Avaliação cefalométrica do tratamento da Classe II, divisão 1, de Angle com os aparelhos extrabucal de Kloehn e fixo edgewise: influência do padrão facial

O presente estudo foi realizado com o propósito de avaliar respostas cefalométricas ao tratamento com aparelho extrabucal de Kloehn associado ao aparelho fixo edgewise convencional. Telerradiografias iniciais (T1) e finais (T2) de dois grupos de 30 pacientes tratados com estes aparelhos foram selecionadas e definidas pelo índice cefalométrico de Jarabak para determinação do padrão esquelético craniofacial. Os grupos foram denominados favorável (hipodivergente) e desfavorável (hiperdivergente). A idade média, no início do tratamento, foi de 11,03 anos e final de 14,72 com o tempo médio de tratamento de 3,6 anos para o grupo favorável. No grupo desfavorável a idade inicial foi de 11,51 anos e final de 15,17 anos com tempo médio de tratamento de 3,4 anos. Foi utilizado um sistema de análise de resposta de tratamento em coordenadas X e Y representativos dos movimentos dentários e das bases ósseas decompondo-os em seus vetores horizontais e verticais. Os resultados e respostas do tratamento foram analisados e comparados entre os grupos favorável e desfavorável utilizando o teste t-Student. Os resultados mostraram não haver diferenças estatisticamente significantes na resposta cefalométrica no tratamento com o aparelho extrabucal de Kloehn associados ao aparelho fixo edgewise quanto aos padrões faciais favorável e desfavorável. O tratamento promoveu uma restrição do deslocamento anterior maxilar e um menor deslocamento anterior mandibular. Quanto à movimentação dentária maxilar, houve uma restrição do movimento mesial e extrusivo dos molares superiores no grupo favorável, enquanto que o movimento dos dentes inferiores foi mínimo no sentido anterior e vertical.

Splint maxilar modificado como auxiliar na correção da má oclusão de Classe II, Divisão 2, sem crescimento: relato clínico

Neste artigo é descrito o caso clínico de um paciente adulto, sem crescimento, com má oclusão de Classe II, divisão 2, tratado com um splint maxilar modificado. Foi exercida força extra-bucal com direção de tração parietal com força de 400 gramas, com uso diário de 14 horas durante 1 ano. Com este aparelho removível corrigiu-se completamente a relação de Classe II dos molares e pré-molares, levando estes dentes à oclusão normal, não havendo extrusão dentária, mantendo constante o plano mandibular. Após a correção dos dentes posteriores com o splint maxilar modificado, utilizou-se aparelhagem fixa convencional para corrigir as inclinações dos dentes anteriores e finalizar o caso.

Postsurgical stability of counterclockwise maxillomandibular advancement surgery: Affect of articular disc repositioning

Purpose: This study evaluated the affect of disc displacement and articular disc repositioning on stability after surgical counterclockwise rotation and advancement of the maxillomandibular complex.Patients and Methods: A total of 72 patients (59 females, 13 males), with an average age of 30 years (range, 15 to 60 years) were evaluated. The patients were divided into 3 groups. Group 1 (G1; n = 21), with healthy temporomandibular joints (TMJs), underwent double jaw surgery only. Group 2 (G2; n = 35), with articular disc dislocation, underwent articular disc repositioning using the Mitek anchor (Mitek Surgical Products, Westwood, MA) technique concomitantly with orthognathic surgery. Group 3 (G3; n = 16), with articular disc dislocation, underwent orthognathic surgery only. Average postsurgical follow-up was 31 months. Each patient's lateral cephalograms were traced, digitized twice, and averaged to estimate surgical changes and postsurgical stability.Results: After surgery, the occlusal plane angle was decreased significantly in all 3 groups: by -6.3 +/- -15.0 degrees in G1, by -9.6 +/- 4.8 degrees in G2, and by -7.1 +/- 4.8 degrees in G3. The maxillomandibular complex was advanced and rotated counterclockwise similarly in all 3 groups, with advancement at the menton of 12.4 +/- 5.5 mm in G1, 13.5 +/- 4.3 mm in G2, and 13.6 +/- 5.0 mm in G3; advancement at the B point of 9.5 +/- 4.9 mm in G1, 10.2 +/- 3.7 mm in G2, and 10.8 +/- 3.7 mm in G3; and advancement at the lower incisor edge of 7.1 +/- 4.6 mm in G1, 6.6 +/- 3.2 mm in G2, and 7.9 +/- 3.0 mm in G3. Postsurgery, the occlusal plane angle increased in G3 (2.6 +/- 3.8 degrees; 37% relapse rate) but remained stable in G1 and G2. Postsurgical mandibular changes in the horizontal direction demonstrated a significant relapse in G3 at the menton (-3.8 +/- 4.1 mm; 28%), the B point (-3.0 +/- 3.4 mm; 28%), and the lower incisor edge (-2.3 +/- 2.1 mm; 34%) but remained stable in G1 and G2.Conclusions: Maxillomandibular advancement with counterclockwise rotation of the occlusal plane is a stable procedure for patients with healthy TMJs and for patients undergoing simultaneous TMJ disc repositioning using the Mitek anchor technique. Those patients with preoperative TMJ articular disc displacement who underwent double-jaw surgery and no TMJ intervention experienced significant relapse. (C) 2008 American Association of Oral and Maxillofacial Surgeons.

