Dental Press Jounal of Orthodontics
Dental Press International

v. 18, no. 4

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 18, no. 4

July / August



MEDLINE — International recognition of the development of Brazilian Orthodontic science

David Normando

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Because all I need is free steps, hand in hand, and eyes wide open. 

(Guimarães Rosa)

Increase in scientific production requires that periodicals be indexed in databases, in order to make information available quickly and systematically to clinical and scientific communities. The main purpose of an indexing service is to ensure prompt access to information and documents of any kind whenever one searches for a specific subject in information systems or databases. 

Having a journal indexed in a database not only means merit recognition, but also corroborates the quality of published articles. Therefore, all scientific periodicals must comprise, among other features, visibility and accessibility, both of which are facilitated by indexation. 

We have all witnessed the development of Brazilian Orthodontics in the last decades. We are no longer seen as mere knowledge consumers once we have become one of the countries with the greatest scientific production in Orthodontics in the world. Numerous clinical and scientific awards permeate our daily routine, ratifying our ongoing path. Despite the volcanic eruption of the specialty, our editorial production process has always been discredited. Would we be really capable of producing and maintaining an orthodontic journal with as much quality as the international periodicals used as means to ascend to our scientific success?

Dental Press Journal of Orthodontics team always believed so. We have been restlessly working for 18 years in order to achieve the same success as our Brazilian Orthodontics has achieved. Thus, we are happy to announce* that the Dental Press Journal of Orthodontics is indexed in the MEDLINE/PubMed, the most important database providing references to health sciences information. It is a National Library of Medicine (NLM) journal citation database which has been providing over 22 million bibliographic citations since 1960. The Dental Press Journal of Orthodontics can be accessed through the following link:

Dental Press editors have known, since the publication of its first issue, in 1996, that the aim of scientific journals is to communicate and disclose scientific discussion and development, playing a leading role in breaking paradigms and being responsible for spreading knowledge about new clinical practices. This has been the case since the first publications, initially in the Journal dês Sçavans, a French journal published since 1665, and the Philosophical Transactions of the Royal Society of London, firstly published a few years later. 

We must bear in mind that databases often carry out evaluations; therefore, we must keep quality standards, at risk of exclusion. Thus, to refine our criteria for manuscript acceptance and strictly monitor our ethical principles is surely an essential task. For this reason, Brazilian periodicals are little represented in international databases. It is important to highlight that only a small number of these journals have been indexed in MEDLINE/ PubMed and ISI. The indexed ones have been internationally recognized, publishing more and better articles as a reward. Additionally, science is like an iceberg of which visible portion, above the water level, represents scientific production indexed in international databases. 

Hence, I sign this editorial with free steps, eyes wide open and many hands interlaced, in the attempt of expressing my gratitude to all assistant editors, former editors, authors, reviewers as well as other members of Dental Press publishing company, who have assiduously contributed not only for accomplishing the objectives of the Dental Press Journal of Orthodontics, but also for its international indexation. Undoubtedly, one more victory of Brazilian Orthodontics competency.

David Normando — editor-in-chief


Orthodontic Insight

Orthodontic movement of endodontically treated teeth

Alberto Consolaro, Renata Bianco Consolaro

Orthodontics-endodontics. Endodontic treatment-orthodontics. Periapical diseases-orthodontics. Orthodontics-dental trauma.

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Often there is the need of moving teeth endodontically treated or teeth still in endodontic treatment. In order to collaborate with the comprehension and substantiation of the following subjects will be discussed: 1) Orthodontic movement in endodontically treated teeth without periapical lesion, 2) Orthodontic movement in endodontically treated teeth with inflammatory periapical lesion, and 3) Orthodontic movement in teeth endodontically treated due to aseptic pulp necrosis by dental trauma. In practically all situations, endodontically treated teeth to be orthodontically moved must be subjected to a careful evaluation by the endodontist about the conditions, adequate or not, of the endodontic treatment. Then, in this paper it was sought to induce an insight for new clinical researches about the theme that may definitely prove the information obtained by interrelations of information in parallel to clinical practice.

