Desenvolvimento e análise de um método de avaliação de maturação óssea por meio de medidas das vértebras cervicais em radiografias cefalométricas laterais

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Mandibular growth and dentoalveolar development in the treatment of Class II, division 1, malocclusion using Balters Bionator according to the skeletal maturation

OBJECTIVE: The purpose of the study was to evaluate the influence of the skeletal maturation in the mandibular and dentoalveolar growth and development during the Class II, division 1, malocclusion correction with Balters bionator. METHODS: Three groups of children with Class II, division 1, malocclusion were evaluated. Two of them were treated for one year with the bionator of Balters appliance in different skeletal ages (Group 1: 6 children, 7 to 8 years old and Group 2: 10 children, 9 to 10 years old) and the other one was followed without treatment (Control Group: 7 children, 8 to 9 years old). Lateral 45 degree cephalometric radiographs were used for the evaluation of the mandibular growth and dentoalveolar development. Tantalum metallic implants were used as fixed and stable references for radiograph superimposition and data acquisition. Student's t test was used in the statistical analysis of the displacement of the points in the condyle, ramus, mandibular base and dental points. Analysis of variance one-fixed criteria was used to evaluate group differences (95% of level of significance). RESULTS: The intragroup evaluation showed that all groups present significant skeletal growth for all points analyzed (1.2 to 3.7 mm), but in an intergroup comparison, the increment of the mandibular growth in the condyle, ramus and mandibular base were not statically different. For the dentoalveolar modifications, the less mature children showed greater labial inclination of the lower incisors (1.86 mm) and the most mature children showed greater first permanent molar extrusion (4.8 mm).

Cinta de náilon como cerclagem óssea - estudo experimental em coelhos e ratos

The aim of this study was to evaluate the biocampatibility of the commercial nylon band used as bone cerclage, comparing with traditional metal cerclage wires. Twenty one rabbits and fifteen rats, healthy and without orthopedics problems were used. A commercial nylon band and a surgical stainless steel wire 0 were used in right (SN) and left (SA) rabbits's hindlimb, respectively. Otherwise, on rats SN was on the left hindlimb, and SA on the right hindlimb. Both experimental species were divided into three groups according to the end of the evaluation period. Clinical, radiographic, macroscopic and histologically evaluation were performed at 30, 60 and 150 days postoperatively. All the animals showed normal limb function differences between groups were not observed at clinical and macroscopic evaluation. On both species, radiographic changes were slightly higher on SN. Histological differences were not observed in both species. Nylon bands do not cause foreign body reaction and other histological changes in rabbits and rats.

Long-term skeletal and dental effects and treatment timing for functional appliances in Class II malocclusion

Objective: To analyze the long-term skeletal and dentoalveolar effects and to evaluate treatment timing of Class II treatment with functional appliances followed by fixed appliances.Materials and Methods: A group of 40 patients (22 females and 18 males) with Class II malocclusion consecutively treated either with a Bionator or an Activator followed by fixed appliances was compared with a control group of 20 subjects (9 females and 11 males) with untreated Class II malocclusion. Lateral cephalograms were available at the start of treatment (mean age 10 years), end of treatment with functional appliances (mean age 12 years), and long-term observation (mean age 18.6 years). The treated sample also was divided into two groups according to skeletal maturity. The early-treatment group was composed of 20 subjects (12 females and 8 males) treated before puberty, while the late-treatment group included 20 subjects (10 females and 10 males) treated at puberty. Statistical comparisons were performed with analysis of variance followed by Tukey's post hoc tests.Results: Significant long-term mandibular changes (Co-Gn) in the treated group (3.6 mm over the controls) were associated with improvements in the skeletal sagittal intermaxillary relationship, overjet, and molar relationship (similar to 3.0-3.5 mm). Treatment during the pubertal peak was able to produce significantly greater increases in total mandibular length (4.3 mm) and mandibular ramus height (3.1 mm) associated with a significant advancement of the bony chin (3.9 mm) when compared with treatment before puberty.Conclusion: Treatment of Class II malocclusion with functional appliances appears to be more effective at puberty. (Angle Orthod. 2013;83:334-340.)

