Reaproveitamento imediato da ação expansora em um caso de expansão rápida da maxila assistida cirurgicamente

Immediate reutilization of the expanding action in a case of rapid maxillary expansion surgically assisted. The orthopedic rapid maxillary expansion (RME) and rapid maxillary expansion surgically assisted (RMESA) are conducted with the aim of giving an appropriate jaw, capable of providing a normal occlusion. In extreme cases, where there is a severe atresia, it is necessary to perform an expansion beyond that allowed by the expander, followed by another conventional device or a butterfly expander, when the atresia is in the anterior maxillary region. In this situation, there are two options: wait about 90 days to allow intermaxillary suture restructuring and perform a new RME / RMESA or proceed immediately to the expansion process. Considering the biological cost, financial and clinical time, the procedure of reusing the immediate expander action becomes the technique of choice in these cases, been the operational procedure performed simplified and in just four steps. This work will show a case report where, after accomplishing the RMESA was observed that even after changing the shape of the maxillary arch, the severity of atresia could not be corrected, especially in the anterior region, and more expansion was needed. Aiming to correct the atresia in the anterior maxilla, the technique used was to reuse the immediate expander action through the change of an intraoral screw expander for a conventional butterfly type screw expander.

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.

Aparelho de Herbst associado a aparelhos fixos: descrição de técnica

This paper aims at describeconstruction and installation sequences of a new design of appliance that allows continuously protraction of the mandible, using the telescopic mechanism of the Herbst appliance. This appliance has the advantage to be easily assembled by the orthodontist, without the necessity of molding and the assistance of a specialized laboratory, as well as the constant permanence in the mouth of the patient for being fixed.

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.

Avaliação das alterações dentárias e esqueléticas induzidas pelo uso do aparelho de Herbst no tratamento da classe II na dentadura mista: Revisão sistemática

Objective: evaluate the immediate dental and skeletal changes induced by the Herbst appliance on early treatment of Angle´s Class II malocclusion. Material and Method: several electronic databases such as Scopus, Pub Med, Medline, Cochrane Library, Lilacs and Scielo were searched. The abstracts that fullfilled the selection criteria were selected and those that did not provide enough information about these criteria were selected but the final decision of including them or not on the research, was taken after the complete reading of the article. The selection criteria were: clinical studies with Class II individuals, both male and female, with initial age of 7 to 10 years, treated with the Herbst appliance that analysed the dental and/or skeletal changes evaluated on lateral cephalometric radiographs; researches where the treatment performed did not involve extractions or surgical interventions; studies that included patients without syndromes or health concerns and articles published in English or Portuguese. Results and Conclusions: five articles were selected. The articles showed that significant changes happened in the mandibular sagittal lenght, on facial convexity angle, on maxillo-mandibular relationship, on retroclination of the upper incisors and on distal movement of the upper molars, on proclination of the lower incisors and on extrusion of the lower molars. The appliance exerted a limited effect on the anterior relocation of the maxillary complex and on facial heights. However, more studies about the performance of the Herbst appliance on early treatment of Class II are needed.

Modificação de forma e dimensões dos arcos superior e inferior obtidas em modelos de estudo após expansão rápida da maxila com o aparelho hyrax

The aim of an orthodontic treatment is the achievement of a balanced, esthetic and, most of all, stable, intra and inter arches relationship. A common problem observed in occlusion is posterior crossbite and atresic maxilla. This problem may be treated by slow expansion, rapid expansion or surgically assisted expansion. For the present study cast models of 14 children between 7 and 11 years old were evaluated. There were 7 male and 7 female subjects that presented posterior crossbite and needed rapid maxillary expansion. The Hyrax appliance performed the therapy for correction of this transversal alteration, which is a common possibility in the treatment of this malocclusion. It was observed that the distance between the upper first molars and upper cuspids increased significantly; the length of the upper arch decreased and its perimeter increased significantly. At the lower arch there were no dimensional changes.

Trainer for Kids (T4K), um único aparelho para o tratamento de dois problemas verticais: mordida aberta anterior e mordida profunda

The Trainer for Kids is a prefabricated funcitonal appliance indicated for early treatment of the Class I malocclusion, crowding, anterior open bite, deep bite and oral habits (finger and/or sucking, atypic deglutition, tongue interposition and oral breathing). The aim of this paper is show two case reports treated with the T4K appliance being an anterior open bite and a deep bite.

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.

