RESUMEN
PURPOSE: The aim of this study was to evaluate the effect of combining a bone-borne palatal expander (distractor) with a maxillary osteotomy in the treatment of narrowed maxillae in treated cleft palate patients. Few articles in the literature isolated the effects of transpalatal distraction in cleft patients and most either excluded cleft patients or grouped them with non-cleft patients. The hypothesis is that the use of a bone-borne palatal expander in conjunction with a maxillary osteotomy would improve the amount of maxillary expansion at the anterior segment with less tipping of the segments and provide a harmonious arch form. METHODS: We studied four patients above 14 years of age with repaired cleft palate and progressive anterior constriction of the arch. All patients received a bone-borne distractor (UNI-Smile Distractor, Titamed, Belgium) combined with a LeFort I level osteotomy without pterygomaxillary disjunction. Dental models and CBCT measurements were used to analyze the skeletal and dental effects of the intervention. RESULT: All the patients who completed the trial had satisfactory expansion and normalization of the maxillary arch form. The average increase in the intercanine distance was 12.9 mm while the average increase in the intermolar distance was 7.2 mm. No significant change in molar inclination or buccal bone thickness was observed. CONCLUSION: The use of bone-borne palatal expanders aided by a maxillary osteotomy (transpalatal distraction) in treated cleft palate patients can provide a harmonious arch form in adolescent and adult patients. This trial was registered in the clinical trials registry with the ID NCT03837652 on February 12, 2019.
Asunto(s)
Fisura del Paladar , Osteogénesis por Distracción , Técnica de Expansión Palatina , Adolescente , Femenino , Humanos , Masculino , Fisura del Paladar/cirugía , Fisura del Paladar/diagnóstico por imagen , Tomografía Computarizada de Haz Cónico , Maxilar/cirugía , Maxilar/anomalías , Osteogénesis por Distracción/métodos , Osteogénesis por Distracción/instrumentación , Osteotomía Le Fort/métodos , Técnica de Expansión Palatina/instrumentaciónRESUMEN
Objective: The objective of this randomized clinical trial was to study the skeletal and dental effects of low-level laser therapy (LLLT) along with a miniscrew-assisted expander (Hyrax) after six months of retention. Methods: After sequence generation, concealed allocation, and implementation, 24 female patients were randomly divided (1:1) into two-groups: bone-borne rapid palatal expansion (BBE) without LLLT (n = 12) and BBE with LLLT (n = 12). Eligibility criteria included female patients aged 10-13 years old with bilateral posterior crossbites. Intraoral and extraoral photographs, cone-beam computed tomography images, and digital study models were obtained before expansion and six months after retention. The 7 mm Hyrax appliance was anchored to four palatal mini-screws, which were activated twice daily for 15 days, then locked and kept in place as a retainer. LLLT was performed in the laser group during expansion and retention, according to the guidelines provided. Results: The records of 24 patients were analyzed. According to the post-retention measurements, both groups showed a significant increase in nasal and maxillary widths and total facial height. In the laser group, the Sella-Nasion-Point A and Point A-Nasion-Point B angles and the interpremolar apical distance were significantly increased. Conclusions: Within the limitations of this study, the results suggest that the parameters and protocol of LLLT do not clinically affect the efficiency of BBE in prepubertal and pubertal patients.
RESUMEN
OBJECTIVES: To evaluate anchorage control using miniscrews vs an Essix appliance in treatment of Class II malocclusion by distalization using the Carrière Motion Appliance (CMA). MATERIALS AND METHODS: Twenty-four postpubertal female patients with Class II, division 1 malocclusion were randomly distributed into two equal groups. CMA was bonded in both groups, and one group was treated with miniscrews as anchorage (12 patients, mean age = 18.0 years) while the other group was treated with an Essix appliance as anchorage (12 patients, mean age = 17.8 years). For each patient, two cone-beam computed tomographic scans were obtained: one preoperatively and another after completion of distalization. RESULTS: In the Essix appliance group, there was a statistically significant anterior movement (2.2 ± 1.43 mm) as well as proclination of the lower incisor (5.3° ± 4.0°), compared to a nonsignificant anterior movement (0.06 ± 1.45 mm) and proclination (0.86° ± 2.22°) in the miniscrew group. The amount of maxillary molar distalization was higher in the miniscrew group (2.57 ± 1.52 mm) than in the Essix appliance group (1.53 ± 1.11 mm); however, the difference was not statistically significant. CONCLUSIONS: Miniscrews led to a decrease in the amount of anchorage loss in the mandibular incisors, both in terms of anterior movement and proclination.
Asunto(s)
Maloclusión Clase II de Angle , Métodos de Anclaje en Ortodoncia , Adolescente , Cefalometría , Femenino , Humanos , Maloclusión Clase II de Angle/diagnóstico por imagen , Maloclusión Clase II de Angle/terapia , Maxilar , Diseño de Aparato Ortodóncico , Técnicas de Movimiento DentalRESUMEN
OBJECTIVES: To compare the root resorption resulting from miniscrew-supported maxillary posterior dentoalveolar intrusion using two different force magnitudes. MATERIALS AND METHODS: Adult patients with skeletal open bite, indicated for maxillary posterior dentoalveolar intrusion, were recruited and randomly assigned to the comparison or intervention groups. The comparison group involved applying 200 g of intrusive force per segment, which measured 20 g per root, while this force was 400 g per segment in the intervention group, measuring 40 g per root. RESULTS: Twenty participants were included in the final analysis after 2 patients dropped out, 1 in each group, to end up with 10 subjects (200 roots) per group. There was statistically significant root resorption of 0.84 ± 0.96 mm and 0.93 ± 1.00 mm in the comparison and the intervention groups, respectively. However, there was no statistically significant difference between the groups. CONCLUSIONS: Root resorption inevitably took place in association with orthodontic intrusion. However, increasing the magnitude of the intrusive force did not increase the amount of root resorption, either statistically or clinically.
Asunto(s)
Mordida Abierta , Métodos de Anclaje en Ortodoncia , Resorción Radicular , Adulto , Humanos , Maxilar/diagnóstico por imagen , Resorción Radicular/diagnóstico por imagen , Resorción Radicular/etiología , Técnicas de Movimiento Dental/efectos adversosRESUMEN
OBJECTIVES: To compare the effects of two different force magnitudes on maxillary posterior segment intrusion using mini-screws. The null hypothesis was that there would be no difference between the two force magnitudes. MATERIALS AND METHODS: Adult patients with skeletal open bite and a dental open bite ranging from 3 to 8 mm were recruited for this trial. The comparator group had 200 g of intrusive force applied for posterior segment intrusion, whereas 400 g of force was applied in the intervention group. Primary outcomes were the amount of posterior teeth intrusion and anterior open bite closure. RESULTS: Twenty-two subjects were randomized to include 11 participants in each group. One participant dropped out in each group, leaving us with 10 subjects to be analyzed per group. There was statistically significant posterior teeth intrusion of 2.42 ± 2.06 and 2.26 ± 1.87 mm for the comparator and intervention groups, respectively, with no difference between them. Statistically significant open bite closure was achieved in both groups, measuring 2.24 ± 1.18 and 3.15 ± 1.06 mm in the comparator and intervention groups, respectively, with no difference between them. CONCLUSIONS: Both the 200 g and 400 g intrusive forces yielded similar outcomes in terms of posterior teeth intrusion and anterior open bite closure.