Association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone / Relação entre a influência da gravidade da apneia obstrutiva do sono e alterações craniofaciais e do posicionamento do osso hioide

Abstract Introduction The association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone is still scarcely addressed in the literature. Objective To evaluate whether the intensity of obstructive sleep apnea is associated with craniofacial alterations and the position of the hyoid bone in children with mixed dentition. Methods 76 children aged 7 to 10 years old were examined by otorhinolaryngological evaluation, polysomnography, and orthodontic assessment, including cephalometry. The participants were divided in 3 groups: primary snoring, mild obstructive sleep apnea and moderate to severe obstructive sleep apnea. Cephalometric measures of the face and hyoid bone were assessed. These measures were compared among the different groups by unpaired Student's t test. Moreover, these measures were correlated with the patient's obstructive apnea and hypopnea index variable using Pearson's correlation test. Results Of the 76 children, 14 belonged to group 1, with primary snoring; 46 to group 2, with mild obstructive sleep apnea; and 16 to group 3, with moderate-severe obstructive sleep apnea. There was no difference between the groups regarding the craniofacial variables. Children with obstructive sleep apnea showed a longer distance from the hyoid bone to the mandibular plane when compared to the primary snoring group (p < 0.05). Between the two obstructive sleep apnea subgroups, patients with moderate or severe disease showed significantly shorter horizontal distance between the hyoid bone and the posterior pharyngeal wall (p < 0.05), when compared to the groups with mild obstructive sleep apnea. We also observed a significant positive correlation between obstructive apnea and hypopnea index and the distance from the hyoid to the mandibular plane (p < 0.05) as well as a significant negative association between obstructive apnea and hypopnea index and the horizontal distance from the hyoid to the posterior pharyngeal wall (p < 0.01). Conclusion We did not observe any association between obstructive sleep apnea and linear lateral alterations of the face. In contrast, there is a direct association between obstructive sleep apnea severity and the inferior and posterior position of the hyoid bone in children aged 7 to 10 years old.

Resumo Introdução A relação entre a intensidade da apneia obstrutiva do sono e alterações esqueléticas da face e do hioide em crianças é pouco explorada na literatura. Objetivo Avaliar se a intensidade da apneia obstrutiva do sono correlaciona-se às alterações craniofaciais e ao posicionamento do osso hioide em crianças em fase de dentição mista. Método Foram submetidas 76 crianças entre 7 e 10 anos à avaliação otorrinolaringológica, polissonografia e avaliação ortodôntica, inclusive cefalometria. Os participantes foram divididos em 3 grupos: grupo 1 com ronco primário, grupo 2 com apneia obstrutiva do sono leve e grupo 3 com apneia obstrutiva do sono moderada/grave. Foram analisadas medidas cefalométricas da face e do osso hioide. Essas medidas foram comparadas entre si dentro dos diferentes grupos por teste t de Student não pareado. Além disso, essas medidas foram correlacionadas com a variável índice de apneias obstrutivas e hipopneias do paciente através do teste de correlação de Pearson. Resultados Das 76 crianças, 14 constituíram o grupo 1, ronco primário; 46 o grupo 2, apneia obstrutiva do sono leve; e 16 o grupo 3, apneia obstrutiva do sono moderada/grave. Não se observou diferença significante entre os grupos para as variáveis craniofaciais. Observou-se maior distância do osso hioide ao plano mandibular nos dois grupos com apneia obstrutiva do sono quando comparado ao ronco primário (p < 0,05). Entre os dois subgrupos da apneia obstrutiva do sono, os pacientes com doença moderada ou grave apresentaram distância horizontal entre o hioide e a parede posterior da faringe significantemente menor (p < 0,05), quando comparados aos grupos com apneia obstrutiva do sono leve. Observamos ainda correlação significantemente positiva entre índice de apneias obstrutivas e hipopneias e a distância do hioide ao plano mandibular (p < 0,05) e significantemente negativa entre índice de apneias obstrutivas e hipopneias e distância horizontal do hioide com a parede posterior da faringe (p < 0,01). Conclusão Não observamos relação da apneia obstrutiva do sono com alterações lineares laterais da face. Em contraste, existe relação direta entre a gravidade da apneia obstrutiva do sono e a posição inferior e posterior do osso hioide em crianças entre 7 e 10 anos.

Association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone.

