Aparelho Herbst x osteotomia sagital mandibular bilateral no tratamento do padrão II, classe II, divisão 1 em adultos: relato de casos

Two treatment options are available for adult patients with skeletal Class II malocclusion caused by mandibular deficiency: combined mandibular advancement surgery and orthodontic treatment or mandibular advancement appliance. This study aimed to analyze the effects of two therapeutic modalities of Class II malocclusion treatment with mandibular deficiency. Two distinct individuals with Class II malocclusion division 1 and mandibular deficiency were treated after growth spurt. The first individual used the Herbst appliance as a therapeutic option and the second individual was treated with bilateral sagittal osteotomy. The cephalometric, occlusion and face results were evaluated for both individuals. Correction of Class II malocclusion was observed on both Herbst and surgery patients resulting on a normal occlusal relationship with normal overjet and overbite. Therefore it was concluded that Herbst appliance can be used to treat borderline skeletal Class II in adult patients.

Efeitos do aparelho de Herbst no tratamento proecoce da má oclusão classe II de Angle

Due to its high prevalence in general population, Angle Class II malocclusion has been widely studied by several authors, as well as the methods for its treatment. Among the possible treatment methods stands out the Herbst appliance. Reintroduced more than three decades ago in the orthodontics community, it became the most utilized appliance because it does not require patient compliance, and provides continued action through bilateral telescopic tubes. The objective of the present article was to demonstrate the early treatment of Class II Division 1 malocclusion with mandibular retrusion using Herbst appliance.

Estudo em telerradiografia em norma de 45º no tratamento da classe II com aparelho de Herbst

The aim of this retrospective study was to evaluate mandibular and maxillary changes induced by the use of Herbst applianceand by natural growth through oblique cephalometric radiographs in children with Class II division 1 malocclusion with mandibular retrusion. A sample of 49 individuals with age ranging from 8 to 10 years old (before growth peak) with Class II division 1, were into two groups: Herbst treated group (n=24) and control group (n=25). Both groups were paired for gender and chronological age. Statistical analysis was performed through Student’s t test. The Herbst appliance promoted the Class II correction in a 7 months period by mesialization of lower permanent first molars and distalization of upper permanent first molars. The Herbst appliance had no influence over the mandibular structure or the mandibular length. It was concluded that early treatment with Herbst appliance corrected the Class II malocclusion by means of dentoalveolar changes.

Tratamento da classe II divisão 2 com aparelho de Herbst após o pico de crescimento puberal

Patients with Class II division 2 malocclusion and mandibular retrusion have limited treatment options after the growth peak, such as surgical-orthodontic treatment or mandibular advancement devices. Among bite-jumping devices, the Herbst appliance allows greater increase of mandibular growth since it does not require patient compliance and allows continuous use. This case report presents the treatment of a Class II division 2 malocclusion in a patient after growth peak, performed in two stages. The first stage included the upper incisors proclination and overjet increase with multibracket appliance to benefit next stage. The second stage involved mandibular advancement using Herbst appliance aiming to correct the Class II molar relationship. The treatment resulted in a stable occlusion with periodontal health, normal functions and facial aesthetics improvement. Dental and skeletal changes arising from treatment could be assessed by cephalometric analysis and superimposition of pretreatment and post-treatment cephalometric tracings. Antero-posterior discrepancy was corrected by means of dental movement as well as by mandibular growth increment stimulated by the Herbst appliance.

Alterações dimensionais em pacientes submetidos à expansão rápida da maxila com aparelho do tipo Haas

The maxillary atresia is a alteration in the transverse dimension that can result in a unilateral or bilateral crossbite. For correction of atresia of the upper dental arch appliances with the intent to expand the arch of orthopedic or orthodontic manner are used, obtaining across-compatibility between the dental arches. The purpose of this study was to evaluate the dimensional changes of the maxillary in patients in the mixed dentition with atresia in the upper dental arch, using occlusal radiographs taken before, after rapid maxillary expansion and after removal of the appliance. Methods: the sample consisted of 35 patients who used the appliance type conventional Haas, in the mixed dentition, according to the standard protocol for installation, activation, containment and removal of the appliances rapid maxillary expansion. Results: the results confirm that the suture opening occurs in greater quantities in the anterior (4.3 mm) than posterior to (3.74 mm), representing a triangular opening of 7 degrees on average with the posterior opening 87% of the quantity of anterior opening. The molars region expanded about 5 mm, and the base bone 3.7 mm, representing a 74% bone expansion of the expansion teeth.

Análise tomográfica da articulação temporomandibular no tratamento com Herbst em adulto jovem

Class II malocclusion features a high prevalence in Brazil, being considered as a routine in orthodontic clinics. A number of appliances are shown in the literature in order to correct Class II malocclusion with mandibular retrusion. Herbst´s fixed functional appliance, idealized by Emil Herbst (1905) and reintroduced, in the 1980´s, by Hans Pancherz is highlighted for maintaining the mandible continuously advanced, showing a shorter active treament time, an immediate esthetic impact on the facial profile, as well as requiring no patient´s commitment. Recent researches indicate the use of this appliance in individuals after pubertal growth surge. The aim of the present study is to show the orthodontics practitioner the option to use this appliance so as to treat Class II in individuals after the growth surge, obtaining satisfactory outcomes and further Class II correction.

