RESUMO
Four premolar extractions is a successful protocol to treat Class I malocclusion, but it is a less efficient way when compared with other Class II treatment protocols. Objective: The objective of this study was to evaluate the influence of anteroposterior discrepancy on the success of four premolar extractions protocol. For that, treatment efficiency of Class I and complete Class II malocclusions, treated with four premolar extractions were compared. Methods: A sample of 107 records from 75 Class I (mean age of 13.98 years - group 1) and 32 Class II (mean age of 13.19 years - group 2) malocclusion patients treated with four premolar extractions was selected. The initial and final occlusal status of each patient was evaluated on dental casts with the PAR index. The treatment time was calculated based on the clinical charts, and the treatment efficiency was obtained by the ratio between the percentage of PAR reduction and treatment time. The PAR index and its components, the treatment time and the treatment efficiency of the groups were statistically compared with t tests and Mann-Whitney U-test. Results: The Class II malocclusion patients had a greater final PAR index than Class I malocclusion patients, and similar duration (Class I - 28.95 mo. and Class II - 28.10 mo.) and treatment efficiency. Conclusion: The treatment of the complete Class II malocclusion with four premolar extractions presented worse occlusal results than Class I malocclusion owing to incomplete molar relationship correction. .
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Adulto Jovem , Dente Pré-Molar/cirurgia , Má Oclusão Classe I de Angle/terapia , Má Oclusão Classe II de Angle/terapia , Extração Seriada/métodos , Fatores Etários , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do TratamentoRESUMO
UNLABELLED: Four premolar extractions is a successful protocol to treat Class I malocclusion, but it is a less efficient way when compared with other Class II treatment protocols. OBJECTIVE: The objective of this study was to evaluate the influence of anteroposterior discrepancy on the success of four premolar extractions protocol. For that, treatment efficiency of Class I and complete Class II malocclusions, treated with four premolar extractions were compared. METHODS: A sample of 107 records from 75 Class I (mean age of 13.98 years--group 1) and 32 Class II (mean age of 13.19 years--group 2) malocclusion patients treated with four premolar extractions was selected. The initial and final occlusal status of each patient was evaluated on dental casts with the PAR index. The treatment time was calculated based on the clinical charts, and the treatment efficiency was obtained by the ratio between the percentage of PAR reduction and treatment time. The PAR index and its components, the treatment time and the treatment efficiency of the groups were statistically compared with t tests and Mann-Whitney U-test. RESULTS: The Class II malocclusion patients had a greater final PAR index than Class I malocclusion patients, and similar duration (Class I - 28.95 mo. and Class II - 28.10 mo.) and treatment efficiency. CONCLUSION: The treatment of the complete Class II malocclusion with four premolar extractions presented worse occlusal results than Class I malocclusion owing to incomplete molar relationship correction.
Assuntos
Dente Pré-Molar/cirurgia , Má Oclusão Classe II de Angle/terapia , Má Oclusão Classe I de Angle/terapia , Extração Seriada/métodos , Adolescente , Adulto , Fatores Etários , Criança , Feminino , Humanos , Masculino , Análise de Regressão , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCTION: The objective of this study was to evaluate the long-term stability of open-bite surgical-orthodontic correction. METHODS: Thirty-nine patients at an initial mean age of 20.83 years were evaluated cephalometrically at pretreatment (T1), immediately after treatment (T2), and at the last recall (T3), with a mean follow-up time of 8.22 years. The surgical protocol included single-jaw or double-jaw surgery. Because the patients had different anteroposterior malocclusions, the sample was divided into a Class I and Class II (I-II) subgroup (3 Class I, 20 Class II malocclusion patients) and a Class III subgroup (16 patients). The dentoskeletal characteristics of the total sample and the subgroups were compared at T1, T2, and T3 with dependent analysis of variance (ANOVA). RESULTS: Overbite relapse in the posttreatment period was statistically significant in the whole sample and the Class I-II subgroup. Fourteen patients of the whole sample (35.9%) had clinically significant open-bite relapse (negative overbite). CONCLUSIONS: There was a statistically significant open-bite relapse in the overall sample and in the Class I-II subgroup. The clinically significant values of long-term open-bite correction stability were 64.11%, 47.82%, and 87.50% in the overall sample, the Class I-II subgroup, and the Class III subgroup, respectively.
