A heuristic model for cephalometric diagnosis of sagittal dysplasia.

OBJECTIVE: To identify the best-suited cephalometric parameter for assessing the sagittal skeletal discrepancy in the Indian population. DESIGN: An in vitro, observational, single-blinded, retrospective study. SETTING: Department of Orthodontics and Dentofacial Orthopaedics. METHODS: A total of 94 lateral cephalograms were used in this study. The study involved one key person and two examiners. The key person collected the radiographs, coded, analysed and classified them into three groups (skeletal classes I, II and III). Subsequently, the coded radiographs were independently analysed by the two examiners. They classified the cases by matching a minimum of 6 out of 11 parameters. On completion of diagnosis by the examiners, the samples were decoded and matched with the original diagnosis given by the key person. The samples in which identification of a particular cephalometric parameter matched the original evaluation as given by the key person was regarded as correctly diagnosed. The number of correctly assessed cases was used to judge the diagnostic performance of all the parameters in all the cases. Cross-validation of the method was performed, and a diagnostic algorithm was developed for diagnosis. RESULTS: ß angle and Pi angle showed a positive predictive value of 1 in both skeletal class I and II cases. ANB angle, W angle and HBN angle showed a positive predictive value of 1 in skeletal class III cases. CONCLUSION: No single cephalometric parameter can independently be used to diagnose sagittal skeletal discrepancy in all cases. However, a conclusive diagnosis on the type of sagittal skeletal malocclusion can be made by using a simple and easy to use diagnostic algorithmic process having a combination of cephalometric parameters.

Comparison of dental measurements between conventional plaster models, digital models obtained by impression scanning and plaster model scanning.

OBJECTIVE: Comparison of dental measurements between conventional plaster models, digital models obtained by impression scanning and plaster model scanning. PURPOSE: To evaluate and to compare the accuracy and reliability of tooth size, arch width and Bolton tooth size discrepancy measurements on 3 Dimensional (3D) digital models obtained by plaster dental model scanning, dental impression scanning and conventional plaster models. MATERIAL AND METHODS: This study was carried out on the maxillary and mandibular dental models of 25 patients with Angle Class I molar relationship and minimal crowding. Mesio-distal dimensions of the teeth, intercanine and intermolar arch width, and Bolton tooth size discrepancy measurements were calculated by conventional methods on plaster models, digital methods and on 3D models obtained from plaster model scanning and impression scanning. All measurements were repeated after three weeks for each of the investigated methods. Reliability of measurements was evaluated by Dahlberg formula and Pearson Correlation Coefficient. Comparisons of dental measurements between three methods were achieved with ANOVA Test. RESULTS: The repeated measurements were highly correlated for all methods. Method error was found within clinically acceptable limits. There was no significant difference between dental measurements on plaster dental models, digital models obtained from plaster dental model scanning and dental impression scanning. Results showed the methods being highly reliable and accurate for tooth size, arch width and Bolton analysis at total and anterior proportion calculation. CONCLUSION: Digital measurements of tooth size, arch width and Bolton tooth size discrepancy on digital models obtained from plaster dental model scanning and dental impression scanning showed high accuracy and reliability. There was no significant difference between the three methods for dental measurements.

Evaluations of the tongue and hyoid bone positions and pharyngeal airway dimensions after maxillary protraction treatment.

OBJECTIVE: To assess changes in the tongue and hyoid bone positions and airway dimensions after maxillary protraction using lateral cephalograms. METHODS: Lateral cephalograms were obtained before (C0) and after (C1) an observation period for untreated children with skeletal Class I malocclusion and before (T0), immediately after (T1), and one year after (T2) maxillary protraction in children with skeletal Class III malocclusion. Cephalometric measurements were compared between the time points in both patient groups. RESULTS: Immediately after maxillary protraction, the tongue moved superiorly and the nasopharyngeal and superior oropharyngeal airway dimensions increased. No significant changes in the middle or inferior oropharyngeal airway dimensions or in the hyoid bone position were noted after treatment. CONCLUSIONS: Maxillary protraction improved tongue posture and modified the nasopharyngeal and superior oropharyngeal airway dimensions in patients with skeletal Class III malocclusion. Consequently, maxillary protraction may restore the intra- and extraoral balance and improve respiratory function.