Orthodontics Highlights

Matheus Melo Pithon

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Patients with fixed orthodontic appliance find it much more difficult to clean their teeth. The presence of brackets, wires, elastics, buttons and other accessories promote greater plaque retention, favoring the appearance of white spot lesions, dental caries and periodontal disease. Daily, orthodontists see patients with dirty teeth. What must be done in these situations? There are various devices and resources available for cleaning these patients? teeth. Among these, manual and electric toothbrushes are very important. Would electric toothbrushes be more effective in cleaning compared with the manual type? To answer these questions, German and American researchers conducted a clinical study1 in which they evaluated the effectiveness of manual, conventional electric, and orthodontic electric toothbrushes (Fig 1) in cleaning the teeth of patients using fixed orthodontic appliances. The authors were able to verify that electric brushes performed better cleaning when compared with the manual type. In the comparison between electric brushes, the specific type for orthodontic use, promoted greater cleanliness. The findings of this study are relevant and important, because orthodontists have gained proof of a new ally in the maintenance of their patients? oral health. 



An interview with Jonas Capelli Júnior

Carlos Alexandre Câmara, Ildeu Andrade Junior, Carlos Jorge Vogel, Sissy Maria Mendes Machado

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»PhD and Full Professor in Orthodontics, Rio de Janeiro State University (UERJ).

»Associate Professor of Orthodontics, UERJ.

»Director of the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO).

»Peer-reviewer of the following journals: Archives of Oral Biology, Dental Press Journal of Orthodontics, European Journal of Orthodontics, Journal of Biomechanics, Journal of the World Federation of Orthodontists and The Angle Orthodontist

All young people have an idol to follow, which can be a rock star or a great professor. Many people, including the greatest professors, do not realize their positive influence in their students? education. When I started the specialization course in Orthodontics at the Rio de Janeiro State University (UERJ), I knew nothing about this specialty, dentist?s offices or teaching, and I needed orientation. Having good-hearted and altruist professors determined the path I should follow. Among such professors, I would like to highlight Prof. Jonas Capelli Jr. ? the expert I present in this interview. Being from the first class of the course, he has always been a model to us. Dr. Capelli Jr. is the Director of the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) and has received many awards, such as the CDABO Case Report of the Year, for the best case report published during 2007 in the AJO-DO. In addition, he has had more than 60 articles published in scientific journals. Therefore, coordinating this interview could not be more rewarding and satisfactory to me. I proudly claim that it will provide us with a wide range of expertise concerning our clinical and scientific practice within our beloved field. In addition, this interview will allow us to know more about the professor who has been considered a positive and inspiring milestone in his students? lives as well as in the history of Brazilian Orthodontics. 

Sissy Maria Mendes Machado

Original Article

Effects of surface treatment of provisional crowns on the shear bond strength of brackets

Josiane Xavier de Almeida, Mauren Bitencourt Deprá, Mariana Marquezan, Luciana Borges Retamoso, Orlando Tanaka

Acrylic resins. Orthodontic brackets. Shear bond strength.

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Objective: To assess the adhesive resistance of metallic brackets bonded to temporary crowns made of acrylic resin after different surface treatments. 

Methods: 180 specimens were made of Duralay and randomly divided into 6 groups (n = 30) according to surface treatment and bonding material: G1 ? surface roughening with Soflex and bonding with Duralay; G2 ? roughening with aluminum oxide blasting and bonding with Duralay; G3 ? application of monomer and bonding with Duralay; G4 ? roughening with Soflex and bonding with Transbond XT; G5 ? roughening with aluminum oxide blasting and bonding with Transbond XT and G6: application of monomer and bonding with Transbond. The results were statistically assessed by ANOVA/Games-Howell. 

Results: The means (MPa) were: G1= 18.04, G2= 22.64, G3= 22.4, G4= 9.71, G5= 11.23, G6= 9.67. The Adhesive Remnant Index (ARI) ranged between 2 and 3 on G1, G2 and G3 whereas in G4, G5 and G6 it ranged from 0 to 1, showing that only the material affects the pattern of adhesive flaw. 

Conclusion: The surface treatment and the material influenced adhesive resistance of brackets bonded to temporary crowns. Roughening by aluminum blasting increased bond strength when compared to Soflex, in the group bonded with Duralay. The bond strength of Duralay acrylic resin was superior to that of Transbond XT composite resin.

