The influence of varying maxillary central incisor vertical dimension on perceived smile aesthetics.

OBJECTIVE: To evaluate patient perception of the smile focused on analysis of the upper incisors. DESIGN: Cross-sectional study. SETTING: Department of Clinical and Social Dentistry at Federal University of Paraíba, João Pessoa, Brazil. PARTICIPANTS: The sample consisted of 135 individuals (73 women and 62 men). METHODS: Images with different characteristics associated with the incisal edges were shown at random and analysed using a Likert scale. Data were analysed using the Chi-square test or Fisher's exact test with a statistically significant difference ( P < 0.05). RESULTS: Smile I (difference of 1.5 mm in relation to the central incisor and lateral) was considered the most aesthetic, while Smile III (no difference in height between the central and lateral incisors) was the least aesthetic. A significant difference was found between perception of smile II (difference of 1 mm in relation to the central incisor and lateral) and age groups ( P < 0.005), with 31% (n = 13) of individuals aged 45-64 years considering smile II as not pleasant, 4.4% (n = 2) aged 15-24 years and 8.3% (n=4) aged 25-44 years and 4.4% (n = 2) aged 15-24 years considering the same. A significant difference was also found in relation to educational background of the assessor and smile perception, with smile III ( P = 0.0441) and smile IV ( P = 0.0053) considered the most aesthetic ( P = 0.0116). CONCLUSION: The smile considered most attractive among the sample was that with 1.5 mm steepness between the central and lateral incisors, while a flat smile arc was considered least attractive.

Correlação entre Padrões de Crescimento Facial e Terceiros Molares Inclusos / Correlation between Facial Growth Patterns Andincluded Third Molars

Objetivos: Analisar a prevalência dos padrões de crescimento facial e sua correlação com terceiros molares inclusos. Materiais e Métodos: A amostra, composta por 40 pacientes, foi obtida em um centro de radiologia odontológica, a partir deum banco de dados de arquivos de 800 pacientes, obedecendo a critérios de inclusão como: idade acima de 19 anos; presença de telerradiografia em norma lateral e uma radiografia panorâmica, obtidas na mesma época; presença de, no mínimo, um terceiro molar incluso com ápices dentários completamente fechados; permanência de todos os elementos dentários no lado do hemi-arco do elemento incluso; ausência de tratamento ortodôntico prévio. As telerradiografias foram utilizadas para a análise cefalométrica, utilizando-se os ângulos FMA, SN.GoMe e SN.Gn, interpretados de acordo com o padrão USP de análise cefalométrica e comparados com as normas préestabelecidas por essa análise, para a classificação dos padrões faciais em braquicefálico, mesocefálico ou dolicocefálico. A presença e a distribuição dos terceiros molares inclusos foram observadas com a utilização de radiografias panorâmicas. A correlação entre os ângulos dos padrões faciais e os terceiros molares inclusos foi verificada através do teste de Spearman (p<0,05). Dos pacientes pesquisados, 40% apresentaram perfil dolicocefálico, 35% mesocefálico e 25% braquicefálico. Conclusão:Não se constatou nenhuma significância para a correlação dos padrões faciais, nos três ângulos avaliados, com o número de terceiros molares inclusos. (AU)

Objective: This study analyzes the prevalence of facial growth patterns and their possible correlation with included third molars. Material and Methods: The sample consisted of 40 patients from a file database of 800 patients, referred to a dental radiology center. The following inclusion criteria were considered: 19 years or older; records including a lateral teleradiograph and a panoramic radiograph obtained at the same time; presence of at least one included third molar with completely closed apexes; presence of all teeth on the hemiarch of the included tooth; no history of orthodontic treatment. Teleradiographs were used for cephalometric analysis considering the angles FMA, SN.GoMe and SN.Gn, interpreted according to the USP standard analysis and compared with pre-established standards for the classification of facial patterns (brachycephalic, mesocephalic or dolichocephalic). The presence and distribution of third molars were observed using panoramic radiographs. The correlations between the angles of the facial patterns and the presence of included third molars was analyzed using Spearman's test (p<0.05). Conclusion: The patients' profiles identified were as follows: 40% dolichocephalic, 35% mesocephalic and 25% brachycephalic. No significant correlation was found between the facial patterns ­ for all the three angles analyzed ­ and the number of included third molars. (AU)

Resistência ao Cisalhamento de Braquetes Colados com Dois Tipos de Agentes de União e Expostos à Ação de Bebidas Ácidas / Shear Bond Strength of Orthodontic Brackets Bond with Two Types of Bonding Agents and Exposed to Acidic Beverages