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern.

INTRODUCTION: Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. OBJECTIVE: This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. METHODS: A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). RESULTS: A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). CONCLUSION: The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Severe unilateral scissors-bite with a constricted mandibular arch: Bite turbos and extra-alveolar bone screws in the infrazygomatic crests and mandibular buccal shelf.

A 33-year-old woman had a chief complaint of difficulty chewing, caused by a constricted mandibular arch and a unilateral full buccal crossbite (scissors-bite or Brodie bite). She requested minimally invasive treatment but agreed to anchorage with extra-alveolar temporary anchorage devices as needed. Her facial form was convex with protrusive but competent lips. Skeletally, the maxilla was protrusive (SNA, 86°) with an ANB angle of 5°. Amounts of crowding were 5 mm in the mandibular arch and 3 mm in the maxillary arch. The mandibular midline was deviated to the left about 2 mm, which was consistent with a medially and inferiorly displaced mandibular right condyle. Ectopic eruption of the maxillary right permanent first molar to the buccal side of the mandibular first molar cusps resulted in a 2-mm functional shift of the mandible to the left, which subsequently developed into a full buccal crossbite on the right side. Treatment was a conservative nonextraction approach with passive self-ligating brackets. Glass ionomer bite turbos were bonded on the occlusal surfaces of the maxillary left molars at 1 month into treatment. An extra-alveolar temporary anchorage device, a 2 × 12-mm OrthoBoneScrew (Newton A, HsinChu City, Taiwan), was inserted in the right mandibular buccal shelf. Elastomeric chains, anchored by the OrthoBoneScrew, extended to lingual buttons bonded on the lingually inclined mandibular right molars. Cross elastics were added as secondary uprighting mechanics. The maxillary right bite turbos were reduced at 4 months and removed 1 month later. At 11 months, bite turbos were bonded on the lingual surfaces of the maxillary central incisors, and an OrthoBoneScrew was inserted in each infrazygomatic crest. The Class II relationship was resolved with bimaxillary retraction of the maxillary arch with infrazygomatic crest anchorage and intermaxillary elastics. Interproximal reduction was performed to correct the black interdental spaces and the anterior flaring of the incisors. The scissors-bite and lingually inclined mandibular right posterior segment were sufficiently corrected after 3 months of treatment to establish adequate intermaxillary occlusion in the right posterior segments to intrude the maxillary right molars. The anterior bite turbos opened space for extrusion of the posterior teeth to level the mandibular arch, and the infrazygomatic crest bone screws anchored the retraction of the maxillary arch. In 27 months, this difficult malocclusion, with a Discrepancy Index score of 25, was treated to a Cast-Radiograph Evaluation score of 22 and a pink and white esthetic score of 3.

Diagnostic validity of different cephalometric analyses for assessment of the sagittal skeletal pattern

Abstract Introduction: Numerous cephalometric analyses have been proposed to diagnose the sagittal discrepancy of the craniofacial structures. Objective: This study aimed at evaluating the reliability and validity of different skeletal analyses for the identification of sagittal skeletal pattern. Methods: A total of 146 subjects (males = 77; females = 69; mean age = 23.6 ± 4.6 years) were included. The ANB angle, Wits appraisal, Beta angle, AB plane angle, Downs angle of convexity and W angle were used to assess the anteroposterior skeletal pattern on lateral cephalograms. The sample was classified into Class I, II and III groups as determined by the diagnostic results of majority of the parameters. The validity and reliability of the aforementioned analyses were determined using Kappa statistics, sensitivity and positive predictive value (PPV). Results: A substantial agreement was present between ANB angle and the diagnosis made by the final group (k = 0.802). In the Class I group, Downs angle of convexity showed the highest sensitivity (0.968), whereas ANB showed the highest PPV (0.910). In the Class II group, ANB angle showed the highest sensitivity (0.928) and PPV (0.951). In the Class III group, the ANB angle, the Wits appraisal and the Beta angle showed the highest sensitivity (0.902), whereas the Downs angle of convexity and the ANB angle showed the highest PPV (1.00). Conclusion: The ANB angle was found to be the most valid and reliable indicator in all sagittal groups. Downs angle of convexity, Wits appraisal and Beta angle may be used as valid indicators to assess the Class III sagittal pattern.