Assuntos
Mordida Aberta/cirurgia , Ortodontia Corretiva , Procedimentos Cirúrgicos Ortognáticos , Adolescente , Adulto , Placas Ósseas , Parafusos Ósseos , Fios Ortopédicos , Cefalometria , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Má Oclusão Classe I de Angle/cirurgia , Má Oclusão Classe I de Angle/terapia , Má Oclusão Classe II de Angle/cirurgia , Má Oclusão Classe II de Angle/terapia , Má Oclusão Classe III de Angle/cirurgia , Má Oclusão Classe III de Angle/terapia , Mandíbula/cirurgia , Maxila/cirurgia , Mordida Aberta/terapia , Osteotomia/métodos , Osteotomia de Le Fort/métodos , Técnica de Expansão Palatina , Recidiva , Estudos Retrospectivos , Extração Seriada , Adulto JovemRESUMO
Class III malocclusions are considered one of the most complex and difficult orthodontic problems to diagnose and treat. Skeletal and/or dental asymmetries in patients presenting with Class III malocclusions can worsen the prognosis. Recognizing the dentoalveolar and skeletal characteristics of subdivision malocclusions and their treatment possibilities is essential for a favorable nonsurgical correction. Therefore, this article presents a nonsurgical asymmetric extraction approach to Class III subdivision malocclusion treatment which can significantly improve the occlusal and facial discrepancies.
Assuntos
Cimentos Dentários , Má Oclusão/terapia , Ortopedia , Adolescente , Criança , HumanosRESUMO
Class III malocclusions are considered one of the most complex and difficult orthodontic problems to diagnose and treat. Skeletal and/or dental asymmetries in patients presenting with Class III malocclusions can worsen the prognosis. Recognizing the dentoalveolar and skeletal characteristics of subdivision malocclusions and their treatment possibilities is essential for a favorable nonsurgical correction. Therefore, this article presents a nonsurgical asymmetric extraction approach to Class III subdivision malocclusion treatment which can significantly improve the occlusal and facial discrepancies.
Assuntos
Adolescente , Criança , Humanos , Cimentos Dentários , Má Oclusão/terapia , OrtopediaRESUMO
This article reports the case of a 19-year-old young man with Class III malocclusion and posterior crossbite with concerns about temporomandibular disorder (TMD), esthetics and functional problems. Surgical-orthodontic treatment was carried out by decompensation of the mandibular incisors and segmentation of the maxilla in 4 pieces, which allowed expansion and advancement. Remission of the signs and symptoms occurred after surgical-orthodontic intervention. The maxillary dental arch presented normal transverse dimension. Satisfactory static and functional occlusion and esthetic results were achieved and remained stable. Three years after the surgical-orthodontic treatment, no TMD sign or symptom was observed and the occlusal results had not changed. When vertical or horizontal movements of the maxilla in the presence of moderate maxillary constriction are necessary, segmental LeFort I osteotomy can be an important part of treatment planning.
Assuntos
Má Oclusão Classe III de Angle/cirurgia , Osteotomia de Le Fort/métodos , Transtornos da Articulação Temporomandibular/cirurgia , Humanos , Masculino , Má Oclusão Classe III de Angle/complicações , Técnica de Expansão Palatina , Transtornos da Articulação Temporomandibular/etiologia , Adulto JovemRESUMO
This article reports the case of a 19-year-old young man with Class III malocclusion and posterior crossbite with concerns about temporomandibular disorder (TMD), esthetics and functional problems. Surgical-orthodontic treatment was carried out by decompensation of the mandibular incisors and segmentation of the maxilla in 4 pieces, which allowed expansion and advancement. Remission of the signs and symptoms occurred after surgical-orthodontic intervention. The maxillary dental arch presented normal transverse dimension. Satisfactory static and functional occlusion and esthetic results were achieved and remained stable. Three years after the surgical-orthodontic treatment, no TMD sign or symptom was observed and the occlusal results had not changed. When vertical or horizontal movements of the maxilla in the presence of moderate maxillary constriction are necessary, segmental LeFort I osteotomy can be an important part of treatment planning.
Assuntos
Humanos , Masculino , Adulto Jovem , Má Oclusão Classe III de Angle/cirurgia , Osteotomia de Le Fort/métodos , Transtornos da Articulação Temporomandibular/cirurgia , Má Oclusão Classe III de Angle/complicações , Técnica de Expansão Palatina , Transtornos da Articulação Temporomandibular/etiologia , Adulto JovemRESUMO
INTRODUCTION: The objectives of this investigation were to compare the initial cephalometric characteristics of complete Class II Division 1 malocclusions treated with 2 or 4 premolar extractions and to verify their influence on the occlusal success rate of these treatment protocols. METHODS: A sample of 98 records from patients with complete Class II Division 1 malocclusion was divided into 2 groups with the following characteristics: group 1 consisted of 55 patients treated with 2 maxillary first premolar extractions at an initial mean age of 13.07 years; group 2 included 43 patients treated with 4 premolar extractions, with an initial mean age of 12.92 years. Initial and final occlusal statuses were evaluated on dental casts with Grainger's treatment priority index (TPI), and the initial cephalometric characteristics were obtained from the pretreatment cephalograms. The initial cephalometric characteristics and the initial and final occlusal statuses of the groups were compared with the t test. A multiple regression analysis was used to evaluate the influence of all variables in the final TPI. RESULTS: The 2-premolar extraction protocol provided a statistically smaller TPI and consequently a better occlusal success rate than the 4-premolar extraction protocol. The 4-premolar extraction group had statistically smaller apical base lengths, more vertical facial growth patterns, and greater hard- and soft-tissue convexities at pretreatment than the 2-premolar extraction group. However, the multiple regression analysis showed that only the extraction protocol was significantly associated with the final occlusal status. CONCLUSIONS: The initial cephalometric characteristics of the groups did not influence the occlusal success rate of these 2 treatment protocols.