Objetivos: Avaliar a influência de bebidas ácidas na resistência de união de braquetes ortodônticos colados com os agentes resinosos Transbond™ PLUS Color Change (TPCC) e Ortholink™ e quantificar o Índice de Remanescente Adesivo (IRA) após a descolagem do braquete, a fim de constatar qual compósito apresenta maior resistência à tensão cisalhante e o local onde ocorreu a falha adesiva, respectivamente. Materiais e Métodos: Noventa e seis incisivos bovinos tiveram braquetes colados em sua superfície vestibular e foram divididos em dois grupos (n=48), de acordo com o agente de união utilizado: I) TPCC e II)Ortholink. Em seguida, cada grupo foi separado em quatro subgrupos (n=12), de acordo com a substância na qual as amostras seriam imersas: S1) Coca-cola®, S2) Suco de laranja Del Valle®, S3) Gatorade® e S4) saliva artificial (controle). As amostras dos subgrupos S1, S2 e S3 foram submetidas a três ciclos corrosivos diários de 5 minutos, com intervalos de 2 horas, durante 30 dias, sendo sempre recolocadas em saliva artificial até que um novo ciclo fosse iniciado. Ao fim deste período, foram submetidas ao ensaio mecânico de cisalhamento e à avaliação do IRA. Resultados: Não foram encontradas diferenças estatisticamente significantes para as resinas entre si e entre os subgrupos, nos dois parâmetros testados (p>0,05). Conclusão: Não houve influência das substâncias ácidas testadas sobre a força de adesão dos compósitos utilizados, possuindo ambos resistências semelhantes, e que tanto a interface resina/ braquete quanto braquete/dente apresentaram falhas adesivas. (AU)

Objective: To evaluate the influence of acidic beverageson the bond strength of orthodontic brackets bonded with the resinous agents Transbond ™ PLUS Color Change (TPCC) and Ortholink ™.The Adhesive Remnant Index (ARI) after bracket removal was further quantified, in order to determine which composite has a higher resistance to shear stress and where there was adhesive failure. Material and Methods: Ninety-six bovine incisors had brackets bonded on their vestibular surfaces and were divided into two groups (n = 48), according to the bonding agent used: I) TPCC and II) Ortholink. Then, each group was divided into four subgroups (n = 12) in accordance with the substance inwhich the samples would be immersed: S1) Coca-Cola®, S2) Orange juice Del Valle®, S3) Gatorade® and S4) artificial saliva (control). Samples of subgroups S1, S2 and S3 were subjected to three corrosive cycles daily for 5 minutes with 2 hours intervals for 30 days, each being replaced in artificial saliva until a new cycle was started. At the end of this period, sampleswere subjected to mechanical shear test and the ARI assessment. Results: No statistically significant differences were found betweenthe compositesand between the subgroups for the two parameters tested (P>0.05). Conclusion: There was no influence of acidic beverageson the bond strength of the composites, asboth showedsimilar resistance, and the resin/bracket interfaces as well asthe bracket/tooth interfaces showed adhesive failures. (AU)

Avaliação das reabsorções radiculares durante o tratamento ortodôntico / Radiographyc evaluation of root resorption during the orthodontic treatment

A terapia ortodôntica fatalmente traz um encurtamento radicular iatrogênico e irreversível em quase todos os dentes, variando quanto a sua gravidade. O objetivo deste trabalho foi avaliar radiograficamente a ocorrência de reabsorção radicular em pacientes que foram submetidos ao tratamento ortodôntico no Curso de Especialização de Ortodontia da Ciec – Uningá, em São Luís/MA. Foram realizadas duas séries de tomadas radiográficas periapicais, antes e após 12 meses de tratamento, pela técnica do paralelismo, de incisivos superiores de 42 pacientes, excluindo pacientes que já haviam sido submetidos a tratamento ortodôntico, com tratamento endodôntico, mordida aberta, dentes com rizogênese incompleta ou qualquer radiografia em que não fosse possível visualizar o ápice radicular. Foi utilizado o escore proposto por Levander e Malmgren, em 1988 (graus 0, 1, 2, 3 e 4), o qual se refere a uma quantidade específica de reabsorção, comparando-se o grau de reabsorção nas radiografias inicial e final. Não houve diferença estatisticamente significativa entre os elementos analisados, 88% (37) dos pacientes apresentaram algum grau de reabsorção, considerando antes e após 12 meses de tratamento. Porém, 66% (28) do total de pacientes apresentou aumento no grau de reabsorção nesse intervalo de tempo, sendo 86,9% (23) destes para o grau suave, reafirmando o caráter estimulador das forças ortodônticas na ocorrência de reabsorções radiculares, sendo estas, no geral, em nível leve, quando controladas. Ratifica-se, portanto, a importância do controle radiográfico periódico para identificar aqueles pacientes que apresentam risco de reabsorção, a ser controlada, sendo levado em consideração o custo-benefício de se prosseguir com o tratamento em determinados casos...

