Configurações dentárias reduzidas no contexto de estudos epidemiológicos: associação com desfechos de saúde e validação de critério diagnóstico / Shortened dental configurations in the context of epidemiological studies: association with health outcomes and validation of diagnostic criteria

Objetivou-se mapear os conceitos de configuração dentária reduzida empregados em estudos epidemiológicos associados com desfechos em saúde (estudo 1), bem como avaliar a validade de uma configuração utilizada em estudos epidemiológicos (pares de dentes antagonistas) (Estudo 2). Para o estudo 1 realizou-se uma revisão de literatura do tipo Scoping review com busca nas bases de dados PubMed/Medline, Scopus, Web of Science, Scielo e Cochrane. Dois pesquisadores treinados realizaram a seleção e extração de dados de estudos que avaliaram a associação entre configuração dentária reduzida (exposição) e desfechos em saúde clínicos e centrados na pessoa (saúde geral e saúde bucal), relacionados ao comportamento em saúde (padrões de dieta), além de mortalidade. Desfechos foram classificados de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde e com a Classificação Internacional de Doenças da Organização Mundial de Saúde (OMS). Configurações dentárias reduzidas basearam-se na contagem de dentes presentes, na posição dos dentes considerando estética, oclusão dentária e condições periodontais. A busca inicial resultou em 12525 referências, sendo 283 incluídos. A atualização da busca incluiu 117 artigos (ntotal=400). Saúde geral (n=186) e saúde bucal (n=192) foram abordadas em número semelhante de estudos. A maioria dos desfechos foram clínicos de saúde geral (n=169), sendo as doenças endócrinas, nutricionais ou metabólicas (n=55) frequentes. Em 144 estudos foram abordadas medidas centradas na pessoa, sendo a qualidade de vida relacionada a saúde bucal (QRSB) a mais frequente (n=60). Os desfechos clínicos de saúde bucal foram predominantemente relacionados às funções de ingestão (n=42) e doenças ou distúrbios do complexo orofacial (n=23). Padrões de dieta (n=39) e mortalidade (n=34) também foram estudados. A configuração dentária reduzida definida como meta pela OMS foi a mais frequente (n=181). Para o estudo 2 avaliou-se a acurácia de pares de dentes antagonistas para mensurar a presença de pares de pré-molares e molares em contato oclusal e a concordância entre a prevalência de Arco Dental Reduzido (ADR) e Dentição funcional (DF) quando unidades oclusais dentárias (UOs)/pares de oclusão posterior (POPs) foram definidas por pares de dentes antagonistas ou pares de dentes em contato oclusal. Dados obtidos em inquérito epidemiológico de saúde bucal realizado em município de Minas Gerais, Brasil. UOs e POPs foram definidos pelo critério epidemiológico (condição da coroa dentária) ou critério clínico "padrão ouro" (registro em papel carbono dos contatos oclusais durante a máxima intercuspidação habitual). Foram calculados sensibilidade, valor preditivo positivo (VPP), valor preditivo negativo (VPN) e acurácia do critério epidemiológico. Sensibilidade, especificidade, VPP e VPN foram 88,5, 87,9, 92,5 e 81,9%, respectivamente, e acurácia foi de 88,3%. Os resultados sobre a concordância observada, coeficientes Kappa e valores estatísticos ß em relação à prevalência de ADR e DF (antagonista e contato oclusal) variaram de 0,82 a 0,98, indicando alto índice de concordância. Efeitos das configurações dentárias reduzidas têm sido investigados principalmente em relação às doenças endócrinas, nutricionais ou metabólicas e medidas de QVRSB. Há diversidade de desfechos em saúde. Critério epidemiológico mostrou-se válido e pode ser utilizado em estudos epidemiológicos para calcular a prevalência de configurações dentárias reduzidas que consideram POPs.

This study mapped definitions of shortened dental configurations and health outcomes employed in association studies (Study 1), as well as to evaluate the validity of a configuration used in epidemiological studies (pairs of antagonistic teeth) (Study 2). For study 1, a literature review of the Scoping review type was carried out with a search in PubMed/Medline, Scopus, Web of Science, Scielo and Cochrane databases. Two trained researchers performed the selection and data extraction of studies that evaluated the association between reduced tooth configuration (exposure) and clinical and person-centered health outcomes (general health and oral health), related to health behavior (dietary patterns), in addition to mortality. Outcomes were classified according to the International Classification of Functioning, Disability and Health and the International Classification of Diseases of the World Health Organization (WHO). Shortened dental configurations were based on the number of teeth present, the position of the teeth regarding esthetics, dental occlusion and periodontal conditions. The initial search resulted in 12525 references, 283 of which were included. The search update included 117 articles (ntotal=400). General health (n=186) and oral health (n=192) were addressed in a similar number of studies. Most outcomes were general health clinics (n=169), with endocrine, nutritional or metabolic diseases (n=55) being frequent. In 144 studies, person-centered measures were addressed, with oral healthrelated quality of life (OHQoL) being the most frequent (n=60). Clinical oral health outcomes were predominantly related to eating functions (n=42) and diseases or disorders of the orofacial complex (n=23). Diet patterns (n=39) and mortality (n=34) were also studied. The shortened dental configuration defined as a goal by the WHO was the most frequent (n=181). For study 2, the accuracy of pairs of antagonistic teeth was evaluated to measure the presence of pairs of premolars and molars in occlusal contact and the agreement between the prevalence of Shortened Dental Arch (SDA) and Functional Dentition (FD) when units occlusal (UOs)/posterior occlusion pairs (POPs) were defined by pairs of antagonistic teeth or pairs of teeth in occlusal contact. Data obtained from an epidemiological survey of oral health carried out in the municipality of Minas Gerais, Brazil. UOs and POPs were defined by epidemiological criteria (condition of the dental crown) or clinical "gold standard" criteria (carbon paper recording of occlusal contacts during maximum habitual intercuspation). Sensitivity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of the epidemiological criterion were calculated. Sensitivity, specificity, PPV and NPV were 88.5, 87.9, 92.5 and 81.9%, respectively, and accuracy was 88.3%. The results on observed agreement, Kappa coefficients and ß statistical values in relation to the prevalence of SDA and FD (antagonist and occlusal contact) ranged from 0.82 to 0.98, indicating a high level of agreement. Effects of reduced tooth configurations have been investigated mainly in relation to endocrine, nutritional or metabolic diseases and OHQoL measures. There is a diversity of health outcomes. Epidemiological criteria proved to be valid and can be used in epidemiological studies to calculate the prevalence of reduced dental configurations that consider POPs.

