Objectively measured adherence may affect side effects of mandibular advancement therapy in subjects with obstructive sleep apnea.

PURPOSE: The purpose of this study was to determine if objectively measured adherence to oral appliance (OA) treatment may affect dental changes and temporomandibular disorders (TMD) in patients with obstructive sleep apnea (OSA). METHODS: The original study group consisted of adults with OSA who were referred for OA therapy. Eight indicators of subjective side effects of using OA (temporomandibular joint (TMJ) and muscle pain, pain in teeth, jaw stiffness in the morning, clicking, dry mouth, hypersalivation, gingival irritation) were evaluated by a questionnaire. Three occlusal indicators (overjet, overbite, molar occlusion) and clinical TMD signs (TMJ pain, muscle pain, clicking, jaw deviation on opening) were evaluated at baseline and at the 3-, 6-, and 12-month follow-up. In addition, objective adherence monitoring for OA was registered. Statistical analyses included the chi-square test, Fisher's exact test, paired sample t-test, and linear regression analyses. RESULTS: A total of 58 adults with OSA were referred for OA therapy. Mean (SD) age was 50.7 (11.7) and mean apnea-hypopnea index (AHI) was 19.5 (10.0). At 1-year follow-up, the study group consisted of 28 men and 12 women. Overjet but not overbite reduced significantly after 1-year OA therapy. The average nightly wear of OA was related to overjet and overbite reduction, and to TMD signs. Hypersalivation, dry mouth, and tooth discomfort were the most common subjective side effects of OA therapy. CONCLUSION: There was a time-dependent relationship with the nightly wear of OA and reduction in overjet and overbite, and clinical TMD signs. With 60% of mandibular advancement, dental changes and TM-disorders were considered mild/minor in the 1-year study period.

Dentoskeletal effects of the forsus™ fatigue resistance device in the treatment of class II malocclusion: A systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review and meta-analysis is to quantitatively compare previous studies that evaluated skeletal and dentoalveolar effects of the Forsus™ Fatigue Resistance Device (FRD) in the treatment of Class II malocclusion with a matched untreated control group. MATERIALS AND METHODS: Four electronic searches PubMed, Web of Science, Cochrane Library, and Science Direct that were limited to articles on human studies comparing the effect of Forsus appliance with a matched control group in the treatment of Class II malocclusion from the year (2000-2017). An additional manual search was carried out by examining the references of the included articles, SEARCH terms included; Forsus and Class II malocclusion. The quality of the included studies was assessed using the modified methodological score for clinical trials. The data were analyzed using Michael Borenstein's Comprehensive Meta-Analysis Software (V3.3.070, Biostat, Inc., US). RESULTS: Seven studies were included comprising 273 participants (Forsus group = 142; control group = 131). The results indicated a statistical significant skeletal effect of the Forsus appliance on increasing the occlusal plane only (P < 0.001). The results also indicated a statistical significant (P < 0.001) dentoalveolar effects of the Forsus appliance on the following outcomes; protruding, proclining, and intruding lower incisors; retroclining upper incisors, distalizing and intruding upper molars, as well as reducing overjet and overbite. CONCLUSIONS: The Forsus™ showed positive effects on the maxillary incisors and first molars as well as overjet and overbite. However, multiple negative effects were reported on the occlusal plane and lower incisors that need to be considered when using such appliance in treating Class II malocclusion.