Mandibular growth and dentoalveolar development in the treatment of Class II, division 1, malocclusion using Balters Bionator according to the skeletal maturation

Paulo Roberto dos Santos-Pinto, Lídia Parsekian Martins, Ary dos Santos-Pinto, Luiz Gonzaga Gandini Junior, Dirceu Barnabé Raveli, Cristiane Celli Matheus dos Santos-Pinto

Angle Class II malocclusion. Orthopedics. Growth and development.

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Objective: The purpose of the study was to evaluate the influence of the skeletal maturation in the mandibular and dentoalveolar growth and development during the Class II, division 1, malocclusion correction with Balters bionator. 

Methods: Three groups of children with Class II, division 1, malocclusion were evaluated. Two of them were treated for one year with the bionator of Balters appliance in different skeletal ages (Group 1: 6 children, 7 to 8 years old and Group 2: 10 children, 9 to 10 years old) and the other one was followed without treatment (Control Group: 7 children, 8 to 9 years old). Lateral 45 degree cephalometric radiographs were used for the evaluation of the mandibular growth and dentoalveolar development. Tantalum metallic implants were used as fixed and stable references for radiograph superimposition and data acquisition. Student?s t test was used in the statistical analysis of the displacement of the points in the condyle, ramus, mandibular base and dental points. Analysis of variance one-fixed criteria was used to evaluate group differences (95% of level of significance). 

Results: The intragroup evaluation showed that all groups present significant skeletal growth for all points analyzed (1.2 to 3.7 mm), but in an intergroup comparison, the increment of the mandibular growth in the condyle, ramus and mandibular base were not statically different. For the dentoalveolar modifications, the less mature children showed greater labial inclination of the lower incisors (1.86 mm) and the most mature children showed greater first permanent molar extrusion (4.8 mm).

Evaluation of the reliability of measurements in cephalograms generated from cone beam computed tomography

Maurício Barbosa Guerra da Silva, Bruno Cabús Gois, Eduardo Franzotti Sant’Anna

Cone beam computed tomography. Digital dental radiography. Interventional radiography.

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Objective: The purpose was to compare angular and linear measurements generated in digital cephalometric radiographs and cephalograms synthesized from three-dimensional images. 

Methods: Twenty-six individuals (12 men and 14 women) with mean age of 26.3 years were selected. Digital cephalometric radiographs and CBCTs were taken on the same day. The images were imported and analyzed on Dolphin Imaging V.10.5 software, which synthesized cephalograms in perspective projection and magnification of 9.7%. A single observer marked the points and repeated the procedure with an interval of time of ten days to evaluate intraexaminer error. In the statistical analysis paired Student?s t test was used to establish the correlation between the measurements. 

Results: The angular measurements GoGn.SN and IMPA, which involved the Gonial point (Go) and the linear measurements that involved the lips presented significant difference (p < 0.05). The other measurements presented good correlation. 

Conclusion: The measurements in the synthesized cephalograms proved to be reliable.

Cephalometric changes in Class II division 1 patients treated with two maxillary premolars extraction

Marisana Piano Seben, Fabricio Pinelli Valarelli, Karina Maria Salvatore de Freitas, Rodrigo Hermont Cançado, Aristeu Correa Bittencourt Neto

Corrective Orthodontics. Cephalometry. Retrospective studies. Tooth extraction.

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Objective: The purpose of this study was to evaluate the cephalometric alterations in patients with Angle Class II division 1 malocclusion, orthodontically treated with extraction of two maxillary premolars. 

Methods: The sample comprised 68 initial and final lateral cephalograms of 34 patients of both gender (mean initial age of 14.03 years and mean final age of 17.25 years), treated with full fixed appliances and extraction of the first maxillary premolars. In order to evaluate the alterations due the treatment between initial and final phases, the dependent t test was applied to the studied cephalometric variables. 

