Maxillary Atresia Research Articles

Cleft lip/palate patients’ oral health status: an epidemiological study at a Brazilian pediatric hospital

Cleft lip/palate is a congenital maxillofacial malformation which results from genetic and environmental factors. In Brazil, the prevalence is 1 in every 673 live births. Several alterations result from oral clefts and affects function, aesthetics, and social life. Due to morphofunctional changes, these patients are more susceptible to disorders of the oral cavity. This study aimed to conduct an epidemiological study about alterations of the stomatognathic complex in cleft lip/palate patients at Albert Sabin Pediatric Hospital in Fortaleza, Ceará, Brazil. Files containing medical records, imaging exams and dental models of 64 patients from 2005 to 2017 were analyzed. There was a higher prevalence of males, patients from the countryside and the left unilateral transforaminal cleft subtype. 85.9% of the patients had undergone cheiloplasty and palatoplasty. About 74% of patients had dental agenesis, 71.9% developed the precanine tooth, 26.6% presented dental shape anomalies and 65.6% presented maxillary atresia. The mean DMFT index (decayed, missing, and filled teeth) of the patients was 3.51. These results corroborate and add valuable information to the available literature on cleft lip/palate patients. Our results demonstrate that cleft patients present dental and skeletal alteration that need specialized treatment.

Rapid maxillary expansion for maxillary atresia and mandibular alignment: A mixed dentition case report

Introduction: Posterior crossbite is a common malocclusion in orthodontics. It often accompanies maxillary atresia, leading to unilateral or bilateral posterior crossbite. Rapid maxillary expansion (RME) is an approach to treat atresia, correct transverse discrepancies, and increase the perimeter of the maxillary arch. Objective: To present the case of an 8-year-old patient with maxillary atresia, skeletal Class I, dental Class I, and no space in the maxillary anterior and mandibular regions for the alignment of the incisors. Clinical procedures: RME was performed using a HYRAX type expander. After 20 days of daily activations, there was a change in the morphology of the palate, an increase in the arch perimeter, facilitating the eruption of incisors and canines. Final considerations: RME is an effective and efficient orthopedic treatment, recommended for correcting transverse deviations, normalizing structural and functional problems. As positive side effects, the indirect action on the mandibular molars and canines allowed the alignment of the incisors.

Tratamento ortodôntico de um paciente com necessidades especiais: um relato de caso

ABSTRACT This report presents the case of an adult patient with mental and intellectual limitations, whose main complaint was dental aesthetics. Dental treatment was performed at the Piracicaba Dental School and approved by the Ethics Committee (CAAE: 65752322.2.0000.5418). Clinically, the patient had inadequacies in the dental arrangement, with periodontal involvement that put the dental elements at risk. In intraoral clinical aspects, the deficiency was identified as maxillary atresia. The buccolingual inclination of the mandibular anterior teeth highlighted the severe crowding and anterior crossing of these teeth. Dental treatment was carried out aiming at the remission of periodontal and orthodontic problems in an integrated manner and with approaches that allowed greater interaction, participation, and patient compliance during treatment. Supra and subgingival scrapings and extraction of the upper left lateral incisor were performed. After three months of periodontal treatment, orthodontic treatment was started with fixed orthodontic appliances. The main objective was to level and align the teeth in both arches to achieve better aesthetic and functional conditions. Due to the COVID-19 pandemic, treatment has been discontinued. This resulted in the regression of the results obtained, including regarding self-care. People with disabilities require dental care with specific strategies for their needs, which must be carried out by a multidisciplinary team. Despite the access limitation imposed by the pandemic, the patient reestablished his motivation to restart treatment, which was facilitated by the bond of trust established between him and the team.