Assuntos
Cefalometria , Má Oclusão Classe II de Angle/patologia , Má Oclusão Classe II de Angle/terapia , Ortodontia Corretiva/métodos , Extração Dentária , Adolescente , Dente Pré-Molar/cirurgia , Criança , Ossos Faciais/crescimento & desenvolvimento , Feminino , Humanos , Masculino , Desenvolvimento Maxilofacial , Análise de Regressão , Estudos Retrospectivos , Base do Crânio/anatomia & histologia , Resultado do Tratamento , Dimensão VerticalRESUMO
O objetivo deste estudo retrospectivo foi comparar os resultados oclusais e a eficiência do tratamento das más oclusões de Classe I e de Classe II completa, ambas tratadas com extrações de quatro pré-molares. A eficiência do tratamento foi definida como a porcentagem de alterações oclusais pelo tempo de tratamento. O Grupo 1, constituído por 75 pacientes que apresentavam inicialmente má oclusão de Classe I, apresentava idade inicial média de 13.98 anos (D.P.: 2.08, mín.: 10.54 e máx.: 23.13), e o Grupo 2, composto por 32 pacientes que apresentavam inicialmente má oclusão de Classe II completa, bilateral, apresentava idade inicial média de 13.19 anos (D.P.: 1.58, mín.: 10.48 anos e máx.: 18.58 anos). As avaliações oclusais foram realizadas em modelos de gesso dos pacientes nas fases inicial e final utilizando os índices PAR e IPT. Os índices oclusais, o tempo de tratamento e o grau de eficiência dos grupos foram comparados pelo teste t. Os resultados demonstraram que o Grupo 1 obteve melhores resultados oclusais e maior porcentagem de alterações oclusais do que o Grupo 2. Entretanto, não houve diferença significante no tempo de tratamento e na eficiência dos protocolos de tratamento entre os grupos avaliados.
The objective of this retrospective study was to compare the occlusal outcomes and the treatment efficiency in the treatment of the Class I and Class II complete malocclusions, both treated with extraction of four premolars. The treatment efficiency was defined as the percentage of occlusal changes by the treatment time. The Group 1, composed by 75 patients who presented initially Class I malocclusion, presented initial mean age of 13.98 years (S.D.: 2.08, min.: 10.54 years and max.: 23.13 years), and the Group 2, composed by 32 patients who presented initially complete Class II, bilateral, presented initial mean age of 13.19 years (S.D.: 1.58, min.: 10.48 years and max.: 18.58 years). The occlusal evaluations were accomplished in study models of the patients in the initial and final phases using the indexes PAR and TPI. The occlusal indexes, the treatment time and efficiency of the groups were compared with the t test. The results demonstrated that the Group 1 achieved better occlusal outcomes and greater percentage of occlusal changes than the Group 2. However, there was no significant difference in the treatment time and efficiency in the treatment protocols between the groups considered.
Assuntos
Humanos , Adolescente , Dente Pré-Molar , Má Oclusão Classe I de Angle , Má Oclusão Classe II de Angle , Ajuste Oclusal , Extração SeriadaRESUMO
INTRODUCTION: The objectives of this study were to compare the amounts of apical root resorption that occur after treatment with 2 removable appliances-the Fränkel function regulator and the eruption guidance appliance (EGA)-in an untreated control group, and to determine the prevalence of root resorption in the maxillary and mandibular incisors and the dental arches. METHODS: After treatment, periapical radiographs were obtained of the maxillary and mandibular incisors with the long-cone paralleling technique from 72 patients divided into 3 groups. Group 1 included 24 patients treated with the Fränkel appliance, group 2 consisted of 24 patients treated with the EGA, and group 3 comprised 24 untreated subjects. Some patients in groups 1 and 2 were also treated with fixed appliances. Subgroups of patients who had used exclusively 1 functional appliance were also formed and evaluated. Root resorption was scored according to the method of Levander and Malmgren. RESULTS: Results of the Kruskal-Wallis tests showed significantly greater resorption in the Fränkel group, the EGA group, and the EGA subgroup in relation to the control group. However, there were no statistically significant differences between the Fränkel and the EGA groups and the subgroups. The amounts of resorption were predominantly small and similar in the experimental groups and the subgroups. The prevalence of resorption for the incisors was greatest for the maxillary central, followed by the maxillary lateral, mandibular central, and mandibular lateral. CONCLUSIONS: It was concluded that the Fränkel group, the EGA group, and the EGA subgroup had significantly greater resorption than the control group. There was no difference in the amount of resorption between the Fränkel and the EGA groups.
