Where do we come from? Where are we going?

The aim of the present paper was to re-analyze the scientific nature of our profession and to attract the focus of the orthodontist to problems and controversies within the development of the orthodontic profession over the past century. The controversy related to the application of the same words used differently within bone biology and orthodontics; the definition of the treatment goal based on perception of beauty; the trend to focus on efficacy and marketing more than on treatment of the individual patients; and the isolation of the effect of the orthodontic appliance from growth and function and the lack of understanding the word "stability" are analyzed from a critical stand point.

Impact of Treatment with Full-fixed Orthodontic Appliances on the Periodontium and the Composition of the Subgingival Microbiota.

AIMS: The purpose of this study was to evaluate the impact of fullfixed orthodontic appliances on the periodontium in adult patients. METHODS: Seventeen periodontally and systemically healthy subjects were selected from the Periodontal Clinic of Guarulhos University, 7 males and 10 females (mean age: 38.3 ± 6.3 years). The patients undergoing orthodontic treatment were submitted a clinical examination, a cone beam computed tomography at baseline and after 12 months of treatment. Subgingival biofilm samples were analyzed by Checkerboard DNA-DNA hybridization. Statistical analysis was performed by a Wilcoxon test. RESULTS: The percentage of sites with visible plaque increased (p =0.003), but no significant reduction in marginal bone was observed. The mean periodontal pocket depth was reduced (p=0.001) and the clinical attachment level significantly improved (p =0.001). There was a significant reduction in the mean proportions of the Actinomyces sp and an increase in the orange complex species. The proportions of the red complex species remained unchanged. CONCLUSIONS: In spite of increase in plaque accumulation no significant clinical or tomographic iatrogenic changes in periodontally healthy adults undergoing orthodontic full-fixed appliance treatment could be detected. The microbiological changes did not affect the periodontal parameters in monitored adult patients that received short period of orthodontic treatment.

Incorrect measurements and misleading conclusions in the article "Comparison of the efficacy of tooth alignment among lingual and labial brackets: an in vitro study".

BACKGROUND/OBJECTIVE: To reproduce the methods and results of the study by Alobeid et al. (2018) in which the efficacy of tooth alignment using conventional labial and lingual orthodontic bracket systems was assessed. MATERIALS/METHODS: We used the identical experimental protocol and tested (i) regular twin bracket (GAC-Twin [Dentsply]) and lingual twin bracket systems (Incognito [3M]), (ii) together with NiTi 0.014" wires (RMO), and (iii) a simulated malocclusion with a displaced maxillary central incisor in the x-axis (2 mm gingivally) and in the z-axis (2 mm labially). RESULTS: The method described by Alobeid et al. (2018) is not reproducible, and cannot be used to assess the efficacy of tooth alignment in labial or lingual orthodontic treatment. Major flaws concern the anteroposterior return of the Thermaloy-NiTi wire ligated with stainless steel ligatures. The reproduced experimental setting showed that a deflected Thermaloy-NiTi wire DOES NOT move back at all to its initial stage (= 0 per cent correction) because of friction and binding (see supplemented video), neither with the tested labial nor with the lingual brackets. Furthermore, an overcorrection of up to 138 per cent, which the authors indicate for some labial bracket-wire combinations and which deserves the characterization "irreal", stresses the inappropriateness of the method of measurement.Further flaws include: a) incorrect interpretation of the measurement results, where a tooth tripping around (overcorrection) is interpreted as a better outcome than a perfect 100 per cent correction; b) using a statistical test in an inappropriate and misleading way; c) uncritical copying of text passages from older publications to describe the method, which do not correspond to this experimental protocol and lead to calculation errors; d) wrong citations; e)differences in table and bar graph values of the same variable; f) using a lingual mushroom shaped 0.013" Thermaloy-NiTi wire which does not exist; g) drawing uncritical conclusions of so called "clinical relevance" from a very limited in vitro testing. CONCLUSIONS: Clinical recommendations based on in vitro measurements using the Orthodontic Measurement and Simulation System (OMSS) should be read with caution.

The role of orthodontics in the repair of gingival recessions.

