A clinical approach to managing open-bite malocclusion associated with severe crowding.

Open bite has been identified as one of the most challenging malocclusions in orthodontics. The treatment approach is complex, the resulting esthetics may not meet the patient's expectations, and the chance of recurrence is high. A 13-year-old girl presented a skeletal Class II malocclusion associated with anterior and posterior open bite, maxillary transverse deficiency, severe anterior crowding, and a hyperdivergent facial pattern. Orthodontic treatment was performed with a Haas expander and subsequent standard edgewise appliances, and the 4 first premolars were extracted. The vertical control of facial growth was undertaken with vertical pull chincap therapy, mini-implants associated with a titanium-molybdenum alloy cantilever on the right and left buccal sides, and a stainless steel alloy transpalatal arch. Posttreatment records showed a bilateral Class I molar relationship, ideal overbite and overjet, and improved facial profile and gingival health. The cephalometric analysis revealed a good balance of the skeletal pattern and facial profile, with an appropriate inclination of the maxillary and mandibular incisors. After a 7-year retention period, the outcome was pleasant facial esthetics and smile and stability of the dental occlusion. This case shows that the clinical approach was adequate, with treatment outcomes achieving positive aspects of function, esthetics, and stability.

Traumatismo dentário de incisivos superiores em pacientes da Clínica de Ortodontia da UFRJ: prevalência e fatores predisponentes dentofaciais / Dental traumatism of upper incisors in patients of UFRJ Orthodontic Clinic: prevalence and dentofacial predisposing factors

Resumo Objetivos: Avaliar a prevalência de traumatismo dentário em incisivos superiores de pacientes submetidos a tratamento na Clínica de Ortodontia da UFRJ (Universidade Federal do Rio de Janeiro) e correlacionar oito fatores predisponentes dentofaciais desses indivíduos ao tipo de trauma sofrido. Materiais e Métodos: 765 prontuários de pacientes da Clínica de Ortodontia da UFRJ foram analisados em busca de trauma nos incisivos superiores. 40 prontuários de pacientes traumatizados e com documentação inicial completa foram selecionados. Radiografias cefalométricas laterais foram extraídas dos exames volumétricos, modelos, fotografias e prontuários foram analisados. Resultados: A incompetência labial, o acentuado grau de overjet e a acentuada protrusão e projeção dos incisivos superiores, presentes nos pacientes Classe II esqueléticos, atuam como principais fatores predisponentes para a ocorrência de traumatismo dentário. Conclusões: O tratamento ortodôntico em duas fases, deve ser foco de futuros estudos visando avaliar sua atuação como uma medida preventiva na redução dos índices de trauma dental nesses pacientes.(AU)

Abstract Objective: To evaluate the prevalence of dental trauma in upper incisors of patients submitted to treatment in the orthodontic clinic of UFRJ (Federal University of Rio de Janeiro) and to correlate eight predisposing dentofacial factors of these individuals with the type of trauma suffered. Materials and Methods: 765 medical records of patients of UFRJ Orthodontics Clinic were analyzed for upper incisor trauma. 40 medical records of trauma patients with complete initial documentation were selected. Lateral cephalometric radiographs were extracted from the volumetric exams, models, photographs, and medical records were analyzed. Results: Labial incompetence, marked degree of overjet and protrusion and projection of the upper incisors, present in Class II skeletal patients, act as the main predisposing factors for the occurrence of dental traumatism. Conclusions: two-phase orthodontic treatment should be the focus of future studies aiming to evaluate its performance as a preventive measure in reducing dental trauma rates in these patients.(AU)

Indirect orthodontic bonding with drop-shaped hot glue tray: a simple and cost-effective technique

Despite being associated with more accuracy, the indirect bonding procedure is not yet the gold standard, probably because of sensitivity of the numerous variables that must be controlled. The aim of this article was to present a modified, standardized, and low-cost indirect bonding technique that allows this procedure to be performed successfully. The technique covers an initial clinical stage, to obtain the models; a laboratory stage, which involves placement of brackets on the models following the facial axis of the clinical crown and the labial projection of the marginal ridges of the posterior teeth and construction of transfer tray using hot glue; and a second clinical stage, to properly transfer the brackets to patient's teeth. Hot glue used to build the tray molds the teeth and perfectly adapts to the teeth, having enough stiffness to maintain their anatomy and the position of the brackets, but also presenting adequate flexibility to allow removal of the tray avoiding excessive stress over the brackets. In conclusion, the new simplified indirect bonding technique presented here provides a precise placement of brackets on the models, a cheaper way to transfer them to patient, and an easy removal of transfer tray, being a very simple and cost-effective method.