The orthodontic treatment brings a shortening and irreversible iatrogenic root, in almost all teeth, varying as to its severity. The aim of this study was to evaluate radiographically the occurrence of root resorption in patients who were under orthodontic treatment in the Specialization Course in Orthodontics Ciec – Uningá in São Luís/MA. We conducted two sets of periapical radiographs taken before and after 12 months of treatment, through the technique of parallelism, the maxillary incisors of 42 patients, excluding patients who have been under orthodontic treatment previously, endodontically treated teeth, open bite, teeth with incomplete root formation or any radiograph in which it was not possible to visualize the apex. We used the score proposed by Levander (grades 0, 1, 2, 3, 4), which refers to a specific amount of resorption, comparing degree of resorption in the initial and final radiographs. There was no statistically significant difference between the elements analyzed, 37 (88%) patients had some degree of resorption, whereas before and after 12 months of treatment. However 28 (66%) of all patients showed an increase in the degree of resorption in this time interval, and that 23 (86.9%) for the degree of soft, reaffirming the stimulator character of orthodontic forces on the occurrence of root resorption, that in general, in light level when controlled. Ratification is, therefore, the importance of periodic radiographic control to identify those patients at risk of resorption, to be controlled, being taken into account the cost-benefit of continuing treatment in certain cases...

Treatment effects of the Jasper Jumper and the Bionator associated with fixed appliances.

BACKGROUND: The aim of this study was to evaluate the effects of Class II malocclusion treatment with the Jasper Jumper and the Bionator, associated with fixed appliances. METHODS: The sample comprised 77 young individuals divided into 3 groups: Group 1 consisted of 25 patients treated with the Jasper Jumper appliance associated with fixed appliances for a mean period of 2.15 years; group 2 had 30 patients, treated with the Bionator and fixed appliances, for a mean treatment time of 3.92 years; and the control group included 22 subjects followed for a mean period of 2.13 years. The initial and final lateral cephalograms of the patients were evaluated. Intergroup comparison at the initial stage and of the treatment changes were performed by analysis of variance. RESULTS: Their effects consisted in a restrictive effect on the maxilla, a slight increase in anterior face height, retrusion and extrusion of the maxillary incisors, labial tipping and protrusion of the mandibular incisors in both groups and intrusion with the Jasper Jumper appliance, maxillary molar distalization with the Jasper Jumper, extrusion and mesialization of the mandibular molars, both appliances provided significant improvement of the maxillomandibular relationship, overjet, overbite and molar relationship. CONCLUSIONS: The effects of both appliances in class II malocclusion treatment are similar; however, treatment with the Jasper Jumper was shorter than with the Bionator.

Ulotomia: coadjuvante do tratamento da má oclusão / Ulotomia: adjunctive treatment of malocclusion

Objetivo: o objetivo deste trabalho é relatar um caso clínico, no qual a técnica cirúrgica de ulotomia foi uti-lizada como tratamento inicial de correção de má oclu-são dental, evitando maiores alterações na oclusão. Relato de caso: Uma paciente de sete anos de idade, sexo feminino, procurou atendimento odontológico re-ferindo apresentar um atraso na erupção do elemento dentário 12. Foi observada a presença de tecido gengi-val de coloração mais pálida e que, ao toque, eviden-ciava-se a borda incisal do referido elemento dentário. Além disso, foi verificada a presença de inflamação e hiperplasia gengival na região dos dentes ântero-supe-riores, devido aos problemas oclusais, que impediam o fechamento normal da boca, levando à paciente à condição de respiradora bucal. Dessa forma, optou-se pela ulotomia por se tratar de um procedimento cirúr-gico minimamente invasivo, visando apenas a exérese do tecido gengival que revestia a coroa de dente não irrompido, permitindo assim um caminho desimpedi-do para vir a ocupar a sua posição no arco dentário. Considerações finais: a ulotomia é um procedimento de fácil execução para o profissional e rápida recuperação para o paciente infantil, sendo um passo inicial para o tratamento da má-olcusão.

Class II malocclusion treatment using Jasper Jumper appliance associated to intermaxillary elastics: a case report.

