclusão de classe II. Materiais e métodos: Uma pesquisa sistemática foirealizada usando Medline, Google Scholar, Cochrane e Lilacs. Foram incluidos artigos em inglês, espanhol, português e alemão, usando termos MeSH selecionados anteriormente e termos de texto livre. A pesquisa incluiu artigos que tratavam do tratamento da tração extraoral cervical, revisões sistemáticas, meta-análise, ensaios clínicos e estudos de coorte, caso-controle e transversais. A qualidade metodológica foi avaliada usando várias escalas de acordo com o tipo de estudo. Resultados: a busca gerou 334 artigos, 259 foram eliminados por serem duplicados e 34 foram eliminados por não atenderem aos critérios de inclusão. 41 artigos foram avaliados em texto completo, 21 foram excluídos por não atenderem aos critérios de inclusão, totalizando 20 artigos. Conclusões: Os artigos oferecidos apresentaram recomendações variadas, porém claras. De acordo com a literatura e o julgamento clínico, o momento do tratamento é recomendado durante o surto de crescimento puberal. A força mais eficiente é de 450 a 500g por lado, durante 12 a 14 horas por dia. Um arco externo longo e dobrado de 15 graus deve ser usado em pacientes com padrões normais e hipodivergentes. O controle do crescimento maxilar depende da idade, força, duração do tratamento, etc. Alterações no overjet podem ser esperadas devido a alterações na inclinação dentária, crescimento ou uso de aparelhos adicionais; uma distalização molar média de 1 mm a 2 mm pode ser alcançada.

Tongue position assessment during oral phase deglutition in children with anterior open bite and normal vertical overbite.

INTRODUCTION: Tongue position during deglutition presents great variability and can be assessed clinically or with different techniques. AIM: This study aims to determine tongue position during deglutition in children aged 8-16 years with anterior open bite (AOB) and normal vertical overbite (NVO) using a fluorescein technique. SETTINGS AND DESIGN: A cross-sectional analytical study was conducted to assess tongue contact points during the oral phase of deglutition. SUBJECTS AND METHODS: A total of 132 children with AOB and 132 children with NVO were included in this study. The difference between tongue contacts in both groups was performed, and the association between tongue position and anterior occlusion was establish. STATISTICAL ANALYSIS USED: Normal distribution analysis, Parson's Chi-square test (P < 0.05). RESULTS: In AOB, about 28.8% showed tongue contact on the palatal surface of the incisors during the oral phase, 25.8% at the gingival margin, and 22% on the palatal rugae. Regarding NVO, 53% showed contact on the palatal rugae, 28.8% at the gingival margin, and 13.6% at the palatal surface. CONCLUSION: AOB group presented a higher prevalence of impaired tongue positions compared to NVO controls. The palatal surface was the most frequent contact point in the AOB, whereas tongue showed contact points at the palatal rugae in NVO.

Lower Arch Dimensions in Children with Anterior Open Bite and Normal Vertical Overbite: A Cross-sectional Study.

AIM: Dental arch is a dynamic structure and its size depends on genetic and environmental factors. The aim of this study was to determine lower arch dimensions in children between 8 and 16 years with anterior open bite (AOB) and normal vertical overbite (NVO). MATERIALS AND METHODS: A cross-sectional study was performed in 132 individuals with AOB and 132 with NVO between 8 and 16 years selected from public schools. Intercanine width, arch length, intermolar and interpremolar distances, and arch perimeter of the lower arch were measured in previously digitalized models using the GOM inspection program and an optical three-dimensional scanner. RESULTS: Individuals with NVO presented smaller lower arch size with statistical differences in intercanine (P = 0.024, 95% confidence interval [CI]: 0.01, 0.02) and intermolar (P = 0.000, 95% CI: -1.76, -0.53) width and nonsignificant differences in the arch perimeter (P = 0.239, 95% CI: -1.57, 0.39) according to Mann-Whitney U-test. CONCLUSION: Individuals between 8 and 16 years of age with NVO showed smaller lower dental arch than individuals with AOB in most dimensions.

