Effects of the Forsus fatigue-resistant device and mandibular anterior repositioning appliance in Class II malocclusion treatment.

INTRODUCTION: Fixed functional appliances have been used to treat Class II malocclusion by a huge number of professionals. This retrospective study aimed to analyze the effects of the Forsus fatigue-resistant device and compare the findings with a well-matched group treated with the mandibular anterior repositioning appliance (MARA). METHODS: The Forsus group was composed of 14 patients at an initial mean age of 12.4 ± 1.3 years, treated with the Forsus fatigue-resistant device followed by a fixed orthodontic appliance. The MARA group comprised 18 patients at an initial mean age of 12.1 ± 1.3 years, treated with MARA followed by fixed orthodontic appliances. The untreated control group consisted of 14 patients matched with the other groups. Posttreatment changes were calculated as T1 - T2. Intergroup comparisons regarding treatment changes were performed using repeated-measures analysis of variance followed by Tukey's test. RESULTS: During treatment, the Forsus group showed a statistically significant decrease in maxillary protrusion and maxillomandibular sagittal discrepancy in the control group. The MARA group showed significantly greater retrusion of maxillary incisors than the Forsus and the control group. Overjet decreased significantly more in the treated groups in relation to the control group. Molar relationship improved significantly more in both treated groups, and both showed more correction than the untreated control group. CONCLUSIONS: The Forsus and MARA associated with fixed appliances effectively corrected the Class II malocclusion, mostly using dentoalveolar changes and maxillary growth restriction.

Likert scale vs visual analog scale for assessing facial pleasantness.

INTRODUCTION: This study aimed to compare the 2 most commonly used methods for assessing facial pleasantness, the Likert scale and the visual analog scale (VAS). METHODS: For assessing facial pleasantness, an album was assembled containing the front and profile view facial photographs of 10 patients (5 females, 5 males) who sought orthodontic treatment representing each of the different sagittal and vertical facial discrepancies (straight profile, convex profile, concave profile, long faces, and short faces). The facial pleasantness of the patients was judged by 3 groups of 90 evaluators (47 females and 43 males): 30 orthodontists (mean age, 32.41 years), 30 oral maxillofacial surgeons (mean age, 36.83 years), and 30 laypeople (mean age, 36.83 years). The evaluators judged the facial pleasantness using VAS and a 5-point Likert scale. At the end of the evaluation, the evaluators completed a questionnaire about their preferred scale. Analysis of variance and Tukey and Kruskal-Wallis tests were used to compare the data from VAS and Likert scale, respectively. The Spearman correlation coefficient was used to estimate the correlation between the 2 scales. Fisher transformation and z-statistic were used to estimate the correlation among the evaluator groups. In all tests, a 5% statistical significance level was adopted. RESULTS: Both scales presented similar answers; only VAS values for the scores of pleasant and very pleasant according to the Likert scale could not be distinct. Most evaluators preferred the Likert scale as they found it easier to convey their opinion than VAS. CONCLUSIONS: Although both scales can be used to assess facial pleasantness, the Likert scale seems more appropriate as the evaluators preferred it because of its simplicity.

Effects of orthodontic treatment with aligners and fixed appliances on speech.

OBJECTIVES: To evaluate effects of orthodontic treatment with aligners and conventional fixed appliances on production of speech. MATERIALS AND METHODS: This was a parallel, randomized clinical trial. Patients with Angle Class I malocclusion, moderate crowding, and no speech impairment were randomly allocated to two groups: patients with orthodontic aligners (OAs; n = 20; mean age = 23.60 ± 5.65 years) and those with conventional fixed appliances (n = 20; mean age = 20.56 ± 4.51 years) and treated at the University of North Parana's clinic in Londrina, Brazil. Evaluation of speech production was performed semiobjectively by a speech therapist (myofunctional orofacial examination) and subjectively (self-assessment) at five time points: baseline, immediately after insertion of appliances, and subsequently at 3, 30, and 180 days after insertion. For intergroup comparison, independent t, χ2, Fisher exact, and Mann-Whitney tests were used; for intragroup comparison, the Friedman test was applied (α = 5%). RESULTS: In the semiobjective evaluation, patients with OAs exhibited a change in production of speech production, compared with patients with fixed appliances, immediately and 3 days after insertion of appliances (P < .001). Thirty days after insertion, the groups were similar (P = .487), an outcome that was unchanged at 180 days. However, in the self-assessments, patients in both groups reported significant speech difficulties immediately and 3 days after insertion of appliances, but such impairment was no longer perceived at 30 days or 180 days. CONCLUSIONS: Although the speech therapist identified changes in speech production at the start of treatment in the OA group only, patient self-assessments demonstrated that orthodontic treatment, regardless of the type of appliance used, interfered with their perception of speech.

Perceived pain during rapid maxillary expansion in children with different expanders.