Three-dimensional analysis of posterior tooth inclinations in transverse and sagittal relationships: A cross-sectional study

To compare tooth inclinations in different sagittal skeletal patterns and transverse maxillary relationships three-dimensionally. A cross-sectional study carried out with 132 three-dimensional digital models in the complete permanent dentition divided into six groups (n=22); three groups with maxillary atresia: G1- skeletal class I, G2- skeletal class II and G3-skeletal class III; three groups without maxillary atresia: G4- skeletal class I; G5- skeletal class II and G6- skeletal class III. The comparison between the skeletal pattern was performed by the non-parametric tests of Kruskal Wallis and Dunn and between the groups by the non-parametric test of Mann Whitney. Subjects with skeletal class II and maxillary atresia had a greater lingual inclination of the maxillary teeth than those with class I and III; Subjects with skeletal class II without atresia had a less lingual inclination of the mandibular molars than the other classes (p<0.05). The maxillary premolars showed no variation in dental inclination with atresia, independent of the skeletal class in G1, G2, and G3 (p>0.05). The mandibular premolars showed that the groups without atresia G4, G5, and G6 presented no significant difference (p>0.05). Lower premolars in skeletal class III malocclusion individuals with atresia had a more negative inclination than the others. There is a difference in the inclination of posterior teeth between individuals with and without maxillary atresia and skeletal classes I, II, and III.

The effects of miniscrew-assisted rapid palatal expansion on the upper airway of adults with midpalatal suture in the last two degrees of ossification.

Transverse deficiencies of the maxillary basal bone have been treated in adult patients using miniscrew-assisted rapid palatal expansion (MARPE) therapy. However, the midpalatal suture's degree of ossification may affect the upper airway dimensions. This study compared the volumetric changes of the total upper, retropalatal, retroglossal airways, and the minimal transverse airway constriction after MARPE therapy in patients with midpalatal suture in the last stages of ossification. This controlled clinical trial included a total of 20 adult patients (mean age 24.5 ± 6.2 years) with maxillary atresia treated with MARPE. Preoperative (T0) cone-beam computed tomography scans were used to determine the degree of midpalatal suture ossification. Two groups were formed considering the last two stages of sutural ossification "D" or "E" (n=10 per group). After 120 days of the therapy (T1), cone-beam computed tomography assessments were performed to compare the pre and post-treatment outcomes. The total upper, retropalatal, and retroglossal airways and the minimal transverse airway constriction were evaluated. The three-dimensional reconstruction was performed with OsiriX MD software. The comparisons were carried out using mixed models for repeated measures at fixed time points (α=0.05). Groups D and E showed no significant difference for any of the analyzed parameters (P > 0.05). Both groups showed a statistically significant increasefor all airway segments after the treatment with MARPE (P < 0.05). The total upper airway increased (11.6% and 16.1%) for groups D and E, respectively (P=0.3356). MARPE therapy resulted in dimensional gains of the upper airway for adult patients, irrespective of the intermaxillary sutural degree of ossification.

Rapid maxillary expansion and nasal patency in mouth breathing children with maxillary atresia due to or not due to allergic rhinitis.

To evaluate the effects of rapid maxillary expansion (RME) on nasal patency in mouth breathing (MB) children with maxillary atresia due to or not due to allergic rhinitis (AR) associated with asthma. Fifty-three MB children/adolescents (aged 7-14 years) with mixed or permanent dentition and maxillary atresia participated, with or without unilateral or bilateral crossbite. They formed the groups: RAD (AR + asthma; clinical treatment, RME); RAC (AR + asthma; clinical treatment, no RME); and D (mouth breathers; RME only). RAD and RAC patients received topical nasal corticosteroid and/or systemic H1 antihistamine (continuous use) and environmental exposure control. All were evaluated before RME (T1) and 6 months after (T2) with the CARATkids score, acoustic rhinometry, and nasal cavity computed tomography (CT). Patients RAD and D underwent RME (Hyrax® orthopedic appliance). A significant reduction in the CARATkids score occurred in the RAD (-4.06; p < 0.05), similarly when patient and parent/guardian scores were evaluated (-3.28 and -3.16, respectively). Acoustic rhinometry (V5) showed increased nasal volume in all groups, significantly higher in RAD patients than in RAC and D (0.99 × 0.71 × 0.69 cm3, respectively). CT of the nasal cavity documented increased volume in all three groups, with no significant differences between them. In MB patients with AR, asthma, and maxillary atresia, RME increased nasal cavity volume and improved respiratory symptoms. However, it should not be used as the only treatment for managing patients with respiratory allergies.