Aparelho de Thurow modificado e aparelho ortodôntico fixo no tratamento da classe II com mordida aberta anterior

This work had aim to present two clinical cases with open bite Class II malocclusion that treated in the phase of the mixed dentition with the modified Thurow appliance and in the permanent dentition with fixed appliance. The dentoskeletal effects of these appliances were carefully analyzed with the aid of metallic implants inserted in both maxilla and mandible. The correction of the malocclusion and the improvement of the skeletal, dental and facial relationship were observed in both cases. The modified Thurow appliance followed by fixed-appliance as a two-phase treatment protocol revealed to be an effective treatment approach for the two young people that initially presented a Class II division 1 malocclusion associated to anterior open bite presented.

Efeitos esqueléticos e dentários decorrentes da expansão rápida maxilar

This study evaluated the maxillary transversal changes caused by the rapid maxillary expansion (RME) accomplished by Hyrax appliance. Sixteen children from both genders were selected and treated, with ages between 7.7 to 10.8 years, who presented unilateral or bilateral posterior crossbite. Postero-anterior radiographs were taken at the beginning of the treatment, end and post-retention period. The treatment promoted an average opening of 8.8 mm of IMD (intermolar distance), 2.33 mm of IAD (interapex distance) and none of IID (interincisal distance). At the end of retention period, relapse was observed, with a decrease of 4.3 mm of IMD, 1.23 mm of IAD, a non-significant enlargement of IID (0,38 mm).These results confirm the significant influence of Hyrax appliance on transverse dimensions, represented by enlargement of IMD and IAD and its effectiveness to solve posterior crossbites.

Sistema Essix MTM: uma alternativa estética para a movimentação

The increased interest in orthodontics by adults has led companies to develop new treatment alternatives that use less visible and more aesthetic orthodontic appliances. The aesthetic aligners stand out among the treatment options that attend these expectations. This paper presented some relevant aspects of these devices, as well as two cases treated with Essix MTM (Dentsply) system, in which all aesthetic and functional objectives proposed treatment have been achieved. The results of this study support the idea that, when properly indicated, aesthetic aligners are a viable treatment option within the clinical routine of the orthodontist.

Tratamento da má-oclusão de classe II divisão 1 de Angle, com aparelho de Herbst splint metálico seguido de aparelho fixo, na dentição permanente

The Herbst appliance is currently one of the most used appliances for the correction of Class II division 1 with mandibular retrusion. When used in peak, or just after the peak of growth it can result in some skeletal gain, which is favorable to the correction of anteroposterior discrepancy with effective and stable results. This article aims to report a case of a patient with malocclusion Class II division 1 with mandibular retrusion, associated with maxillary protusion, treated in two stages: with Herbst splint metallic appliance followed by fixed appliance orthodontic treatment.

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.

Variáveis que afetam o procedimento de colagem direta ortodôntica: braquetes e materiais adesivos

Following the introduction of the acid-etching technique in enamel surface, direct attachment of orthodontic appliances on the surface of the tooth and/or restorations became a routine procedure in the assembly of the fixed devices. The attainment of a success result is related to the criterion attention to the details and the steps of the bonding technique, as well as, to the knowledge of the characteristics of the adhesive materials and orthodontic brackets. This paper presents some aspects of various types of brackets and adhesives materials.

Variáveis que afetam o procedimento de colagem direta ortodôntica: procedimentos clinicos

Direct bonding of orthodontics attachments to the teeth or restoration has become a routine in fixed appliance therapy. The technique used seems to be simple, but meticulous attention to detail and steps, a thorough understanding of factors involved are needed to ensure a successful outcome into different surfaces. It is the purpose of this article to review concerning aspects to orthodontic bonding in enamel and restorations fabricated from different materials; affording assistance to the reader wiser accomplishment and successful procedure.

Herbst esplinte metálico fundido: novo modelo de confecção com Duralay

A má oclusão de Classe II é originária de vários fatores etiológicos e uma das características mais comum desta má oclusão é a retrusão mandibular3, por esse motivo, os aparelhos de avanço mandibular são eleitos para o tratamento e correção desta má oclusão. Um destes aparelhos é o Herbst, que apresenta várias formas de ancoragens na sua confecção10. Tradicionalmente, as bandas eram o sistema de ancoragem mais usado, no entanto, pela alta frequência de quebras as mesmas foram substituídas por esplinte metálico12. Esse aparelho quando confeccionado de cromo cobalto pelo método da prótese parcial removível, apresenta como desvantagens a quantidade de passos laboratoriais e a possível contração do metal, podendo ocasionar a má adaptação da estrutura metálica à boca do paciente. Dessa forma, este artigo apresenta um novo método de confecção do aparelho de Herbst esplinte metálico fundido com uso da Duralay e liga níquel cromo. Esse método diminui os passos laboratoriais, proporciona maior resistência à tração e minimiza a contração da estrutura metálica, pois a resina química Duralay proporciona menor expansão do que a cera2.

Ertty System®: distalização segmentar

Introduction: Ertty System® is an intraoral system of biomechanical forces to move teeth anteroposteriorly. The application of forces on this system results in the distalization of the molar and all lateral segment in the side to be distalized, including premolars and canine, resulting in alveolar bone remodeling. This system is indicated to correct uni- or bilateral maxillary dental Class II malocclusion in permanent dentition both in children and adults. It is contraindicated in case of skeletal asymmetries, protrusion of maxillary and mandibular teeth, skeletal Class II and Class II subdivision malocclusions with mandibular midline deviation. This study describes Ertty System® and presents two clinical cases treated using this system. The two female patients presented with Class II malocclusion subdivision and maxillary midline deviation. Results: It was achieved correct alignment and leveling, Class I dental relation and correction of upper midline. Conclusion: The success and stability of results confirmed diagnosis and treatment adequacy.