Dentofacial deformities are associated with lower degrees of self-esteem and higher impact on oral health-related quality of life: results from an observational study involving adults.

PURPOSE: Patients with dentofacial deformities tend to show poorer oral health-related quality of life, but few studies thus far have focused on this topic. Therefore, the objectives of this study were to evaluate oral health-related quality of life, self-esteem, and depression in patients with Class II and Class III dentofacial deformities before orthodontic treatment and to compare these patients with controls with harmonic faces. MATERIALS AND METHODS: This observational, cross-sectional study compared 2 groups (experimental vs control) of patients recruited at an outpatient orthodontic clinic. Oral health-related quality of life was assessed using a short form of the Oral Health Impact Profile, self-esteem was evaluated with the Rosenberg Self-Esteem Scale, and depression symptoms were assessed using the General Hospital Depression Scale (outcome variables). The presence of dentofacial deformities (ie, group allocation) was the primary predictor variable. The χ(2) test and Spearman correlation coefficient were used to analyze data. RESULTS: The total sample was composed of 68 individuals (34 in each group). In the experimental group, 55.9% of patients were women, and 88.2% presented a Class III occlusal relation. The mean age in the experimental group was 27.56 years. Significant differences were observed between the 2 groups in oral health-related quality of life (P < .001) and self-esteem (P < .019), but no differences were found for depression (P = .161). CONCLUSIONS: Patients with dentofacial deformities had a more negative oral health-related quality of life and a lower self-esteem compared with controls. No association was observed between dentofacial deformities and depression.

Calcium phosphate cement in orbital reconstructions.

Treatment of facial trauma sequelae is a complex and challenging process. There is still controversy over suitable materials for orbital wall reconstruction. This study evaluated calcium phosphate cement (CPC) implants manufactured by rapid prototyping in the repair of orbital wall defects secondary to trauma. Computed tomographic scans of 5 patients were used for surgery planning and production of CPC implants. Implants were used to restore orbital wall anatomy, ocular alignment, and facial contour. Benefits resulting from the use of implants, such as a reduced operating time, patient response to biomaterial implantation, biomaterial integrity and stability, and patient satisfaction with treatment, were analyzed qualitatively. Our results suggest that CPC is an effective and safe material for orbital reconstruction because of its biocompatibility and easy production and placement.

Vertical alveolar growth in subjects with infraoccluded mandibular deciduous molars.

INTRODUCTION: Our objective was to compare vertical alveolar growth in areas adjacent to infraoccluded deciduous molars with growth in areas of deciduous molars and normal occlusion for a period of at least 1 year by using digital subtraction radiography. METHODS: This case-control study included 40 pairs of panoramic radiographs of growing patients with infraoccluded deciduous molars and 40 pairs of radiographs of patients without infraoccluded deciduous molars. One radiograph at baseline was obtained at diagnosis, and the other at least 1 year later. The subjects and the controls were matched according to chronologic age and time interval between the 2 radiographs. The 2 groups were compared with regard to vertical alveolar growth and vertical tooth movement. Measurements were assessed by using nonparametric tests (Mann-Whitney and Friedman) and a multiple comparison test. Significance was set at 5%. RESULTS: A statistically significant difference was observed between the groups with regard to vertical alveolar growth measured on the bone crest between the first permanent molars and second premolars. CONCLUSIONS: Vertical alveolar growth between the first permanent molar and the second premolar adjacent to the infraoccluded teeth was smaller than in areas adjacent to teeth with normal occlusion.

Orthodontic-restorative treatment as an option for biologic replacement of a maxillary central incisor: 5-year follow-up.

The maxillary central incisor is the tooth most often affected by trauma, especially in the age range of 7 to 10 years, when high-impact sports are prevalent. The options for conservative treatment should be prioritized in these patients, aiming to achieve a biologic response that might provide continuity of growth of the alveolus, to provide functional and esthetic development of the affected region. This case report describes a patient with a history of trauma during the deciduous dentition with consequent intrusion, root dilaceration, and retention of the maxillary left central incisor. The treatment involved extraction of the traumatized tooth and mesial movement of the lateral incisor and posterior segments.