Surgical effects of rehabilitation protocols on dental arch occlusion of children with cleft lip and palate

Aim: to evaluate the surgical effects of two rehabilitation protocols on dental arch occlusion of 5-year-old children with or without cleft lip and palate. Methods: this is a retrospective longitudinal study the sample comprised 45 digitized dental casts divided into followed groups: Group 1 (G1) ­ children who underwent to cheiloplasty (Millard technique) at 3 months and to one-stage palatoplasty (von Langenbeck technique) at 12 months; Group 2 (G2) ­ children who underwent to cheiloplasty (Millard technique) and two-stage palatoplasty (Hans Pichler technique for hard palate closure) at 3 months and at 12 months to soft palate closure (Sommerlad technique); and Group 3 (G3) ­ children without craniofacial anomalies. Linear measurements, area, and occlusion were evaluated by stereophotogrammetry software. Shapiro-Wilk test was used to verify normality. ANOVA followed by posthoc Tukey test and Kruskal-Wallis followed by posthoc Dunn tests were used to compared groups. Results: For the measures intercanine distance (C-C'), anterior length of dental arch (I-CC'), and total length of the dental arch (I­MM'), there were statistical differences between G1x G3 and G2xG3, the mean was smaller for G1 and G2. No statistically significant differences occurred in the intermolar distance and in the dental arch area among groups. The occlusion analysis revealed significant difference in the comparison of the three groups (p=0.0004). Conclusion: The surgical effects of two rehabilitation protocols affected the occlusion and the development of the anterior region of the maxilla of children with oral clefts when compared to children without oral clefts.

Dental arch characteristics among South Indian twins - A morphometric study

Genetic and environmental factors are essential in occlusal variations and malocclusion and have been of considerable interest to orthodontists. Studies on twin pairs are one of the most effective methods for investigating genetically determined occlusal variables. Many studies have focused on distances between first molars or between canines but malocclusions can also occur in other regions of the dental arch. Aim: To evaluate the characteristics of the dental arch between pairs of Monozygotic (MZ) and Dizygotic (DZ) twins from Southern India. Methods: A random sample of 51 twin pairs (12­18years old) participated in this study. The zygosity of twin pairs was recorded by facial appearance. The occlusion of the first permanent molars was recorded according to Angle's classification. Study models were prepared to assess dental arch characteristics (i.e., arch form, arch perimeter, arch length; intercanine, intermolar width, and teeth size discrepancy). The obtained data was statistically analyzed using SPSS software 19.0. The student's t-test (two-tailed, independent) and Chi-square test was used to determine the significance of studied parameters. Results: Angle's Class I molar relation was more commonly observed followed by the Class II molar relationship among twins. The measured dental arch dimensions did not show a statistically significant difference among twin pairs. The ovoid arch form was commonly observed among Monozygotic and Dizygotic Twins. There was a similarity among MZ and DZ twins in the anterior and overall Bolton's ratio. Conclusion: There were similar occurrences of measured parameters among twins, which showed genetic predominance in the expression of measured dental arch traits

Evaluation of palatal volume in children with cleft lip and palate: a comparison of two surgical protocols / Avaliação volumétrica do palato em crianças com fissura labiopalatina: comparação de dois protocolos cirúrgicos

Objective: Compare the palatal volume in children with unilateral cleft lip and palate before and after two surgical protocols. Material and Methods: Retrospective data collection was performed in a specialized hospital. The sample comprised 120 digitized dental models divided into, Group 1 (G1) ­ participants submitted to cheiloplasty at 3 months (Millard technique) and one-step palatoplasty at 12 months (von Langenbeck technique); Group 2 (G2) ­ participants submitted to cheiloplasty (Millard technique) and hard palate closure (Hans Pichler technique) at 3 months and soft palate closure at 12 months (Sommerlad technique). The dental models were evaluated at Time 1 (T1): before primary plastic surgeries, Time 2 (T2): 1st post-surgical phase, and Time 3 (T3): 2nd post-surgical phase. The volume was measured through stereophotogrammetry system software. Parametric and non-parametric statistical tests were applied (α=5%). Results: The intragroup analysis revealed that G1 had a statistically significant increase in volume at T2 followed by a reduction at T3 (p=0.003); G2 showed a statistically significant increase of dental arch volume between T1 and T2 (p=0.001). There was no statistically significant difference in the intergroup and gender analyses (p>0.05). Conclusion: The surgical protocol influenced the palatal volume of children with unilateral cleft lip and palate. This study suggested that two-step palatoplasty protocol has a tendency to be more appropriate.(AU)

Objetivo: Comparar o volume palatino em crianças com fissura unilateral de lábio e palato antes e após dois protocolos cirúrgicos. Material e Métodos: A coleta de dados retrospectiva foi efetuada em um hospital especializado. A amostra foi composta por 120 modelos dentários digitalizados divididos em, Grupo 1 (G1) ­ participantes submetidos a queiloplastia aos 3 meses de vida (técnida de Millard) e a palatoplastia em única etapa aos 12 meses (técnica de von Langenbeck); Grupo 2 (G2) ­ participantes submetidos a queiloplastia (técnica de Millard) e fechamento do palato duro (técnica de Hans Pichler) aos 3 meses de vida e fechamento do palate mole aos 12 meses (técnica de Sommerlad). Os modelos dentários foram avaliados em Tempo 1 (T1): antes das cirurgias plásticas primárias, Tempo 2 (T2):1ª fase pós-cirúrgica e Tempo 3 (T3): 2ª fase pós-cirúrgico. O volume foi mensurado por meio do software do sistema de estereofotogrametria. Testes estatísticos paramétricos e não-paramétricos foram utilizados (α=5%). Resultados: As análises intragrupos indicaram que G1 apresentou aumento estatisticamente significante em T2 seguido de redução em T3 (p=0.003). G2 apresentou crescimento estatisticamente significativo do volume palatino entre T1 e T2 (p=0.001). Não houve diferença estatisticamente significante nas análises intergrupos e entre gêneros (p>0.05). Conclusão: O protocolo cirúrgico influenciou o volume palatino das crianças com fissura unilateral de lábio e palato. Este estudo sugeriu que o protocolo da palatoplastia em duas etapas possui uma tendência de ser mais apropriado.(AU)

