Maxillary molar intrusion with zygomatic anchorage in open bite treatment: lateral and oblique cephalometric evaluation

Purpose We aimed to use lateral and oblique radiographs to evaluate dental and skeletal changes arising from maxillary molar intrusion with zygomatic anchorage in open bite patients. Methods We conducted a pilot study including nine patients (six females and three males; mean age, 18.7±5.1 years) with skeletal open bite treated with titanium miniplates for posterior dentoalveolar intrusion. Lateral and oblique (right and left, 45°) radiographs were obtained before (T1) and 6 months after intrusion (T2). A paired t test was used for statistical evaluation. Results The maxillary posterior teeth were intruded 2.03± 0.87 mm (p<0.01) with 450×g of force, which resulted in counterclockwise rotation of the mandible (1.57°, p=0.02) and clockwise rotation of the occlusal plane (4.27±2.66°, p=0.01). Anterior facial height decreased by a mean of 1.79±1.51 mm (p<0.01). No significant change in the palatal plane or in anteroposterior molar movement was observed. Conclusion The oblique radiograph at 45° was useful for the assessment of molar intrusion and anteroposterior displacement. The treatment of anterior open bite with skeletal anchorage provided intrusion of molars and counterclockwise rotation of the mandible, resulting in open bite closure.

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

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Utilização do bite block para correção da mordida aberta anterior

Bite block is a functional orthodontic appliance that promotes relative intrusion or dental eruption inhibition. The purpose of this study is to present the effects of bite block on the treatment of an open bite case report.

Descrição do aparelho VABB (Vertically Activated Bite Block) para o tratamento da mordida aberta anterior

Nowadays, the correction of skeletal vertical dysplasia is considered a great challenge in Orthodontics. The skeletal open bite treatment presents limitations related to vertical growth pattern, the extension of open bite and especially the stability, which is very questioned. The treatment of skeletal open bite is mostly realized by the inhibition of vertical alveolar posterior development (relative intrusion) or absolute intrusion of posterior teeth, through vertical forces, generated by the action of masticatory muscles. The purpose of this article is to present a new appliance for the treatment of skeletal open bite, the VABB (Vertically Activated Bite Block) or modified Bite Block, whose action mechanism is to limit the vertical development of the molars, by the action of facial muscles and two bilateral expansion screws that provide a counterclockwise rotation of the mandible. It will also be presented a clinical case and the technical steps for the construction of this appliance.

Relação entre hábitos bucais, alterações oronasofaringianas e mal-oclusões em pré-escolares de Vitória, Espírito Santo, Brasil

O objetivo deste estudo foi estimar a prevalência das mal-oclusões e variáveis a elas associadas, como hábitos deletérios (HD) e as alterações oronasofaringianas (AO), respiração bucal, deglutição atípica e fonação atípica, em crianças com idade de três anos, no Município de Vitória, Espírito Santo, Brasil. A amostra constituiu-se de 291 crianças de ambos os sexos, matriculadas nos Centros de Educação Infantil, selecionadas por meio de amostragem probabilística por conglomerados. A análise de regressão logística indicou maior risco relativo (RR) de crianças com sobressaliência alterada, mordida aberta e mordida cruzada, em apresentar: respiração bucal (RR = 1,89; IC: 1,56-2,03), (RR = 2,46; IC: 2,00-3,02), (RR = 1,45; IC: 1,23-1,72); deglutição atípica (RR = 2,57; IC: 1,87-3,52), (RR = 3,49; IC: 2,53-4,81), (RR = 1,86; IC: 1,46-2,39) e fonação atípica (RR = 2,25; IC: 1,66-3,05), (RR = 3,18; IC: 2,38-4,25), (RR = 1,71; IC: 1,32-2,22), respectivamente. Foi mostrado haver associação entre sucção de dedo e de chupeta com sobressaliência alterada (p < 0,001) e sucção de chupeta e mordida aberta (p < 0,001). Esses resultados indicam que a prevalência das mal-oclusões está associada aos HD e às AO.

Prevalence of Malocclusion and Related Oral Habits in 5-to 6-year-old Children

Purpose: To verify the prevalence of malocclusion and the influence of harmful oral habits on deciduous dentition in 5- and 6-year-old children enrolled in Brazilian public elementary schools during 2010.Materials and Methods: Exams were conducted in 1385 children from 56 Brazilian elementary schools using the method recommended by the World Health Organization (WHO) for epidemiological surveys on oral health. Information about the type of arch, social and economic data and harmful oral habits of the children were collected through a structured questionnaire.Results: In relation to canine occlusion, a high prevalence of Class I (74.5%), followed by Class II (19.4%), was found. Among all participants, 22% showed high overjet, 7.8% showed edge-to-edge occlusion and 2.3% showed anterior crossbite. In relation to overbite, 13.2% had short overbite, 14.3% open bite and 16.8% high overbite. The presence of posterior crossbite occurred in 14.6% of children. Maxillae predominantly exhibited the type I arch (67.9%) and mandibles predominantly exhibited type II (51.7%). In relation to harmful oral habits, 43.4% used a pacifier, 84.8% used a bottle and finger sucking was reported by 17.2%.Conclusion: There was a high prevalence of malocclusion associated with oral habits harmful to deciduous dentition.

