Assessment of oral health literacy of principal caregivers and its association with dental caries in Mexican disabled pediatric patients

Open bite can be defined as an absence of occlusion, most frequently located in the anterior region of dental arches and its etiology is multifactorial. We present a clinical case of an 8 years and 10 months child presenting an anterior open bite (AOB) with transverse maxillary deficiency caused by tongue thrust during mixed dentition. The malocclusion was corrected by means of a McNamara expander with a palatal crib jointly with the association of speech therapy for tongue repositioning, and otolaryngology to treat adenoid hypertrophy due to its correlation with AOB. The multidisciplinary approach was effective in correcting the malocclusion with stable results after 2 years post-treatment.

Multidisciplinary approach in the anterior open bite using a McNamara expander with palatal crib during mixed dentition stage: A case report

Open bite can be defined as an absence of occlusion, most frequently located in the anterior region of dental arches and its etiology is multifactorial. We present a clinical case of an 8 years and 10 months child presenting an anterior open bite (AOB) with transverse maxillary deficiency caused by tongue thrust during mixed dentition. The malocclusion was corrected by means of a McNamara expander with a palatal crib jointly with the association of speech therapy for tongue repositioning, and otolaryngology to treat adenoid hypertrophy due to its correlation with AOB. The multidisciplinary approach was effective in correcting the malocclusion with stable results after 2 years post-treatment.

Long-Term Assessment of Periodontal Tissues after Corticotomy-Assisted Orthodontic Arch Expansion

Objectives: The aim of the study was the long-term assessment of the condition of periodontal tissues after corticotomy-assisted orthodontic expansion in patients with transverse maxillary deficiency. Materials and Methods: The study included a group of 18 adults (9 women, 9 men) aged between 24 and 40 years who were at least 5 years post treatment. The following parameters were assessed: the full mouth plaque index (FMPI), full mouth bleeding on probing (FMBOP), probing depth (PD), clinical attachment level (CAL), gingival recession height (GR), recession width (RW), papilla height (PH), papilla width (PW), bone sounding (BS), phenotype, and KT. Results: During examination performed at least 5 years after the completion of orthodontic treatment, the values of PD and CAL were found to be considerably decreased compared to the examination one year post treatment (PD: −0.23; 95% Cl: −0.29, −0.16) (CAL: −0.04; 95% Cl: −0.17, 0.10). The other parameters—FMPI, FMBOP, GR, RW, PH, PW, BS, phenotype, and KT—did not change significantly. Conclusions: Corticotomy-assisted orthodontic arch expansion does not have a negative effect on the periodontium in long-term observations. Clinical Relevance: Orthodontic arch expansion can lead to bone dehiscence and gingival recession. Long-term observations revealed that corticotomy-assisted orthodontic expansion of the upper arch is not followed by negative changes in periodontal status.

Custom fabrication of cast splint microimplant-assisted rapid palatal expansion appliances for treatment of maxillary deficiency in young adults

Background: The objective of this article was to illustrate the process in the fabrication of a custom cast splint Microimplant-Assisted Rapid Palatal Expansion (MARPE) appliance for treatment of maxillary deficiency in young adults. Findings: The fabrication of a custom-made MARPE appliance allows the casting base to design according to the shape of the patient’s palate close to the palatal mucosa. In this new design, one end consists of a casting body, inserting hole, and teeth retention device (circumferential rings) connected to the other end by a jackscrew. Connection of all parts in the integral casting unit increases the strength of the expansion appliance and avoids distortion, deformation, or damage to the palatal mucosa due to increased resistance from the oromaxillofacial area. Conclusion: This custom design can improve the clinical outcome of maxillary expansion, especially in patients with narrow and high-arched palates.

Management of maxillary deficiency in a growing child with facemask therapy and RME- A case report

Class III malocclusion is one of the most difficult problems to treat. It has a multifactorial etiology involving both genetic and environmental causes. The dental and skeletal effects of maxillary protraction with a facemask are well documented in several studies. Although incorporation of expansion appliance along with facemask therapy can improve correcting both sagittal and transverse discrepancy of maxilla. The following case shows early treatment of a 9 year old boy with maxillary deficiency using an expansion screw along with facemask. Facemask therapy was followed by fixed orthodontic treatment to settle the occlusion. Treatment was completed after 14 months with positive overjet, class I molar and canine relationship on right and left side.

Is there a relationship between transverse maxillary deficiency and sella turcica: A cephalometric analysis study?