Utilização do arco de Connecticut (CIA®) para intrusão dos dentes anteriores ­ relato de caso / Use of Connecticut arch (CIA®) for intrusion of maxillary anterior teeth ­ case report

Resumo A sobremordida profunda é uma má oclusão vertical que pode apresentar um conjunto de características esqueléticas, dentárias e neuromusculares que produzem uma quantidade excessiva de trespasse vertical na região dos incisivos. O tratamento da sobremordida pode ser realizado pela extrusão dos dentes posteriores, distalização dos dentes posteriores, inclinação vestibular dos dentes anteriores (com intrusão relativa) e intrusão real dos incisivos superiores e/ou inferiores. Existem diferentes técnicas para tratamento da sobremordida, entretanto, muitas destas apresentam efeitos adversos decorrentes do tipo de mecânica aplicada. O arco Connecticut Intrusion Arch CIA® é um arco de intrusão que possui dobra em "V" pré-calibrada na região posterior, que é confeccionada com o alicate nº 291 (Zattyr®), proporcionando forças de intrusão adequadas (leve e contínua). O objetivo do trabalho foi realizar revisão de literatura sobre o arco CIA®, no qual foi descrito: definição, aplicabilidade, vantagens e desvantagens. Foi realizado um passo a passo da técnica de confecção deste arco e demonstrada sua aplicação em um caso clínico. O arco de intrusão, confeccionado de forma simples e padronizada, foi efetivo na intrusão dos incisivos e no controle mecânico vertical e sagital no sistema straight wire do caso clínico apresentado e de acordo com os resultados que foram encontrados na revisão de literatura (AU)

Abstract Deep overbite is a vertical malocclusion that may present a set of skeletal, dental, and neuromuscular features that produce an excessive amount of vertical overjet in the incisor region. The treatment of overbite can be performed by extrusion of the posterior teeth, distalization of the posterior teeth, vestibular inclination of the anterior teeth (with relative intrusion), and real intrusion of the upper and lower incisors. There are different techniques for treating overbite, however, many of these have adverse effects due to the type of applied mechanics. The Connecticut Intrusion Arch CIA® is a pre-calibrated "V" bend in the rear region, which is made with pliers # 291 (Zattyr®) that provides adequate (light and continuous) intrusion forces. The objective of the work was to carry out a literature review on the CIA® arch, where it was described: definition, applicability, advantages, and disadvantages. A step-by-step technique of making this arch was performed and the application of the same was demonstrated in a clinical case. The simple and standardized intrusion arch was effective in incisor intrusion and vertical and sagittal mechanical control in the straight wire system in the clinical case presented and according to the results that were found in the literature review (AU)

Alterações dimensionais de maxilas portadoras de caninos impactados / Dimensional changes of maxillas with impacted canines

O objetivo do estudo foi avaliar medidas do arco superior realizadas em imagens por Tomografia Computadorizada de Feixe Cônico (TCFC) de pacientes com caninos impactados localizados por vestibular e palatino. Método: A amostra consistiu de imagens axiais de TCFC de 63 pacientes de ambos os sexos (44 do sexo feminino e 19 do masculino) com média de idade de 17,8 anos. Empregou-se software OnDemand® 3D para obter as medidas de distância intermolar, perímetro e comprimento maxilar. Inicialmente, foi realizada análise descritiva e exploratória dos dados. Foi aplicado teste t de Student para comparar os dois grupos com canino impactado uni e bilateralmente e análise de variância (ANOVA) para comparar os grupos, quanto à posição do canino impactado, por vestibular ou palatino. A reprodutibilidade entre as medidas foi avaliada pelo coeficiente de correlação intraclasse (ICC), considerado o nível de significância de 5% Resultados: Pôde-se verificar que do total de voluntários, 39 indivíduos apresentavam caninos impactados unilateralmente e 24 bilateralmente. Desses, 26 apresentavam-se na posição vestibular e 37 na posição palatina. Observou-se que a distância intermolares foi significativamente menor no grupo com canino impactado bilateralmente (p<0,05), o perímetro e o comprimento do arco maxilar não diferiram significativamente entre os pacientes com caninos impactados unilateral ou bilateralmente (p>0,05). Porém esses parâmetros se apresentaram significativamente menores (p<0,05) nos pacientes com canino impactados na posição palatina. Conclusões: Maxilas com caninos impactados bilateralmente apresentam distância intermolar menor e caninos impactados por palatino estão presentes em maxilas com o menor perímetro de arco.(AU)

Objective: The purpose of the study was to evaluate measurements of the upper arch performed by Cone Beam Computed Tomography (CBCT) images of patients with impacted canines located in the vestibular and palatal areas. Method: The sample consisted of axial CBCT images of 63 patients of both genders (44 female and 19 male) with a mean age of 17.8 years. OnDemand® 3D software was used to obtain the measurements of intermolar distance, perimeter and maxillary length. Initially, descriptive and exploratory data analysis was performed. Student t test was applied to compare the two groups with unilaterally and bilaterally impacted canines, and analysis of variance (ANOVA) was used to compare the groups regarding the position the impacted canine, either vestibular or palatal. Reproducibility between measurements was evaluated by the intraclass correlation coefficient (ICC), considering the level of significance of 5%. Results: It was possible to verify that of the total number of volunteers, 39 individuals had unilaterally and 24 bilaterally impacted canines. Of these, 26 were in the vestibular position and 37 in the palatal position. It was observed that the intermolar distance was significantly smaller in the group with bilaterally impacted canines (p<0.05), the perimeter and maxillary arch length did not differ significantly among patients with unilaterally or bilaterally impacted canines (p>0.05). However, these parameters were significantly lower (p<0.05) in patients with impacted canines in the palatal position. Conclusions: Maxillas with bilaterally impacted canines present smaller intermolar distance, and palatal canines impacted are present in maxillary with the smallest arch perimeter.(AU)

Brazilian Adults Believe that Complete Dentures would be the Solution to the Oral Impacts Caused by Reduced Dentition