INTRODUCTION: The association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone is still scarcely addressed in the literature. OBJECTIVE: To evaluate whether the intensity of obstructive sleep apnea is associated with craniofacial alterations and the position of the hyoid bone in children with mixed dentition. METHODS: 76 children aged 7 to 10 years old were examined by otorhinolaryngological evaluation, polysomnography, and orthodontic assessment, including cephalometry. The participants were divided in 3 groups: primary snoring, mild obstructive sleep apnea and moderate to severe obstructive sleep apnea. Cephalometric measures of the face and hyoid bone were assessed. These measures were compared among the different groups by unpaired Student's t test. Moreover, these measures were correlated with the patient's obstructive apnea and hypopnea index variable using Pearson's correlation test. RESULTS: Of the 76 children, 14 belonged to group 1, with primary snoring; 46 to group 2, with mild obstructive sleep apnea; and 16 to group 3, with moderate-severe obstructive sleep apnea. There was no difference between the groups regarding the craniofacial variables. Children with obstructive sleep apnea showed a longer distance from the hyoid bone to the mandibular plane when compared to the primary snoring group (p<0.05). Between the two obstructive sleep apnea subgroups, patients with moderate or severe disease showed significantly shorter horizontal distance between the hyoid bone and the posterior pharyngeal wall (p<0.05), when compared to the groups with mild obstructive sleep apnea. We also observed a significant positive correlation between obstructive apnea and hypopnea index and the distance from the hyoid to the mandibular plane (p<0.05) as well as a significant negative association between obstructive apnea and hypopnea index and the horizontal distance from the hyoid to the posterior pharyngeal wall (p<0.01). CONCLUSION: We did not observe any association between obstructive sleep apnea and linear lateral alterations of the face. In contrast, there is a direct association between obstructive sleep apnea severity and the inferior and posterior position of the hyoid bone in children aged 7 to 10 years old.

Rapid Palatal Expansion and Utilization of E-space in Mixed Dentition: Mechanics that Helps in the Corrective Orthodontic Treatment.

AIM AND OBJECTIVE: The objective of this article was to report two clinical cases, showing the benefits of interceptive treatment using rapid palatal expansion (RPE) and the preservation of E-space. BACKGROUND: It is important to follow-up child throughout its development to detect irregularities in their occlusion and to avoid or attenuate orthodontic treatments in the future. Posterior crossbite and transverse maxillary deficiency can easily be corrected by RPE that enhances the width of the maxilla and promotes a gain of space in the arch. Another way to gain space in the arch is by using the E-space, which is the difference between the mesiodistal distance of the second primary molar in relation to the second premolar. This additional space can be used to resolve negative, mild, or moderate crowding. CASE DESCRIPTIONS: Two clinical cases that presented malocclusions due to lack of space and maxillary deficiency, along with clinical technic of how the RPE and E-space can be used to bring those patients back to normality. CONCLUSION: We concluded that with a right diagnosis, correct interceptive timing, and using what growth provides, the development can be reestablished. CLINICAL SIGNIFICANCE: The clinical importance of this report is that RPE and E-space are efficient interceptive orthodontic treatments to correct skeletal posterior crossbite (SPC) and gain space in dental arches. HOW TO CITE THIS ARTICLE: Lopes BKB, Scheicher GV, Matsumoto MAN, et al. Rapid Palatal Expansion and Utilization of E-space in Mixed Dentition: Mechanics that Helps in the Corrective Orthodontic Treatment. Int J Clin Pediatr Dent 2021;14(1):133-139.

Effect of photobiomodulation on the stability and displacement of orthodontic mini-implants submitted to immediate and delayed loading: a clinical study.

The aim of this study was to evaluate the effect of photobiomodulation (PBM) on the stability and displacement of orthodontic mini-implants (MIs) submitted to loading. Forty-eight and 35 mini-implants (1.5 × 8 × 1 mm) were assessed for stability and displacement, respectively (19 patients). MIs were allocated according to the intervention in 1-PBM + immediate loading (IL), 2-PBM + delayed loading (DL) (four weeks after implantation), 3-IL only, and 4-DL only. PBM (Therapy XT, DCM) was implemented using a red emission (660 nm, 4 J/cm2, 0.1 W, 20 s) immediately after implantation (day 0) and infrared emissions (808 nm; 8 J/cm2, 0.1 W, 40 s) in the following appointments every 48-72 h during two weeks (days 2, 4, 7, 9, 11, and 14). Loading of 150 gF was applied during three months for all MIs. The stability was assessed by resonance frequency analysis (Osstell ISQ), and images from Cone beam computed tomography were evaluated to determine the amount of the displacement of the MI's head. MIs from the PBM groups presented lower loss of stability (P = 0.0372). When the analysis considered the loading protocol as an additional variable, group two showed the lowest loss of stability, being significantly different from groups that did not receive PBM (P = 0.0161). There was no difference between groups two and four during the period without loading (P > 0.05). DL groups presented lower loss when the effective period of loading was assessed, independently of the application of PBM (P < 0.0001). All groups showed displacement of the MIs head without significant differences (P > 0.05). DL potentiated the effect of PBM, decreasing the loss of stability.