Resumo Introdução: numerosas análises cefalométricas foram propostas para diagnosticar a discrepância sagital das estruturas craniofaciais. Objetivo: este estudo teve como objetivo avaliar a confiabilidade e validade de diferentes análises esqueléticas para a identificação do padrão esquelético sagital. Métodos: foram incluídos 146 indivíduos (homens = 77; mulheres = 69; idade média = 23,6 ± 4,6 anos). O ângulo ANB, a avaliação de Wits, o ângulo Beta, o ângulo do plano AB, o ângulo de convexidade de Downs e o ângulo W foram utilizados para avaliar o padrão esquelético anteroposterior em cefalogramas laterais. A amostra foi classificada nos grupos Classe I, II e III, conforme os resultados diagnósticos da maioria dos parâmetros. A validade e a confiabilidade das análises acima mencionadas foram determinadas usando estatísticas Kappa, sensibilidade e valor preditivo positivo (VPP). Resultados: foi encontrada uma concordância significativa entre o ângulo ANB e o diagnóstico feito pelo grupo final (k = 0,802). No grupo Classe I, o ângulo de convexidade de Downs mostrou a maior sensibilidade (0,968), enquanto o ANB apresentou o maior VPP (0,910). No grupo Classe II, o ângulo ANB mostrou a maior sensibilidade (0,928) e o maior VPP (0,951). No grupo Classe III, o ângulo ANB, a avaliação de Wits e o ângulo Beta apresentaram a maior sensibilidade (0,902), enquanto o ângulo de convexidade de Downs e o ângulo ANB apresentaram o maior VPP (1,00). Conclusão: o ângulo ANB foi considerado o indicador mais válido e confiável em todos os grupos sagitais. O ângulo de convexidade de Downs, a avaliação de Wits e o ângulo Beta podem ser usados como indicadores válidos para avaliar o padrão sagital de Classe III.

[Evaluation of accuracy of virtual occlusal definition in Angle class I molar relationship].

OBJECTIVE: To evaluate the accuracy of virtual occlusal definition in non-Angle class I molar relationship, and to evaluate the clinical feasibility. METHODS: Twenty pairs of models of orthognathic patients were included in this study. The inclusion criteria were: (1) finished with pre-surgical orthodontic treatment and (2) stable final occlusion. The exclusion criteria were: (1) existence of distorted teeth, (2) needs for segmentation, (3) defect of dentition except for orthodontic extraction ones, and (4) existence of tooth space. The tooth-extracted test group included 10 models with two premolars extracted during preoperative orthodontic treatment. Their molar relationships were not Angle class I relationship. The non-tooth-extracted test group included another 10 models without teeth extracted, therefore their molar relationships were Angle class I. To define the final occlusion in virtual environment, two steps were included: (1) The morphology data of upper and lower dentition were digitalized by surface scanner (Smart Optics/Activity 102; Model-Tray GmbH, Hamburg, Germany); (2) the virtual relationships were defined using 3Shape software. The control standard of final occlusion was manually defined using gypsum models and then digitalized by surface scanner. The final occlusion of test group and control standard were overlapped according to lower dentition morphology. Errors were evaluated by calculating the distance between the corresponding reference points of testing group and control standard locations. RESULTS: The overall errors for upper dentition between test group and control standard location were (0.51±0.18) mm in non-tooth-extracted test group and (0.60±0.36) mm in tooth-extracted test group. The errors were significantly different between these two test groups (P<0.05). However, in both test groups, the errors of each tooth in a single dentition does not differ from one another. There was no significant difference between errors in tooth-extracted test group and 1 mm (P>0.05); and the accuracy of non-tooth-extracted group was significantly smaller than 1 mm (P<0.05). CONCLUSION: The error of virtual occlusal definition of none class I molar relationship is higher than that of class I relationship, with an accuracy of 1 mm. However, its accuracy is still feasible for clinical application.