Response of human pulps after professionally applied vital tooth bleaching

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Skeletal and dental components of Class II correction with the bionator and removable headgear splint appliances

The purpose of this study was to differentiate the dentoalveolar and skeletal effects to better understand orthodontic treatment. We evaluated the treatment changes associated with the bionator and the removable headgear splint (RHS). Methods: The sample comprised 51 consecutively treated Class II patients from 1 office who had all been successfully treated with either a bionator (n = 17) or an RHS appliance (n = 17). Class II patients waiting to start treatment later served as controls (n = 17). A modified version of the Johnston pitchfork analysis was used to quantify the dentoalveolar and skeletal contributions to the anteroposterior correction at the levels of the molars and the incisors. Results: Both appliances significantly improved anteroposterior molar relationships (2.15 mm for the bionator, 2.27 mm for the RHS), primarily by dentoalveolar modifications (1.49 and 2.36 mm for the bionator and the RHS, respectively), with greater maxillary molar distalization in the RHS group. Overjet relationships also improved significantly compared with the controls (3.11 and 2.12 mm for the bionator and the RHS, respectively), due primarily to retroclination of the maxillary incisors (2.2 and 2.38 mm for the bionator and the RHS, respectively). The differences between overall corrections and dentoalveolar modifications for both molar and overjet relationships were explained by skeletal responses, with the bionator group showing significantly greater anterior mandibular displacement than the RHS group. Conclusions: The bionator and the RHS effectively corrected the molar relationships and overjets of Class II patients primarily by dentoalveolar changes. (Am J Orthod Dentofacial Orthop 2008; 134: 732-41)

Evaluation of 2 endodontic techniques used to treat human primary molars with furcation radiolucency area: A 48-month radiographic study

Objective: To evaluate 2 techniques for the treatment of human primary molars with necrotic Pulp and bifurcation bone loss by means of radiographic examination for 48 months. Method and Materials: Fifty-one mandibular primary molars were evaluated in children ranging from 4.5 to 6.5 years of age. The teeth with necrotic pulp and bifurcation bone loss were diagnosed by radiographic examination. The teeth were divided into 2 groups: group 1 (28 teeth)-pulpotomy technique using formocresol as a temporary dressing between sessions and coronal chamber obturation with zinc oxide-eugenol cement; and group 2 (23 teeth)-pulpectomy technique with calcium hydroxide paste as a temporary dressing between sessions and root canal obturation with a dense Calcium hydroxide paste. Standardized radiographs were taken immediately after the fillings were completed and after 12, 24, 36, and 48 months. The radiographs were digitized and analyzed with software that outlined and measured the bifurcation radiolucency. Results: Bifurcation radiolucency reduced significantly or repaired completely for both treatnients in the first 12 months. Minor radiographic reduction of the lesion was observed from 12 to 24 months, and no significant reduction of the remaining radioulcent area was observed from 24 to 48 months after treatment. Conclusion: The 2 endodontic techniques evaluated showed similar results. The main effect of treatment on the lesion repair was obtained in the first year after treatment.

Bruxismo na infância: um sinal de alerta para odontopediatras e pediatras

OBJETIVO: Apresentar uma revisão de literatura sobre o bruxismo na infância, abordando os fatores etiológicos, as características clínicas, os sinais e sintomas, a importância do diagnóstico por parte dos pediatras e odontopediatras e o tratamento multidisciplinar desta condição parafuncional. FONTES DE DADOS: Foram selecionados os artigos mais relevantes sobre o tema publicados desde 1907 até 2007, com pesquisa realizada no Medline, na Bibliografia Brasileira de Odontologia (BBO) e em livros de Odontologia. SÍNTESE DOS DADOS: O bruxismo é definido como um hábito não funcional do sistema mastigatório, caracterizado pelo ato de ranger ou apertar os dentes, podendo ocorrer durante o dia e durante o sono. A etiologia é multifatorial e a literatura sugere vários fatores associados: dentário, fisiológico, psicológico e neurológico. As forças exercidas pelo bruxismo podem provocar distúrbios em diferentes graus nos dentes e nos tecidos de suporte, na musculatura e na articulação têmporo-mandibular. O sinal mais comum é o desgaste nas faces incisais dos dentes anteriores e oclusais nos posteriores, além de mobilidade e hipersensibilidade dentárias, fratura de cúspides e restaurações e hipertonicidade dos músculos mastigatórios. CONCLUSÃO: O conhecimento dos fatores etiológicos e das características clínicas do bruxismo na infância é fundamental para que o diagnóstico seja precoce, permitindo que pediatras, odontopediatras e psicólogos possam estabelecer um tratamento multidisciplinar e favoreçam o desenvolvimento integral da criança para a promoção de saúde e bem-estar individual.