Results: The dentoskeletal alterations due to extraction of two maxillary premolars in the Class II division 1 malocclusion were: maxillary retrusion, improvement of the maxillomandibular relation, increase of lower anterior face height, retrusion of the maxillary incisors, buccal inclination, protrusion and extrusion of the mandibular incisors, besides the reduction of overjet and overbite. The tissue alterations showed decrease of the facial convexity and retrusion of the upper lip. 

Conclusions: The extraction of two maxillary premolars in Class II division 1 malocclusion promotes dentoskeletal and tissue alterations that contribute to an improvement of the relation between the bone bases and the soft tissue profile.

Fixed Lingual Mandibular Growth Modificator: A new appliance for Class II correction

Osama Hasan Alali

Orthodontic appliance design. Functional orthodontic appliances. Angle Class II malocclusion.

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Introduction: This article demonstrates the description and use of a new appliance for Class II correction. 

Material and Methods: A case report of a 10-year 5 month-old girl who presented with a skeletally-based Class II division 1 malocclusion (ANB = 6.5°) on a slightly low-angle pattern, with ML-NSL angle of 30° and ML-NL angle of 22.5°. Overjet was increased (7 mm) and associated with a deep bite. 

Results: Overjet and overbite reduction was undertaken with the new appliance, Fixed Lingual Mandibular Growth Modificator (FLMGM). 

Conclusion: FLMGM may be effective in stimulating the growth of the mandible and correcting skeletal Class II malocclusions. Clinicians can benefit from the unique clinical advantages that FLMGM provides, such as easy handling and full integration with bracketed appliance at any phase. 

Anatomical evaluation of the cervical vertebrae of Wistar rats by means of digital radiographs and its correlation with the maturation stages of human cervical vertebrae

Roberto Hiroshi Matsui, Julio Cezar de Melo Castilho, Luiz César de Moraes, Mônica Fernandes Gomes, Kurt Faltin Junior, Miriam Yumi Matsui

Growth and development. Cervical vertebrae. Radiography.

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Introduction: Biological age is an important parameter for growth and development assessment. It can be evaluated through the observation of radiographic changes in skeletal maturation of cervical vertebrae. 

Objective: This study aims to: a) verify if there is correlation between growth curve and the stages of bone age of animals used in laboratories, by evaluating radiographs of the cervical vertebrae; b) correlate these stages with their correspondents in humans. 

Methods: 35 Wistar rats were evaluated for a period of 160 days, starting at day 22nd (weaning), with cross sections for periodic weighing, length measurement and digital radiography. Radiographs of the cervical vertebrae (C2 and C3) were measured by means of a computer program (Radio IMP). Data were submitted to statistical analysis (ANOVA) and Pearson correlation. 

Results: Growth spurt was characterized by fast increasing in weight and length. Through ANOVA, differences were observed in the cervical measurements between days 22, 97, 127, 157, 187 and 217 (p < 0.001). A high correlation was found between increasing in body length and weight, as well as in cervical vertebrae height (r = 0.86). Increments in concavities of vertebrae were also observed, similar to humans. 

Conclusions: There is correlation between body growth and maturation of cervical vertebrae in rats. Despite the continuous development of concavities, it was not possible to clearly identify the 5/6 stages as in studies of cervical vertebrae maturation in humans.

Effect of moisture on dental enamel in the interaction of two orthodontic bonding systems

André Pinheiro de Magalhães Bertoz, Derly Tescaro Narcizo de Oliveira, Carla Maria Melleiro Gimenez, André Luiz Fraga Briso, Francisco Antônio Bertoz, Eduardo César Almada Santos

Dental primer. Scanning electron microscopy. Orthodontic brackets.

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Objective: The purpose of this study was to assess by means of scanning electron microscopy (SEM) the remaining adhesive interface after debonding orthodontic attachments bonded to bovine teeth with the use of hydrophilic and hydrophobic primers under different dental substrate moisture conditions. 

Material and Methods: Twenty mandibular incisors were divided into four groups (n=5). In Group I, bracket bonding was performed with Transbond MIP hydrophilic primer and Transbond XT adhesive paste applied to moist substrate, and in Group II a bonding system comprising Transbond XT hydrophobic primer and adhesive paste was applied to moist substrate. Brackets were bonded to the specimens in Groups III and IV using the same adhesive systems, but on dry dental enamel. The images were qualitatively assessed by SEM. 

