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Occlusions are among the problems of public health due to their high epidemiological dimension in the childhood phase and are considered by the World Health Organization the third odontological problem. Among them are the crossbites, which, if not treated early, may lead to craniofacial alterations in adulthood, compromising the structures of the stomatognathic apparatus. The objective of this study was to report the clinical case of a male child with a functional unilateral posterior crossbite, treated by the planas direct tracks technique. The clinical case refers to a 3-year-old patient, with a left unilateral posterior crossbite and with midline deviation. Following the protocol of neuro-occlusal rehabilitation with the use of Planas Direct Tracks, wearings were performed on the occlusal interferences of the 63 tooth and the confection of slopes in inclined planes using composite resin, which was installed on the upper tooth of the crossed side, in order to promote the occlusal balance. After 31 days of treatment, there was bite uncrossing and midline leveling. We conclude that the favorable clinical outcome has been achieved and that the Planas Direct Tracks technique is effective for the treatment of functional crossbites.
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Annali di stomatologia
corrective orthodontics
Neuro-occlusal rehabilitation by the Planas direct tracks method: case report
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Neuro-occlusal rehabilitation by the Planas direct tracks method: case report
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                                                                                                     Case report



    Neuro-occlusal rehabilitation by the Planas direct
    tracks method: case report




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    José Ísper Garbin Artênio, DDS                          Introduction
    Gabriela Teruel Peres, DDS
    Tânia Adas Saliba, DDS                                  The malocclusions can produce changes both from




                                                                                          io
    Bruno Wakayama, DDS                                     the aesthetic and functional points of view, affecting
    Clea Adas Saliba Garbin, DDS                            chewing, swallowing, breathing, phonation and the
                                                            children’s quality of life (1-4). Occlusions are among




                                                                      az
                                                            the public health problems due to their high
    São Paulo State University (UNESP), School              epidemiological dimension in the childhood phase
    of Dentistry, Araçatuba (SP), Brazil                    and are considered by the World Health Organization
                                                            the third odontological problem, being proceeded by




                                                                    rn
                                                            periodontal disease and by dental caries (5-7).
    Corresponding author:                                   Among the occlusions, the anterior and posterior
    Gabriela Teruel Peres                                   crossbites stand out, being classified didactically in
    Postgraduate Program in Preventive and Social Den-      skeletal, dental and functional. The skeletal crossbite




                                                     te
    tistry,                                                 is the result of a discrepancy in the maxillary and/or
    São Paulo State University (UNESP)                      mandibular bone structure. The dental is caused by
    José Bonifácio 1193                                     an altered pattern of eruption of the teeth and the
    16015-050 Araçatuba, São Paulo, Brazil
                                                   In       functional is characterized by the existence of
    E-mail: teruel_gabi@hotmail.com                         premature contacts that depreciate the occlusion,
                                                            causing skeletal changes if not treated early. The
                                                            permanence of functional crossbite can lead to facial
    Summary                                                 and postural asymmetry, temporomandibular and
                               ni

                                                            masticatory problems (8, 9).
    Occlusions are among the problems of public             Given these points, early corrective and preventive
    health due to their high epidemiological dimen-         interception of crossbite in early childhood and the
                             io


    sion in the childhood phase and are considered          correct choice of treatment are essential. Neuro-
    by the World Health Organization the third odon-        Occlusal Rehabilitation (NOR), using the Planas
    tological problem. Among them are the cross-            Direct Tracks technique, elucidated by Pedro Planas,
                           iz



