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Doctoral Thesis
DOI
https://doi.org/10.11606/T.23.2019.tde-26032019-100016
Document
Author
Full name
Lucas Cardinal da Silva
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2018
Supervisor
Committee
Morea, Gladys Cristina Dominguez (President)
Abrao, Jorge
Aidar, Luis Antonio de Arruda
Pannuti, Claudio Mendes
Title in Portuguese
Efeitos adversos da expansão rápida da maxila nos tecidos dentários e de suporte de indivíduos jovens com fissura labiopalatina unilateral
Keywords in Portuguese
Fissura palatina
Ortodontia interceptora
Técnica de expansão maxilar
Abstract in Portuguese
O presente estudo teve por objetivo a avaliação das consequências da expansão rápida da maxila em indivíduos com fissura labiopalatina unilateral nos seguintes desfechos: rizogênese, reabsorção radicular, espessura da tábua óssea e deiscência. Este estudo de coorte prospectivo foi composto por 30 participantes, sendo 20 homens e 10 mulheres, entre 8 e 15 anos. Os participantes foram alocados em 3 grupos, conforme o tipo de atresia maxilar, e tratados com diferentes tipos de aparelho expansor: G1, Hyrax; G2, Expansor em Leque; G3, Mini-Hyrax Invertido. Foram realizadas Tomografias Computadorizadas de Feixes Cônicos imediatamente antes do tratamento e 90 dias após contenção do aparelho. Medições lineares foram obtidas pelo mesmo examinador cegado. A estatística inferencial dos dados, após testes de normalidade e homogeneidade, foi realizada pela análise de regressão multinível. As raízes que apresentavam o ápice aberto ao início do tratamento demonstraram um aumento estatisticamente significante após o tratamento. Em contrapartida, não houve alterações significativas no comprimento radicular das raízes que apresentavam o ápice fechado no início do tratamento. Uma diminuição significativa da espessura da tábua óssea vestibular, bem como um aumento significativo da deiscência pode ser observado. Não houve diferença significante entre o lado com e sem a fissura para todas as variáveis apresentadas, assim como não houve diferença entre os grupos. Os achados neste estudo permitem concluir que as forças ortopédicas da expansão rápida da maxila não são capazes de interromper o processo de desenvolvimento radicular, tampouco causar reabsorção radicular apical externa significativa em indivíduos com fissura labiopalatina unilateral. Contudo, uma diminuição significativa de volume ósseo vestibular posterior é esperada, mas não deve ser considerada importante clinicamente.
Title in English
Adverse effects of rapid maxillary expansion on dental and supporting tissues of young subjects with unilateral cleft lip and palate
Keywords in English
Cleft palate
Interceptive orthodontics
Palatal expansion technique
Abstract in English
The present study aimed to evaluate the consequences of rapid maxillary expansion in subjects with unilateral cleft lip and palate in the following outcomes: root formation, root resorption, buccal bone thickness and dehiscence. This prospective cohort study comprised 30 participants, 20 male and 10 female, between 8 and 15 years old. Participants were allocated in 3 groups, according to the type of maxillary constriction, and were treated with different types of expanders: G1, hyrax; G2, fan-type; G3, inverted mini-hyrax. Cone Beam Computed Tomography scans were performed immediately before treatment and after 90 days of retention. Linear measurements were obtained by the same blinded examiner. The inferential statistics of the data, after normality and equality tests, was performed with a multilevel regression analysis. The roots presenting open apexes at the beginning of treatment showed a statistically significant increase in length after treatment. On the other hand, there were no significant changes in the root length of roots that had a closed apexes at the beginning of the treatment. A significant decrease in buccal bone thickness as well as a significant increase in dehiscence were observed. There was no significant difference between the cleft and non-cleft side for all variables, as there was no significant difference between groups. The findings in this study allow to conclude that the orthopedic forces of rapid maxillary expansion are not able to interrupt the root development process nor to cause significant external apical root resorption in subjects with unilateral cleft lip and palate. However, a significant decrease in posterior buccal bone volume is expected, but it should not be considered important in a clinical perspective.
 
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Publishing Date
2019-05-22
 
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