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This paper emphasizes the important role that secondary bone grafting plays on the treatment of patients with alveolar clefts. The authors present a literature review and, based on panoramic radiographs, retrospectively and longitudinally analyze the behavior of permanent canines after completion of secondary bone grafting in 50 patients at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil. Twelve patients with unilateral cleft lip and alveolus and 38 patients with complete unilateral cleft lip and palate (n = 50) had undergone bone grafts to repair their residual alveolar clefts before the eruption of their permanent canines. These patients were observed over an average period of 3 years. In 94% of the sample (47 patients), the permanent canines presented intra-alveolar movement toward the oral cavity. In 72% of those 47 patients (36 patients), the permanent canines spontaneously erupted through the grafted area. In 6% of the 47 patients (3 patients), the permanent canines required orthodontic traction.

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This study shows the types of malocclusions that can be treated in the primary dentition and advocates correction of maxillary constrictions from five years of age onwards, when such constrictions lead to crossbites. A preferred method to treat maxillary constrictions is through rapid maxillary expansion (RME) with the Haas expander, even in the early stages of occlusal development. This paper presents a cross-sectional evaluation and a long-term follow-up of the upper permanent incisors during the active and passive phases of RME and shows no signs of root or pulp alterations.

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Literature has shown that, even with the conservative nontraumatic surgical techniques, early repairing surgeries induce changes in the upper dental arch morphologic characteristics in patients with cleft lip and palate. The evaluation of unoperated adult cleft patients enables us to exclude the influence of treatment, emphasizing the morphologic characteristics inherent to the presence of the cleft and its functional counterbalances, that is, the morphologic pattern imposed by cleft. In this study, the maxillary dental casts of 31 unoperated adult complete bilateral cleft lip and palate patients (20 men and 11 women) were compared to a noncleft sample matched for gender. Intercanine, inter-first premolar, inter-second premolar and inter-first molar arch widths measurements as well as arch length were measured from xerox copies taken of the models. The findings indicate the presence of premaxillary prognathism and a progressive increase in the constriction of the dental arches. This constriction of the maxillary segments, even in the absence of surgical intervention, is a result of the absence of an intact palate between the two maxillary processes. Although gender significantly influenced the size of the maxillary arches in the noncleft patients, similar differences were not observed in the cleft group. It seems that the presence of the cleft in itself has the greater influence on the morphologic characteristics of the maxillary arch than gender.

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OBJECTIVE: This report is a retrospective study that compares the craniofacial morphology of adult subjects with unoperated bilateral complete cleft lip and palate (BCLP) with that of a noncleft group. METHODS: The study was performed on standardized lateral cephalograms obtained at the Hospital for Research and Rehabilitation of Cleft Lip and Palate, University of São Paulo, Brazil. The research group consisted of 28 subjects (20 males, 8 females) with unoperated BCLP, ranging in age from 15 to 41 years. The control group was matched to the cleft group with regard to gender and age. The findings were analyzed on the basis of the two-way analysis of variance (ANOVA) for cleft and gender. RESULTS: The most striking difference between the groups was the extremely prominent premaxilla in the cleft group that gave the BCLP face a very convex profile. The mandible exhibited a vertical growth pattern that resulted in a steep mandibular plane, an obtuse gonial angle and a long lower face height. The posterior face height was reduced. The cranial base dimensions were smaller, but there was no difference in cranial base angulation. CONCLUSIONS: These findings confirm that in subjects with unoperated BCLP, the initial characteristics of the cleft malformation persist during growth.

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This study comprised a sample of 31 patients with Class III malocclusion (21 girls and 10 boys), with ages ranging from 5 years 2 months to 11 years 6 months. All patients were in the deciduous or mixed dentition. The indicated treatment was rapid maxillary expansion, immediately followed by maxillary protraction with the facial mask. Mean treatment time was 8 months, varying from 4 to 24 months. The therapy induced both dental and skeletal alterations. Skeletal alterations consisted of maxillary anterior displacement and mandibular downward and backward rotation, improving facial profile. Dental alterations, known as dentoalveolar compensations, consisted of a tendency of labial tipping of the maxillary incisors and lingual tipping of the mandibular incisors.

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This article illustrates an unusual situation, the ectopic eruption of the mandibular permanent lateral incisor, through the case report of a patient with a Class I malocclusion at an early stage of the mixed dentition. The article is focused on the diagnosis of the ectopic eruption and advocates treatment with an active orthodontic therapy at the early stage of the mixed dentition, before the eruption of the permanent cuspid.