Análise de Bolton: uma proposta alternativa para a simplificação de seu uso

INTRODUÇÃO: as discrepâncias entre o tamanho mesiodistal dos dentes superiores e inferiores e seus efeitos sobre a oclusão têm sido relatados há muito tempo. O método proposto por Bolton para o diagnóstico de discrepância de tamanho dentário é, inegavelmente, um dos mais difundidos no meio ortodôntico, devido à sua relativa simplicidade. Entretanto, a aplicação desse método requer cálculos matemáticos e o uso de tabelas que, muitas vezes, inviabilizam a sua utilização durante a avaliação clínica. OBJETIVO: avaliar o método proposto por Wolford, que não requer o uso de tabelas, como alternativa ao método tradicional de Bolton. MÉTODOS: a amostra foi composta por 90 pares de modelos dentários iniciais de pacientes adultos, com diferentes más oclusões. A proporção entre os dentes inferiores e superiores foi calculada para cada paciente, resultando na obtenção de dois índices (a razão total e a razão anterior). Os índices foram obtidos por meio do método originalmente proposto por Bolton e por um método alternativo, composto por duas fórmulas (uma simplificada e a variação da mesma), que foram analisadas separadamente. RESULTADOS: comparadas ao método de Bolton, as fórmulas simplificadas mostraram uma tendência de superestimar as discrepâncias dentárias inferiores (total e anterior), embora em pequena proporção. CONCLUSÕES: ambas as fórmulas do método alternativo podem ser utilizadas em substituição ao método tradicional, uma vez que mostraram diferenças médias menores que 0,58mm quando comparadas ao método de Bolton, não apresentando, portanto, significância clínica.

Orthodontic movement of teeth with intraosseous defects: histologic and histometric study in dogs

The purpose of this study was to evaluate histologically, in dogs, the periodontal healing of 1-walled intraosseous defects in teeth that were subjected to orthodontic movement toward the defects. The defects were surgically created bilaterally at the mesial aspects of the maxillary second premolars and distal aspects of the mandibular second premolars of 4 mongrel dogs. One week after creating the defects, an orthodontic appliance was installed, and the teeth were randomly assigned to 1 of 2 treatment groups: those in the test group received a titanium-molybdenum alloy rectangular wire spring that performed a controlled tipping root movement, and those in the control group received a passive stainless steel wire. Active orthodontic movement of the test teeth lasted 2 months and was followed by a stabilization period of another 2 months, after which the animals were killed. Throughout the study, routine daily plaque control was performed on the dogs with a topical application of a 2% chlorhexicline gel. The results showed no difference between the groups, with some regularization of the defects and periodontal regeneration limited to the apical portion of the defects. Histometric analysis showed a significant difference in bone height; on average, it was 0.53 mm smaller in the test group. It was concluded that orthodontic movement does not interfere with the healing of 1-walled intraosseous defects, with the exception of the linear extent of new bone apposition.

Congenital fistulae of the lower lip in Van der Woude syndrome: A histomorphological study

Objective: To evaluate a significant number of cases of fistulae of the lower lip with the light microscope in order to investigate the histological variation and to attempt to define the histopathological pattern of the lesion.Methods: Congenital fistulae of the lower lips of 17 patients with Van der Woude syndrome were analyzed by light microscopy,Results and Conclusion: the walls of most of the fistulae consisted of stratified nonkeratinized squamous epithelium and a lamina propria of dense connective tissue with areas of lymphohistiocytic inflammatory infiltrates. Bundles of striated muscle fibers, blood vessels, nerves, adipose tissue, and mixed acinar glands were observed. These glands surrounded the entire wall of the lesion, and their excretory ducts opened into the lumen of the fistula, explaining the clinical observation of elimination of mucous secretion through the opening of the fistula, Two microform cases of fistula were analyzed that presented only a depression in the epithelium at the site corresponding to the opening of the fistula.