Restoration of occlusal vertical dimension in dental erosion caused by gastroesophageal reflux: case report.

The authors describe a minimally invasive procedure for occlusal rehabilitation in a young patient presenting with mild mandibular prognathism and loss of occlusal vertical dimension caused by dental erosion from chronic gastroesophageal reflux.

Solitary median maxillary central incisor syndrome and holoprosencephaly: a case report.

Solitary median maxillary central incisor syndrome (SMMCIS) is a rare anomaly that affects 1 in 50,000 live births. Of unknown etiology, SMMCIS is characterized by the presence of a single central incisor located on the maxillary midline and may be associated with developmental defects and systemic alterations. SMMCIS also is associated with short stature, mild forms of deviation in craniofacial morphology, and intellectual disability. The purposes of this paper were to: describe the clinical case of an 8-year-old boy with a permanent central incisor located at the midline in association with holoprosencephaly; and highlight the most important aspects related to diagnosis and treatment of solitary median maxillary central incisor syndrome.

Repairing ceramic restorations: final solution or alternative procedure?

This article provides an overview of dental ceramics. It addresses possible modes of failure and factors that may influence the decision to either repair or replace ceramic restorations. The authors' intention was to present ceramic repair as a reliable, low-cost, low-risk technique.

Orthodontic space closure of lost traumatized anterior teeth - case report.

This case report refers to an 11-year-old boy with avulsion of the upper left central and lateral incisors. The teeth were replanted after 4 h, splinted with a semi-rigid splint for 12 days, and then endodontically treated. Severe progressive root resorption was seen after 2 years and the teeth were extracted. The boy had a normal occlusion with spacing in both jaws and slight protrusion of the anterior teeth. The treatment objectives were to close some of the spaces by mesial movement of the buccal segments in the upper jaw to minimize bone loss for a future single osseointegrated implant. Fixed appliance in combination with a removable plate was used for the mesial movements, levelling, and alignment of the upper jaw. Fixed appliance in the lower jaw and Class II traction were used for the final adjustment of the occlusion. A good occlusion with coincident upper and lower midlines and up-righted anterior teeth were achieved. A Maryland bridge was performed as a temporary solution for a future osseointegrated implant.

The quad-helix appliance in the primary dentition--orthodontic and orthopedic measurements.

Changes in the midpalatal suture and the alterations in intercanine and intermolar widths with the use of the quad-helix appliance were evaluated. Study casts and occlusal radiographs from 10 patients with a mean age of 4 years and 10 months (SD 11 months) were analyzed. A statistically significant palatal suture widening was observed in all cases. The proportion of dental tipping accomplished with the treatment was greater than opening of the suture.

Evaluation of the use of low-level laser therapy in pain control in orthodontic patients: A randomized split-mouth clinical trial.

OBJECTIVE: To evaluate the effect of using low-level laser therapy (LLLT) to control pain and discomfort during orthodontic treatment. MATERIALS AND METHODS: A randomized, split-mouth clinical trial was conducted with 30 volunteers in need of orthodontic treatment, of both genders, aged between 18 and 40 years, who were randomly divided into two groups. One hemiarch was considered the exposed group (EG) and the other, the placebo group (PG). Both groups had elastic separators placed mesially and distally to the first molars of the two hemiarches at different times. The EG received an AIGaAs diode LLLT (810 nm, 100 mW, 2J/cm(2)) application for 15 seconds per point (interdental papilla at the mesial, distal, and near the root apex) immediately after separator placement on the maxillary right side. The PG also had elastics placed around the maxillary right molars, but received only simulated LLLT application. The elastics were left in place for 5 days, and after a waiting period of 1 week, they were inserted on the left side in both groups; however, the order of laser application was changed. While the separator remained in place, the patient marked his degree of perceived discomfort on a Visual Analog Scale (VAS) at 5 minutes (T0), 24 hours (T1), and 120 hours (T2), after LLLT application. RESULTS: A statistically significant difference was observed (P < .005) in reducing discomfort in the exposed group compared with the placebo group. This reduction of discomfort in the EG was observed at all time intervals. CONCLUSIONS: A sincle AIGaAs diode LLLT application may be indicated for the control or reduction of pain in the early stages of orthodontic treatment.