INTRODUCTION: Skeletal, dental and profile discrepancies can be amended by using functional orthodontic appliances. OBJECTIVE: This study is a report of the treatment of a patient, 11 years and 4 months old, with Class II, division 1, malocclusion, convex profile, protrusion of upper incisors, pronounced overjet and overbite, and mild crowding. METHODS: The patient was treated with a Jasper Jumper associated to fixed appliances for 6 months and Class II intermaxillary elastics (3/16-in) during the last 4 months. After debonding, a Hawley retainer was used during daytime and a modified Bionator for night use during one year. In the lower dental arch a bonded lingual retainer was used. This treatment combination improved the profile, as well as the overjet, overbite and molar relation. RESULTS: There was clockwise mandibular rotation and increase of lower anterior facial height. The lower incisors were protruded and extruded and the lower molars were extruded. The centric occlusal relation was checked and it was coincident to the maximum usual intercuspation. CONCLUSIONS: It was demonstrated that the Jasper Jumper is an efficient alternative to Class II malocclusion treatment, providing improvement in the facial profile, although the changes are more dentoalveolar than skeletal.

Dentoskeletal changes induced by the Jasper jumper and the activator-headgear combination appliances followed by fixed orthodontic treatment.

INTRODUCTION: The aim of this study was to compare the dentoskeletal changes of patients with Class II Division 1 malocclusion treated with either the Jasper jumper appliance or the activator-headgear combination, both associated with fixed appliances. METHODS: The sample comprised 72 subjects with Class II Division 1 malocclusion divided into 3 groups: group 1 included 25 subjects treated with fixed appliances and the force modules of the Jasper jumper at an initial mean age of 12.72 years, group 2 included 25 subjects treated with the activator-headgear combination followed by fixed appliances at an initial mean age of 11.07 years, and group 3 included 22 untreated subjects at an initial mean age of 12.67 years. Initial cephalometric characteristics and dentoskeletal changes were compared with analysis of variance. RESULTS: Both experimental groups had similar dentoskeletal changes: restrictive effect on the maxilla, clockwise mandibular rotation and a slight increase in anterior face height, retrusion of the maxillary incisors, distalization of the maxillary molars, protrusion of the mandibular incisors, extrusion of the mandibular molars, and significant improvements of the maxillomandibular relationship, overjet, overbite, and the molar relationship. CONCLUSIONS: The effects of the Jasper jumper and the activator-headgear combination followed by fixed orthodontic appliances were similar in Class II malocclusion treatment.

Class II malocclusion treatment using Jasper Jumper appliance associated to intermaxillary elastics: a case report

INTRODUCTION: Skeletal, dental and profile discrepancies can be amended by using functional orthodontic appliances. OBJECTIVE: This study is a report of the treatment of a patient, 11 years and 4 months old, with Class II, division 1, malocclusion, convex profile, protrusion of upper incisors, pronounced overjet and overbite, and mild crowding. METHODS: The patient was treated with a Jasper Jumper associated to fixed appliances for 6 months and Class II intermaxillary elastics (3/16in) during the last 4 months. After debonding, a Hawley retainer was used during daytime and a modified Bionator for night use during one year. In the lower dental arch a bonded lingual retainer was used. This treatment combination improved the profile, as well as the overjet, overbite and molar relation. RESULTS: There was clockwise mandibular rotation and increase of lower anterior facial height. The lower incisors were protruded and extruded and the lower molars were extruded. The centric occlusal relation was checked and it was coincident to the maximum usual intercuspation. CONCLUSION: It was demonstrated that the Jasper Jumper is an efficient alternative to Class II malocclusion treatment, providing improvement in the facial profile, although the changes are more dentoalveolar than skeletal.

INTRODUÇÃO: discrepâncias esqueléticas, dentárias e de perfil podem ser melhoradas com a utilização de aparelhos ortopédicos funcionais. OBJETIVO: esse artigo tem o objetivo de relatar o tratamento de um paciente de 11 anos e 4 meses de idade com má oclusão de Classe II divisão 1, ½ cúspide bilateral, alteração de perfil, protrusão dos incisivos superiores, overjet e overbite acentuados e apinhamento suave. MÉTODOS: o paciente foi tratado por meio do Jasper Jumper associado ao aparelho fixo por 6 meses e elásticos intermaxilares de Classe II (3/16") nos últimos 4 meses. Após a remoção do aparelho fixo, foram utilizadas as contenções, a placa de Hawley para uso diurno e o Bionator modificado para uso noturno, por um ano. No arcada inferior, foi utilizada contenção 3x3 fixa colada de canino a canino. Essa combinação de tratamento melhorou o perfil, bem como os trespasses horizontal e vertical, além da relação molar. RESULTADOS: houve rotação mandibular no sentido horário e aumento da altura facial anteroinferior. Os incisivos inferiores foram protruídos e extruídos, e os molares inferiores sofreram extrusão. A relação cêntrica oclusal foi checada e era coincidente com a máxima intercuspidação habitual. CONCLUSÃO: comprovou-se que o Jasper Jumper é uma alternativa eficiente para o tratamento da Classe II, proporcionando melhoras no perfil facial, embora as alterações sejam mais dentoalveolares do que esqueléticas.