Abstract Objective: To evaluate the direct and oral impact-mediated association between reduced dentitions and the self-perceived need for complete dentures (CD) in dentate adults. Material and Methods: Data from the Brazilian Oral Health Survey (2010) were analyzed. The outcome was self-perceived need for CD. Functional dentition (FDClassV) was defined by the presence of the following criteria: level I - ≥1 tooth in each arch, level II - 10 teeth in each arch, level III - 12 anterior teeth, level IV - ≥ 3 posterior occluding pairs (POPs) of premolars and level V - ≥1 bilateral POPs of molars. Oral impacts were assessed with Oral Impacts on Daily Performances scale. Results: FDClassV was associated with a less self-perceived need for CD both directly and mediated by oral impacts. Dentitions without level V were associated with the outcome mediated by oral impacts. Between individuals with 10 teeth in each arch, self-perceived need for CD was similar for those who had or not anterior teeth and POPs. Individuals with <10 teeth in each arch and level III did not have a higher frequency of self-perceived need for CD compared to those with level II. Conclusion: Oral impacts mediated the association between reduced dentitions and self-perceived need for CD. Individuals with tooth loss may report need for CD, even when they have dental configurations compatible with functionality.

Influência do banda-alça na manutenção de espaço do arco inferior após a perda precoce de molares decíduos: um estudo piloto / Influence of loop band on mandibular arch space maintenance after early loss of deciduous molars: a pilot study

Objetivo: Avaliar a influência do dispositivo banda-alça na perda de espaço após exodontia precoce de molares decíduos inferiores em escolares, em um período de 3 meses. Materiais e métodos: Trata-se de um estudo piloto de ensaio clínico randomizado, com dois grupos paralelos. A amostra incluiu 25 crianças, entre 6 e 9 anos, com indicação clínica e radiográfica de exodontia unilateral de um molar decíduo inferior. Estes foram divididos em Grupo Controle (G1): sem intervenção; e Grupo Intervenção (G2): com instalação de banda-alça. Todos os pacientes foram moldados antes do procedimento de exodontia (T1) e no acompanhamento de 3 meses (T2). Um avaliador cego quanto aos grupos e tempo realizou as medidas estabelecidas nos modelos de gesso. A análise estatística foi realizada por meio dos testes T pareado e T de Student nos casos de distribuição normal dos dados e testes não-paramétricos Wilcoxon e Mann-Whitney para distribuição não normal. Resultados: Todos os participantes foram classificados como Classe I, com overjet de até 3mm e padrão facial mesocéfalo. A maioria (64%) teve o segundo molar decíduo perdido. Após 3 meses, o G1 perdeu, em média, 0,75mm a mais na distância linear do espaço de extração comparado ao G2 (P<0,05). Conclusão: Concluiu-se que, embora os dois grupos apresentaram perda de espaço, o G1 (sem intervenção) apresentou uma perda de espaço maior no período de acompanhamento de 3 meses.

Objective: To evaluate the influence of the band and loop space maintainer on space loss after the early extraction of mandibular primary molars in schoolchildren, over a period of 3 months. Materials and Methods: a pilot study of a randomized clinical trial was carried out, with two parallel groups. The sample included 25 children, aged between 6 and 9 years, with clinical and radiographic indication for unilateral extraction of a mandibular primary molar. The patients were divided into Control Group (G1): with no intervention; and Intervention Group (G2): with the installation of the space maintainer. A dental cast was obtained before the extraction procedure (T1) and at the 3-month followup (T2). An evaluator, blinded to the groups and time, performed the established measures in the dental casts. Statistical analysis was performed using Paired Sample T test and Student's T test in cases of normal data distribution, and nonparametric Wilcoxon and Mann-Whitney tests for non-normal distribution. Results: All participants were classified as Class I, with an overjet of up to 3 mm and a mesocephalic facial pattern. The majority (64%) had a lost second deciduous molar. After 3 months, the G1 lost, on average, 0.75mm more in the linear distance from the extraction space (P<0.05). Conclusion: It was concluded that, although the two groups showed space loss, G1 (without intervention) showed a greater loss of space in the 3-month follow-up period.

3D technology to measure dental arches and create a template for lingual brackets technique

ABSTRACT Objective: This study aims at identifying anatomical dimensions of dental arches, based on landmarks currently used in the lingual orthodontic technique, and create an archwire form template to be used in orthodontic clinics. Methods: Maxillary and mandibular dental casts of 140 Caucasian individuals with natural and normal occlusion were digitized (3D), and the images were analyzed with Delcam Power ShapeTM 2010 software. The dental arch shapes and sizes were obtained from 14 landmarks selected on the lingual surface of the teeth. Points and segments defined by the software were used to create an archwire form template. Results: Various dental arch patterns were found for both maxilla and mandible. The smallest sizes were found in females, and the largest were found in male subjects. Six categories were defined for each gender, three for the maxilla and three for the mandible (Small, Medium and Large). A template was created with eighteen anatomic lingual archwire designs, nine for the maxilla and nine for the mandible, for both genders. Conclusions: Landmarks evaluated in this study showed dental arch differences between genders. This information enables making orthodontic lingual archwires that are more compatible with the anatomical forms and sizes of the maxilla and mandible. The findings also allowed the creation of a template for an anatomic lingual metallic archwire form to be used in the lingual technique.

RESUMO Objetivo: O presente estudo tem como objetivo encontrar as formas anatômicas e dimensões das arcadas dentárias com base em pontos de referência utilizados na técnica ortodôntica lingual, e criar um diagrama com um maior número de arcos metálicos para serem utilizados na clínica ortodôntica. Métodos: 140 modelos de indivíduos caucasianos com oclusão normal e natural foram digitalizados (3D) e as imagens, analisadas com o software Delcam Power ShapeTM 2010. A determinação das formas e tamanhos das arcadas dentárias foi obtida a partir de 14 pontos selecionados na superfície lingual dos dentes. Outros pontos e segmentos foram utilizados, com o auxílio do software, para definir um diagrama. Resultados: Foram encontrados diferentes tamanhos de arcadas dentárias linguais, tanto para a maxila quanto para a mandíbula. Os menores tamanhos foram os femininos, e os maiores, os masculinos. Definiram-se seis tamanhos para cada sexo, sendo três para a maxila e três para a mandíbula, nomeados como P, M e G. Foi criado um diagrama com dezoito desenhos de arcos linguais anatômicos, nove para a maxila e nove para a mandíbula, para ambos os sexos. Conclusões: A posição dos pontos de referência nesse estudo evidenciou diferenças entre os sexos, o que permitiu a criação de arcos mais compatíveis com as formas e dimensões anatômicas da maxila e mandíbula. A diferença entre os tamanhos das arcadas dentárias linguais possibilitou a criação de um diagrama com formas de arcos metálicos linguais anatômicos para serem utilizados na técnica lingual, para auxiliar o profissional a criar os seus próprios arcos.