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This study was designed to investigate the effect of nonsurgical rapid maxillary expansion in adult patients diagnosed as having real or relative transverse maxillary deficiency. Thirty-eight patients were consecutively treated with a fixed rapid maxillary expansion appliance of the Haas design. Successful expansion, as judged by clinical evidence of the creation of a diastema at the central incisors, was possible in 81.5% of the patients. Morbidity ranged from mild discomfort to significant pain, edema, and palatal lesions, which, in most instances, did not compromise the expansion. Only moderate maxillary expansion was possible in most patients, but enough was obtained to facilitate the achievement of satisfactory final interocclusal relations.

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The dental compensation presented in patients with the Class III malocclusion, or mandibular prognathism, and its importance to the surgical-orthodontic treatment, was evaluated in this study. The study involved the cephalometric examination of two groups of patients, who were considered either adequately or inadequately treated during the presurgical orthodontic phase. The results showed that dental compensation is common in both the maxillary and mandibular arches. Such compensation is more frequently eliminated from the mandibular arch during presurgical orthodontic treatment. There was some correlation between decompensation and the amount of mandibular reduction during surgery and a strong correlation between cephalometric postsurgical mandibular excess and the lower anterior facial height.

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The purpose of this study was to determine the incidence of ectopic eruption of the maxillary first permanent molars in cleft patients. Panoramic radiographs of 70 Brazilian Caucasian children, 6 to 8 years old and with complete unilateral cleft lip and alveolus, were assessed. Fourteen of 70 patients (20%) presented with ectopic eruption of one or both maxillary first permanent molars. Sixteen of 19 ectopically erupted molars (85%) were of a reversible type of ectopic eruption and 3 (15%) were irreversible. No significant differences were found between sexes or between cleft sides.

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Our aim was to evaluate the isolated effects of cheiloplasty and palatoplasty on dentofacial morphology. Ninety-three lateral cephalograms of white male adult patients with complete unilateral cleft lip and palate were analyzed in this study. The sample was divided into three groups according to the surgical treatment received: (1) nonoperated group (NO)-35 patients without surgical treatment; (2) operated lip group (OL)-23 subjects with lip closure only; (3) operated lip and palate group (OLP)-35 individuals with both lip and palatal closure. No statistically significant differences in the cephalometric measurements between the OL and OLP groups were found. There were, however, several significant differences between these two groups (OL and OLP) and the nonoperated group (NO). Thus, the differences in dentofacial morphology in patients with unilateral cleft lip and palate, seem to be influenced principally by the surgically repaired lip. Influences of the palatal repair appeared to be minimal and statistically insignificant.

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There is an agreement among orthodontists that a posterior crossbite relationship should be treated early. The Haas expansion appliance is frequently chosen whenever a maxillary skeletal constriction exists in the deciduous, mixed, or permanent dentition. In this study we evaluated the efficacy of rapid maxillary expansion for 32 children between 5 and 11 years of age, by inspection of anteroposterior radiographs. Our results confirm previous data in the literature that the triangular opening in the frontal alveolar area is greater than in other parts of the midpalatal suture. It is evident that with expansion there is a real orthodontic effect, even at an early age.

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A total of 229 adult white patients with cleft lip or palate were evaluated, through cephalometric radiographs, to determine cleft-type influence on mandibular structure and spatial position. The sample includes adult patients with unilateral complete cleft lip and alveolus (n = 50), complete cleft lip and palate (n = 118), and isolated cleft palate (n = 61). A group of 65 subjects with normal occlusion and without cleft lip or palate was used as a control group. All groups were matched according to sex. When compared, the cleft groups and the normal group showed that the mandibular structure was significantly different. The mandible in the cleft groups displayed shorter mandibular ramus and body length, without difference between the cleft types. Mandibular position relative to cranial base was similar in the cleft groups with involvement of the palate, and differed significantly from that observed in the group with cleft lip and alveolus and in the subjects without cleft. Palatal clefts induce a significant downward and backward rotation of the mandible associated with a more obtuse gonial angle. Thus a small mandible is a structural characteristic of all cleft types studied. However, mandibular shape and spatial position are strongly influenced in clefts that involve the palate.

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Using a sample of 204 caucasian adults of both sexes, with complete unilateral cleft lip and alveolus, isolated cleft palate and complete unilateral cleft lip, alveolus and palate, the influence of surgery on maxillary morphology and spatial position for the three main types of cleft lip and/or palate were evaluated. 113 cleft patients operated on at conventional timings were compared to 91 cleft patients who had never been operated on. Findings permit the conclusion that cheiloplasty in cleft lip and alveolus patients is associated with osseous remodelling in the anterior alveolar region, without significant changes in anterior nasal spine or other areas of the maxilla. In isolated cleft palate subjects palate repair does not promote significant changes in maxillary morphology and spatial position. The most evident effects were seen in the cleft lip, alveolus and palate group: reconstructive surgery in these patients leads to a severe maxillary retroposition associated with a downward rotation.