Effects of rapid maxillary expansion on sleep disturbance scale for children: A longitudinal CASE-series study.

To evaluate the effects of rapid maxillary expansion (RME) on Sleep Disturbance Scale for Children (SDSC) with maxillary atresia. The sample consisted of 27 paediatric patients evaluated through a Brazilian version of the SDSC, answered by their guardians at the following experimental time points: T0 (before installing the Hyrax expander), T1 (on the day of expander stabilization), T2 (3 months after expander stabilization), T3 (immediately after expander removal, following 6 months of retention), and T4 (3 months post-retention). Multilevel Poisson analysis adjusted for repeated measures was performed to compare outcomes across the assessment time points. The mean age of patients was 9.1 years (SD = 1.46). The total SDSC scores decreased and were statistically significant from T2 onwards (P < .01), with a decrease of 24% at T4 compared with T1 (IRR 0.76; 95% CI 0.69-0.84). The mean scores at T4 were already lower than the cutoff point for risk of sleep disorders. Regarding the specific domains, there was a significant reduction in sleep breathing disorders, sleep-wake transition disorders, and disorders of excessive somnolence as of T2 (P < .01), T3 (P < .05) and T4 (P < .05), respectively. RME in children with maxillary atresia had a positive effect on the reduction of total SDSC scores after 3 months of expander stabilization, sustained over 6 and 9 months and significant reduction in sleep breathing disorders domain, sleep-wake transition disorders domain, and disorders of excessive somnolence domain over time points.

Correlation of age and skeletal effects after miniscrew assisted rapid palatal expansion.

To evaluate the skeletal and dentoalveolar effects after miniscrew assisted rapid palatal expansion (MARPE) and their correlation with the age of the patients. Settings and sample population: Sample comprised 19 patients with maxillary atresia and posterior crossbite, treated with MARPE. Cone-beam computed tomographs (CBCT) were evaluated before and after expansion. Three patients were excluded since the midpalatal suture was not opened. Thus, 16 patients (11 female; 5 male) were evaluated, with a mean age of 24.92 years (s.d.=7.60). The time between the installation of MARPE and the second CBCT was, on average, 1.64 months (s.d.=1.12). Linear and angular measurements were performed: bone thickness and level, tooth inclination, transverse dental widths, and nasal base and jugula widths. Comparison was performed with dependent t-test and correlations with Pearson coefficient. MARPE was 84.2% successful. There was significant reduction in the buccal bone thickness of the first molars and an increase in the palatal bone thickness of all teeth. First molars showed significant buccal inclination. All transverse dimensions showed a significant increase. Older patients tended to show a less maxillary transverse skeletal increase. A greater maxillary transverse increase was accompanied by a greater intermolar width increase and also a greater buccal bone loss in the mesiobuccal roots of the maxillary first molars. MARPE corrected the maxillary atresia in adult patients, with significant transverse increases, a slight decrease in buccal bone thickness and buccal inclination of the first molars, combining skeletal and dental effects. Older patients presented less transverse skeletal increases. Key words:Palatal expansion technique, skeletal anchorage, cone-beam computed tomography.