Assuntos
Má Oclusão Classe II de Angle/terapia , Aparelhos Ortodônticos Funcionais/efeitos adversos , Reabsorção da Raiz/etiologia , Análise de Variância , Estudos de Casos e Controles , Criança , Feminino , Humanos , Incisivo/patologia , Masculino , Ortodontia Interceptora/efeitos adversos , Ortodontia Interceptora/instrumentação , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Erupção DentáriaRESUMO
INTRODUCTION: Although the eruption guidance appliance has been used to correct Class II malocclusions for many years and its effects have been demonstrated, there is no study on the stability of the changes it produces. Therefore, the objective of this study was to investigate the long-term stability of cephalometric dentoskeletal and occlusal changes after eruption guidance appliance therapy. METHODS: Thirty-nine patients were evaluated. Occlusal evaluations were made with the peer asseessment rating index, and anterior tooth irregularity was evaluated with the Little irregularity index. Cephalometric and occlusal data were obtained at pretreatment, posttreatment, and postretention. The data were analyzed by dependent 1-way analysis of variance (ANOVA) for comparison between the 3 stages of the experimental group, with the Newman-Keuls test as a second step. To compare the cephalometric experimental group changes with mean population changes, the t test was used. RESULTS: Cephalometrically, in the postretention stage, overjet remained stable, overbite showed significant relapse, and molar relationship improved toward a Class I relationship. The peer asseessment rating index showed stability of the occlusion. The Little irregularity index demonstrated a statistically significant relapse of crowding in the postretention stage. CONCLUSIONS: Cephalometrically, overjet and molar relationship were stable in the long term after treatment with the eruption guidance appliance; however, there was relapse of the overbite. Occlusally, correction of the malocclusion elevated by the peer assessment rating was stable. There was relapse of the anterior teeth crowding.
Assuntos
Má Oclusão Classe II de Angle/terapia , Aparelhos Ortodônticos Funcionais , Ortodontia Interceptora/instrumentação , Erupção Dentária , Análise de Variância , Cefalometria/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino , Revisão dos Cuidados de Saúde por Pares , Prevenção Secundária , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
The orthodontic treatment of an adult patient with a skeletal Class III malocclusion, increased anterior facial height, negative overjet, and bilateral posterior crossbite is presented. Treatment options included mandibular first premolar or third molar extractions with dentoalveolar compensation or combined surgical-orthodontic treatment. Mandibular third molar extraction with dentoalveolar compensation was the treatment choice. Biofunctional brackets, with accentuated lingual crown torque on the maxillary incisors and accentuated buccal crown torque on the mandibular incisors, were used. The anterior crossbite was corrected with intermaxillary elastics from the palatal aspect of the maxillary incisors to the labial aspect of the mandibular incisors. Class III elastics moved the maxillary teeth mesially and assisted in retruding the mandibular teeth. Patient compliance with the elastics was excellent, and satisfactory dentofacial esthetics were achieved. This treatment protocol has rigorous indications, and it is not a routine plan. The mechanotherapy and the pros and cons of this approach are discussed.
Assuntos
Má Oclusão Classe III de Angle/terapia , Ortodontia Corretiva/métodos , Adaptação Fisiológica , Adulto , Análise do Estresse Dentário , Feminino , Humanos , Dente Serotino/cirurgia , Aparelhos Ortodônticos , Fechamento de Espaço Ortodôntico/métodos , Ortodontia Corretiva/instrumentação , Extração Dentária , Torque , Dimensão VerticalRESUMO
A dificuldade no correto registro de relação cêntrica opõe-se ao fato de que o cirurgião-dentista necessita realizar a maioria dos seus trabalhos nessa posição craniomandibular. O sistema R.O.C.A. (Relacion Oclusal Centrica Armonica) é proposto para ser utilizado pelo clínico, para obter o registro preciso da relação cêntrica. Propriamente empregado, o paciente é capaz de fechar a mandíbula em relação cêntrica sem auxílio, eliminando a possibilidade do erro operatório durante as manobras de manipulação mandibular. Seu uso clínico é simples e eficiente, facilitando o trabalho do profissional.