Midpalatal suture maturation: Classification method for individual assessment before rapid maxillary expansion

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Time reduction of light curing: Influence on conversion degree and microhardness of orthodontic composites

Introduction: The aim of this study was to assess the influence of curing time and power on the degree of conversion and surface microhardness of 3 orthodontic composites. Methods: One hundred eighty discs, 6 mm in diameter, were divided into 3 groups of 60 samples according to the composite used-Transbond XT (3M Unitek, Monrovia, Calif), Opal Bond MV (Ultradent, South Jordan, Utah), and Transbond Plus Color Change (3M Unitek)-and each group was further divided into 3 subgroups (n = 20). Five samples were used to measure conversion, and 15 were used to measure microhardness. A light-emitting diode curing unit with multiwavelength emission of broad light was used for curing at 3 power levels (530, 760, and 1520 mW) and 3 times (8.5, 6, and 3 seconds), always totaling 4.56 joules. Five specimens from each subgroup were ground and mixed with potassium bromide to produce 8-mm tablets to be compared with 5 others made similarly with the respective noncured composite. These were placed into a spectrometer, and software was used for analysis. A microhardness tester was used to take Knoop hardness (KHN) measurements in 15 discs of each subgroup. The data were analyzed with 2 analysis of variance tests at 2 levels. Results: Differences were found in the conversion degree of the composites cured at different times and powers (P < 0.01). The composites showed similar degrees of conversion when light cured at 8.5 seconds (80.7%) and 6 seconds (79.0%), but not at 3 seconds (75.0%). The conversion degrees of the composites were different, with group 3 (87.2%) higher than group 2 (83.5%), which was higher than group 1 (64.0%). Differences in microhardness were also found (P < 0.01), with lower microhardness at 8.5 seconds (35.2 KHN), but no difference was observed between 6 seconds (41.6 KHN) and 3 seconds (42.8 KHN). Group 3 had the highest surface microhardness (35.9 KHN) compared with group 2 (33.7 KHN) and group 1 (30.0 KHN). Conclusions: Curing time can be reduced up to 6 seconds by increasing the power, with a slight decrease in the degree of conversion at 3 seconds; the decrease has a positive effect on the surface microhardness.

Use of a type IIB external skeletal fixator in experimental tarsocrural arthrodesis in dogs

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Can cone-beam computed tomography superimposition help orthodontists better understand relapse in surgical patients?

This case report describes the interdisciplinary treatment of a 19-year-old Brazilian man with a Class I malocclusion, a hyperdivergent profile, an anterior open bite, and signs of temporomandibular joint internal derangement. The treatment plan included evaluation with a temporomandibular joint specialist and a rheumatologist, orthodontic appliances, and maxillomandibular surgical advancement with counterclockwise rotation. Cone-beam computed tomography images were taken before and after surgery at different times and superimposed at the cranial base to assess the changes after orthognathic surgery and to monitor quantitatively the internal derangement of the temporomandibular joints and surgical relapse. Our protocol can improve the orthodontist's understanding of surgical instability, demonstrate the clinical value of cone-beam computed tomography analysis beyond the multiplanar reconstruction, and guide patient management for the best outcome possible.

O uso do Plasma Rico em Plaquetas (PRP) na cirurgia ortopédica

The aim of this work is to study a still little known technique in the Brazilian Veterinary Medicine, that is the use of the Platelet Rich Plasma (PRP), specifically in the small animals orthopedics, including the concept of PRP, why its use in orthopedics, its production method and application, its indications, vantages and disadvantages, and also evaluate the results achieved through the use of PRP both in Human Medicine as in Veterinary Medicine. Moreover, it aims to establish the feasibility of this technique for its use in veterinary orthopedic surgery, especially as an adjunct in fracture repair

Bone stress and strain after use of a miniplate for molar protraction and uprighting: a 3-dimensional finite element analysis

The aim of this study was to use the finite element method to evaluate the distribution of stresses and strains on the local bone tissue adjacent to the miniplate used for anchorage of orthodontic forces. Methods: A 3-dimensional model composed of a hemimandible and teeth was constructed using dental computed tomographic images, in which we assembled a miniplate with fixation screws. The uprighting and mesial movements of the mandibular second molar that was anchored with the miniplate were simulated. The miniplate was loaded with horizontal forces of 2, 5, and 15 N. A moment of 11.77 N.mm was also applied. The stress and strain distributions were analyzed, and their correlations with the bone remodeling criteria and miniplate stability were assessed. Results: When orthodontic loads were applied, peak bone strain remained within the range of bone homeostasis (100-1500 mu m strain) with a balance between bone formation and resorption. The maximum deformation was found to be 1035 mu m strain with a force of 5 N. At a force of 15 N, bone resorption was observed in the region of the screws. Conclusions: We observed more stress concentration around the screws than in the cancellous bone. The levels of stress and strain increased when the force was increased but remained within physiologic levels. The anchorage system of miniplate and screws could withstand the orthodontic forces, which did not affect the stability of the miniplate.