Cephalometric changes after maxillary expansion in children and adolescents with Angle class III malocclusions: systematic review and clinical implications

It is consensus that Class III treatment is clinically challenging considering, mainly, bone growth. Its diagnosis requires correct assessment of maxillary and mandible involvement since treatment must be directed to the bone base responsible for the malocclusion in order to correct it and provide improvement in the facial pattern. One of the main academic gaps in this subject is the approach to its treatment. In this context, this study aimed to group randomized clinical trials (RCTs) on cephalometric changes observed after maxillary expansion in these dental-skeletal disharmonies. RCTs published in English whose subjects were children and adolescents with Angle class III malocclusion and maxillary atresia were collected. In addition, at least one of the randomized groups should have maxillary (palatal) expansion and the measurement of cephalometric changes observed after palatal expansion as intervention. After inserting the PICO strategy and performing the systematic search, a total of 708 results were retrieved, of which 416 came from Scopus, PubMed, Cochrane, and Web of Science databases. When analyzing cephalometric results, mainly associated with the use of face mask, and considering the limiting factors of this review, it is clear that this type of intervention has become a viable option in clinical practice; however, new qualitative and meta-analytical reviews should be carried out in view of the publication of new randomized clinical trials in order to infer more accurate results and with greater power of evidence.

ROLE OF THE DENTIST IN CONGENITAL SYPHILIS EARLY DIAGNOSIS

Objectives The aim of this study was to review the role of the dentist in congenital syphilis early diagnosis. Study Design A search for articles published in PubMed and Scielo was performed in the period from 2010 to 2021, using the terms “congenital syphilis” AND “oral manifestations.” Results The condition was divided into late and early syphilis. Periostitis is the facial signal of early syphilis. As for late syphilis, which develops in untreated infants, facial signals are described as the Hutchinson triad, including Hutchinson's teeth, interstitial keratitis, and deafness. These 3 signals are not always present, and the investigation of other clinical signs such as frontal bossing and maxillary atresia, are required. Additionally, pregnant women should be examined for oral manifestations of primary and secondary syphilis to be treated and avoid vertical transmission. The importance of early diagnosis is due to the high figures of congenital syphilis cases in Brazil. During 2019, 24.130 new cases were diagnosed, and 173 deaths occurred. Conclusions Dentists can contribute to congenital syphilis early diagnosis by performing a complete clinical exam, and searching for signals located in the maxillofacial complex. It is necessary to use strategies to optimize diagnosis and treatment so that it does not progress to more severe stages. The aim of this study was to review the role of the dentist in congenital syphilis early diagnosis. A search for articles published in PubMed and Scielo was performed in the period from 2010 to 2021, using the terms “congenital syphilis” AND “oral manifestations.” The condition was divided into late and early syphilis. Periostitis is the facial signal of early syphilis. As for late syphilis, which develops in untreated infants, facial signals are described as the Hutchinson triad, including Hutchinson's teeth, interstitial keratitis, and deafness. These 3 signals are not always present, and the investigation of other clinical signs such as frontal bossing and maxillary atresia, are required. Additionally, pregnant women should be examined for oral manifestations of primary and secondary syphilis to be treated and avoid vertical transmission. The importance of early diagnosis is due to the high figures of congenital syphilis cases in Brazil. During 2019, 24.130 new cases were diagnosed, and 173 deaths occurred. Dentists can contribute to congenital syphilis early diagnosis by performing a complete clinical exam, and searching for signals located in the maxillofacial complex. It is necessary to use strategies to optimize diagnosis and treatment so that it does not progress to more severe stages.

The Hyrax appliance with tooth anchorage variations in surgically assisted rapid maxillary expansion: a finite element analysis.