Morphological configuration of the cranial base among children aged 8 to 12 years.

BACKGROUND: Cranial base is used as reference structure to determine the skeletal type in cephalometric analysis. The purpose was to assess the cranial base length on lateral cephalic radiographs of children between 8 and 12 and compare these measurements with baseline studies in order to evaluate the relationship between the length and the cranial base angle, articular angle, gonial angle and skeletal type. METHODS: A Cross-sectional study in 149 children aged 8-12 years, originally from Aburrá Valley, who had lateral cephalic radiographs and consented to participate in this study. The variables studied included: age, sex, sella-nasion, sella-nasion-articular, sella-nasion-basion, articular-gonion-menton, gonion-menton, sella-nasion-point B, sella-nasion-point A y point A-nasion-point B. These variables were digitally measured through i-dixel 2 digital software. One-way ANOVA was used to determine mean values and mean value differences. The values obtained were compared with previous studies. A p value <0.05 was considered significant. RESULTS: Cranial base lengths are smaller in each age and sex group, with differences exceeding 10 mm for measurement, compared both with the study by Riolo (Michigan) and the study carried out in Damasco (Antioquia). No relation was found between the skeletal type and the anterior cranial base length, the sella angle and the cranial base angle. Also, no relation was found between the gonial angle and sella angle or the cranial base angle. CONCLUSION: The cranial base varies from one population to another. Accordingly, compared to other studies it is shorter for the assessed sample.

Frequency of pulpal and periapical disorders prior to orthodontic treatment / Frecuencia de los trastornos pulpares y periapicales antes del tratamiento de ortodoncia

Introduction and objective: Orthodontic forces can aggravate a pre-existent pulpal condition. The aim of the present study was to determine the frequency of pulpal disorders in patients prior to orthodontic treatment. Materials and methods: Transversal study. 37 patients (19 female, 18 male) who met the following criteria were included: Patients with permanent dentition (including second molars) with full root formation, with a complete set of periapical radiographs, and no previous orthodontic treatment. Patients using pacemakers or with history of previous orthodontic treatment were excluded. Clinical testing of pulpal vitality and sensitivity, as well as periapical condition, was performed. Relative and absolute frequencies for pulpal and periapical diagnoses were described. Also, stratification by gender, age, arch, and area was implemented. Results: 981 teeth were analyzed, 48.6% of the teeth showed pulpal or periapical disorders (477/981). Pulpless teeth were found mostly in female patients (72.2%), patients with 41 years of age on average (26%), and patients exhibiting three or more restorations (2.8%). 20.5% teeth were affected with periapical conditions (39/942). The first left maxillary molar showed the highest frequency of pulpal and periapical disorders. 73.5% exhibited poorly-performed obturation or condensation techniques from the 34 affected teeth (25/34). 74.3% of affected teeth were in the maxilla and 64.1% were in the posterior area of the mouth. Conclusion: A detail clinical and radiological examination of pulpal and periapical status should be performed before the onset of orthodontic treatment.