Stability of maxillary protraction therapy in children with Class III malocclusion: a systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to evaluate the stability of treatment effects of maxillary protraction therapy in Class III children. MATERIALS AND METHODS: Multiple electronic databases were searched from 01/1996 to 10/2016. Randomized clinical trials, controlled clinical trials, and cohort studies with untreated Class III controls and a follow-up over 2 years were considered for inclusion. The methodological quality of the studies and publication bias were evaluated. Mean differences and 95% confidence intervals (CI) of six variables (SNA, SNB, ANB, mandibular plane angle, overjet, and lower incisor angle) were calculated. RESULTS: Ten studies were included in the qualitative analysis, and four studies were included in the quantitative analysis. Compared with the control group, after treatment, the treated group showed significant changes: SNA +1.79° (95% CI: 1.23, 2.34), SNB -1.16° (95% CI -2.08, -0.24), ANB +2.92° (95% CI 2.40, 3.44), mandibular plane angle +1.41° (95% CI 0.63, 2.20), overjet +3.94 mm (95% CI 2.17, 5.71) and lower incisor angle -3.07° (95% CI -4.92, -1.22). During follow-up, the changes in five variables reflected significant relapse. Overall, the treated group showed significant changes only in ANB +1.66° (95% CI 0.97, 2.35) and overjet +2.41 mm (95% CI 1.60, 3.23). CONCLUSIONS: Maxillary protraction can be a short-term effective therapy and might improve sagittal skeletal and dental relationships in the medium term. But some skeletal and dental variables showed significant relapse during the follow-up period. Long-term studies are still required to further evaluate its skeletal benefits. CLINICAL RELEVANCE: The study evaluated the medium-term stability of skeletal and dental effects of maxillary protraction in Class III children and discussed whether the therapy can reduce the need for orthognathic surgery.

Principales alteraciones bucodentales en pacientes con diabetes mellitus / Main oral and dental changes in patients with diabetes mellitus

Se efectuó un estudio descriptivo y transversal de 126 pacientes con diabetes mellitus de tipos 1 y 2 atendidos en el Centro de Atención al Diabético desde enero hasta marzo del 2016, con vistas a determinar las alteraciones bucodentales presentes en ellos. En la serie predominaron el sexo femenino, los diabéticos de tipo 2, los dientes perdidos, la higiene bucal deficiente, la periodontopatía avanzada, así como la xerostomía como alteración bucal más común y la hipertensión arterial como enfermedad asociada. Se recomienda llevar a cabo estrategias educativas para elevar la educación sanitaria de la población, evitar futuras complicaciones e incentivar la realización de nuevas investigaciones científicas que permitan el mejoramiento de la salud bucal y general.

A descriptive and cross-sectional study of 126 patients with diabetes mellitus types 1 and 2 assisted in the Center for Care to the Diabetic Patient was carried out from January to March, 2016, aimed at determining the oral and dental changes present in them. The female sex, diabetics type 2, the lost teeth, inadequate oral hygiene, advanced periodontopathy, as well as the xerostomy as the most common oral change and hypertension as associated disease prevailed in the series. It is recommended to carry out educational strategies to increase the health knowledge of the population, in order to avoid future complications and to motivate the realization of new scientific investigations that allow the improvement of the oral and general health.

Dental arch changes associated with rapid maxillary expansion: A retrospective model analysis study.

INTRODUCTION: Transverse deficiency of the maxilla is a common clinical problem in orthodontics and dentofacial orthopedics. Transverse maxillary deficiency, isolated or associated with other dentofacial deformities, results in esthetic and functional impairment giving rise to several clinical manifestations such as asymmetrical facial growth, positional and functional mandibular deviations, altered dentofacial esthetics, adverse periodontal responses, unstable dental tipping, and other functional problems. Orthopedic maxillary expansion is the preferred treatment approach to increase the maxillary transverse dimension in young patients by splitting of the mid palatal suture. This orthopedic procedure has lately been subject of renewed interest in orthodontic treatment mechanics because of its potential for increasing arch perimeter to alleviate crowding in the maxillary arch without adversely affecting facial profile. Hence, the present investigation was conducted to establish a correlation between transverse expansion and changes in the arch perimeter, arch width and arch length. METHODS: For this purpose, 10 subjects (five males, five females) were selected who had been treated by rapid maxillary expansion (RME) using hyrax rapid palatal expander followed by fixed mechanotherapy (PEA). Pretreatment (T1), postexpansion (T2), and posttreatment (T3) dental models were compared for dental changes brought about by RME treatment and its stability at the end of fixed mechanotherapy. After model measurements were made, the changes between T1-T2, T2-T3 and T1-T3 were determined for each patient. The mean difference between T1-T2, T2-T3 and T1-T3 were compared to assess the effects of RME on dental arch measurements. Results are expressed as mean ± standard deviation and are compared by repeated measures analysis of variance followed by a post-hoc test. Arch perimeter changes are correlated with changes in arch widths at the canine, premolar and molar regions. RESULTS: The intercanine arch width increased by 2.9 mm, inter first premolar width increased by 3.2 mm, inter second premolar width increased by 4.6 mm, intermolar width increased by 4.4 mm, arch perimeter increased by 3.2 mm, arch length decreased by 1.8 mm from pretreatment to posttreatment. There is a strong positive correlation of arch perimeter with intercanine width (r (2) = 0.99), interpremolar width (r (2) = 0.99) and intermolar width (r (2) = 0.98), indicating that there is a significant increase in arch perimeter with increase in arch width at the canine, premolars and molar regions. CONCLUSION: Findings of this study demonstrate that there was a significant increase in the intercanine, inter first premolar, inter second premolar intermolar arch width and arch perimeter from pretreatment to postexpansion, which was stable at the end of fixed mechanotherapy (PEA). There was a nonsignificant decrease in arch length from pretreatment to postexpansion that further decreased nonsignificantly from postexpansion to posttreatment.