    bites, which, if not treated early, may lead to cran-   becomes attractive because of its orthopedic
    iofacial alterations in adulthood, compromising         benefits. The NOR in its foundation is intended to
    the structures of the stomatognathic apparatus.         remove occlusal interferences that cause physiolo -
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    The objective of this study was to report the clini-    gical and morphological disorders in order to
    cal case of a male child with a functional unilater-    reprogram the patient’s musculature (4, 6, 7, 9, 10).
    al posterior crossbite, treated by the planas direct    The treatment with Planas Direct Tracks is a thera-
    tracks technique. The clinical case refers to a 3-      peutic resource, in which there is the addition of
    year-old patient, with a left unilateral posterior      composite resins applied directly in the occlusal of
    crossbite and with midline deviation. Following         the deciduous teeth, forming a barrier that prevents
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    the protocol of neuro-occlusal rehabilitation with      the return of the mandible to the deviation position
    the use of Planas Direct Tracks, wearings were          in which it was accustomed, seeking the harmo -
    performed on the occlusal interferences of the 63       nization of the occlusal plane in relation to the
    tooth and the confection of slopes in inclined          Camper plane, and the altered vertical dimension
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    planes using composite resin, which was in-             pathologically (4, 6).
    stalled on the upper tooth of the crossed side, in      This technique is cited by many Authors as a way to
    order to promote the occlusal balance. After 31         treat functional crossbite because it presents
    days of treatment, there was bite uncrossing and        advantages as a low cost when compared to
©




    midline leveling. We conclude that the favorable        orthopedic and/or orthodontic appliances, uses the
    clinical outcome has been achieved and that the         function as growth stimulus, presents no risk of
    Planas Direct Tracks technique is effective for the     overcorrection, is fast and does not depend on the
    treatment of functional crossbites.                     patient collaboration (6, 11, 12). However, despite the
                                                            citations about the technique, there are few findings
    Key words: malocclusion, children, corrective or-       in the literature that contextualize the theme, making
    thodontics.                                             it difficult to study and disseminate it, and then being

    Annali di Stomatologia 2018;IX(1):53-58                                                                      53
    J. Ísper Garbin Artênio et al.


    almost unknown in the dental environment.                 the mandibular deviation from the position of centric
    In this way, the present study aims to report the         relation to maximum habitual intercuspation,
    clinical case of a male child with a functional           characterized by the dental interferences.
    unilateral posterior crossbite, treated by the Planas     No abnormal conditions were detected on panoramic
    Direct Tracks technique, in order to determine its        radiographic examination. For differential diagnosis, it




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    efficacy and its occlusal stability.                      was used the data set obtained with the clinical and
                                                              radiographic exams, study models, intra-buccal and




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                                                              postural photographs. In the anamnesis, it was
    Clinical case                                             verified that the patient was breastfed for 3 months,
                                                              the chewing preference side was the left side and he
    The present clinical case was performed with a            was not in dental treatment at another location (Fig. 4).




                                                                                             io
    patient L.S.B., male, 3 years old, deciduous dentition.   Initially, there were made removals of premature
    He was diagnosed in the initial clinical examination      contacts and after that, the tracks were made in
    with left functional unilateral posterior crossbite,      composite resin, following the protocol of adhesive




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    midline deviation, straight facial pattern, absence of    restorations. Prophylaxis, relative isolation of the
    dental caries lesions and soft tissue normality. The      operative field, conditioning of the teeth with 37%
    patient had a habit of using a baby bottle twice a day,   phosphoric acid, application of the adhesive system
    and the caregiver was instructed to stop this habit       and the confection of the tracks, with composite resin




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    (Fig. 1-3).                                               photopolymerizable. For this, the insertion of the
    According to the NOR protocol, there was classified       composite resin in an inclined plane on 63 tooth was
    the functional unilateral posterior crossbite with        determinant to establish the correct neuromuscular
    manipulation of the mandible for the examination of       excitation in the rehabilitation of the stomatognathic




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    the intermaxillary relation. This procedure evidenced     system.
                                                     In                                Figure 1. Initial of treatment: left
                                                                                       functional unilateral posterior
                                                                                       crossbite.
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                                                                                       Figure 2. Initial of treatment: left
                                                                                       functional unilateral posterior
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                                                                                       crossbite.
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    54                                                                             Annali di Stomatologia 2018;IX(1):53-58
    Neuro-occlusal rehabilitation by the Planas direct tracks method: case report


                                                                                           Figure 3. Initial of treatment: left
                                                                                           functional unilateral posterior
                                                                                           crossbite.