Resumen Introducción y objetivo: Las fuerzas de ortodoncia pueden agravar una condición pulpar preexistente. El objetivo del presente estudio fue determinar la frecuencia de los trastornos pulpares en los pacientes antes del tratamiento de ortodoncia. Materiales y métodos: Estudio transversal. 37 pacientes (19 mujeres, 18 hombres) que se reunieron se incluyeron los siguientes criterios: Los pacientes con dentición permanente (incluyendo segundos molares) con la formación de raíces por completo, con un juego completo de radiografías periapicales, y ningún tratamiento ortodóncico anterior. Se excluyeron los pacientes que utilizan marcapasos o con antecedentes de tratamiento ortodóncico anterior. Las pruebas clínicas de vitalidad y sensibilidad pulpar, así como la condición periapical, se llevó a cabo. Se describen las frecuencias relativas y absolutas para diagnósticos pulpares y periapicales. Además, se llevó a cabo la estratificación por sexo, edad, arco, y el área. Resultados: Se analizaron 981 dientes, 48,6% de los dientes mostraron trastornos pulpares o periapicales (477/981). Los dientes sin pulpa se encuentran sobre todo en pacientes de sexo femenino (72,2%), los pacientes con 41 años de edad en promedio (26%), y los pacientes que presentan tres o más restauraciones (2,8%). El 20,5% de los dientes se vieron afectados con condiciones periapicales (39/942). El primer molar superior izquierdo mostró la mayor frecuencia de trastornos pulpares y periapicales. 73,5% exhibió técnicas de obturación, o de condensación realizados pobremente de los dientes afectados (25/34). 74,3% de los dientes afectados se encontraban en el maxilar y el 64,1% se encontraba en la zona posterior de la boca. Conclusión: Una detallada exploración clínica y radiológica del estado pulpar y periapical se debe realizar antes del inicio de un tratamiento de ortodoncia.

Agreement between cranial and facial classification through clinical observation and anthropometric measurement among Envigado school children.

BACKGROUND: To evaluate the agreement between cranial and facial classification obtained by clinical observation and anthropometric measurements among school children from the municipality of Envigado, Colombia. METHODS: This cross-sectional study was carried out among 8-15-year-old children. Initially, an indirect clinical observation was made to determine the skull pattern (dolichocephalic, mesocephalic or brachycephalic), based on visual equivalence of right eurion- left eurion and glabella-opisthocranion anthropometric points, as well as the facial type (leptoprosopic, mesoprosopic and euryprosopic), according to the left and right zygomatic, nasion and gnation points. Following, a direct measurement was conducted with an anthropometer using the same landmarks for cranial width and length, as well as for facial width and height. Subsequently, both the facial index [euryprosopic (≤80.9%), mesoprosopic (between 81% - 93%) and leptoprosopic (≥93.1%)] and the cranial index [dolichocephalic (index ≤ 75.9%), mesocephalic (between 76% - 81%), and brachycephalic (≥81.1%)] were determined. Concordance between the indices obtained was calculated by direct and indirect measurement using the Kappa statistic. RESULTS: A total of 313 students were enrolled; 172 (55%) were female and 141 (45%) male. The agreement between the direct and indirect facial index measurements was 0.189 (95% CI 0.117-0261), and the cranial index was 0.388 (95% CI 0.304-0.473), indicating poor concordance. CONCLUSIONS: No agreement was observed between direct measurements conducted with an anthropometer and indirect measurements via visual evaluation. Therefore, the indirect visual classification method is not appropriate to calculate the cranial and facial indices.

Tratamientos para la maloclusión Clase II esquelética combinada / Treatments for skeletal Class II malocclusion combined

La maloclusión clase II se presenta por una variedad de configuraciones dentales, funcionales y esquelétales, basadas en: la posición anteroposterior del maxilar y de la mandíbula, posición de los dientes maxilares y mandibulares, y el patrón vertical de los pacientes clase II; siendo el retrognatismo la característica más prevalente en estos pacientes. La etiología es multifactorial incluyendo asi la genetica, el componente familiar y factores medioambientales. La experiencia de varios expertos ha demostrado que es necesario combinar diferentes medios terapéuticos para poder conseguir unos resultados plenamente satisfactorios. Los aparatos intra y extraorales usados para la corrección de la maloclusión esquelética clase II han sido: placas de hawley, planos de mordida, tracción extraoral, aparatología funcional (activadores, bionator, twin-block, Fränkel), las pantallas vestibulares, combinación de aparatología funcional con aparatos extraorales, minitornillos; y más específicamente en el caso de pacientes rotadores posteriores mandibulares se ha usado la tracción extraoral combinada con aparatología funcional con bloques posteriores de mordida. El éxito del tratamiento depende del control y de la evaluación constante al crecimiento y desarrollo de los pacientes clase II en crecimiento. Este artículo describe el caso de una paciente con diagnóstico de clase II esquelético con patrón de crecimiento vertical.