It is known that a correct transverse maxillary dimension is a key factor for a stable occlusion, which brings functional and esthetic benefits for the patient. In patients presenting maxillary atresia and the completion of bone growth, a highly recommended option for correction is the surgically assisted rapid maxillary expansion (SARME) associated with the Hyrax appliance. The objective of this study was to evaluate the influence of tooth anchorage variations of the Hyrax appliance in SARME through finite element analysis, evaluating which anchorage option might be associated with more effective orthopedic results with less undesired side effects. Five different dental anchoring conditions for the Hyrax appliance were simulated through FE analysis applying premolars and molars as anchorage, having the same force applied by the activation of the Hyrax screw (0.5mm) in all groups. The maxillary displacement results (axes X, Y, and Z) and generated stresses for both teeth and maxillary bone were calculated and represented using a color scale. All groups presented significant bone displacement and stress concentration on anchoring teeth, with the group presenting anchorage in the 1st and 2nd molars showing the greatest maxillary horizontal displacement (axis X) and suggesting the lowest tendency of dental vestibular inclination. Variations in dental anchorage might substantially affect the maxillary bone and teeth displacement outcome. The protocol for the Hyrax apparatus in SARME applying the 1st and 2nd molars as anchorage might generate less tilting and inclination of the anchoring teeth.

Clinical, Histological, and Scintigraphic Comparative Study of the Use of Mandibular Bone Marrow and Peripheral Blood in Bone Neoformation

Materials and Methods The study included 16 patients with maxillary atresia. The region was grafted with xenograft blocks associated with the following treatments: G1, the patient's peripheral blood during surgery, and G2, dripping of mandibular bone marrow blood until the xenograft was completely wet. After 7 and 14 days, scintigraphic images of the regions of interest (ROI) were taken to quantify pixels, which indicate osteogenic activity. Additionally, trephined samples obtained at the time of implant placement were stained in H&E, and newly formed bone tissue was quantified. The data were tabulated and statistically analyzed at a significance level of 5%. Results Scintigraphic data showed greater osteogenic activity with mandibular bone marrow blood (G2) at all times evaluated (p < 0.05). As for the histomorphometric analysis, a greater amount of bone tissue was observed in samples treated with mandibular bone marrow blood (G2) compared to peripheral blood (G1) (p < 0.05). Conclusions The appositional bone reconstruction technique in the block associated with mandibular bone marrow blood increased bone neoformation and osteogenic activity compared to conventional graft treatment with peripheral blood.

Dentoskeletal changes and their correlations after micro-implant-assisted palatal expansion (MARPE) in adults with advanced midpalatal suture ossification.

To evaluate and correlate the dentoskeletal changes of adult patients after miniscrew-assisted rapid palatal expander (MARPE) in the two final stages of midpalatal suture ossification. This interventional pre-post clinical study consisted of 20 adults (24.9±1.8 years), with transverse maxillary atresia, divided into two subgroups (n=10) based on the ossification degree of the midpalatal suture: stage D, fusion completed in the palatine bone; and stage E, fusion anteriorly in the maxilla. Cone beam computed tomography (CBCT) in the pre- (T0) and post-treatment (T1) time intervals were used to evaluate the anterior and posterior sutural opening, activation of the expander screw, vestibular-lingual inclinations, and widths of first premolars and first molars. Maxillary interincisor diastema was measured on patients' plaster models in the same timepoints. The Wilcoxon-Mann-Whitney test, generalized linear models (GLM), and chi-square (χ2) test were employed. All variables significantly increased after MARPE therapy regardless of the ossification degree (P<0.05). Patients with stage D suture presented wider interincisal diastema and maxillary suture opening (on both regions, anterior and posterior) when compared with patients with stage E (P<0.05). Maxillary interincisor diastema was positively associated with anterior and posterior suture opening for all subjects (P<0.05). MARPE therapy was unsuccessful in six patients, mostly presented by individuals with E maturation stage of the midpalatal suture. After MARPE, a significant correction in the transverse defect of the maxillary basal bone was achieved for adults in the last two midpalatal suture maturation stages. Adult patients in stage D of maxillary suture ossification are more susceptible to dentoskeletal changes following MARPE therapy as compared to patients with stage E.

Perceived pain during rapid maxillary expansion in children with different expanders.