Improvement in Peer Assessment Rating scores after nonextraction, premolar extraction, and mandibular incisor extraction treatments in patients with Class I malocclusion.

INTRODUCTION: Different treatment protocols implemented for correction of Class I malocclusion aim at achieving ideal occlusal characteristics. This study was planned to evaluate the improvement in the occlusal characteristics of Class I patients treated with nonextraction (NE), all first premolar extractions (PME), and mandibular incisor extraction (MIE) as assessed by the percentage of improvement in Peer Assessment Rating (PAR) scores. METHODS: This retrospective cross-sectional study was conducted on the pretreatment and posttreatment dental casts of 108 subjects with Class I malocclusion. The total sample was divided into 3 equal groups according to the treatment protocol implemented: NE, PME, and MIE. The mean pretreatment and posttreatment PAR scores, and the percentages of improvement were compared among the 3 treatment modalities using Kruskal-Wallis and post-hoc Dunnett T3 tests. RESULTS: The mean percentages of improvement in the PAR score were 75.8% ± 25.8% in the NE group, 73.1% ± 19.4% in the PME group, and 70.6% ± 24.1% in the MIE group. There was no significant difference (P = 0.351) in the percentages of improvement in PAR scores among the 3 treatment modalities. However, the mean pretreatment and posttreatment PAR scores varied significantly (P <0.001) in the 3 groups. The average pretreatment and posttreatment PAR scores were highest in the MIE group and lowest in the NE group. CONCLUSIONS: The comparable percentages of improvement in PAR scores among the 3 groups denote that equivalent occlusal corrections were achieved in Class I patients treated with the NE, PME, and MIE protocols.

Evaluation of arch forms depending on the angle classification.

It is generally accepted that each individual has his or her own dental arch form. However, during orthodontic treatment, industrially preshaped archwires are widely used. The resulting use of the same arch form for all malocclusions may compromise occlusal stability after orthodontic treatment. AIM: To determine the average dental arch form of a non-consulting Moroccan population depending on the Angle classification, after digitization of plaster models of the dental arches. MATERIAL AND METHODS: A sample of 50 dental students aged between 21 and 27 was selected. After digitization of the plaster models to produce a cloud of points, the barycentric method was applied to this representation, enabling all the arch shapes of each series to be superimposed with Photoshop CS 5 software (layer mode) and the average curves for each Angle class to be thereby determined. RESULTS: The average maxillary and mandibular arch forms were defined for each class: Class I: a normal maxillary form and an ovoid mandibular form; Class II: a tapered maxillary form and a narrow tapered mandibular form; Class III: narrow tapered forms for both upper and lower arches. Globally speaking, in this sample an ovoid mandibular arch form and a normal maxillary arch form are the dominant shapes. DISCUSSION AND CONCLUSION: The studied population exhibited specific arch form features. This study could serve as the basis for the choice and use of preformed archwires better-adapted to the needs of our patients.

European College of Orthodontics: Commission of affiliation and titularisation.

Date of birth: 12/01/1992; sex: male. A. PRETREATMENT RECORDS: 25/05/2005; 13 years 4 months. DIAGNOSIS: Angle Class I; Teeth missing prior to treatment: third molars. TREATMENT PLAN: Appliances and devices: Hyrax appliance, multibracket straight-wire appliances, 0.022×0.028″, Roth technique; start of treatment: 13 years 6 months; 06/07/2005. B. POSTTREATMENT RECORDS: 06/12/2007; 15 years 11 months. DURATION OF ACTIVE TREATMENT: 2 years 5 months. RETENTION: Hawley maxillary retainer;12/12/08; bonded lingual mandibular wire from 33 to 43; 12/12/08. C. POSTRETENTION RECORDS: (1 year minimum): Duration of retention: Maxilla: 1 year; mandible: permanent.