INTRODUCTION: The goal of this research was to assess the impact of orthodontic root movement on gingival recessions. METHODS: Twelve consecutive adult patients with a mandibular incisor presenting buccal or lingual gingival recession and with the root positioned outside the alveolar bone were enrolled. The roots were moved toward the center of the alveolar process with a goal oriented segmented appliance. The following variables were measured at baseline and after orthodontic treatment: (1) recession depth, (2) recession width, and (3) recession area. In addition, pocket probing depth, keratinized tissue height, and changes in Miller's classification were registered. RESULTS: The depth, width, and area of the gingival recessions were reduced in all patients without increased pocket probing depth. On average, the recession depth decreased with 23%, the width with 38%, and the recession area with 63% of the baseline value. All patients improved in Miller's classification from Class III and IV to Class I or II. CONCLUSIONS: Orthodontic correction of the root toward the center of the alveolar envelope consistently reduced gingival recessions. The changes in Miller's classification indicated improved prognosis for full root coverage with mucogingival surgery.

Can forces be applied directly to the root for correction of a palatally displaced central incisor with a dilacerated root?

This case report describes the interdisciplinary treatment of an ectopic horizontally placed maxillary right central incisor with severe root dilaceration. The root was distally angulated and entrapped by the root of the maxillary right lateral incisor. The initial force system was aimed at an occlusal displacement and applied to the crown. During the second phase, a button was cemented onto the apex of the impacted tooth. A force from the apex to a temporary anchorage device in the palate moved the root toward the midline. Finally, a root canal and an apectomy were performed and the central incisor could be moved to its ideal position. The treatment generated a normal height of the alveolar bone and an ideal occlusion with a healthy periodontium.

Reposicionamento mandibular em pacientes adultos ­ uma alternativa à cirurgia? Um acompanhamento de dois anos / Is mandibular repositioning in adult patients an alternative to surgery? Two-year follow-up

Muitos pacientes adultos com discrepâncias esqueléticas não aceitam a proposta de intervenção cirúrgica para corrigi-las. O objetivo desse trabalho é verificar a resposta ao reposicionamento mandibular, simulando a correção esquelética nesses pacientes. Trinta e dois pacientes sem sinais de disfunção temporomandibular (DTM) foram indicados para o reposicionamento mandibular, sendo essa uma técnica não invasiva. Foi explicado para eles que essa abordagem estava baseada em resultados descritos em relatos de casos clínicos. Antes do início de qualquer tratamento, foi feita a documentação inicial (teleradiografia , radiografia PA, modelos de estudo e fotografias) (T0). Após, a mandíbula foi reposicionada para camuflar a discrepância esquelética através de um levante de mordida feito em Triad® Gel. Três meses mais tarde (T1), 23 pacientes mostraram-se adaptados a nova oclusão, com ausência de problemas funcionais e sem nenhuma quebra no levante de mordida. As mudanças esqueléticas que ocorreram durante o reposicionamento foram verificadas em radiografias sagitais e frontais, enquanto as alterações intra-articulares que ocorreram durante os dois anos de acompanhamento (T2) foram avaliadas em imagens tomográficas. Nenhuma alteração significativa foi observada nesses acompanhamentos de dois anos, tanto para a recidiva quanto para a sobrecorreção. O reposicionamento é uma abordagem não invasiva e deve ser considerada como uma alternativa válida à cirurgia em alguns pacientes. Variações morfológicas observadas nas radiografias feitas em T0 e nos resultados dos exames clínicos iniciais das avaliações de disfunção mostraram apenas indicativos vagos ou insignificantes sobre a previsibilidade da adaptação ao reposicionamento.(AU)

Many adult patients with skeletal discrepancies refuse surgical intervention for their correction. The aim of this research was to assess the reaction to mandibular repositioning in simulating a skeletal correction in such patients. Thirty-two patients without any signs of temporomandibular dysfunction (TMD) were offered mandibular repositioning, as a non-invasive alternative. It was explained to them that the approach was based on the results described in case reports. Before starting any treatment initial records, headfilms, study casts, and photos were taken (T0). The mandible was then repositioned to camouflage the skeletal discrepancy by means of an occlusal built-up in Triad® Gel. Three months later (T1), 23 patients had adapted to the new occlusion what was reflected in functional problems absence and lack of built-up fracture. In these patients, the mandibular position was maintained by orthodontic adjusting of occlusion to the built-up position (T1). Skeletal changes that occurred during repositioning were assessed on sagittal and frontal headfilms while intra-articular changes occurring during a 2-year follow-up period (T2) were evaluated on images constructed from CBCT images. No significant changes were observed during the follow-up period, neither in the direction of relapse nor in the direction of further normalization of the condylar positioning were observed during the 2-year observation. Repositioning is a non-invasive intervention and may be considered a valid alternative to surgery in some patients. Morphological variables from the radiographs taken at T0 and the results of the initial clinical evaluation of dysfunction yielded only vague and insignificant indications regarding the predictability of adaptation to the repositioning. (AU)

[Mandibular repositioning in adult patients. An alternative to surgery in some patients? A two-year follow-up]. / Le repositionnement mandibulaire : une alternative à la chirurgie chez des patients adultes ? Un suivi sur deux ans.

