Análisis descriptivo del Wala Ridge en la discrepancia ósea maxilo-mandibular en ortodoncia
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2016
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20/01/2016
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Universidad Complutense de Madrid
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Abstract
En los años cuarenta comienza a emplearse la radiología craneal con fines diagnósticos en ortodoncia ,1 la cual solo nos aporta información en sentido sagital y vertical, pero no en sentido transversal.2 A partir de 1961 Haas3 propone la expansión palatina como medio terapéutico en casos donde existe una deficiencia transversal en niños y adolescentes. 4 Sin embargo autores como Bishara y Staley5 o Proffit.6 consideran el ensanchamiento del paladar en pacientes sin crecimiento, un tratamiento insatisfactorio, o en cualquier caso controvertido, debido al cierre de la sutura palatina, así como el resto de suturas circunmaxilares que articulan con el maxilar, las cuales terminan su maduración y concluyen su fusión al final de la adolescencia.7 No siempre que nos encontramos frente a una mordida cruzada existe una compresión maxilar. Por eso, de acuerdo a autores como Lorente1 o Puigdollers,8 es tan importante realizar un adecuado diagnóstico. Tradicionalmente se ha valorado más el diagnóstico y tratamiento de las dimensiones sagital y vertical que la dimensión transversal. Sin embargo, en la última década se ha puesto más énfasis en la importancia de analizar los problemas transversales, con el objeto de mejorar los resultados de los tratamientos, evitar efectos secundarios y mejorar la estabilidad a largo plazo. Según Vanarsdall44 el éxito y la estabilidad de los resultados tras el tratamiento ortodóntico es fruto de un adecuado diagnóstico. Sin embargo, está demostrado que los métodos diagnósticos tradicionales y rutinarios para un adecuado análisis de la discrepancia transversal entre maxilar y mandíbula son en muchos casos deficientes. La rigidez de la sutura media palatina y de las suturas faciales adyacentes observadas con la edad, no nos permiten ensanchar el complejo maxilar (Melsen 1975, Persson y Thilander 1977). Por este motivo la expansión de los segmentos bucales con aparatología fija tiene limitaciones y tenderá a ser inestable, pudiendo generar predisposición a la aparición de dehiscencias y recesiones gingivales, especialmente en pacientes sin crecimiento...
In the 1940s, the use of cranial radiology began for diagnostic purposes in orthodontics1. However, it only provides information on the sagittal and vertical planes, but not on the transverse plane2. In 1961, Haas3 proposed palatal expansion as a therapy in cases where there is a transverse deficiency in children and adolescents. 4 However, authors such as Bishara and Staley5 or Proffit6 consider widening the palate in patients who have completed their growth an unsatisfactory treatment or, in any case, a controversial one due to the closure of the palatal suture and the other circummaxillary sutures that articulate with the maxilla, which culminate their maturation and conclude their fusion at the end of adolescence7. Not every case of cross-bite involves maxillary compression. That is why, according to authors such as Lorente1 or Puigdollers8, it is so important to make a proper diagnosis. Traditionally, more importance has been given to the diagnosis and treatment of the sagittal and vertical planes than the transverse dimension. However, in the last decade more emphasis has been placed on the importance of analysing transverse problems in order to improve treatment results, avoid side effects and increase long-term stability. According to Vanarsdall44, the success and stability of results after orthodontic treatment is fruit of a proper diagnosis. However, there is evidence that traditional and routine diagnostic methods for a proper analysis of the transverse discrepancy between maxilla and mandible are often deficient. The rigidity of the mid-palatal suture and the adjacent facial sutures observed with age prevent us from widening the maxillary complex (Melsen 1975, Persson and Thilander 1977). Therefore, the expansion of the buccal segments with fixed appliances has limitations and will tend to be unstable. It can also cause a predisposition to the appearance of dehiscence and gingival recession, especially in patients who have completed their growth19...
In the 1940s, the use of cranial radiology began for diagnostic purposes in orthodontics1. However, it only provides information on the sagittal and vertical planes, but not on the transverse plane2. In 1961, Haas3 proposed palatal expansion as a therapy in cases where there is a transverse deficiency in children and adolescents. 4 However, authors such as Bishara and Staley5 or Proffit6 consider widening the palate in patients who have completed their growth an unsatisfactory treatment or, in any case, a controversial one due to the closure of the palatal suture and the other circummaxillary sutures that articulate with the maxilla, which culminate their maturation and conclude their fusion at the end of adolescence7. Not every case of cross-bite involves maxillary compression. That is why, according to authors such as Lorente1 or Puigdollers8, it is so important to make a proper diagnosis. Traditionally, more importance has been given to the diagnosis and treatment of the sagittal and vertical planes than the transverse dimension. However, in the last decade more emphasis has been placed on the importance of analysing transverse problems in order to improve treatment results, avoid side effects and increase long-term stability. According to Vanarsdall44, the success and stability of results after orthodontic treatment is fruit of a proper diagnosis. However, there is evidence that traditional and routine diagnostic methods for a proper analysis of the transverse discrepancy between maxilla and mandible are often deficient. The rigidity of the mid-palatal suture and the adjacent facial sutures observed with age prevent us from widening the maxillary complex (Melsen 1975, Persson and Thilander 1977). Therefore, the expansion of the buccal segments with fixed appliances has limitations and will tend to be unstable. It can also cause a predisposition to the appearance of dehiscence and gingival recession, especially in patients who have completed their growth19...
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Tesis inédita de la Universidad Complutense de Madrid de la Facultad de Odontología del Departamento de Estomatología III (Medicina y Cirugía Bucofacial), leída el 20-01-2016