Class II malocclusion present a variety of dental, skeletal and functional configurations, based on the anteroposterior position of the maxilla and mandible, position of maxillary and mandibular teeth and the vertical pattern of class II patients, being the retrognatism the most prevalent characteristic in these patients. The etiology is multifactorial including genetic, familial components and environmental factors. The experience of several experts has demonstrated the need to combine different therapeutic means to achieve its full effect. Intra and extraoral appliances used for the correction of skeletal class II malocclusion include Hawley plates , bite planes, headgear, functional appliances (activators, bionator, twin -block, Frankel) , buccal screens, combination of functional with extraoral appliance, mini-screws, and more specifically in the case of mandibular posterior rotator patients the use of high-pull headgear combined with functional appliances with posterior bite blocks and the most recent treatment, orthodontic miniscrews. Treatment success depends on constant monitoring and evaluation of growth and development of growing Class II patients. This article describes the case of a patient diagnosed with skeletal class II with a vertical growth pattern.

La sonrisa y sus dimensiones / The smile and its dimensions

La sonrisa como una expresión común en los seres humanos para expresar una variedad de emociones de forma voluntaria o involuntaria, debe estar enmarcada por una serie de características que permiten identificar desde el punto de vista fisiológico, anatómico y funcional cualquier tipo de alteración. En esta revisión se hará un enfoque de la sonrisa en diferentes perspectivas, su clasificación,parámetros y formas de valoración de la misma. Por medio de un análisis completo de la sonrisa y sus elementos se pueden identificar alteraciones en la zona estética tanto en forma como en función y mostrar las alternativas terapéuticas que permitan tratar a los pacientes de manera integral.

As a common human expression that conveys a variety of emotions in intentional and unintentional ways, the smile must be characterized by a series of features that allow identifying all possible alterations in its physiological, anatomical, and functional aspects.This article will approach the smile from different perspectives, classifications, and standards for its assessment. By means of a thorough analysis of the smile and its elements, formal and functional alterations in the esthetic zone will be identified in order to suggest the best therapeutic options to provide patients with comprehensive treatment.

Perfil epidemiológico de la oclusión dental en escolares de Envigado, Colombia / Epidemiological profile of dental occlusion in children attending school in Envigado, Colombia

Objetivos La oclusión ideal es un estándar hipotético basado en las relaciones morfológicas de los dientes, se caracteriza por una perfección en la anatomía y posición dental, contactos mesiodistales, alineamiento en el arco e interdigitación dental. El propósito de este estudio fue determinar el perfil epidemiológico de la oclusión dental en escolares del municipio de envigado de instituciones públicas, del área urbana y rural, durante el primer semestre de 2010. Materiales y Métodos Se realizo un estudio epidemiológico descriptivo de corte transversal en pacientes con edades entre los 5 y los 12 años de edad. Se calculo un tamaño de muestra de 436 estudiantes, distribuidos en 6 instituciones educativas del área rural y 6 del área urbana. Se realizó un examen clínico de la cavidad oral donde se evaluaron diferentes variables oclusales en los tres planos del espacio: sagital, trasversal y vertical. Resultados Se evaluaron un total 436 sujetos, con una edad promedio de 8 años (8±1,9), la maloclusión con mayor prevalencia para la dentición permanente, fue del 49,7 % (176/354) para la maloclusión clase I, 43,5 % (154/354) para la maloclusión clase II y del 6,8 % (24/354) para la maloclusión clase III. Conclusión La maloclusión clase I de Angle fue la más prevalente con alteraciones en los planos vertical y trasversal y problemas de espacio en el segmento anterior.