To evaluate and compare the intensity of pain caused by rapid maxillary expansion (RME) with two expanders: Hyrax and Haas type, in growing patients. Thirty-nine patients (23 girls and 16 boys) with an average age of 9.3 years (SD = 1.39 years) were randomized into two groups and treated with Hyrax- and Haas-type expanders. In both groups, initial activation of the expander screw was one full turn on the first day followed by 2/4 of a turn two times a day (morning and night) for 7 days. Inclusion criteria were patients presenting with a posterior crossbite or maxillary atresia between 7 and 12 years old. To evaluate the intensity of pain during the active phase of the treatment, a combination of the Numerical Rating Scale and Wong-Baker Faces Pain Scale was used. Mann-Whitney test was used to compare the two treatment groups. There was significant inverse correlation between days following insertion and pain. During the expansion period, 100% of the children reported some pain. Hyrax expander subjects reported greater pain than those treated with the Haas-type expander only on the first day. The level of pain remained greater in girls throughout treatment. Pain was reported regardless of the type of expander and was higher in the Hyrax group only on the first day of activation.

Abordagem precoce da má oclusão de Classe II esquelética com atresia maxilar e mordida aberta anterior e o uso de alinhadores ClearCorrect – relato de caso

Adequate planning and early treatment of Angle Class II malocclusion with maxillary atresia and anterior open bite provides harmonization of maxillomandibular bone bases in the three planes of space. Orthodontic aligners have emerged as an alternative treatment having the following advantages: being more aesthetic and more comfortable for the patient, less treatment time when they are correctly indicated, less chairside time, less complications, possibility of remote monitoring, easier feeding, and dental hygiene. On the other hand, they offer difficulties to treat adults with severe skeletal Class II malocclusions, posterior crossbite and anterior open bite. Therefore, the objective of this clinical case report is to early correct skeletal Class II malocclusion with maxillary atresia through the use of mechanical orthopedics and devices that help eliminate habits and close the anterior open bite, and later the use of orthodontic aligners to finish the treatment. It was concluded that the early interceptive treatment of malocclusion was efficient to harmonize the bone bases in the anteroposterior, vertical, and transversal directions, changing this malocclusion from high to low complexity and, consequently, highly predictable and with an excellent prognosis for treatment with orthodontic aligners. The treatment with ClearCorrect aligners corrected the occlusion in a shorter period of time when compared to corrective orthodontics and with a high predictability in relation to the virtual setup.

Maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion

The objective of the present study was to compare the maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion (MARPE). The sample comprised 37 patients with Class I malocclusion treated without tooth extraction, divided into 2 groups: group 1 comprises 21 patients with a mean age of 19.55years (standard deviation=1.31), submitted to orthodontic treatment with Damon self-ligating appliance, and evaluated until the end of the alignment and leveling stage. Group 2 comprises 16 patients with a mean age of 24.92years (standard deviation=7.60), with maxillary atresia, who underwent MARPE, and were evaluated after the removal of the expander. Buccal bone thickness; dental inclinations; and transverse distances of the maxillary arch, nasal base, and jugula widths were measured on cone-beam computed tomography scans before and after treatment. The intergroup comparison was performed with the independent t test. With treatment, there was a significantly greater decrease in buccal bone thickness of canines and premolars in the self-ligating group, the premolars presented a greater buccal inclination in the self-ligating group, and the intercanine and intermolar distances and nasal base and jugula widths showed significantly greater increases in the MARPE group than in the self-ligating group. MARPE treated more severe skeletal transverse maxillary discrepancies and obtained better results than self-ligating appliances in terms of buccal bone loss, tooth inclination, and transverse skeletal increase of the maxilla. MARPE presented more skeletal effects and self-ligating appliances, more dental effects.