Orthodontic treatment of a midline diastema related to mesiodens and thumb-sucking habit

OBJETIVO: A associação de mesiodens com hábito de sucção digital como fatores etiológicos de diastemas medianos é uma situação clínica incomum e, quando presente, provoca um comprometimento estético e funcional. O objetivo desse trabalho é descrever o caso clínico de um paciente, aos 9 anos de idade, com mordida aberta anterior e um diastema mediano de 9 mm. DESCRIÇÃO do CASO: Após o diagnóstico ortodôntico, a conduta terapêutica foi a exodontia do mesiodens e instalação de uma grade palatina fixa para controle do hábito de sucção digital. em seguida, bráquetes ortodônticos foram colados nos incisivos centrais superiores e o diastema foi fechado possibilitando a irrupção espontânea dos incisivos laterais. Quando adequados níveis de trespasse vertical e horizontal entre os incisivos foi alcançado e o hábito removido, o tratamento foi finalizado. CONCLUSÃO: É importante ressaltar que com o objetivo de alcançar resultados estéticos e funcionais satisfatórios, minimizando sequelas ao desenvolvimento da oclusão deve-se realizar o diagnóstico precoce e intervenção imediata dos diastemas medianos patológicos.

Moebius Syndrome: Clinical Manifestations in a Pediatric Patient

Moebius syndrome is a congenital, nonprogressive disorder clinically characterized by loss of facial expression, impaired stomatognathic system functions, incapacity to close the eyelids, and several oral impairments. The purpose of this paper was to present the clinical manifestations and the dental treatment in a 5-year, 2-month-old male Moebius syndrome patient. The child presented with facial asymmetry, difficulty performing facial mimic movements and pronouncing some letters, and compromised suction, mastication, breathing, and deglutition. An intraoral examination revealed hypofunction of the perioral muscles, cheeks and tongue, ankyloglossia, anterior open bite, and absence of carious lesions and dental anomalies. The dental treatment consisted of frenectomy and further placement of a removable orthodontic appliance with a palatal crib for correction of the anterior open bite. After 12 months of follow-up, anterior open bite decreased and speech, deglutition, and mastication improved. (Pediatr Dent 2009;31:289-93) Received March 8, 2008 vertical bar Lost Revision July 22, 2008 vertical bar Revision Accepted July 28, 2008

Sistema de Apoio Ósseo para Mecânica Ortodôntica (SAO®): miniplacas para ancoragem ortodôntica. Parte I: tratamento da mordida aberta

Este trabalho descreve uma nova forma de ancoragem por meio de miniplacas denominada SAO®, Sistema de Apoio Ósseo para Mecânica Ortodôntica. Após a descrição do sistema, protocolos de tratamento para mordidas abertas esqueléticas são apresentados. A aplicação de cantiléveres e alças apoiadas diretamente nos tubos do sistema de ancoragem permite que associações de problemas verticais e sagitais (Classe II e III) sejam tratadas de formas distintas. A aplicação de forças leves e constantes e o controle tridimensional das forças aplicadas são o grande diferencial desse novo sistema.

A case of Zimmermann-Laband syndrome with supernumerary teeth

Background: Zimmermann-Laband syndrome is a rare autosomal dominant disorder that is characterized by gingival fibromatosis, ear, nose, bone, and nail defects, and hepatosplenomegaly.Methods: This case report describes the clinical presentation and periodontal findings in a 13-year-old female patient with previously undiagnosed Zimmermann-Laband syndrome.Results: Clinical and radiographic findings and genetic counseling confirmed the diagnosis of Zimmermann-Laband syndrome. The most striking oral findings were the presence of gingival enlargement involving both the maxillary and mandibular arches, anterior open bite, non-erupted teeth, and two supernumerary teeth. Periodontal treatment consisted of gingivectomy in four quadrants. Histopathologic evaluation of excised tissue supported the diagnosis of gingival fibromatosis. The patient was referred for appropriate orthodontic treatment and genetic counseling, and has been closely followed for the earliest signs of hepatosplenomegaly.Conclusions: Dental practitioners should be alert for developmental abnormalities that may occur in patients with gingival fibromatosis as this may indicate the presence of a rare disorder like Zimmermann-Laband syndrome. A comprehensive medical history and physical systemic evaluation are essential for correct diagnosis and treatment of these cases.