INTRODUCTION: A number of adult patients with skeletal discrepancies refuse surgical intervention. AIMS: The aim was to assess the reaction to mandibular repositioning in simulating a skeletal correction in such patients. MATERIALS AND METHODS: 32 consecutive patients without any signs of temporo-mandibular dysfunction (TMD) were offered mandibular repositioning, as a non-invasive alternative and it was explained to them that the approach was based on the results described in case reports. Before initiating any treatment initial records, headfilms, study casts and photos were taken (T0) and the mandible was repositioned to camouflage the skeletal discrepancy by means of an occlusal built-up in Triad® Gel. RESULTS: Three months later (T1) 23 patients had adapted to the new occlusion reflected in absence of functional problems and lack of fracture of the built-up. In these patients the mandibular position was maintained by orthodontics adjusting the occlusion to the built-up position (T1). The skeletal changes occurring during repositioning were assessed on sagittal and frontal head films while intra-articular changes occurring during a 2-year follow-up period (T2) were evaluated on images constructed from CBCT images. No significant changes, neither in the direction of a relapse nor in the direction of further normalization of the condylar positioning, were observed during the 2-year observation period. CONCLUSIONS: Repositioning is a non-invasive intervention and may be considered a valid alternative to surgery in some patients. Morphological variables from the radiographs taken at T0 and the results of the initial clinical evaluation of dysfunction yielded only vague and insignificant indications regarding the predictability of adaptation to the repositioning.

Evaluation of maxillary buccal alveolar bone before and after orthodontic alignment without extractions: A cone beam computed tomographic study.

OBJECTIVES:: To assess the changes in the maxillary buccal alveolar bone during alignment without extractions. Secondarily, to evaluate the changes in arch dimensions and buccolingual inclinations of teeth and to identify risk factors for bone loss. MATERIALS AND METHODS:: Twenty-two adolescents with crowded permanent dentitions were treated without extractions with Damon 3MX brackets. Cone beam computed tomographic scans were taken before treatment (T0) and after alignment (T1). Bone thickness (BT) and height from the cementoenamel junction to the alveolar crest (BH) were evaluated at the maxillary central incisors, second premolars, and buccal roots of first molars. Changes in all variables from T0 to T1 were assessed. Correlations between bone changes and initial bone thickness, initial arch widths, initial crowding, amount of expansion, amount of tipping, and amount of molar rotation were calculated. RESULTS:: BT decreased and BH increased significantly for the incisors and mesiobuccal root of the first molars. Arch dimensions generally increased together with tipping. Bone loss was correlated with crowding and amount of expansion in the premolar region. Initially thinner BT was correlated with greater apical migration of bone for the incisors. CONCLUSIONS:: Nonextraction alignment with self-ligating brackets led to arch expansion associated with tipping of teeth. Expansion related to alignment resulted in horizontal and vertical bone loss at the incisors and mesiobuccal root of the first molars. Thinner BTs and more severe crowding before treatment increased the risk for buccal bone loss.

Bioactive nano-fibrous scaffold for vascularized craniofacial bone regeneration.

There has been a growing demand for bone grafts for correction of bone defects in complicated fractures or tumours in the craniofacial region. Soft flexible membrane like material that could be inserted into defect by less invasive approaches; promote osteoconductivity and act as a barrier to soft tissue in growth while promoting bone formation is an attractive option for this region. Electrospinning has recently emerged as one of the most promising techniques for fabrication of extracellular matrix such as nano-fibrous scaffolds that can serve as a template for bone formation. To overcome the limitation of cell penetration of electrospun scaffolds and improve on its osteoconductive nature, in this study, we fabricated a novel electrospun composite scaffold of polyvinyl alcohol (PVA)-poly (ε) caprolactone (PCL)-Hydroxyapatite based bioceramic (HAB), namely, PVA-PCL-HAB. The scaffold prepared by dual electrospinning of PVA and PCL with HAB overcomes reduced cell attachment associated with hydrophobic PCL by combination with a hydrophilic PVA and the HAB can contribute to enhance osteoconductivity. We characterized the physicochemical and biocompatibility properties of the new scaffold material. Our results indicate PVA-PCL-HAB scaffolds support attachment and growth of stromal stem cells; [human bone marrow skeletal (mesenchymal) stem cells and dental pulp stem cells]. In addition, the scaffold supported in vitro osteogenic differentiation and in vivo vascularized bone formation. Thus, PVA-PCL-HAB scaffold is a suitable potential material for therapeutic bone regeneration in dentistry and orthopaedics.