Objectives Ideal occlusion is a hypothetical standard based on teeth's morphological relationships and is characterised by perfection in anatomy and dental position, mesiodistal contacts, arch alignment and dental interdigitation. This investigation was aimed at determining the epidemiological profile of dental occlusion of children attending urban and rural public schools in Envigado during the first semester, 2010. Materials and Methods A cross-sectional, prospective, descriptive epidemiological study was carried out on patients ranging from 5 to 12 years of age. A sample size of 436 students from 6 rural schools 6 urban institutions was calculated. The oral cavity was clinically examined and different occlusal variables on the three planes of space were evaluated: sagittal, transversal, and vertical. Results 436 subjects were evaluated; average age was 8 years (±1.9). The most prevalent malocclusion for permanent dentition was Angle's Class I (49.7%, 176/354), followed by Angle's Class II (43.5%, 154/354) and Angle's Class III (6.8%, 24/354). Conclusion Angle's Class I malocclusion was the most prevalent condition with alterations in both vertical and transversal planes and space problems in the anterior segment.

[Epidemiological profile of dental occlusion in children attending school in Envigado, Colombia]. / Perfil epidemiológico de la oclusión dental en escolares de Envigado, Colombia.

OBJECTIVES: Ideal occlusion is a hypothetical standard based on teeth's morphological relationships and is characterised by perfection in anatomy and dental position, mesiodistal contacts, arch alignment and dental interdigitation. This investigation was aimed at determining the epidemiological profile of dental occlusion of children attending urban and rural public schools in Envigado during the first semester, 2010. MATERIALS AND METHODS: A cross-sectional, prospective, descriptive epidemiological study was carried out on patients ranging from 5 to 12 years of age. A sample size of 436 students from 6 rural schools 6 urban institutions was calculated. The oral cavity was clinically examined and different occlusal variables on the three planes of space were evaluated: sagittal, transversal, and vertical. RESULTS: 436 subjects were evaluated; average age was 8 years (±1.9). The most prevalent malocclusion for permanent dentition was Angle's Class I (49.7%, 176/354), followed by Angle's Class II (43.5%, 154/354) and Angle's Class III (6.8%, 24/354). CONCLUSION: Angle's Class I malocclusion was the most prevalent condition with alterations in both vertical and transversal planes and space problems in the anterior segment.

Diagnóstico y tratamiento temprano de la malposición intralveolar de caninos permanentes / Diagnosis and early treatment of intra-alveolar malposition of permanent canines

El diagnóstico y tratamiento temprano es un procedimiento que cada día toma más fuerza entre los profesionales del área de la salud en general y los odontólogos en particular. Con relación a las alteraciones oclusales, los caninos retenidos son una anomalía de erupción y aunque en nuestro medio no conocemos ninguna estadística, nos vemos enfrentados a ella con mucha frecuencia. El desarrollo del canino es único y su patrón de erupción es el más tortuoso de todos los dientes de la cavidad bucal, por lo cual la vigilancia de este proceso es mandatoria. El diagnóstico de esta alteración debe hacerse desde el momento en que se establece la dentición mixta, utilizando para ello todos los elementos necesarios como signos clínicos duraonte la inespección y palpación y los análisis radiográficos pertinentes

Una técnica sencilla de distalización de caninos retenidos / A simple technique for distalization of impacted canines

El diagnóstico y tratamiento temprano de caninos retenidos se hace necesario con el fin de evitar complicaciones posteriores que comprometan la integridad del arco dental. Se plantea la terapia de la tracción temprana cuando el canino se encuentra alto en el vestíbulo y con mayor inclinación mesial. Se recomienda la utilización de un aparato removible con el fin de evitar efectos deletéreos a los dientes adyacentes. Esta terapia puede ser única o corresponder a la primera fase de un tratamiento más complejo, dependiendo de las necesidades del paciente