Desire for orthodontic treatment and associated factors among adolescents in Southern Brazil.

OBJECTIVE: To estimate the prevalence of the desire for orthodontic treatment and investigate associated factors among adolescents in southern Brazil. MATERIALS AND METHODS: A cross-sectional study was carried out with 704 adolescents aged 12 and 13 years at municipal public schools in the city of Balneário Camboriú (southern Brazil). The adolescents answered a previously tested questionnaire addressing satisfaction with their dental appearance, speech function, chewing function, and the desire for orthodontic treatment. The parents/guardians answered a questionnaire addressing satisfaction with their child's dental appearance and socioeconomic variables. A trained and calibrated orthodontist collected clinical data on malocclusion using the Dental Aesthetic Index (DAI). Statistical analysis was performed using multivariate Poisson regression with robust variance. RESULTS: The prevalence of the desire for orthodontic treatment was 69.6% (490/704). In the adjusted analysis, the outcome was significantly more prevalent among girls (P < .001), those with difficulty chewing (P  =  .026), those dissatisfied with their dental appearance (P < .001), and those with greater malocclusion severity (P < .001). The following orthodontic characteristics were associated with the desire for orthodontic treatment in the multivariate model: diastema in anterior segment (P < .001), anterior maxillary irregularity (P < .001), maxillary overjet ≥6 mm (P < .001), and mandibular overjet (P  =  .047). CONCLUSIONS: The desire for orthodontic treatment among 12- and 13-year-old adolescents is influenced by gender, dissatisfaction with one's dental appearance, difficulty chewing, malocclusion severity, and orthodontic characteristics. These findings should be considered together with normative indications regarding the need for orthodontic treatment in adolescents.

Customized and low-cost aspirator device for intra-oral sandblasting.

This paper presents a simple technique that uses a novel device made of low-cost materials and is very helpful in routine clinical activity. This device plays an important role in reducing the suspension of particles in the air when a sandblaster of aluminum oxide powder is used intraorally to create additional micromechanical retention prior to applying a bonded restoration.

Combined periodontal and orthodontic treatment in a patient with aggressive periodontitis: a 9-year follow-up report.

A combined periodontal and orthodontic treatment demands a detailed evaluation in both specialties, particularly when the periodontium is reduced. This is especially true for adult patients, but young patients can also suffer from advanced periodontitis. This article describes combined periodontal and orthodontic therapy in a young patient with severe localized and aggressive periodontitis, tooth crown abnormalities, and missing maxillary second premolars. Periodontal treatment was carried out. Once attachment gain and bone stability were confirmed, orthodontic therapy commenced. It lasted 32 months, during which segmented mechanics and only light forces were used. The result of this intervention was satisfactory, and long-term stability (9 years) with periodontal maintenance was achieved.

Camouflage treatment for class III malocclusion combined with traction of an impacted maxillary central incisor.

This case report describes the treatment of a patient with an unerupted maxillary left central incisor, class III malocclusion with crossbite of the maxillary posterior teeth and lateral open bite. Treatment consisted of rapid maxillary expansion followed by anterior space opening, maxillary protraction and traction of the unerupted teeth with a light force system. Favorable results were obtained in terms of correcting incisor position and class III malocclusion. The results achieved remained stable throughout a 4-year retention period.