Association between polymorphisms in genes encoding estrogen receptors (ESR1 and ESR2) and excreted bisphenol A levels after orthodontic bracket bonding: a preliminary study.

BACKGROUND: Bisphenol A (BPA) is released from orthodontic composites used for bracket bonding. Genetic variations could modify the metabolism of this chemical within the organism. Considering that free BPA binds to estrogen receptors causing harmful effects to health, the present in vivo study aimed to evaluate the association between genetic polymorphisms in genes encoding estrogen receptors (ESR1 and ESR2) and excreted BPA levels in orthodontic patients. METHODS: Quantification of BPA levels in the urine of 16 patients was performed in a gas chromatograph mass spectrometer before (T0), at 24 h (T1), and 1 week (T2) after bracket bonding. DNA was extracted from saliva, and one genetic polymorphism in ESR1 (rs2234693) and two in ESR2 (rs4986938 and rs1256049) were analyzed by real-time PCR. Increases in BPA levels in the urine at T1 and T2 were grouped according to the genotype, and mean differences were compared by unpaired T test or Mann-Whitney test according to the normality of the data. The established alpha was 5%. RESULTS: BPA levels increased significantly at T1 and T2. There were no statistically significant differences in the increases in BPA levels according to the genotype for any genetic polymorphism (P > 0.05), at neither 24 h nor 1 week after bracket bonding. CONCLUSIONS: The results suggested that there are no association between excreted BPA levels after bracket bonding and the evaluated genetic polymorphisms in ESR1 and ESR2. Further research should be performed in order to confirm these results.

Additional intraoral radiographs may change the judgment regarding the final position of orthodontic mini-implants.

OBJECTIVE: This study aimed to assess if additional vertical bitewing (VBW) and/or occlusal (OC) radiographs may change initial judgment based only on periapical radiograph (PAR) about the final position of orthodontic mini-implants (OMI). METHODS: Subjective and objective analyses were performed. Radiographic images of 26 OMI were divided into four groups: PAR, PAR+VBW, PAR+OC and ALL (PAR+VBW+OC). For subjective analysis, five observers were asked to assess if the position of OMI was favorable to its success, using questionnaires with a four-point scale for responses: 1= definitely not favorable, 2= probably not favorable, 3= probably favorable, or 4= definitely favorable. Each group containing sets of images was presented to them in four different viewing sessions. Objective evaluation compared horizontal distances between OMI tip and the root nearest to the device in PAR and VBW. RESULTS: Most of observers (3 out of 5) changed their initial judgment based on PAR about OMI position when additional radiographs were analyzed. Differences between groups (i.e. PAR vs. PAR+VBW; PAR vs. PAR+OC; and, PARvs.ALL) were statistically significant for these observers. For those that changed their judgment about OMI position, confidence level could significantly increase, decrease or even be maintained, not indicating a pattern. There was no agreement for distances between OMI tip and the root nearest to the device in PAR and VBW. CONCLUSION: Considering the limitations of the study, it is concluded that additional radiographic images may change the judgement about OMI final position without necessarily increasing the degree of certainty of such judgment.