OBJECTIVES: To evaluate and compare the intensity of pain caused by rapid maxillary expansion (RME) with two expanders: Hyrax and Haas type, in growing patients. MATERIALS AND METHODS: Thirty-nine patients (23 girls and 16 boys) with an average age of 9.3 years (SD = 1.39 years) were randomized into two groups and treated with Hyrax- and Haas-type expanders. In both groups, initial activation of the expander screw was one full turn on the first day followed by 2/4 of a turn two times a day (morning and night) for 7 days. Inclusion criteria were patients presenting with a posterior crossbite or maxillary atresia between 7 and 12 years old. To evaluate the intensity of pain during the active phase of the treatment, a combination of the Numerical Rating Scale and Wong-Baker Faces Pain Scale was used. Mann-Whitney test was used to compare the two treatment groups. RESULTS: There was significant inverse correlation between days following insertion and pain. During the expansion period, 100% of the children reported some pain. Hyrax expander subjects reported greater pain than those treated with the Haas-type expander only on the first day. The level of pain remained greater in girls throughout treatment. CONCLUSIONS: Pain was reported regardless of the type of expander and was higher in the Hyrax group only on the first day of activation.

Self-perception of facial esthetics by patients with different profiles compared with assessments of orthodontists and lay people.

INTRODUCTION: This study evaluated the perception of facial esthetics of patients with different profiles as assessed by orthodontists, lay people, and patients. METHODS: The sample comprised 120 patients (81 females, 39 males; mean age, 26.3 years) selected from private practices at the onset of orthodontic treatment. The patients were divided into 3 groups of 40 according to the type of facial profile. The groups were composed of straight, concave, and convex profiles, on the basis of the facial convexity angle (G.Sn.Pog') measured on the initial cephalometric tracings. Patients analyzed only their frontal (smiling and at rest) and profile facial photographs and evaluated the pleasantness of these images on a 5-point Likert scale. A group of 30 orthodontists and 30 lay people also evaluated the patients' facial pleasantness, using the same scale. Factorial analysis of variance (convexity and sex) was used to evaluate the differences between the convexities, and analysis of variance mixed model (type of evaluator and sex) to compare the 3 categories of evaluators, using the aligned rank transform technique. The correlation between the convexity angle and facial pleasantness was assessed by the Spearman correlation coefficient. RESULTS: Patients and lay people assigned higher pleasantness scores than orthodontists, with statistically significant differences for all evaluations, except for the frontal analysis of the convex group. The correlation coefficients regarding profile convexity and facial pleasantness were negative, indicating a tendency that more convex or concave facial profiles received lower pleasantness scores; however, this correlation was only significant in the evaluation of profile photographs by orthodontists. CONCLUSIONS: Patients with different profiles were scored with acceptable faces by lay people and patients themselves. Orthodontists' perceptions were different; they attributed lower pleasantness scores. Discrepant profiles affect facial esthetics in the profile view when judged by orthodontists.

Influence of orthodontic appliance design on employment hiring preferences.

INTRODUCTION: The objective of this study was to evaluate the extent to which different types of orthodontic appliances influence the hiring process of an individual applying for a customer service position. METHODS: A total of 7 images were created for 2 adult models: 1 male and 1 female. One image was produced without orthodontic appliances, and 6 simulated the use of orthodontic appliances, including a conventional metallic appliance with a gray elastic ligature, a conventional metallic appliance with blue elastic ligature, a conventional appliance with a transparent elastic ligature, a self-ligating metal appliance, a self-ligating esthetic appliance, and a clear aligner. A photo album was designed for each model and delivered, along with a questionnaire, to individuals in charge of job interviews and hiring. These evaluators included 236 individuals, divided into 4 groups according to age and gender: males between 18-35 years (M), males over 35 years (M > 35), females between 18-35 years (F), and females over 35 years (F > 35). The evaluators quantified the chance of hiring the models using a Visual Analogue Scale. The Mann-Whitney test was used to compare the evaluators according to gender and age. The Wilcoxon test was used to compare the models according to gender. The Kruskal-Wallis and Dunn post hoc tests were used to compare the appliances according to design. A 5% significance level was used for all tests. RESULTS: The clear aligner group showed the highest likelihood of being hired, followed by the group without orthodontic appliances, the groups with esthetic appliances (ie, conventional appliance with a transparent elastic ligature, and self-ligating esthetic appliance), and the groups with metallic appliances (ie, self-ligating metal appliance, conventional metallic appliance with gray elastic ligature, and conventional metallic appliance with blue elastic ligature). CONCLUSIONS: Assuming all other qualifications of the applicants are equivalent, the use of an orthodontic appliance may influence job interviews. The better the esthetics of the appliance, the higher the likelihood of the individual being hired.

Stability of early treatment of anterior open bite: clinical performance of bonded lingual spurs.

Anterior open bite (AOB) is a malocclusion that generates aesthetic, speech, feeding and psychological issues, a fact that emphasises the importance of conducting early treatments to fix the disorder. Finger-sucking, pacifiers and oral habits are the main aetiological factors of AOB; thus, it is necessary to apply interceptive treatments focused on correcting and improving bite stability during childhood in order prevent the need of undergoing advanced therapy. The aim of this article is to present the early diagnosis of aetiological factors causing severe AOB and the interceptive treatment based on the use of bonded lingual spurs for one year. Results showed excellent bite stability after two years of follow-up; in other words, the proper treatment applied for the recommended growth and developmental periods enabled case stability.