Soft tissue profile changes in class II patients treated with first bicuspid extraction / Alterações do perfil mole em pacientes portadores de classe II tratados com extrações de primeiros pré-molares

Objetivo: Avaliar mudanças nos tecidos moles da área labial decorrentes do tratamento ortodôntico com extrações de primeiros pré-molares em 20 indivíduos classe II de Angle. Material e métodos: Foram utilizadas 40 telerradiografias de perfil escaneadas, sendo 20 radiografias iniciais e 20 radiografias pós-tratamento. Dezoito pontos foram digitalizados sobre as telerradiografias e analisados utilizando o programa Radiocef 4.0 (Radio Memory Ltda.). Foram utilizadas medidas lineares e angulares para medir a variação da posição dos lábios dos indivíduos. Foi realizado cálculo de erro do método. Valores pré e pós-tratamento foram comparados entre si utilizando o teste t de Student para dados pareados. Resultados: A retrusão média dos lábios superior e inferior foi de 2 mm. Foi observado um aumento significativo do ângulo nasolabial de 5,36°, o que resultou em uma diminuição da convexidade facial. O ângulo do lábio superior (ULA) diminuiu 4,74°. Conclusão: Pode-se concluir que planejamentos envolvendo extração de primeiros prémolares em pacientes com maloclusão classe II resultam em uma pequena alteração da convexidade do perfil facial (aumento do ângulo nasolabial e diminuição do ângulo do lábio superior).

Objective: To assess soft tissue changes in the lip area after orthodontic treatment with first bicuspid extraction in 20 Angle class II patients. Methods: A total of 40 profile cephalograms were digitized and measured: 20 obtained at baseline and 20 after treatment. Eighteen landmarks were marked on the cephalograms and analyzed using the Radiocef software version 4.0 (Radio Memory Ltda.). Linear and angular measurements were used to analyze changes in upper and lower lip position. Statistical analysis included calculation of error. Pre- and post-treatment measurements were compared using the Student t test for paired samples. Results: Upper and lower lips showed a mean retrusion of 2 mm. There was a significant increase in the nasolabial angle, of 5.36°, leading to a decreased facial convexity. The upper lip angle (ULA) retruded -4.74°. Conclusions: Our findings suggest that treatment of class II patients including first bicuspid extraction result in small changes in the patients' facial profile (increased nasolabial angle and decreased upper lip angle).

Gingival margin alterations and the pre-orthodontic treatment amount of keratinized gingiva.

The purpose of this retrospective study was to associate the amount of keratinized gingiva present in adolescents prior to orthodontic treatment to the development of gingival recessions after the end of treatment. The sample consisted of the intra-oral photographs and orthodontic study models from 209 Caucasian patients with a mean age of 11.20 +/- 1.83 years on their initial records and 14.7 +/- 1.8 years on their final records. Patients were either Angle Class I or II and were submitted to non-extraction orthodontic treatment. Gingival recession was evaluated by visual inspection of the lower incisors and canines as seen in the initial and final study models and intra-oral photographs. The amount of recession was quantified using a digital caliper and the observed post-treatment gingival margin alterations were classified as unaltered, coronal migration of the gingival margin or apical migration of the gingival margin. The width of the keratinized gingiva was measured from the mucogingival line to the gingival margin on the pre-treatment photographs. The teeth that developed gingival recession and those that did not have their gingival margin position changed did not differ in relation to the initial amount of keratinized gingiva (3.00 +/- 0.61 and 3.5 +/- 0.86 mm, respectively). Paradoxically, teeth that presented a coronal migration of the gingival margin had a smaller initial amount of keratinized gingiva (2.26 +/- 0.31 mm). The mean amount of initial keratinized gingiva did not predispose lower incisors and canines to gingival recession.

Gingival margin alterations and the pre-orthodontic treatment amount of keratinized gingiva