A 22-year follow-up of the nonsurgical expansion of maxillary and mandibular arches in a young adult: Are the outcomes stable, relapsed, or unstable with aging?

Adult maxillary and mandible arch expansion without a surgical approach can be uncertain when long-term stability is considered. This case report describes the treatment of a 19-year-old woman with an Angle Class I malocclusion with constricted maxillary and mandibular arches. The patient's main complaint was mandibular anterior crowding. The treatment plan included expansion of the mandibular arch concurrent with semirapid maxillary expansion. An edgewise appliance was used to adjust the final occlusion. Smile esthetics and dental alignment were improved without straightening the profile. This outcome was followed up with serial dental casts for 22 years after treatment. At the end of that period, the occlusion and tooth alignment were clinically satisfactory, further supported by mandibular fixed retention. However, the transverse widths were continuously and gradually reduced over time, superposing orthodontic transverse relapse and natural arch constriction caused by aging.

European College of Orthodontics: Commission of Affiliation and Titularisation.

Date of birth: 8 May 2000; sex: female. A. PRETREATMENT RECORDS: 9 years 9months; 4/2010. DIAGNOSIS: Angle Class I. II with ectopic 13, 23; mesial tipping of the roots of 12-22 and space opening at 12-22. Lack of space in 13 and 23 areas. Early loss of 53-63 due to undermining resorption and mesial migration of deciduous molars and first molars. Lower anterior crowding. Deep bite. TREATMENT PLAN: Distalization of the upper molars and premolars. Space opening for alignment of 13-23; Appliances and devices: cervical headgear; lip bumper; multibracket appliance. B. POST-TREATMENT RECORDS: 11/2013; 13 years 5months. DURATION OF ACTIVE TREATMENT: 42 months (brackets: 24 months). A Cl. I relationship with canine guidance has been achieved. The overjet measures 2mm, and the overbite 1mm. The second molars are not fully erupted. The upper incisors are slightly protruded. The profile is well-balanced. RETENTION: 2/2013. Bonded 3-3 retainer in the upper and lower jaws, splint retainers for nighttime use. C. POST-RETENTION RECORDS: (1 year minimum): 6/2015; 15 years 1month. The result is stable. The overbite has increased to 2mm. Inclination of upper incisors has decreased by 2°. All wisdom teeth are planned for extraction. As long as the patient is willing to keep her retainers. The splint aligners are already worn irregularly.

The relationship between Angle type of occlusion and recorded Bennett angle values.

STATEMENT OF PROBLEM: The Bennett angle can be an important parameter to accurately record and program into an articulator during restorative procedures. Few data exist regarding the impact and association of a patient's occlusion types on their recorded Bennett angle values. PURPOSE: The purpose of this in vivo study was to investigate the effect of occlusion type on recorded Bennett angle values. MATERIAL AND METHODS: This study included 98 participants (26.0 ±5.2 years) divided into 4 study groups: Angle class I; Angle class II, division 1; Angle class II, division 2; Angle class III. All recordings were obtained using an ultrasound mandibular recording device with 6 degrees of freedom and a clutch was attached to the mandible. On each participant, 3 protrusive, 3 left laterotrusive, and 3 right laterotrusive movements were recorded. The recording device's software automatically calculated Bennett angle for each participant's left and right mandibular fossae and the data were statistically analyzed. RESULTS: One-way ANOVA did not show significant differences among different Angle classes of occlusion for the Bennett angle values. The average Bennett angle value for all participants was 7.7 degrees. CONCLUSIONS: The results of this study suggest that different Angle occlusion classifications do not appear to have an impact on recorded Bennett angle values. The average Bennett angle value in this study was found to be approximately 8 degrees. This information should be considered when programming average values into an articulator with respect to desired negative error (shorter cusp) during restoration fabrication.

Exploring the association between feeding habits, non-nutritive sucking habits, and malocclusions in the deciduous dentition.