Additional intraoral radiographs may change the judgment regarding the final position of orthodontic mini-implants

ABSTRACT Objective: This study aimed to assess if additional vertical bitewing (VBW) and/or occlusal (OC) radiographs may change initial judgment based only on periapical radiograph (PAR) about the final position of orthodontic mini-implants (OMI). Methods: Subjective and objective analyses were performed. Radiographic images of 26 OMI were divided into four groups: PAR, PAR+VBW, PAR+OC and ALL (PAR+VBW+OC). For subjective analysis, five observers were asked to assess if the position of OMI was favorable to its success, using questionnaires with a four-point scale for responses: 1= definitely not favorable, 2= probably not favorable, 3= probably favorable, or 4= definitely favorable. Each group containing sets of images was presented to them in four different viewing sessions. Objective evaluation compared horizontal distances between OMI tip and the root nearest to the device in PAR and VBW. Results: Most of observers (3 out of 5) changed their initial judgment based on PAR about OMI position when additional radiographs were analyzed. Differences between groups (i.e. PAR vs. PAR+VBW; PAR vs. PAR+OC; and, PARvs.ALL) were statistically significant for these observers. For those that changed their judgment about OMI position, confidence level could significantly increase, decrease or even be maintained, not indicating a pattern. There was no agreement for distances between OMI tip and the root nearest to the device in PAR and VBW. Conclusion: Considering the limitations of the study, it is concluded that additional radiographic images may change the judgement about OMI final position without necessarily increasing the degree of certainty of such judgment.

RESUMO Objetivo: avaliar se a adição de radiografias interproximais verticais (IV) e/ou oclusais (OC) pode alterar o julgamento inicial sobre a posição final dos mini-implantes ortodônticos (MI) baseado somente na radiografia periapical (PA). Métodos: foram realizadas análises subjetivas e objetivas. Imagens radiográficas de 26 regiões contendo MI foram divididas em quatro grupos: PA, PA+IV, PA+OC e TODAS (PA+IV+OC). Na análise subjetiva, cinco observadores foram convidados a avaliar se a posição do MI era favorável para o seu sucesso, utilizando questionários com uma escala de quatro pontos para respostas: 1 = definitivamente não favorável; 2 = provavelmente não favorável; 3 = provavelmente favorável; ou 4 = definitivamente favorável. Cada grupo contendo conjuntos de imagens foi apresentado aos observadores em quatro sessões diferentes. Adicionalmente, uma avaliação objetiva comparou as distâncias horizontais entre a ponta do MI e a raiz dentária mais próxima ao dispositivo na PA e IV. Resultados: a maioria dos observadores (3 de 5) mudou seu julgamento inicial sobre a posição do MI baseado na PA quando radiografias adicionais foram analisadas. Diferenças entre os grupos (ou seja, PA vs PA+IV; PA vs PA+OC; e PAvsTODAS) foram estatisticamente significativas para esses observadores. Para aqueles que mudaram seu julgamento sobre a posição do MI, o nível de confiança das respostas aumentou, diminuiu ou foi mantido, não indicando um padrão. Houve diferença estatisticamente significante entre as distâncias da ponta do MI para a raiz mais próxima ao dispositivo na PA e IV. Conclusão: considerando-se as limitações desse estudo, concluiu-se que imagens radiográficas adicionais podem alterar o julgamento sobre a posição final de MI sem, necessariamente, aumentar o grau de certeza de tal julgamento.

Gingival crevicular fluid volume and periodontal parameters alterations after use of conventional and self-ligating brackets.

OBJECTIVE: The aim of this study was to evaluate the alterations on plaque index (PI), gingival index (GI), gingival bleeding index (GBI), and gingival crevicular fluid (GCF) volume after use of three different brackets types for 60 days. Setting Participants: The sample comprised 20 patients of both sexes aged 11-15 years (mean age: 13.3 years), with permanent dentition, adequate oral hygiene, and mild tooth crowding, overjet, and overbite. METHODS: A conventional metallic bracket Gemini™, and two different brands of self-ligating brackets - In-Ovation®R and SmartClip™ - were bonded to the maxillary incisors and canines. PI, GI, GBI scores, and GCF volume were measured before and 30 and 60 days after bonding of the brackets. Data were analysed statistically using non-parametric tests coefficient at a 5% significance level. RESULTS: There was no statistically significant correlation (P > 0.05) between tooth crowding, overjet, and overbite and the PI, GI, GBI scores, and GCF volume before bonding, indicating no influence of malocclusion on the clinical parameters. Regardless of the bracket design, no statistically significant difference (P > 0.05) was found for GI, GBI scores. PI and GCF volume showed a significant difference among the brackets in different periods. In pairwise comparisons a significant difference was observed when compared before with 60 days after bonding, for the teeth bonded with SmartClip™ self-ligating bracket, (PI P = 0.009; GCF volume P = 0.001). CONCLUSION: There was an increase in PI score and GCF volume 60 days after bonding of SmartClip™ self-ligating brackets, indicating the influence of bracket design on these clinical parameters.