Craniofacial and dental manifestations of triple X syndrome associated with congenital hypothyroidism: a case report.

Triple X syndrome (47,XXX) is a numerical chromosomal alteration that affects 1/1,000 women, in which the woman is born with an extra X chromosome. Some oral changes have been reported in the literature, as hypodontia, influence on deposition of crown enamel and discrepancies in cephalometric measurements. Other systemic complications may lead to oral abnormalities similar to those seen in triple X patients, such as congenital hypothyroidism (CH). This paper reports a triple X syndrome case associated with CH later treated. Besides delay in cognitive and intellectual development, the patient had changes in teeth development and in cephalometric measurements with deficiencies in the maxilla and mandible. This is the first report of a triple X syndrome associated with CH. Both conditions may result in changes in dentofacial development.

Alterações orais em três espécies de Leontopithecus mantidas em cativeiro (Callitrichidae, Primates) / Dental changes in three species of Leontopithecus maintained in captivity (Callitrichidae, Primates)

Foram estudadas as alterações orais que ocorrem em primatas não humanos, cativos, do gênero Leontopithecus, suas diferenças entre espécies, suas freqüências e a influência do cativeiro. Sessenta crânios de Leontopithecus, do acervo do Museu Primatológico do Centro de Primatologia do Rio de Janeiro (CPRJ-FEEMA), foram examinados. O teste do x² foi utilizado para avaliar as diferenças nas incidências das alterações orais e o coeficiente de correlação de Pearson para o estudo da correlação entre o número de alterações e o tempo de cativeiro dos animais. Entre as três espécies estudadas, L. chrysomelas, L. rosalia e L. chrysopygus, as diferenças nas alterações orais foram estatisticamente significativas para cáries, crazing, doença pulpar e maloclusão. O complexo canino-incisivo foi mais afetado do que a série molar. A incidência de alterações orais aumentou à medida que aumentou o tempo de cativeiro dos micos e diferiu nas três espécies de Leontopithecus estudadas, sendo L. chrysopygusi a mais suscetível.

The dental changes occurring in captive non-human primates of the genus Leontopíthecus and its differences among three species, L. chrysomelas, L. rosalía and L. chrysopygus, regarding frequency and captivity influence, were studied. Sixty skulls of the Leontopíthecus, trom the collection of the Museum of Centro de Primatologia do Rio de Janeiro (CPRJ-FEEMA) were examined. The x² test was used to evaluate the differences between incidence of changes observed and Pearson's coefficient of correlation to evaluate the number of changes observed and the time of captivity. The differences among the three species were significant for caries, crazing, pulpar disease and malocclusion. The complex canine-incisors were more affected than the molars. The incidence of oral changes was high in animais maintained more time in captivity conditions and was different in the three species of the Leontopíthecus studied; L. chrysopygus was the most susceptible.