Maxillomandibular arch width differences at estimated centers of resistance: Comparison between normal occlusion and skeletal Class III malocclusion.

OBJECTIVE: To evaluate the differences in maxillomandibular transverse measurements at either the crown or the estimated center of resistance (CR), and to compare values between normal occlusion and Class III malocclusion groups. METHODS: Dental casts and computed tomography (CT) data from 30 individuals with normal occlusion and 30 with skeletal Class III malocclusions were evaluated. Using the casts, dental arch widths (DAWs) were measured from the cusp tips, and basal arch widths (BAWs-cast) were measured as the distance between the points at the mucogingival junction adjacent to the respective cusp tips. The BAWs determined from CT (BAWs-CT) images were measured from the estimated CRs of the teeth. RESULTS: None of the DAW measurements or maxillomandibular DAW differences showed statistically significant intergroup differences. In contrast, the maxillary BAWs-CT and BAWs-cast were lesser in the Class III malocclusion group than in the normal occlusion group. The mandibular BAWs-CT were significantly greater in the Class III malocclusion group than in the normal occlusion group. Moreover, the maxillomandibular BAW differences on both CT and cast showed significant intergroup differences in all transverse measurements. CONCLUSIONS: The maxillomandibular DAW differences showed no significant intergroup differences. In contrast, the maxillomandibular BAW differences on both CT and cast showed significant intergroup differences in all transverse measurements. The maxillomandibular BAW differences at the estimated CRs, measured using CT or casts, can reveal underlying transverse maxillary basal arch deficiencies in patients with skeletal Class III malocclusions.

Semipermanent replacement of missing maxillary lateral incisors by mini-implant retained pontics: A follow-up study.

Agenesis of maxillary lateral incisors can be treated either by closing the space and substituting the canines for the missing lateral incisors or, in adults, by replacing the missing teeth with fixed prosthetics or implants. This article illustrates a method that can be used for a semipermanent implant replacement of the missing incisors in adult patients. An Aarhus mini-implant was inserted perpendicular to the palatal mucosa of the alveolar process of the edentulous area. A pontic was made at chair side of composite material around a stainless steel wire extending from the mini-implant. This replacement approach allowed for the vertical development of the alveolar process and maintained the bone density and morphology of the alveolar process. Five years after placement, periapical radiographs showed that the alveolar process was following the vertical development related to the eruption of the adjacent teeth, and that the morphology and the bone density were maintained, making the later insertion of a dental implant possible without additional surgical buildup.

[Skeletal anchorage in the past, today and tomorrow]. / L'ancrage squelettique au passé, présent et futur.

INTRODUCTION: Skeletal anchorage was not introduced as an alternative to conventional anchorage modalities. The first skeletal anchorage was a ligature through a hole in the infrazygomatic crest. This was replaced by surgical screws and finally the TADs, which were optimized with respect to the material and morphology, were developed. A bracket-like head allows for the use of the mini-implant as indirect anchorage, but should not be a tool for lost control resulting from badly planned biomechanics or failing compliance. Skeletal anchorage should serve as an adjunct to correct biomechanics, to enable treatments that could not be performed prior to the introduction of skeletal anchorage. MATERIALS AND METHODS: The aim of this study was to test the hypothesis that temporary anchorage mini-screws help maintain bone density, height and width of alveolar processes in the extraction sites, and thus prevent the thinning of the alveolar ridge usually observed. RESULTS: In adult patients with degenerated dentitions the application of skeletal anchorage can allow for the displacement of teeth where no anchorage units are present, but also for the redevelopment and maintenance of atrophic alveolar bone. The basis for the optimal use of skeletal anchorage is that the correct line of action for the desired tooth displacement is defined and the necessary force system constructed either with the skeletal anchorage as direct or as indirect anchorage. After a period, during which osseointegrated implants were used as anchorage for tooth movement and bone maintenance, it was accepted that the mini-implants could serve also as anchorage for skeletal displacements avoiding loading of teeth.