Introduction: Conventional direct and indirect bonding techniques fail to obtain the ideal bracket position. Objective: To compare the accuracy of virtual and conventional direct bonding of orthodontic accessories. Methods: A single virtual configuration (dental mannequin with Class I malocclusion) served as basis for generating the reference model (treated virtually) and the intervention models (10 digital models and 10 solid models, obtained by means of prototyping). A total of 560 teeth were then equally distributed between a group of orthodontists (Group I, direct bonding; and Group II, virtual bonding), working in two different time intervals. The individual positions of the accessories were measured after three-dimensional superimposition with customized software. The Student’s-t test for paired samples, and Chi-square tests were used for statistical analysis, both at the level of significance of 5%. Results: In comparison of the errors in raw values, there were significant differences only in the vertical (p< 0.001) and horizontal dimensions (p< 0.001). Considering the groups of ranges by clinical limits of the deviations, these differences were significant in the three dimensions, vertical (p< 0.001), horizontal (p= 0.044) and angular (p= 0.044). Conclusion: Virtual bonding made it possible to obtain more precise/accurate positioning of the orthodontic accessories. The potential accuracy of this method brings new perspectives to refining the indirect bonding protocols.

Purpose: to verify, in the literature, the effects of using the stimulating palatal plate on lip and tongue posture in children with trisomy 21. Methods: a search was conducted in Medline, LILACS, CINAHL, EMBASE, Scopus, Web of Science, and Cochrane. Original articles designed as clinical trials, longitudinal studies, or case-control studies, approaching stimulating palatal plate in the treatment of children with trisomy 21 and assessing habitual lip and tongue posture as an outcome, were included. Literature Review: a total of 376 studies were found, of which 10 met the selection criteria. They were published between 1996 and 2007 and carried out mostly in Europe, with small samples. The age when they began wearing the plate ranged from 1 month to 5 years, and intervention lasted from 4 to 58 months; in most cases, it was combined with orofacial muscle stimulation. Use frequency ranged from two to four times a day, each period lasting from 30 minutes to 2 hours. The children’s tongue and lip posture improved in most pieces of research. Conclusion: studies suggest that using the stimulating palatal plate in combination with orofacial muscle stimulation brings benefits to tongue and lip posture in children presented with trisomy 21.

Individuals with trisomy 21 may have muscle hypotonia of the speech articulation organs, an enlarged protruding tongue positioned on the floor of the mouth, and a lack of lip closure. The stimulating palatal plate is an intraoral appliance that, associated with myofunctional therapy, aims to improve these children’s habitual lip and tongue posture. This study aimed to present the cases of four male children with trisomy 21, with a mean age of 6.7 and a standard deviation of 7.8 months, who used the stimulating palatal plate in association with myofunctional therapy. The children used the plate for 6 months and did exercises based on the orofacial regulation therapy, and their parents received instructions on feeding them and removing deleterious oral habits. In the first session and at the end of the treatment, each child’s face was video-recorded for 5 minutes at rest, and two researchers analyzed independently their habitual tongue and lip posture. Participants who began the treatment earlier and had the most severe postural changes had greater tongue and lip posture improvement.

The objectives of pre-surgical orthopedics are to allow surgical repair with minimal tension of the involved tissues and less restriction to the craniofacial growth. The aim of this study was to evaluate the benefits of nasoalveolar model (NAM) as a pre-operative therapy in a patient with bilateral cleft lip and palate followed by labioplasty and palatoplasty. A 15-day-old patient underwent orthopedic treatment with NAM. After pre-operative treatment, retraction of the pre-maxilla was observed with reduction of the fissure. Due to the successful effects of NAM treatment the patient had a one-step surgery for lip correction. Six months later, due to lip pressure the fissure was further decreased. After six months, the patient underwent palatoplasty. Both surgeries contributed to the remaining closure of the fissure, which were reduced by half compared to the end of pre-operative treatment. The uses of NAM as a pre-operative treatment approached the alveolar segments, centralized the pre-maxilla, decreased the cleft palate resulting in a marked improvement of the arch and provide superior surgical results. In addition, it allows the primary repair of the patient’s lip with asymmetric bilateral fissure in only one-step surgery; in consequence, it will reduce treatment morbidity and decrease cost of treatment.