In Vitro Study of Tooth Surfaces After Interproximal Enamel Reduction: Extraoral Scanner and SEM Analysis

ABSTRACT Objective To perform a morphological evaluation concerning the extent of interproximal enamel reduction (IPR) with different manual instruments in different types of teeth and a qualitative analysis of enamel surface characteristics at the contact point before and after IPR. Material and Methods 40 freshly extracted, caries-free, and intact human teeth were used for the study (20 bicuspids and 20 incisors) and performed IPR just on the mesial surface. The morphological variation of contact point was evaluated by superimposed the stl file, obtained thanks to an extraoral scanner, at T0 and T1 for each tooth. Two types of strip were used, Intensiv Manual Ortho Strips Coarse/Medium and Steelcarbo Horico Strips. Teeth were then cut lengthwise, removed the most apical root portion and the mesial and distal halves were gilded and observed at different magnifications. Results The morphological variation following stripping mainly depends on the extent of the stripping, while the diameter, the type of strip and the shape of the tooth itself do not appear to be relevant. The 500X and 1500X magnifications allowed to appreciate better the characteristics of the surface of the stripped enamel and the differences with the intact enamel. All teeth treated, independently from the kind of strip used, shows deep marks and grooves in the direction of stripping. In both cases, the enamel appears significantly damaged at great magnifications. Conclusion Stripping always and inevitably leads to a change in the shape of the contact point and is directly correlated to the amount of stripping performed. The use of polishing after the removal of enamel interproximal is necessary in all cases.

Associação entre hábitos orais e má oclusão com problemas respiratórios em escolares de 5 anos / Association between oral habits and malocclusion with respiratory problems in 5-year-old schoolchildren

Introdução Toda má oclusão apresenta origem multifatorial, e dentre os fatores que a desencadeiam estão os hábitos. O surgimento de um hábito pode estar relacionado com o emocional, o fisiológico ou com o aprendizado condicionado do indivíduo. Objetivo Analisar as relações entre hábitos e más oclusões associado a problemas respiratórios em escolares de 5 anos. Material e método Foi realizado um estudo transversal com uma amostra de 753 crianças pertencentes à rede municipal de ensino da cidade de Araraquara, SP. Foram realizados exames clínicos para avaliação da má oclusão (Foster & Hamilton), além de aplicado questionários aos pais para avaliação de condição socioeconômica e demográfica, qualidade de vida relacionada à saúde bucal (ECOHIS) e hábitos. A análise dos dados foi feita pela análise bivariada por teste qui-quadrado seguida de modelo de regressão logística múltipla considerando nível de significância de 5%. Resultado A prevalência de crianças com problemas respiratórios e/ou alergias foi de 46,9%, com má oclusão foi de 58,7% e com algum tipo de hábito oral deletério foi de 12,0%. Apresentaram mais chance de ter problemas respiratórios e/ou alergias crianças do sexo masculino (1,40 vezes mais) e crianças com algum hábito oral deletério (1,95 vezes mais). Conclusão Observou-se que apresentaram maior chance de problemas respiratórios e/ou alergias as crianças do sexo masculino, crianças com algum hábito oral deletério e que apresentavam bruxismo.

Introduction All malocclusion has a multifactorial origin, and among the factors that trigger it are the habits. The appearance of a habit can be related to the emotional, physiological or conditioned learning of the individual. Objective Evaluate the relationship between habits and malocclusions associated with respiratory problems in 5-year-old students. Material and method A cross-sectional study were carried out with a sample of 753 children belonging to the municipal education network of the city of Araraquara-SP. Clinical exams were performed for malocclusion evaluation (Foster & Hamilton), applying questionnaires to the parents for evaluation of socioeconomic and demographic condition, oral health related quality of life (ECOHIS) and habits. Data analysis was performed by bivariate analysis using chi-square test followed by multiple logistic regression model considering 5% significance level. Result The prevalence of children with respiratory problems and/or allergies was 46.9%, with malocclusion was 58.7% and with some type of deleterious oral habit was 12.0%. Male children were 1.40 times more likely to present respiratory problems or allergies and children with some deleterious oral habits were 1.95 times more likely to present respiratory problems or allergies. Conclusion It was observed that male children, children that presented deleterious oral habits, and children with bruxism are more likely to have respiratory problems and/or allergies.

Modified Arnold expander: an alternative for mandibular arch expansion

ABSTRACT Introduction: Due to the anatomical constraints of the mandible, mandibular dental arch usually serves as a guideline to determine the required changes in the maxillary transverse dimension. The Schwarz appliance and the Lip Bumper are the traditional orthodontic appliances for mandibular arch expansion in patients with borderline amounts of crowding, and/or transverse discrepancy. However, they often require patient cooperation, which may be a concern for orthodontists in daily practice. Objectives: This article illustrates a simple fixed orthodontic device as an alternative to achieve mandibular arch expansion in patients with moderate tooth-size/arch-length discrepancy. The four reported cases refer to 8 to 10-year-old patients in the mixed dentition, with an Angle Class I or Class II malocclusion, transverse deficiency in both arches, moderate crowding and/or posterior crossbite, combined with compromised smile aesthetics. The patients were treated with rapid maxillary expansion (RME) using Hass expander appliance and the modified Arnold expander (MAE). Conclusion: This low-cost compliance-free orthodontic appliance provided dentoalveolar decompensation by means of uprighting the posterior teeth, with minimal or no adjustments during treatment. The final results were achieved in only three to four months, and fulfilled all treatment objectives, such as an increase in the arch perimeter and width, and a better teeth alignment.