BACKGROUND: This study aimed to explore the association between feeding habits, non-nutritive sucking habits, and malocclusions in deciduous dentition. METHODS: A cross-sectional observational survey was carried out in 275 children aged 3 to 6 years and included clinical evaluations of malocclusions and structured interviews. Statistical significance for the association between feeding habits and the development of malocclusion was determined using chi-square and Fisher's exact tests. In addition, odds ratio (OR) calculations were used for intergroup comparisons. Controlling for confounders was adjusted by excluding children with non-nutritive sucking habits. RESULTS: The results indicated that there were no significant relationships between exclusive breastfeeding or bottlefeeding and the presence of any type of malocclusion (p > 0.05). There was also no significant association between breastfeeding or bottlefeeding duration and malocclusion (p > 0.05). In addition, it was observed that exclusive breastfeeding had a protective effect and diminished the risk of acquiring non-nutritive sucking habits (p = 0.001). CONCLUSIONS: There was no association between feeding habits and malocclusions in the deciduous dentition in this sample of children. Exclusive breastfeeding reduced the risk of acquiring non-nutritive sucking habits.

Un tratamiento antiguo y vigente en ortodoncia: expansión rápida maxilar / An old and current orthodontic treatment: rapid maxillary expansion

Las anomalías transversales se presentan frecuentemente desde edades tempranas. Generalmente son causadas por problemas funcionales como deglución atípica y respiración bucal. Las alteraciones de la oclusión sobre el plano transversal son conocidas como mordidas cruzadas posteriores, pudiendo ser de origen dentario o esqueletal. Si el diagnóstico de nuestro paciente es una compresión maxilar de origen esqueletal, el tratamiento indicado será la expansión rápida del maxilar (ERM). La corrección de la deficiencia transversal del maxilar superior con el uso del disyuntor, constituye un recurso terapéutico capaz de cambiar las relaciones dentarias y esqueléticas en una primera fase del tratamiento, utilizando al máximo los cambios dinámicos asociados con el crecimiento y preparando un mejor entorno orofacial para la erupción de la dentición permanente. En este trabajo se desarrollan tres casos clínicos que modificaron notoriamente su morfología luego del tratamiento con ERM mediante el uso de diferentes tipos de disyuntores...

[A pilot study of root position in orthodontic diagnosis model set-up].

OBJECTIVE: To investigate the importance of root information in diagnosis set-up by constructing three-dimensional (3D) digital models with individual anatomic roots. METHODS: Pretreatment cone-beam CT (CBCT) and laser scanning data were collected from two patients (extraction and non-extraction each) with skeletal Class I malocclusion. Threshold segmentation of the CBCT was performed to generate a 3D digital model which has individually isolated tooth. This model and the scan model were superimposed to generate an integrated model (Mo) composed of high-resolution surface scan crowns sutured to the CBCT roots. Pretreatment dentition plaster model were made into set-up model. The diagnosis model set-up was performed successively by three orthodontists and one senior orthodontic technician. Set-up model scan of each patient after tooth alignment was obtained. The isolated composite teeth were individually superimposed onto the set-up model surface scan to creat set-up model (Ma, Mb, Mc, Md) containing root position. These isolated composite teeth were also superimposed onto the posttreatment surface scan depicting the posttreatment model (M). In order to observe whether diagnosis model set-up would cause exposure of the root, Ma-Md were compared with Mo, which showed the true positions of alveolus. In order to validate the accuracy of the expected root position setup, Ma-Md were compared with the true root position represented by M. Color displacement maps generated to measure the discrepancies of root positions. RESULTS: Nonparallel and exposure of the root was found in all setup models. Color displacement maps through molar superimpositions showed maximum differences of 8.79 mm for the maxillary teeth and 9.96 mm for the mandibular teeth. CONCLUSIONS: Diagnosis model set-up based only on crown can not absolutely ensure the good alignment of roots without root exposure. It is necessary to construct the integrated model including root for diagnosis during tooth arrangement process.

Outcomes of arthrocentesis for the treatment of internal derangement pain: with or without corticosteroids?