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A sample of 97 untreated cleft lip and palate adult patients, with and without Simonart's band, was analyzed. The dimensions and form of the maxillary dental arches were analyzed. Comparison of this sample with a "normal" group indicated maxillary dental arch size and shape are distorted by the presence of a cleft which is characterized by a constriction that becomes more severe in the medial and anterior regions. The presence of Simonart's band affects the cleft arch form, redirecting the anterior extremity of the major segment towards the minor segment.

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The present study evaluated the skeletal alterations induced by rapid maxillary expansion procedures in 30 patients in the primary and mixed dentitions. The results were obtained with the use of lateral cephalometrics before and immediately after the active phase of expansion. The time span between these two cephalometric films ranged from 14 to 21 days; therefore the "growth factor" was not considered. Based on the differences in the cephalometric measurements studied on the first and second tracings, it seems that anterior displacement of the maxilla with significant changes in the SNA angle should not be expected, although point B was repositioned more posteriorly (SNB) because of the mandibular downward and backward rotation, with subsequent increase of the inclination of the mandibular plane. The alterations in the A-P position of the mandible was reflected in the increase of ANB and NAP angles. The maxilla always dislocates downward, displaying a downward and backward rotation in the palatine plane, significantly altering the following measurements: N-ANS, PNS-PNS', A-A', SN.PP. The anchoring molars also follow the downward maxillary displacement (M-M') and, as a direct consequence of the vertical displacement of the maxilla and upper molars (N-ANS, A-A', ANS-Me, N-Me, PNS-PNS'), the facial heights increase.

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Excellent results were obtained by using the classical palatal crib for the patient, who is appraised as having morphological, functional and psychological changes resulting from finger and/or pacifier sucking habits.

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We have evaluated 2,416 children of both sexes from Bauru, with mixed dentition, at the age between 7 and 11 years, enrolled in 18 public and private schools. The data regarding their occlusal conditions were written down in index cards previously elaborated to make possible the percentual calculation and the illustrative graphics. In this article we propose to find out the percentage of normal occlusion and distribution of malocclusions, according to the anteroposterior relationship between the dental archs (following the ANGLE3 classification) and their social-economical status. The results show a low percentual of normal occlusion, in total of 11.47% from the studied population. Class I malocclusion was the most prevalent (55%), followed by class II (42%) and, finally, by class III (3%). The social-economical condition had an influence upon the percentual of normal occlusion and class I malocclusion. In a lower social-economical level there was an increase in the percentual of class I malocclusion to the detriment of the reduction of normal occlusion. Class II and III malocclusions were not influenced by the social-economical status.

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We have evaluated 2,416 children of both sexes from Bauru, with mixed dentition, at the age between 7 and 11 years, enrolled in 18 public and private schools. In this article we propose to find out the percentage of normal occlusion and the distribution of maloclusions, according to the anteroposterior relationship between the dental archs (following the ANGLE3 classification). The results show a low percentual of normal occlusion, in a total of 11.47% from the studied population. Class I malocclusion was the most prevalent (55%), followed by class II (42%) and, by class III (3%).

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The purpose of this paper was to evaluate the effectiveness of a supervision program for motivation and instruction of hygiene buccal in respect of the control of plaque and marginal gingivitis in children with seven to twelve years old, undergoing removable or fixed orthodontic appliance therapy. These patients were divided into two groups. The experimental group was of thirty-eight children who were individually instructed for the hygiene method. They were analysed and instructed periodically. The twenty-five children of the control group were instructed for a correct brushing; however no attempt was done to change their habits. They also have been periodically evaluated. The evaluation of de buccal health conditions was measured in a period of eight months by means of plaque and marginal pappilar gingivitis index. Is was verified a reduction in the plaque and gingivitis index, in the experimental group of 100% and 88.6%, respectively. The control group has showed a reduction of 74.6% and 78.9%, respectively. The control of plaque and gingivitis was more efficient in the patients who were periodically instructed and motivated, with a difference statistically significant, from the third week. These data helped to demonstrate that the plaque and the periodontal disease can be suitably controlled by the patient even with the use of orthodontic appliances. The instructed and supervisioned brushing technic is more efficient than the habitual brushing in the control of plaque and gingivitis in patients with orthodontic appliance.

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