Results: The absence of moisture in etched enamel enabled better interaction between bonding materials and the adamantine structure. The hydrophobic primer achieved the worst micromechanical interlocking results when applied to a moist dental structure, whereas the hydrophilic system proved versatile, yielding acceptable results in moist conditions and excellent interaction in the absence of contamination.

Conclusion: The authors assert that the best condition for the application of primers to dental enamel occurs in the absence of moisture. 

Comparison of shear bond strength of orthodontics brackets on composite resin restorations with different surface treatments

Alexandre Antonio Ribeiro, Ariane Vicente de Morais, Daniel Paludo Brunetto, Antônio Carlos de Oliveira Ruellas, Sérgio Vieira

Shear bond strength. Dental restoration. Dental bonding

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Introduction: Orthodontic patients frequently present composite resin restorations, however there are few studies that evaluate the best way for orthodontic bonding in this situation. 

Objective: The objective of this work was to evaluate the bond strength of orthodontic brackets in resin restorations with surface treatment. 

Methods: Fifty one bovine lower incisors were randomly divided into three groups. On the control group (CG) the brackets were bonded to dental enamel; on experimental groups, brackets were bonded to resin restoration with diamond drill treatment (EGT) and with no treatment (EGN). The teeth were placed in PVC tubes with autopolymerized acrylic resin. The shear test was performed in EMIC universal testing machine. The groups were submitted to ANOVA analysis of variance with Tukey post test to verify the statistical difference between groups (? = 0.05). 

Results: CG (6.62 MPa) and EGT (6.82 MPa) groups presented similar results, while EGN (5.07 MPa) obtained statistically lower results (p < 0.05). 

Conclusion: Therefore, it is concluded that the best technique for bonding of orthodontic brackets on composite resin restorations is the performance of surface detritions.

Long-term evaluation of apical root resorption after orthodontic treatment using periapical radiography and cone beam computed tomography

Jairo Curado de Freitas, Olavo César Porto Lyra, Ana Helena Gonçalves de Alencar, Carlos Estrela

Tooth resorption. Cone beam computed tomography. Corrective orthodontics.

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Objective: To evaluate the frequency of Apical Root Resorption (ARR) after orthodontic treatment at 52-288 months using periapical radiography (PR) and cone beam computed tomography (CBCT). 

Methods: Radiographic images obtained from 58 patients, before (T1) and after orthodontic treatment (T2), and following 52-288 months of treatment were analyzed by three members of the Brazilian Board of Orthodontics. Apical structures were evaluated by PR images (T2 and T3), using Levander and Malmgren scores. The presence of ARR on CBCT images were detected only at T3. The Kolmogorov-Smirnov test was used for statistical analyses, and the level of significance was set at 5%. Kappa statistics determined interobserver agreement. 

Results: The more frequent ARR were with scores 1 in T2 (51.6%) and T3 (53.1%), when evaluated by PR (p > 0.05). When compared the frequencies of ARR in T3 among PR and CBCT images, the differences were significant for maxillary and mandibular pre-molar groups, and for mandibular molar group (p > 0.05). The teeth with highest frequency of ARR presence using CBCT images were maxillary lateral incisors (94.5%) and mandibular central incisors (87.7%), while the premolars showed the lowest frequency. The CBCT images showed that the teeth involved in orthodontic treatment with extraction present higher ARR frequency (p < 0.05). 

Conclusion: PR showed more frequency of ARR in posterior teeth groups when compared with CBCT images. ARR did not change in long-term post treatment.

Morphometric evaluation of condylar cartilage of growing rats in response to mandibular retractive forces

Milena Peixoto Nogueira de Sá, Jacqueline Nelisis Zanoni, Carlos Luiz Fernandes de Salles, Fabrício Dias de Souza, Uhana Seifert Guimarães Suga, Raquel Sano Suga Terada

Articular cartilage. Angle Class III malocclusion. Mandibular condyle.

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Introduction: The mandibular condylar surface is made up of four layers, i.e., an external layer composed of dense connective tissue, followed by a layer of undifferentiated cells, hyaline cartilage and bone. Few studies have demonstrated the behavior of the condylar cartilage when the mandible is positioned posteriorly, as in treatments for correcting functional Class III malocclusion.