The purpose of this retrospective study was to associate the amount of keratinized gingiva present in adolescents prior to orthodontic treatment to the development of gingival recessions after the end of treatment. The sample consisted of the intra-oral photographs and orthodontic study models from 209 Caucasian patients with a mean age of 11.20 ± 1.83 years on their initial records and 14.7 ± 1.8 years on their final records. Patients were either Angle Class I or II and were submitted to non-extraction orthodontic treatment. Gingival recession was evaluated by visual inspection of the lower incisors and canines as seen in the initial and final study models and intra-oral photographs. The amount of recession was quantified using a digital caliper and the observed post-treatment gingival margin alterations were classified as unaltered, coronal migration of the gingival margin or apical migration of the gingival margin. The width of the keratinized gingiva was measured from the mucogingival line to the gingival margin on the pre-treatment photographs. The teeth that developed gingival recession and those that did not have their gingival margin position changed did not differ in relation to the initial amount of keratinized gingiva (3.00 ± 0.61 and 3.5 ± 0.86 mm, respectively). Paradoxically, teeth that presented a coronal migration of the gingival margin had a smaller initial amount of keratinized gingiva (2.26 ± 0.31 mm). The mean amount of initial keratinized gingiva did not predispose lower incisors and canines to gingival recession.

O objetivo deste estudo retrospectivo foi associar a quantidade de gengiva ceratinizada existente em adolescentes pré-tratamento ortodôntico e o desenvolvimento de recessões gengivais pós-tratamento ortodôntico. A amostra consistiu de fotografias intra-orais e modelos de estudo de 209 pacientes leucodermas com idades médias de 11,20 ± 1,83 anos nos exames iniciais e 14,7 ± 1,8 anos nos exames finais. Os pacientes eram Classe I ou II de Angle e foram submetidos a tratamento ortodôntico sem extrações. As recessões gengivais foram avaliadas por inspeção visual dos incisivos e caninos inferiores nas fotografias e nos modelos de estudo iniciais e finais dos pacientes. As alterações da margem gengival pós-tratamento foram medidas com paquímetro digital e subdivididas em inalterada, migração coronal da margem gengival, ou migração apical da margem gengival. A quantidade de gengiva ceratinizada foi medida da linha mucogengival à margem gengival nas fotografias pré-tratamento ortodôntico. Tanto os dentes que desenvolveram recessões gengivais como aqueles que não tiveram a posição da margem gengival alterada não diferiram entre si quanto à quantidade de gengiva ceratinizada inicial (3,00 ± 0,61 e 3,5 ± 0,86 mm, respectivamente). Contraditoriamente, dentes que apresentaram migração coronal da gengiva tinham uma quantidade menor de gengiva ceratinizada inicial (2,26 ± 0,31 mm). A quantidade média de gengiva ceratinizada inicial não predispôs a recessões gengivais de incisivos e caninos inferiores.

Presença de dentes permanentes irrompidos em escolares da região metropolitana de Porto Alegre / Presence of permanent erupted teeth in scholars of metropolitan area of Porto Alegre

Foi realizada uma pesquisa de campo em duas escolas da rede pública estadual de Porto Alegre, com a finalidade de verificar a presença de dentes permanentes irrompidos em crianças com faixa etária entre seis a dez anos. Foram examinadas 327 crianças, considerando as variáveis de idade, sexo e raça. Não foi observada diferença significativa para a época de erupção para as variáveis de raça e sexo. Foi observado que aos seis anos de idade uma porcentagem maior de incisivos inferiores (78,7%) irrompeu antes que os primeiros molaresinferiores (75,9%), assim como a erupção na arcada inferior antecedeu a da arcada superior. O trabalho teve como referência didática uma ampla literatura sobre os diferentes tópicosrelacionados ao processo evolutivo da dentição.

A survey was performed in two public schools of Porto Alegre, with the purpose of demonstrate the presence of erupted pennanent teeth in children with age ranging from 6 to 1 O years old. The sample consisted of 327 patients and the variables examined were age, sex and race. In the 6 year old group, the lowers incisors (78,7%) erupted earlier than the first molars(75,9%) and the teeth on the lower arch erupted before the teeth on upper arch. It was not observed a significant difference (p<0,05) in the time of eruption of the teeth for the variablessex and race. A literature review of teeth evolution process and related factors were alço described.