RESUMO Introdução: Devido aos limites anatômicos da mandíbula, a arcada dentária inferior geralmente serve como guia para determinar as alterações necessárias na dimensão transversal da maxila. O aparelho de Schwarz e o Lip Bumper são os aparelhos usados tradicionalmente para expansão da arcada inferior em pacientes com quantidades limítrofes de apinhamento e/ou discrepância transversal. No entanto, eles requerem a cooperação do paciente, o que pode ser uma preocupação para os ortodontistas na prática diária. Objetivos: O presente artigo ilustra uma alternativa diferente de aparelho fixo para se obter a expansão da arcada inferior em pacientes com discrepância moderada de tamanho dentário e/ou comprimento da arcada. Os quatro casos relatados referem-se a pacientes com 8 a 10 anos de idade, na dentição mista, com má oclusão de Classe I ou II de Angle, deficiência transversal em ambas as arcadas, apinhamento moderado e/ou mordida cruzada posterior, apresentando comprometimento da estética do sorriso. Os pacientes foram tratados com expansão rápida da maxila (ERM), usando aparelho expansor de Hass, e expansor Arnold modificado (EAM). Conclusão: O EAM, que é um aparelho de baixo custo e não depende da colaboração do paciente, promoveu uma descompensação dentoalveolar por meio da verticalização dos dentes posteriores, necessitando de mínimo ou nenhum ajuste durante o tratamento. Os resultados pretendidos foram alcançados em três a quatro meses e cumpriram todos os objetivos do tratamento, como aumento do perímetro e largura da arcada, assim como o melhor alinhamento dos dentes.

Correlation Between Mesio-Distal Teeth Diameters and Arch Width

ABSTRACT Objective: To verify the existence of a correlation between the mesio-distal size of teeth and the arch width by analyzing the data separately for maxillary and mandibular arch in patients with ideal occlusion Material and Methods: 58 patients with ideal occlusion were studied, for a total of 276 files analyzed. Dental casts were then scanned using a professional scanner (Epson Perfection v 330) and images were obtained in TIFF format at 600 dpi. All single teeth measurements were carried out for all teeth of both arches using the VAM software (Vectra, Canfield Scientific, Fairfield, NJ, USA). The repeatability and reproducibility of the measurement method were evaluated using the Gauge R&R method. In case a correlation between tooth size and arch size is found to be significant, a linear regression analysis can be applied through the following statistical relationship: y=a+b*x, where y is the result (inter-molar distance "AvgB66" or inter-canine distance "Cusp 33"), and x the specific tooth. The a and b respectively represent the intercept (point of intersection between the line and the y axis) and the slope of the line that describes the regression ratio. Results: The statistical analysis highlights a significant correlation (p<1%) between the results of the mesio-distal measurements of each tooth and the two variables considered to define the size of each arch ("AvgB66" and "Cusp 33"). Based on these results, a numerical relationship "y=a+b*x" has been extrapolated. Thus, it is possible to calculate the estimated inter-molar or inter canine distance necessary to have the teeth aligned. Conclusion: The inter-canine and inter-molar distances can be estimated starting from measuring the mesio-distal diameter of a single tooth.

Apicotomia associada ao tracionamento ortocirúrgico em dente com dilaceração radicular / Apicotomy associated with orto-surgical treatment in tooth with a root dilaceration

Introdução: A apicotomia é uma técnica, que vem sendo utilizada em dentes com dilaceração radicular acentuada, com o intuito de liberar a porção do dente impactada e, dessa forma, permitir seu reposicionamento na arcada dentária. Este trabalho tem como objetivo apresentar um relato de caso clínico do manejo ortocirúrgico de tracionamento ortodôntico associado à apicotomia em dente incluso com dilaceração radicular acentuada. Relato de caso: O paciente foi encaminhado para o serviço de bucomaxilofacial para exodontia do elemento incluso após insucesso de tracionamento ortocirúrgico, em que se verificou, ao exame radiográfico periapical, dente incluso com dispositivo ortodôntico e dilaceração radicular importante. Diante disso, realizou-se, sob anestesia local, a apicotomia e instalação do dispositivo ortodôntico. O paciente evoluiu bem, e, após 8 meses, o elemento dentário encontrava-se em posição oclusal e em função mastigatória. Considerações finais: Assim, a técnica da apicotomia mostra-se eficaz como alternativa ao insucesso do tracionamento ortodôntico tradicional, sendo uma técnica mais conservadora que a exodontia, necessitando de conhecimento teórico e domínio técnico do profissional... (AU)

Introduction: Apichotomy is a technique that has been used in teeth with severe root laceration in order to release the impacted tooth portion and thus allow its repositioning of the tooth in the dental arch. The aim of this paper is to present a clinical case report of orthosurgical orthodontic traction management associated with apichotomy in an included tooth with severe root laceration. Case report: The patient was referred to the Oral and Maxillofacial Service for extraction of the included element after ortho-surgical traction failure, which was verified by periapical radiographic examination, tooth included with orthodontic device and significant root laceration. Thus, under local anesthesia, apichotomy and orthodontic device installation were performed. The patient progressed well, and after 8 months the dental element was in occlusal position and in masticatory function. Final considerations: Thus, the apichotomy technique is effective as an alternative to the failure of traditional orthodontic traction, being a more conservative technique than extraction and requiring theoretical knowledge and technical mastery of the Professional... (AU)

Factors associated with the need for a complete denture in one arch or both arches among the elderly population

Abstract: This study aimed to identify factors associated with the need for complete dentures in one dental arch or both, among the elderly population. The cross-sectional household study was conducted with a representative sample of elderly people (65 years or older) in the state of São Paulo, Brazil, in 2015. The dependent variable was the need for complete dentures (in one arch or both), and independent variables were socioeconomic and demographic conditions, social capital, self-perception of oral health and access to dental services. Simple and multinomial logistic regression models tested effect measures (p < 0.05). A total of 5,948 elderly people participated. Results indicated that those with greater chances of needing a complete denture in one arch were male (OR = 1.54; CI95%:1.04-2.29), with fewer household goods (OR = 2.25; CI95%:1.50-3.38), lower monthly household income: R$501-1500 (OR = 3.44; CI95%:1.27-9.35), R$1501-2500 (OR = 4.11; CI95%:1.50-11.27), R$2501-4500 (OR = 2.76; CI95%:1.10-6.95), self-reported need for a complete denture (OR = 4.75; CI95%:3.08-7.35), ≥3 years since last dental appointment (OR = 1.80; CI95%:1.06-3.05), and dissatisfaction with last dental appointment (OR = 1.80; CI95%:1.06-3.05). There were more chances of the need for complete dentures in both arches among older elders (OR = 1.44; CI95%:1.06-1.88), with lower monthly household income: R$ < 501 (OR = 4.45; CI95%:1.71-11.60), R$501-1500 (OR = 4.01; CI95%:2.14-7.51), R$1501-2500 (OR = 2.95; CI95%:1.64-5.32), < 3 years of education (OR = 1.45; CI95%:1.13-1.85), feeling unhappy (OR = 2.74; CI95%:1.35-5.57), self-reported need for a complete denture (OR = 8.48; CI95%:5.75-12.50), dissatisfaction with their mouth (OR = 2.38; CI95%:1.64-3.46), ≥3 years since last dental appointment (OR = 4.28; CI95%:2.85-6.43), and dissatisfaction with last dental appointment (OR = 4.28; CI95%:2.85-6.43). The several dimensions of the determinants of the need for a complete denture reflect the influence of both demographic and socioeconomic aspects, social capital, self-perception of oral health and access to dental services.