Objective: The aim of this study was to assess the morphologic and histological aspects of rat condyles in response to posterior positioning of the mandible. 

Methods: Thirty five-week-old male Wistar rats were selected and randomly divided into two groups: A control group (C) and an experimental group (E) which received devices for inducing mandibular retrusion. The animals were euthanized at time intervals of 7, 21 and 30 days after the experiment had began. For histological analysis, total condylar thickness was measured, including the proliferative, hyaline and hypertrophic layers, as well as each layer separately, totaling 30 measurements for each parameter of each animal. 

Results: The greatest difference in cartilage thickness was observed in 21 days, although different levels were observed in the other periods. Group E showed an increase of 39.46% in the total layer, reflected by increases in the thickness of the hypertrophic (42.24%), hyaline (46.92%) and proliferative (17.70%) layers. 

Conclusions: Posteriorly repositioning the mandible produced a series of histological and morphological responses in the condyle, suggesting condylar and mandibular adaptation in rats.

Occlusal assessment in surgically assisted unilateral cleft lip and palate patients

Leanne Matias Portela Leal, Marcus Vinicius Neiva Nunes do Rego, Cosme José Albergaria da Silva Filho, Leopoldino Capelozza Filho, Flavia Artese

Growth. Malocclusion. Cleft lip.

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Objective: The aim of this study was to assess the magnitude of occlusal changes in individuals with unilateral cleft lip and palate (CLP). The study was conducted on study casts of 25 subjects, 14 men and 11 women aged from 7 to 20 years, without previous orthodontic treatment and with surgical repair carried out at São Marcos Hospital, Teresina, Piauí State, Brazil. 

Methods: The casts were assessed by three orthodontists based on the occlusal scores established by Atack et al., whose scores range from 1 to 5, according to the magnitude of transverse and sagittal changes. 

Results: Intra and inter-observer reproducibility of occlusal scores was satisfactory and statistically significant according to the Spearman Correlation test with significance level set at 5%. With regard to the distribution of occlusal scores, 30.67% of the subjects achieved scores 1 and 2, 22% score 3 and 47.53% achieved scores 4 and 5. 

Conclusions: Four was the score most frequently assigned by the observers, disclosing a high degree of transverse and sagittal disorders in the occlusion of patients.

BBO Case Report

Angle Class II malocclusion treated with extraction of permanent teeth

Gustavo Mattos Barreto

Class II malocclusion. Anterior open bite. Orthodontic compensation.

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Angle Class II malocclusion associated with anterior open bite in adult patients demands a carefully elaborated orthodontic planning, aiming at restoring not only harmonious dental and facial esthetics, but also a balanced masticatory function. Orthognathic surgery or permanent teeth extraction are often the choice of treatment, therefore, treatment decision is related to all dental, skeletal and functional aspects. The present report discusses orthodontic compensation carried out by means of upper premolar extraction performed to correct the Class II canine relationship and, consequently, the anterior open bite, accepting that the upper incisors be retroclined. This clinical case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as part of the requirements for obtaining the BBO Certification.

Special Article

Treatment of midfacial hypoplasia in syndromic and cleft lip and palate patients by means of a rigid external distractor (RED)

Eduardo Franzotti Sant’Anna, Adriana de Alcantara Cury-Saramago, Geórgia Wain Thi Lau, John W. Polley, Yasmine Bitencourt Emílio Mendes

Distraction. Maxilla. Midface.

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Introduction: Distraction Osteogenesis (DO) became an alternative for the treatment of severe craniofacial skeletal dysplasias. The rigid external distraction device (RED) is successfully used to advance the maxilla and all the maxillary-orbital-frontal complex (monobloc) in children, adolescents and adults. This approach provides predictable and stable results, and it can be applied alone or with craniofacial orthognathic surgical procedures.

Objective: In the present article, the technical aspects relevant to an adequate application of the RED will be described, including the planning, surgical and orthodontic procedures. 

Dental Press Journal of Orthodontics - v. 18, no. 4 Download full issue pdf