Fissuras labiopalatais: considerações sobre o tratamento interdisciplinar / Cleft palatal and lip: consideration about interdisciplinary treatament

Este trabalho visa fazer uma revisão da etiologia, prevalência, embriologia e protocolo mais difundidos do tratamento das fissuras labiopalatais. As fissuras labiopalatais ocorrem pela falta de coalescência entre os processos faciais embrionários (mandibulares, maxilares e nasais) e palatinos (palato primário e secundário). Todos os grupos raciais e étnicos, independentemente de gênero e áreas geográficas podem ser afetados por essa anomalia, sendo a sua etiologia multifatorial. No Brasil é observada 1:650 casos por nascimentos. A classificação proposta por SPINA et al. (1) e modificada por SILVA FILHO et al. (2), tendo como ponto de referência o forame incisivo, veio facilitar a compreensão e a comunicação universal entre profissionais que compõem a equipe de atendimento do paciente com fissura labiopalatina. O tratamento dessas anomalias exige uma equipe multidisciplinar. E apesar de haver inúmeros protocolos para a reabilitação desses pacientes os centros de tratamento devem ter uma filosofia interdisciplinar consciente e coerente, onde se deve tratar o paciente e não a fissura.

Associação de fatores relacionados à movimentação ortodôntica e o desenvolvimento de recessões gengivais / Association of factors related to orthodontic movement and the development of gingival recessions

O presente estudo teve por objetivo determinar a ocorrência de recessões gengivais pós-tratamento ortodôntico e os fatores a elas associados, como quantidade de gengiva ceratinizada pré-tratamento ortodôntico, alteração na inclinação dos dentes ântero-inferiores, alteração da distância intercaninos inferiores em incisivos e caninos inferiores. A amostra consistiu de fotografias intra-orais e modelos de estudo de 209 pacientes caucasianos com idade média de 11.20 ± 1.83 anos nos exames iniciais e 14.7 ± 1.8 anos nos exames finais. Os pacientes foram classificados como Classe I ou II de Angle e foram submetidos a tratamento ortodôntico com aparelho fixo, sem extrações. Recessões gengivais foram avaliadas em fotografias e modelos de estudo nos incisivos e caninos inferiores, nos exames iniciais e finais dos pacientes. A mensuração da gengiva ceratinizada foi feita em fotografias intra-orais e a distância intercaninos em modelos de gesso, em ambas empregando um paquímetro digital. A alteração das inclinações dos dentes ântero-inferiores foi avaliada em telerradiografia de perfil. Observou-se o aumento significativo de recessões em incisivos e caninos após o tratamento ortodôntico. A quantidade de gengiva ceratinizada previamente ao tratamento ortodôntico e a alteração da inclinação dos dentes ântero-inferiores não estão associadas ao desenvolvimento de recessões gengivais pós-tratamento ortodôntico. Também foi observada uma associação entre largura intercaninos inalterada e migração coronal da margem gengival em incisivos e caninos inferiores pós-tratamento ortodôntico

The aim of the present study was to determine the occurrence of gingival recessions post orthodontic treatment and factors related to orthodontic movement, such as: width of keratinized gingival pre orthodontic treatment, alteration of lower anterior teeth inclination, alteration of lower intercanine distance and the development of gingival recessions in lower incisors and canines. The sample consisted of intraoral photographs and orthodontic study models from 209 caucasian pre and post orthodontic treatment. Patients presented a mean ± SD age of 11.20 ± 1.83 years on their initial records and a mean age of 14.7 ± 1.8 years on their final records, respectively. Patients were classified as Angle Class I or II and had a non-extraction treatment with fixed orthodontic appliances. Gingival recessions were evaluated by inspection of initial and final intra oral photographs and study models. The width of keratinized gingival was measured on intra-oral photographs and the distance between lower intercanines was measured on the study models, both by a digital caliper. Alteration in the lower anterior teeth inclination was evaluated in lateral cephalograms. A significant increase in gingival recession was observed in the lower incisors and canines post orthodontic treatment. The amount of keratinized gingival pre orthodontic treatment and the changes occurred in the lower anterior teeth are not associated to development of gingival recessions post orthodontic treatment. Unaltered intercanine width was associated with coronal margin migration in lower incisors and canines post orthodontic treatment