Influência do tamanho do FOV e posicionamento na arcada de estruturas densas na formação de artefatos em TCFC / Influence of FOV size and positioning int he arcade dense structures in the formation of artifacts in TCFC

O objetivo deste estudo foi analisar a influência do tamanho campo de visão ou FOV (field of view) e o posicionamento na arcada de estruturas densas na formação de artefatos em exames de tomografia computadorizada de feixe cônico(TCFC). Foram utilizadas raízes de dentes bovinos em um simulador de mandíbula em acrílico simulando a posição dos dentes. A obtenção das imagens ocorreu por meio dos tomógrafos Kodak 9000 com FOV pequeno e o Kodak 9500 com FOVs médio e grande. Para aquisição das imagens, o simulador foi posicionado sempre de forma padronizada. O grupo controle foi estabelecido a partir do escaneamento de seis raízes de dentes bovinos hígidas. Cada uma das seis raízes foi substituída por um implante ou raiz bovina preenchida com guta-percha (materiais hiperdensos) e uma nova imagem tomográfica foi realizada em cada tomógrafo para cada modificação. Todas as imagens foram avaliadas no software Image J para avaliação dos valores de cinza na região cervical, média e apical de cada raiz e comparadas com a imagem do grupo controle. Foi verificado que a interação entre tamanho do FOV, material e região não foi significativa (p=0,983). A interação entre material e região, não tiveram diferenças significativas (p=0,904). Para a relação entre tamanho do FOV e material evidenciou-se a presença de diferença significativa (p<0,001). Observou-se que os valores no FOV médio e pequeno apresentaram p<0,001, quando confrontado com o grupo controle. Concluiu-se que os valores de cinza não se diferem conforme localização do material hiperdenso dentro da arcada e que o FOV pequeno é o que apresenta menor média quando se compara material e região. (AU)

The objective of this study was to analyze the influence of the field of view or FOV (field of view) size and the positioning in the arch of dense structures in the formation of artifacts in cone beam computed tomography (TCFC) exams. Bovine tooth roots were used in an acrylic jaw simulator simulating the position of the teeth. The images were obtained using Kodak 9000 tomographs with small FOV and Kodak 9500 with medium and large FOVs. For image acquisition, the simulator was always positioned in a standardized way. The gold standard was established by scanning six roots of healthy bovine teeth. Each of the six roots was replaced by an implant or bovine root filled with gutta-percha (hyperdense materials) and a new tomographic image was performed on each tomography for each modification. All images were evaluated using the Image J software to assess the gray values in the cervical, middle and apical regions of each root and compared with the gold standard image. It was found that the interaction between FOV size, material and region was not significant (p = 0.983). The interaction between material and region, did not have significant differences (p = 0.904). For the relationship between FOV size and material, the presence of a significant difference was evidenced (p <0.001). It was observed that the values in the medium and small FOV presented p <0.001, when compared with the gold standard. It was concluded that the gray values do not differ according to the location of the hyperdense material within the arch and that the small FOV is the one with the lowest average when comparing material and region. (AU)

Determinação da relação cêntrica pelo registro do Arco Gótico de Gysi em paciente edêntulo total / Determining the centric relation for the edentulous patient with the Gothic Arch of Gysi

Este artigo descreve a técnica de confecção dos dispositivos intraorais e a realização do registro do arco gótico, com consequente determinação da Relação Cêntrica (RC) em um paciente edêntulo total. (AU)

The aim of this paper was to describe the technique of intraoral devices making for the recording of the Gothic Arch Tracings, and consequently the determination of the Centric Relation (CR), in a total edentulous patient. (AU)

3D comparison of dental arch stability in patients with and without cleft lip and palate after orthodontic/rehabilitative treatment

Abstract This study aimed to compare the linear dimensions of the dental arches of adult patients with complete unilateral cleft lip and palate (UCLP) after orthodontic and prosthetic treatment with fixed partial dentures (FPD) to patients without clefts, using 3D technology. This retrospective longitudinal study sample consisted of 35 subjects divided into two groups. Included in this sample were 15 complete UCLP individuals who had received orthodontic treatment before rehabilitation with a fixed partial denture (FG), as well as 20 patients without cleft as control group (CG). All patients were aged between 18 and 30 years. Digital dental casts were obtained in two stages: (T1) end of orthodontic treatment and (T2) one year after prosthetic rehabilitation (FG); and (T1) end of orthodontic treatment and (T2) one year after removal of the orthodontic appliance (CG). Intercanine, interfirst premolar and intermolar distances, and incisor-molar length were obtained. A precalibrated and trained examiner performed the assessments. Intergroup differences between T2 and T1 were compared between the groups using the t test or Mann-Whitney test with a significance level of 5% (p<0.05). The intercanine distance variation (T2-T1) showed statistical difference (p=0.005) increasing in the FG group and decreasing in the CG group. In the interfirst premolar distance variation, FG decreased, while CG increased with statistically significant difference (p=0.008). The intercanine distance of individuals with cleft showed stability, while that of the CG had no stability. The CG showed stability in the interfirst premolar distance, while FG had no stability. These findings showed that the FPD is capable of restricting orthodontic results, leading to a stabilization of the dental arches.