Dental and skeletal components of Class II open bite treatment with a modified Thurow appliance

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Effect of clinical use of nickel-titanium springs

Introduction: Our objectives were to determine whether there are changes on the load deflection rate (L/DP) and the average force (FP) of the superelastic pseudoplateau, and whether permanent deformation is changed in nickel-titanium closed-coil springs (CCSs) after 6 months of clinical use. Methods: Twenty-two nickel-titanium CCSs (Sentalloy 100 g; Dentsply GAC, York, Pa) were subjected to tensile mechanical testing at 37 degrees C on activations varying from 3.2 to 16.0 mm before and after 6 months of clinical use. A regression line was fitted over the most horizontal area of the unloading part of the stress-strain graph of every CCS, and its slope was used as L/DP. The FP was determined by the midpoint of the longest segment of the curve that could be fit within the regression line with a R-2 of at least 0.999, and permanent deformation was determined graphically by obtaining the strain value when the measured stress reached zero. The data were analyzed by 3 analyses of variance at 2 levels, with 5% of significance. Results: Time and activation significantly influenced the variables tested (P < 0.001). Time increased the L/DP and permanent deformation but decreased the FP. Activation decreased L/DP, FP, and permanent deformation. Significant interactions between time and activation were detected for FP (P = 0.013) and deformation (P < 0.001). Conclusions: After 6 months of active clinical use, the analyzed springs had a significant but small increase in their L/DP; FP dropped up to 88%, and the CCSs deformed up to 1.26 mm.

Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur

To assess whether serum vitamin D concentration is associated with gait status and mortality among patients with fractures of the proximal femur, six months after suffering the fracture. Consecutive patients aged ≥65 years with fractures of the proximal femur, who were admitted to the orthopedics and traumatology ward of our service between January and December 2011, were prospectively evaluated. Clinical, radiological, epidemiological and laboratory analyses were performed, including vitamin D. The patients underwent surgery and were followed up as outpatients, with return visits 15, 30, 60 and 180 days after discharge, at which the outcomes of gait and mortality were evaluated. Eighty-eight patients were evaluated. Two of them were excluded because they presented oncological fractures. Thus, 86 patients of mean age 80.2 ± 7.3 years were studied. In relation to serum vitamin D, the mean was 27.8 ± 14.5 ng/mL, and 33.7% of the patients presented deficiency of this vitamin. In relation to gait, univariate and multivariate logistic regression showed that vitamin D deficiency was not associated with gait recovery, even after adjustment for gender, age and type of fracture (OR: 1.463; 95% CI: 0.524-4.088; p = 0.469). Regarding mortality, Cox regression analysis showed that vitamin D deficiency was not related to its occurrence within six months, even in multivariate analysis (HR: 0.627; 95% CI: 0.180-2.191; p = 0.465). Serum vitamin D concentration was not related to gait status and/or mortality among patients with fractures of the proximal femur, six months after suffering the fracture.

Morphometric analysis of long-term dentoskeletal effects induced by treatment with Balters bionator

Objective: To evaluate the long-term effects of the standard (Class II) Balters bionator in growing patients with Class II malocclusion with mandibular retrusion by using morphometrics (thin-plate spline [TPS] analysis). Materials and Methods: Twenty-three Class II patients (8 male, 15 female) were treated consecutively with the Balters bionator (bionator group). The sample was evaluated at T0, start of treatment; T1, end of bionator therapy; and T2, long-term observation (including fixed appliances). Mean age at the start of treatment was 10 years 2 months (T0); at posttreatment, 12 years 3 months (T1); and at long-term follow-up, 18 years 2 months (T2). The control group consisted of 22 subjects (11 male, 11 female) with untreated Class II malocclusion. Lateral cephalograms were analyzed at the three time points for all groups. TPS analysis evaluated statistical differences (permutation tests) in the craniofacial shape and size between the bionator and control groups. Results: TPS analysis showed that treatment with the bionator is able to produce favorable mandibular shape changes (forward and downward displacement) that contribute significantly to the correction of the Class II dentoskeletal imbalance. These results are maintained at a long-term observation after completion of growth. The control group showed no statistically significant differences in the correction of Class II malocclusion. Conclusions: This study suggests that bionator treatment of Class II malocclusion produces favorable results over the long term with a combination of skeletal and dentoalveolar shape changes.

Lesão condral do joelho: comparação entre ressonância magnética e vídeo-artroscopia. Efeito da aplicação do plasma rico em plaquetas

Pós-graduação em Bases Gerais da Cirurgia - FMB