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                                                                   The patient was accompanied with 2 biweekly and 1




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                                                                   monthly controls for treatment evaluation and for
                                                                   occlusal adjustments. There was leveling of the
                                                                   midline and uncrossing of the bite, showing that the
                                                                   goal of the treatment was reached and, at the end of
                                                            In     this period, the rebalancing of the stomatognathic
                                                                   apparatus (Figs. 5-8).
                               ni
                                                                   Discussion

                                                                   The high prevalence of posterior crossbite in
                             io

                                                                   preschool children warns the need for prevention and
                                                                   early intervention, since this occlusion does not self-
                                                                   correct and causes physiological, social and
                           iz



                                                                   psychological disorders (9, 13-15).
                                                                   Among the main etiological factors of posterior
                                                                   crossbite, genetic factors, mouth breathing, neglect of
           Ed




                                                                   breastfeeding and sucking habits can be highlighted
                                                                   (9, 16).
                                                                   Since the 40’s, Pedro Planas was concerned with the
                                                                   etiology and diagnosis of childhood occlusion
                                                                   disorders. The reduction in the number of children
                                                                   breastfed, in conjunction with what Planas called
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                                                                   “civilized feeding”, eliminates some of the stimuli
                                                                   needed for growth and changes the pattern of
    Figure 4. Initial of treatment: postural photographs.          development of the respiratory system (6, 10).
                                                                   Moimaz et al demonstrated that the lack of
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                                                                   stimulation caused by breastfeeding can lead to
    The restorative material selected was the composite            occlusions, including crossbite, a fact evidenced in
    resin Z100 (3M), in shade A1. It is a microhybrid resin        this study, in which the patient’s mother reported
    that offers adequate resistance to masticatory efforts,
                                                                   breastfeeding for only 3 months (16).
©




    while allowing good smoothness of surface and
                                                                   The NOR as a treatment of posterior crossbite was
    polishing, avoiding the accumulation of dental biofilm.
                                                                   efficient due to the fast correction of the occlusion
    The finishing was done with diamond tips numbers
                                                                   and because it was made in a single session. The
    1192F and 3118F in high rotation. The final confi -
                                                                   treatment is favorable within 3 to 6 years old children
    guration of the tracks must be wide enough to block the
                                                                   because it corresponds to the stage of greater growth
    return of the mandible to the deflected position and thick
                                                                   and development of the cranio-muscular. In the
    enough for not to fracture when in function.
                                                                   present study, the clinical case was performed in a 3-

    Annali di Stomatologia 2018;IX(1):53-58                                                                                 55
    J. Ísper Garbin Artênio et al.


                                            Figure 5. Clinical case: 30 days
                                            after treatment.




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                                            Figure 6. Clinical case: 30 days
                                            after treatment.




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                                            Figure 7. Clinical case: 30 days
                                            after treatment.
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    56                                  Annali di Stomatologia 2018;IX(1):53-58
    Neuro-occlusal rehabilitation by the Planas direct tracks method: case report


                                                                   that they do not require collaboration of the patient,
                                                                   since they are based on “adhesive restorations” and
                                                                   selective wearings that remain active in the
                                                                   stomatognathic system. As pointed out by Pinzan et
                                                                   al., the collaboration of the child in the use of the




                                                                                                            li
                                                                   removable orthodontic appliance is one of the most
                                                                   critical limitations of his study because it interferes in




                                                                                                          na
                                                                   the efficacy and time of the treatment (5-7, 12, 20, 21).
                                                                   In the clinical case, the patient obtained at the end of
                                                                   the NOR treatment, correction of crossbite, leveling
                                                                   of the midline and return of facial symmetry. Studies
                                                                   corroborate that facial asymmetries are generally




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                                                                   more frequent in individuals presenting unilateral
                                                                   posterior crossbite in the deciduous dentition than
                                                                   those with normal occlusion. Given that, it is inferred




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                                                                   the importance of the treatment in the growth phase
                                                                   of the individual, since this functional occlusal
                                                                   disharmony can cause changes in the skeletal
                                                                   structures generating after-effects in the adulthood.




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                                                                   Conclusion




                                                          te
                                                                   The correction of functional unilateral posterior
                                                                   crossbite through the use of Planas Direct Tracks.
                                                                   The favorable clinical outcome was reached, because
                                                        In         the intervention occurred at an early age and the
                                                                   child’s tissue dynamics was still favorable for remo-
                                                                   deling and accommodation of the stomatognathic
                                                                   apparatus.
                               ni

    Figure 8. Clinical case: 30 days after treatment.              References
                             io


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