Bone-borne distractor versus tooth-borne distractor for maxillary expansion: a Systematic Review

The etiology of transverse maxillary deficiency is considered multifactorial, and has a deleterious effect on the bone development of the maxilla and nasal cavities, causing maxillary atresia and posterior crossbite. The objective of this systematic review was to compare in the scientific literature the effectiveness of the maxillary disjunction treated using dental distractor versus bone distractor. A systematic literature review was performed using the Science Direct, Embase, Cochrane Collaboration Library, and PubMed / MEDLINE databases. The search strategy provided a total of 119 studies. After screening by reading the titles and abstracts, seven articles met all the criteria and were included in this systematic review. Studies have shown that the choice of type of orthodontic-orthopedic appliance is directly related to the prior individualized planning of each patient. With regard to patients who are in the development phase, the recommendation is the use of dental maxillary expanders, such as the Hyrax appliance. In addition, it is not recommended to perform rapid maxillary expansion in adult patients, due to the expansion resistance that occurs in the palatine sutures. The treatment of patients with closed median palatine suture must be done by surgically assisted maxillary expansion.

ORAL AND MAXILLOFACIAL ALTERATIONS IN PATIENTS WITH PYCNODYSOSTOSIS: 2 CASE REPORTS

Pycnodysostosis is a rare, autosomal recessive genetic condition that causes a decrease in bone remodeling due to a mutation in the cathepsin K gene, resulting in clinical and radiographic manifestations, characteristic of the syndrome. This report aims to describe 2 clinical cases of pycnodysostosis with orofacial involvement. The patients had a short stature, height ranging from 134 cm to 152 cm, stunted extremities, open fontanelles and cranial sutures, osteosclerosis, and medical history of repeated fractures in the left tibia, associated with small impact traumas. In the buccomaxillofacial complex, absence of pneumatization of the facial sinuses, maxillary osteomyelitis after dental extraction, maxillary atresia, increased mandibular angle, and enamel hypoplasia were related. It is concluded that the knowledge of clinical, radiographic, and oral and maxillofacial findings of this syndrome are important for the diagnosis and treatment of patients in the multiprofessional context, thus avoiding complications arising from dental procedures.

Tracionamento ortodôntico de canino permanente superior: relato de caso clínico

Objetivo: Descrever uma abordagem conservadora para tratamento de canino permanente superior impactado, através de tracionamento ortodôntico. Detalhamento do caso: Paciente BJFA, 16 anos, sexo feminino, acompanhada na clínica de Ortodontia da ABO em Montes Claros-MG, queixou-se de dentes tortos. Ao exame clínico intrabucal verificou-se atresia maxilar, desvio de linha média dentária superior, apinhamento dentário anteroinferior, incisivo lateral superior direito conóide, retenção prolongada de canino decíduo superior direito, cujo sucessor permanente não se apresentava palpável. Os exames de imagem, sobretudo a tomografia computadorizada, confirmaram a presença de canino permanente superior direito impactado, localizado em região palatina. O tratamento foi realizado através de aparelho ortodôntico fixo, aplicando a terapêutica de expansão transversal da arcada superior com quadrihélice de Ricketts e tracionamento ortodôntico pela técnica de colagem de acessório associada a cantilever. Considerações finais: As técnicas utilizadas permitiram uma abordagem conservadora e menos dispendiosa, mostrando resultados funcionais e estéticos positivos.

Expansão Maxilar Apoiada em Mini-implantes (MARPE) – guia prático para planejamento e instalação

Rapid maxillary expansion (RME) is an orthodontic treatment alternative that aims to increase the transverse direction of the maxilla by separating the median palatine suture (MPS). miniscrew-assisted rapid palatal expansion (MARPE) aims to enhance the orthopedic effects of RME through skeletal anchorage. Thus, the aim of this article is to provide a guide for MARPE planning in cone beam computed tomography (CBCT) and for installation of the expander device with this technique. In addition, a case report of a Caucasian male patient, 16 years and 3 months old with Class II malocclusion, division 1 right subdivision, posterior crossbite of the right side and atresic upper arch in the post-pubertal growth spurt phase will be presented. The patient was treated with MARPE for a period of 5 weeks, when overcorrection of crossbite, correction of maxillary atresia, opening of MPS and creation of a transient diastema between the upper incisors were achieved, evidencing the success of the MARPE technique in a post-pubertal growth spurt patient.