Objectives: The aim of this study was to investigate the dimensions and morphological variations of sella turcica and to test whether a relationship exists between sella turcica and transverse maxillary deficiency. Materials and Methods: The cephalometric radiographs of patients older than 17.99 years, which have been taken before the orthodontic treatment, and patient records were analyzed to investigate sella turcica dimensional and morphological analysis. Linear measurements of sella are as follows sella length, sella width, sellar area, sella height anterior, posterior, and median. The sella turcica morphological shape analysis was performed into six groups (normal sella turcica, oblique anterior wall, sella turcica bridge, double contour of floor, irregularities of the posterior part of the dorsum sella, and pyramidal shape of the dorsum sella). The width of the maxillary arch is measured by the digital caliper. Male participants with a maxillary width of less than 30.8 mm and a maxillary width of less than 31.1 mm in female patients in the first molar region were determined as a transverse maxillary deficiency. The mean dimensions of sella turcica and the relationship between cases with transverse maxillary deficiency and non-skeletal anomaly were compared using independent samples t-tests. The transverse maxillary deficiency and the sellar morphology relationship were compared using Chi-square test. Post hoc multiple comparisons and analyzes were performed at 95% confidence interval by Bonferroni correction. Results: The sella length measurements yielded higher values among the patients with transverse maxillary deficiency (P < 0.05). The normal sella morphology had quantitative superiority in patients without skeletal anomaly in comparison with transverse maxillary deficiency cases (P < 0.05). It was observed that the sella turcica bridge had a statistically superiority in patients with transverse maxillary deficiency (P < 0.05). Conclusion: The increased sellar measurement and sella turcica bridging, may provide knowledge about possible transverse maxillary deficiency.

Combined Orthodontic and Surgical Management for Treatment of Severe Class III Malocclusion with Anterior and Posterior Crossbites

Severe class III malocclusion can be a great challenge, especially in adult patients. This case report describes an adult patient with severe skeletal class III malocclusion and with an obvious maxillary deficiency and mandibular excess causing both anterior and posterior crossbites in addition to a shift in the upper and lower midlines to the left concerning the facial midline. This was complicated by compensatory mechanisms such as the proclination of upper incisors and retroclination of lower incisors. Decompensation of the upper and lower arches was performed combined with upper arch expansion to relieve crowding in the upper arch and correct the posterior crossbite. This was followed by double jaw surgeries, including Le Fort I osteotomy in the maxilla and bilateral sagittal split osteotomy (BSSO) in the mandible. Orthodontic finishing procedures were then used to correct any other dental discrepancies. Remarkable esthetic and functional results were achieved with high patient satisfaction.

Stress distribution and displacement of three different types of micro-implant assisted rapid maxillary expansion (MARME): a three-dimensional finite element study

Background/objective Until 2010, adults underwent surgical treatment for maxillary expansion; however, with the advent of micro-implant-assisted rapid maxillary expansion (MARME), the availability of less invasive treatment options has increased. Nevertheless, individuals with severe transverse maxillary deficiency do not benefit from this therapy. This has aroused interest in creating a new device that allows the benefit of maxillary expansion for these individuals. The aim of this study was to evaluate the efficacy of three MARME models according to tension points, force distribution, and areas of concentration in the craniofacial complex when transverse forces are applied using finite element analysis. Materials and methods Digital modeling of the three MARME models was performed. Model A comprised five components: one body screw expander and four adjustable arms with rings for mini-implant insertion. These arms have an individualized height adjustment that allows MARME positioning according to the patient’s palatal anatomy, thereby preventing body screw expander collision with the lateral mucosa in severe cases of maxillary deficiency. Model B was a maxillary expander with screw rings joined to the body, and model C was similar to model B, except that model C had open rings for the insertion of the mini-implants. Through the MEF (Ansys software), the stresses, distribution, and area of concentration of the stresses were evaluated when transverse forces of 7.85 N were applied. Results The three models maintained the following pattern: model C presented weak stress peaks with limited distribution and lower concentration area, model B obtained median stress peaks with better distribution when compared to that of model C, and model A showed better stress distribution and larger concentration area. In model A, tensions were located in the lateral lamina of the pterygoid process, which is an important site for maxillary expansion. The limitation of the present study was that it did not include the periodontal tissues and muscles in the finite element method evaluation. Conclusions Model A showed the best stress distribution conditions. In cases of severe atresia, model A seems to be an excellent option.

Three-dimensional assessment of the spheno-occipital synchondrosis and clivus after tooth-borne and bone-borne rapid maxillary expansion:

ABSTRACT Objectives To assess changes in spheno-occipital synchondrosis after rapid maxillary expansion (RME) performed with conventional tooth-borne (TB) and bone-borne (BB) appliances. Materials and Methods This study included 40 subjects with transverse maxillary deficiency who received TB RME or BB RME. Cone-beam computed tomography images (CBCT) were taken before treatment (T0), and after a 6-month retention period (T1). Three-dimensional surface models of the spheno-occipital synchondrosis and basilar part of the occipital bone were generated. The CBCTs taken at T0 and T1 were registered at the anterior cranial fossa via voxel-based superimposition. Quantitative evaluation of Basion displacement was performed with linear measurements and Euclidean distances. The volume of the synchndrosis was also calculated for each time point as well as the Nasion-Sella-Basion angle (N-S-Ba°). All data were statistically analyzed to perform inter-timing and intergroup comparisons. Results In both groups, there was a small increment of the volume of the synchondrosis and of N-S-Ba° (P &lt; .05). Basion showed a posterosuperior pattern of displacement. However, no significant differences (P &gt; .05) were found between the two groups. Conclusions Although TB and BB RME seemed to have some effects on the spheno-occipital synchondrosis, differences were very small and clinically negligible.