Aparelho expansor Haas com molas digitais para correção da mordida cruzada anterior e posterior

As mordidas cruzadas anteriores e posteriores podem ser tratadas desde as dentaduras decídua e mista. Embora a literatura descreva diversas técnicas para a correção individualizada desses problemas, o tratamento de pacientes com as duas alterações é pouco documentado. O presente artigo relata o tratamento desses problemas com o expansor tipo Haas associado a molas digitais. Essa alternativa apresenta boa previsibilidade, fácil confecção e instalação, e ótima eficiência.

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.

Tratamento da má oclusão de classe II com aparelho Jasper Jumper

The Jasper Jumper appliance was developed as a fixed orthopedic device that is connected to the upper and lower leveling arches to promote the Class II correction by restricting the maxillary growth (headgear effect), mandibular growth inducement (activator effect) and dentoalveolar changes.

Simplificação no tratamento da fratura de ângulo mandibular por meio do acesso intrabucal

Mandibular fractures are the injury most commonly found in the facial bones. They have varied etiology, such as automobile, motorcycle and cycling accidents, physical abuse and falls. The choice of treatment of mandibular fractures most often employed is the reduction and fixation of bone fragments. Regarding fractures involving the mandibular angle, access headgear is the most widely used, in view of the action of masticatory muscles causing greater displacement of fractured stumps. Therefore, the proposal to introduce a conservative approach and facilitated for the treatment of fractures of the mandibular angle, as well as to demystify the contraindication to intraoral approach cases unfavorable fracture displacement, this work is to report a clinical casesurgical mandibular angle fracture, treated by intraoral approach. The fracture was fixed with two plates, one following the external oblique line system (1.5 mm) and a lower system (2.0 mm), with the help of percutaneous trocar. This approach is very promising for these cases, in order to ease the technical as well as by reducing the technical complications of extraoral approach.

Tráfego veicular e mortalidade por doenças do aparelho circulatório em homens adultos

OBJETIVO: Analisar a associação entre indicadores de exposição à poluição por tráfego veicular e mortalidade por doenças do aparelho circulatório em homens adultos. MÉTODOS: Foram analisadas informações sobre vias e volume de tráfego no ano de 2007 fornecidas pela companhia de engenharia de tráfego local. Mortalidade por doenças do aparelho circulatório no ano de 2005 entre homens ≥ 40 anos foram obtidas do registro de mortalidade do Programa de Aprimoramento de Informações de Mortalidade do Município de São Paulo, SP. Dados socioeconômicos do Censo 2000 e informações sobre a localização dos serviços de saúde também foram coletados. A exposição foi avaliada pela densidade de vias e volume de tráfego para cada distrito administrativo. Foi calculada regressão (α = 5%) entre esses indicadores de exposição e as taxas de mortalidade padronizadas, ajustando os modelos para variáveis socioeconômicas, número de serviços de saúde nos distritos e autocorrelação espacial. RESULTADOS: A correlação entre densidade de vias e volume de tráfego foi modesta (r² = 0,28). Os distritos do centro apresentaram os maiores valores de densidade de vias. O modelo de regressão espacial de densidade de vias indicou associação com mortalidade por doenças do aparelho circulatório (p = 0,017). Não se observou associação no modelo de volume de tráfego. Em ambos os modelos – vias e volume de tráfego (veículos leves/pesados) – a variável socioeconômica foi estatisticamente signifi cante. CONCLUSÕES: A associação entre mortalidade por doenças do aparelho circulatório e densidade de vias converge com a literatura e encoraja a realização de mais estudos epidemiológicos em nível individual e com métodos mais acurados de avaliação da exposição.

Adaptação do aparelho de amplificação sonora no SUS comparado com um modelo de adaptação compacto

In the present days it is critical to identify the factors that contribute to the quality of the audiologic care provided. The hearing aid fitting model proposed by the Brazilian Unified Health System (SUS) implies multidisciplinary care. This leads to some relevant and current questions. OBJECTIVE: To evaluate and compare the results of the hearing aid fitting model proposed by the SUS with a more compact and streamlined care. METHOD: We conducted a prospective longitudinal study with 174 participants randomly assigned to two groups: SUS Group and Streamline Group. For both groups we assessed key areas related to hearing aid fitting through the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire, in addition to evaluating the results of Speech Recognition Index (SRI) 3 and 9 months after fitting. RESULTS: Both groups had the same improvement related to the speech recognition after nine months of AASI use, and the IOI-HA didn't show any statically significant difference on three and nine months. CONCLUSION: The two strategies of care did not differ, from the clinical point of view, as regards the hearing aid fitting results obtained upon the evaluation of patients in the short and medium term, thus changes in the current model of care should be considered.