Treatment of gingival fibromatosis associated with Zimmermann-Laband syndrome

Background: Gingival fibromatosis is a rare condition characterized by a generalized enlargement of the buccal and lingual aspects of the attached and marginal gingiva.Methods: This case report describes the periodontal management of a 13-year-old female patient with gingival fibromatosis associated with Zimmermann-Laband syndrome. The patient presented with gingival enlargement involving the maxillary and the mandibular arches, anterior open bite, and non-erupted teeth. Periodontal treatment included gingivectomy in all four quadrants.Results: Histopathologic evaluation of the excised tissue supported the diagnosis of gingival flbromatosis. A significant improvement in esthetic appearance and eruption of the non-erupted teeth were obtained. The patient was referred for appropriate orthodontic treatment and has been closely followed for the earliest signs of recurrence of gingival enlargement.Conclusions: the successful therapy for gingival fibromatosis depends on correctly identifying the etiological factors and improving the impaired function and esthetic appearance through surgical intervention and adjunctive orthodontics. Maintaining treatment results depends on preservation of periodontal health.

The Effect of Adenoidectomy or Adenotonsillectomy on Occlusal Features in Mouth-breathing Preschoolers

Purpose: The purpose of this study was to evaluate mouth-breathing and nasal-breathing children prior to surgical intervention and 28 months postoperatively, comparing the occlusal features obtained pre- and postoperatively through orthodontic study costs. Methods: The mouth-breathing (MB) group consists of 33 MB children who underwent surgery and presented a nasal-breathing (NB) pattern after surgery The control group comprised 22 NB children. The orthodontic examinations were accomplished prior to surgery (77) and an average of 28 months postoperatively (T2). Results: At T1, the MB and NB children presented no statistically significant difference in any analyzed occlusal features and measurements. At T2, the MB presented larger overjet comparing to NB children (P<.05). MB and NB groups presented statistically similar results (P>.05) concerning intercanine and intermolor distances, second primary molar terminal plane and canine relationship, overbite, crossbite, and open bite. From T1 to T2, the MB and NB groups showed a statistically significant difference in the molar terminal plane. Conclusion: Neither the breathing pattern nor the surgery had any effect on occlusal features in 3- to 6-year-olds. (Pediatr Dent 2012;34:10842) Received May 14, 2010 vertical bar Last Revision April 11, 2010 vertical bar Accepted April 12, 2010

Miniplacas de ancoragem no tratamento da mordida aberta anterior

INTRODUÇÃO: o relato de caso apresentado descreve um tratamento ortodôntico auxiliado por miniplacas, de uma paciente adulta que apresentava mordida aberta anterior acentuada, rotação horária da mandíbula, biprotrusão e ausência de selamento labial. Após a extração dos primeiros molares e retração dentária superior e inferior, associada ao controle vertical propiciado pelas placas, ocorreu uma pequena rotação anti-horária da mandíbula e a correção da mordida aberta anterior, com significativa melhora facial. OBJETIVO: o presente relato corrobora as evidências atuais quanto à eficiência do uso de miniplacas de titânio como ancoragem temporária, especialmente em situações de correções de grande amplitude, envolvendo um problema vertical.

Expanding the spectrum of PTH1R mutations in patients with primary failure of tooth eruption

Objectives: Primary failure of tooth eruption (PFE) is a rare autosomal-dominant disease characterized by severe lateral open bite as a consequence of incomplete eruption of posterior teeth. Heterozygous mutations in the parathyroid hormone 1 receptor (PTH1R) gene have been shown to cause PFE likely due to protein haploinsufficiency. To further expand on the mutational spectrum of PFE-associated mutations, we report here on the sequencing results of the PTH1R gene in 70 index PFE cases. Materials and methods: Sanger sequencing of the PTH1R coding exons and their immediate flanking intronic sequences was performed with DNA samples from 70 index PFE cases. Results: We identified a total of 30 unique variants, of which 12 were classified as pathogenic based on their deleterious consequences on PTH1R protein while 16 changes were characterized as unclassified variants with as yet unknown effects on disease pathology. The remaining two variants represent common polymorphisms. Conclusions: Our data significantly increase the number of presently known unique PFE-causing PTH1R mutations and provide a series of variants with unclear pathogenicity which will require further in vitro assaying to determine their effects on protein structure and function. Clinical relevance: Management of PTH1R-associated PFE is problematic, in particular when teeth are exposed to orthodontic force. Therefore, upon clinical suspicion of PFE, molecular DNA testing is indicated to support decision making for further treatment options. © 2013 Springer-Verlag Berlin Heidelberg.

Avaliação da intrusão dos molares superiores pela técnica de ancoragem com miniplacas de titânio

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)