Class II subdivision malocclusion types and evaluation of their asymmetries.

INTRODUCTION: The primary objective of this study was to determine, by means of frontal photographic evaluation, the distribution of the 2 main types of Class II subdivision malocclusions. The secondary objective was to compare the dentoskeletal asymmetries in these 2 types with a group of normal-occlusion subjects by using submentovertex and posteroanterior radiographs. METHODS: The experimental group included 44 untreated Class II subdivision malocclusion subjects with a mean age of 15.3 years. The control group included 30 subjects with normal occlusions with a mean age of 22.4 years. All had full complements of permanent teeth up to the first molars and had not received orthodontic treatment. Type 1 Class II subdivision malocclusion is coincidence of the maxillary dental midline with the facial midline and deviation of the mandibular midline. Type 2 has the opposite characteristics. The frontal photographs were evaluated subjectively by 2 examiners. In the submentovertex and posteroanterior radiographs, symmetry was assessed by measuring the relative difference in the spatial positions of dentoskeletal landmarks between the right and left sides. Independent t tests were used to compare the dentoskeletal asymmetries of types 1 and 2 with the normal-occlusion group. RESULTS AND CONCLUSIONS: The results showed that 61.36% had type 1, 18.18% had type 2 Class II subdivision malocclusion, and 20.45% had mixed characteristics. The predominant asymmetric dentoalveolar characteristics of both types of Class II subdivision malocclusions were evident when individually compared with a normal-occlusion control group. There was a tendency for the type 1 subjects to have greater mandibular asymmetry than type 2, as compared with the control group.

Avaliação da concordância entre a classificação dos tipos de Classe II, subdivisão, em fotografias e em radiografias póstero-anteriores / Photographic and radiographic classification agreement evaluation of Class II subdivision malocclusion types

O objetivo deste trabalho foi avaliar o grau de concordância entre a classificação dos dois principais tipos de Classe II, subdivisão, em fotografias e em radiografias póstero-anteriores. A amostra consistiu de 44 indivíduos que apresentavam má oclusão de Classe II, subdivisão, com idade média de 15,3 anos, apresentando os dentes permanentes superiores e inferiores, até os primeiros molares e que não haviam sido submetidos a tratamento ortodôntico. Duas examinadoras realizaram uma avaliação subjetiva das fotografias frontais, classificando a Classe II, subdivisão, como tipo 1 quando havia coincidência da linha média dentária superior com a linha média facial e desvio da linha média dentária inferior. O tipo 2 apresentava características opostas. A avaliação nas radiografias PA foi realizada por uma examinadora, analisando os desvios das linhas médias dentárias superior e inferior em relação à linha X. Avaliou-se a concordância entre os dois métodos de classificação dos tipos de Classe II, subdivisão, utilizando-se o coeficiente Kappa. Os resultados obtidos permitiram-nos concluir que, mesmo havendo a mesma tendência de distribuição dos tipos de Classe II, subdivisão, nas fotografias frontais e nas radiografias PA, a concordância entre estes dois métodos de avaliação não foi estatisticamente significante.

Class II subdivision treatment success rate with symmetric and asymmetric extraction protocols.

The purpose of this study was to compare the success rates of Class II subdivision malocclusion patients treated with either symmetric or asymmetric extractions. The sample consisted of 51 patients with Class II subdivision malocclusion. The patients were divided into 2 groups. Group 1 included 28 patients who were treated with 4 premolar extractions. The 23 patients in group 2 were treated with 3 premolar extractions (2 maxillary premolars and 1 mandibular premolar on the Class I side). The initial and final study models were evaluated by means of Grainger's treatment priority index (TPI). Individual evaluations of improvements in maxillary-to-mandibular dental midline deviation, overjet, and overbite were also made. The final mean TPI and the mean improvement in TPI and in the other variables of each group were compared with independent t tests. The results showed a statistically significant difference only for the improvement in maxillary-to-mandibular dental midline deviation of the groups. The 3-premolar-extraction group had a greater improvement of the initial interdental midline deviation. There is a tendency for a slightly better treatment success rate when Class II subdivision patients are treated with asymmetric extraction of 3 premolars, compared with extraction of 4 premolars.