Dens invaginatus type III: report of a case and 10-year radiographic follow-up

Aim the purpose of this article is to report the 10-year follow-up of a right mandibular central incisor with 'dens invaginatus' that was root filled.Summary 'Dens invaginatus ' is a rare malformation of teeth, probably resulting from an infolding of the dental papilla during tooth development. It has alternatively been called 'dens in dente' and 'dilated composite odontome'. Radiographic examination may clearly demonstrate this feature, although no signs may be recognized clinically. If no entrance to the invagination can be detected and there are no signs of pulp pathosis, then no treatment is required other than fissure sealing of the invagination. In deep invaginations, it is likely that root-canal treatment may be required. Occasionally, when the tooth has an immature root, apexification is necessary. Root-canal treatment of a right mandibular central incisor with 'dens invaginatus ' is described along with 10-year follow-up.Key learning pointsBoth clinical and radiographic examinations are necessary to determine morphological features of teeth before root-canal treatment.Sensibility testing to determine the pulp condition is critical prior to treatment.

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.

Pixel intensity and fractal analyses: detecting osteoporosis in perimenopausal and postmenopausal women by using digital panoramic images

Objective. Pixel intensity values (PI) and fractal dimensions (FD) were compared in selected mandibular regions on digital panoramic images of normal, osteopenic, and osteoporotic perimenopausal and postmenopausal women to evaluate their relative efficacies in detecting osteoporotic-associated bone density changes.Study design. Standardized mandibular angle, body, and canine/premolar (C/PM) regions on 54 charge-coupied device (CCD) digital panoramic images of normal and potentially osteoporotic postmenopausal women were analyzed for PI and FD. Lumbar spine and femoral neck dual-energy x-ray absorptiometry QXA) on each patient served as the reference standard examination. Pearson correlation coefficients and analysis of variance (ANOVA) were performed.Results. There was significant correlation among PI measurements (P < 0.01), and no significant correlation between FD. C/PM had significantly lower PI than control C/PM (P = 0.049).Conclusions. Osteoporotic changes in mandibular C/PM cancellous bone were detected in our study population on CCD digital panoramic images by using a robust image analysis paradigm. Future automated application of such image analysis could enable widespread, cost effective screening for osteoporosis in dental settings.

Use of BioGran and Calcitite in bone defects: Histologic study in monkeys (Cebus apella)

The present study compares the biologic behavior of BioGran and Calcitite as fillers for surgical cavities in the mandibles of 4 adult monkeys (Cebus apella). The surgical cavities were prepared through both mandibular cortices, with a diameter of 5 mm, in the angle region. Two cavities were prepared on the right side and 1 on the left and divided into 3 groups: R-1 sites were filled with bioglass (BioGran), R, sites were not filled, and L sites were filled with hydroxyapatite (Calcitite). After 180 days the animals were sacrificed and the specimens were removed for histologic processing. Results showed no bone formation in group R, (empty cavities). BioGran-treated sites showed bone formation and total repair of the bone defect, and the bioglass particles were almost totally resorbed and substituted by bone. The few remaining crystals were in intimate contact with newly formed bone. Calcitite did not allow bone formation, and granules inside the cavities were involved by connective tissue. Based upon those results, the authors concluded that bioglass resulted in total obliteration of the surgical cavity with bone and hydroxyapatite was present in a large amount and involved by connective tissue, without bone formation.

Analysis of failed commercially pure titanium dental implants: A scanning electron microscopy and energy-dispersive spectrometer X-ray study

Background: the failure of osseointegration in oral rehabilitation has gained importance in current literature and in clinical practice. The integration of titanium dental implants in alveolar bone has been partly ascribed to the biocompatibility of the implant surface oxide layer. The aim of this investigation was to analyze the surface topography and composition of failed titanium dental implants in order to determine possible causes of failure.Methods: Twenty-one commercially pure titanium (cpTi) implants were retrieved from 16 patients (mean age of 50.33 +/- 11.81 years). Fourteen implants were retrieved before loading (early failures), six after loading (late failures), and one because of mandibular canal damage. The failure criterion was lack of osseointegration characterized as dental implant mobility. Two unused implants were used as a control group. All implant surfaces were examined by scanning electron microscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) to element analysis. Evaluations were performed on several locations of the same implant.Results: SEM showed that the surface of all retrieved implants consisted of different degrees of organic residues, appearing mainly as dark stains. The surface topography presented as grooves and ridges along the machined surface similar to control group. Overall, foreign elements such as carbon, oxygen, sodium, calcium, silicon, and aluminum were detected in failed implants. The implants from control group presented no macroscopic contamination and clear signs of titanium.Conclusion: These preliminary results do not suggest any material-related cause for implant failures, although different element composition was assessed between failed implants and control implants.