Early treatment of nonsyndromic oligodontia: a clinical case report / Tratamento precoce da oligodontia não-sindrômica: relato de caso clínico

This report aims to describe the clinical case of a 10-year-old male patient (R.C.B.C.), presenting nonsyndromic oligodontia with maternal family trait and absence of 22 permanent teeth. Clinically, the patient had prolonged retention of some primary teeth and presence of permanent maxillary left central incisor, permanent mandibular right central incisor and four first permanent molars. Radiographically, only permanent maxillary second molars and mandibular third molars were developing, whereas all other germs of permanent teeth were missing. Treatment consisted of maxillary expansion followed by moving permanent maxillary left central incisor bucco-mesially, and rehabilitation of spaces with removable denture, where the main goal was to restore function and esthetic harmony. The case has been monitored for the past six years. Nonsyndromic oligodontia is a rare condition that poses significant functional and psychosocial difficulties. Treatment usually requires a multidisciplinary approach among which pediatric dentistry and orthodontics play a major role. In view of its complexity, treatment should be initiated as early as possible to minimize future functional and aesthetic issues. Dental implants are considered as definitive treatment of cases of oligodontia, however, until the patient reached the ideal age, other treatments to ensure aesthetics and function must be performed.

O objetivo deste trabalho é descrever o caso clínico do paciente R.C.B.C., dez anos de idade, gênero masculino, portador de oligodontia não associada à síndrome, com traço familiar materno e ausência de 22 dentes permanentes. Clinicamente, o paciente apresentava retenção prolongada de alguns incisivos, todos os caninos e molares decíduos e presença do incisivo central superior esquerdo, incisivo central inferior direito e os quatro primeiros molares, todos da dentição permanentes. Radiograficamente, apenas os segundos molares superiores e os terceiros molares inferiores estavam em desenvolvimento, com ausência dos demais germes dos dentes permanentes. Terapeuticamente, foi instituída a expansão maxilar seguida de mesialização e vestibularização do incisivo central superior esquerdo e de reabilitação com prótese removível, sendo o objetivo principal restaurar a harmonia estética e a função. O caso foi acompanhado há seis anos. A oligodontia não-sindrômica é considerada rara e impõe importantes dificuldades funcionais e psicossociais aos seus portadores. Geralmente, o tratamento requer uma abordagem interdisciplinar, onde a odontopediatria e a ortodontia desempenham papel primordial. Devido à complexidade envolvida, o tratamento deve ser iniciado o mais cedo possível, para minimizar futuras questões funcionais e estéticas. Os implantes dentários são considerados como tratamento definitivo para os casos de oligodontia, entretanto, até os pacientes alcançarem a idade ideal, outros tratamentos para garantir estética e função devem ser realizados.

Odontoma Complexo Atípico: Relato de Caso / Atypical Complex Odontoma: Case Report

Os odontomas são classificados como tumores benignos, originados do epitélio e do ectomesênquima odontogênico e são considerados mais anomalias de desenvolvimento - hamartomas - do que verdadeiras neoplasias. Representam, sem dúvida, os tumores mais comumente observados entre todos aqueles de origem odontogênica. Sua etiopatogenia constitui um aspecto muito investigado, embora se apresente indeterminada, ficando restringida ao campo das hipóteses, indo desde traumatismos e infecções locais a fatores genéticos. São mais frequentemente diagnosticados na segunda década de vida. Frequentemente, encontram-se inclusos e assintomáticos e geralmente são descobertos em radiografias de rotina, sendo vistos como uma massa intensamente radiopaca, circundada por linha radiolúcida. Raramente ocorre sua irrupção em cavidade oral, e existem algumas teorias que tentam explicá-la. O presente trabalho tem por objetivo apresentar um caso clínico de extenso odontoma irrompido em cavidade oral, discutindo aspectos relevantes do ponto de vista clínico-cirúrgico.

Odontomas are classified as benign tumors arising from epithelium and mesenchyme odontogenic and are considered more developmental abnormalities - Hamartoma - than true neoplasms. Undoubtedly, they are the most commonly tumors seen among those of odontogenic origin. Its pathogenesis is a very investigated, despite presenting indeterminate, being restricted to the realm of hypotheses, ranging from local infections and trauma to genetic factors. They are most frequently diagnosed in the second decade of life, often are included and asymptomatic, and usually are discovered in routine radiographs, being seen as an intensely radiopaque mass surrounded by a radiolucent line. Rarely it occurs eruption in the oral cavity and there are some theories that might explain it. This paper aims to present a case of extensive odontoma erupted into the oral cavity, discussing relevant aspects of the clinical surgery.