Associação entre autopercepção da necessidade de prótese total e configurações dentárias reduzidas entre adultos brasileiros: estudo transversal / Association between self-management of the need for total prosthesis and dental configurations reduced between brazilian adults: a cross-sectional study

A condição que garante a realização de todas as funções bucais mesmo quando o arco dental não está completo é denominada Dentição Funcional (DF). Avaliou-se a associação direta, e mediada pela presença de impactos bucais, entre a autopercepção da necessidade de prótese total (PT) e configurações dentárias reduzidas, em adultos (35-44 anos) brasileiros dentados. Dados foram obtidos pela Pesquisa Nacional de Saúde Bucal (2010) por amostragem por conglomerado, em múltiplos estágios de sorteio, com probabilidade proporcional ao tamanho da população. A coleta de dados envolveu exames bucais e a aplicação de questionários sobre características demográficas, condições socioeconômicas e percepções sobre saúde bucal. Autopercepção da necessidade de prótese total foi medida pela pergunta: O sr(a) considera que necessita usar PT (dentadura) ou trocar a que está usando atualmente? As configurações dentárias reduzidas foram classificadas com base num sistema funcional de classificação das dentições hierarquizado, que considera sequencialmente a presença de: no mínimo um dente em cada arco, 10 dentes em cada arco, 12 dentes anteriores, pares de oclusão posteriores (POP) de pré-molares (≥3) e molares (≥1 bilateral). A configuração dentária que possui todos os critérios, dos cinco níveis, foi definida como uma dentição funcional (DFClassV). O Índice de Impactos Odontológicos no Desempenho Diário (IODD) avaliou a presença de impactos bucais. Associação entre o desfecho (autopercepção da necessidade de PT) e a variável independente principal (configurações dentárias reduzidas) foi investigada por modelo de regressão logística e análise de equações estruturais, incluindo as seguintes covariáveis: satisfação com a boca, impactos bucais (IODD), sangramento, cálculo, bolsa rasa, bolsa profunda, dor de dente, sexo, cor da pele, renda e escolaridade. A amostra total era de 9547 indivíduos sendo que 6.083 indivíduos foram incluídos nesse estudo. Adultos com DFclassV apresentaram uma chance 56% menor de autopercepção da necessidade de prótese total (OR=0,44; IC 95%: 0,28- 0,70). De acordo com os resultados das análises de equações estruturais, DFclassV foi negativa e diretamente associada com o desfecho (Efeito total [CP]=-0,294; p<0,001). Configurações dentárias com perda de dentes anteriores e/ou POP foram associadas com maior autopercepção da necessidade de PT (efeito direto positivo). Configuração dentária sem POP de molares não apresentou efeito direto sobre o desfecho, mas um efeito indireto via IODD (p=0,002). Maior autopercepção da necessidade de prótese foi observada entre aqueles cujas configurações dentárias apresentavam menor número de critérios de funcionalidade, sejam eles, dentes bem-distribuídos, estética e/ou oclusão. (AU)

The condition that ensures the performance of all oral functions even when the dental arch is not complete is called Functional Dentition (FD). It was evaluated the direct association and mediated by the presence of oral impacts between the self-perception of the need for complete dentures (CD) and dental configuration among Brazilian adults (35-44 years) with teeth. Data were obtained by the National Oral Health Survey (2010) by sampling by conglomerate in multiple stages random with probability proportional to the size of the population. Data collection involved oral exams and the application of questionnaires on demographic characteristics, socioeconomic conditions and perceptions about oral health. Self-perception of the need for a prosthesis was measured by the question: Do you consider that you need to use CD (complete denture) or change the one you are currently using? The reduced dental configurations were classified based on a hierarchical functional classification system of teeth, which sequentially considers the presence of: i) at least one tooth in each arch; ii) 10 teeth in each arch; iii) 12 anterior teeth; iv) three or four Posterior Occlusion Pairs (POP) of premolars; and v) at least one bilateral molar POP. The dental configuration that has all the criteria, of the five levels, was defined as a functional dentition (DFClassV). The Dental Impact on Daily Performance (OIDP) evaluated the presence of oral impacts. The association between the outcome (self-perception of CD need) and the main independent variable (reduced dental configurations) was investigated by logistic regression model and analysis of structural equations, including the following covariates: mouth satisfaction, oral impacts (IODD), bleeding, calculus, shallow and deep periodontal pockets, dental pain, sex, skin color, income and schooling. The total sample was 9547 individuals and 6,083 individuals were included in this study. Adults with DFclassV presented a 56% lower chance of self-perception of the prosthesis requirement (OR = 0.44, 95% CI: 0.28-0.70). According to the results of the analysis of structural equations, DFclassV was negative and directly associated with the outcome (Total effect [CP] = -0.294, p <0.001). Dental configurations with loss of anterior teeth and / or POP were associated with greater self-perception of the need for PT (positive direct effect). Dental configuration without POP of molars had no direct effect on the outcome, but an indirect effect via IODD (p = 0.002). Higher selfperception of the need for prostheses was observed among those whose dental configurations presented fewer functionality criteria, be it well-distributed teeth, aesthetics and / or occlusion. (AU)

Análise odontológica de detalhes anatômicos incisais e oclusais, em especial "flor de lis", para identificação forense ­ relato de caso / Dental analysis of incisal and occlusal anatomic details, in particular "flor de lis", for forensic identification ­ case report

A identificação humana é feita pela análise das particularidades de cada indivíduo, inclusive odontológicas, a qual consiste em um método que necessita de documentação prévia ante mortem de qualquer natureza, mas que contenha características específicas e individuais sobre o periciando a ser identificado. O presente trabalho tem como objetivo relatar um caso de identificação cadavérica cujo componente principal foi a comparação de dois modelos ortodônticos fornecidos pela família, com as peculiaridades dos arcos dentais do cadáver, demonstrando inúmeras coincidências e nenhuma divergência excludente. Nesta comparação, foram evidenciados detalhes anatômicos das bordas incisais, em especial a "flor de Lis" no dente 12 e das faces oclusais que foram suficientes para a identificação do desaparecido.

Human identification is done by analyzing the particularities of each individual, including dental ones, which consists of a method that requires previous documentation ante mortem of any nature, but which contains specific and individual characteristics about the victim to be identified. This study aims to report a case of cadaver identification whose main component was the comparison of two orthodontic models provided by the family, with the peculiarities of the dental arches of the corpse, showing numerous coincidences and no exclusionary divergence. In this comparison, anatomical details of the incisal edges were evidenced, especially the "flor de Lis" on tooth 12 and the occlusal faces that were sufficient to identify the disappeared.