PURPOSE: Arthrocentesis (AC) is an acceptable treatment modality in the treatment of internal derangement (ID) pain. This study evaluated outcomes of AC on pain relief of ID pain with or without corticosteroids. MATERIALS AND METHODS: This single-blind clinical trial was conducted on 60 patients with ID pain who were randomly assigned to 2 groups (30 in each group) for AC. The AC of the upper joint space was then performed by using Ringer lactate under local anesthesia in both groups. In the second group, the procedure was followed by the administration of a single-dose intra-articular dexamethasone (8 mg). Assessments were made at baseline (T0), 1 month (T1), and 6 months (T6) after AC; pain, maximum mouth opening, and joint sounds before and after treatment up to 6 months were evaluated. Pain severity was documented according to Visual Analogue Scale. Age, sex, and skeletal maxillomandibular relationship were considered as variable factors, and irrigation with or without corticosteroids was a predictive factor of the study. Pain, click, and maximum mouth opening were other assessment outcomes of the study. RESULTS: Comparison of age, sex, and skeletal relationship did not show any significant differences between the 2 groups. Results did not demonstrate any difference for click between the 2 groups. Comparison of pain severity in T0, T1, and T2 between the 2 groups did not show any significant differences (P < 0.05). The repeat measure test revealed a significant change in T0, T1, and T2 for both groups (P < 0.001). MMO significantly changed between T0 and T1 and T0 and T6 in the 2 groups without any significant differences between them. CONCLUSIONS: The AC is an effective procedure for a short-term reduction of pain in temporomandibular disorder cases. It seems that AC using Ringer solution with or without corticosteroids may have the same effect on pain relief.

Class I malocclusion with anterior crossbite and severe crowding.

This article reports the orthodontic diagnosis and treatment planning carried out with a 14-year and 5-month-old female patient with esthetic and functional complaints. She presented an Angle Class I malocclusion, anterior crossbite and severe crowding in both maxillary and mandibular arches, in addition to a lightly concave straight facial profile. Orthodontic treatment did not require extraction. Crossbite was corrected by protrusion of upper teeth, which contributed to alignment and leveling of teeth, in addition to improving the patient's facial profile. The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as a requirement for the BBO certification.

Class I malocclusion with anterior crossbite and severe crowding

This article reports the orthodontic diagnosis and treatment planning carried out with a 14-year and 5-month-old female patient with esthetic and functional complaints. She presented an Angle Class I malocclusion, anterior crossbite and severe crowding in both maxillary and mandibular arches, in addition to a lightly concave straight facial profile. Orthodontic treatment did not require extraction. Crossbite was corrected by protrusion of upper teeth, which contributed to alignment and leveling of teeth, in addition to improving the patient's facial profile. The case was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) as a requirement for the BBO certification.

Esse artigo relata o diagnóstico, planejamento e execução do tratamento ortodôntico de uma paciente com 14 anos e 5 meses de idade, cuja queixa principal era estética e funcional. A paciente portava má oclusão de Classe I de Angle, mordida cruzada anterior e falta de espaço severo nas arcadas superior e inferior. O perfil facial era reto, com tendência a côncavo. O tratamento ortodôntico foi realizado sem necessidade de exodontias, com a correção da mordida cruzada por meio da projeção dos dentes superiores, o que auxiliou no alinhamento e nivelamento dentário, além de melhorar o perfil facial da paciente. Esse caso foi apresentado ao Board Brasileiro de Ortodontia e Ortopedia Facial (BBO) como parte dos requisitos para obtenção do título de Diplomado pelo BBO.

Bolton ratio in subjects with normal occlusion and malocclusion

AIM: To verify the presence of Bolton anterior and total discrepancy in Brazilian individuals with natural normal occlusion and Angle's Class I and Class II, division 1 malocclusions. METHODS: The sample was divided in three groups (n=35 each): natural normal occlusion; Class I malocclusion; Class II, division 1 malocclusion. Of the 105 Caucasian Brazilian individuals, 24 were boys and 81 were girls aged from 13 to 17 years and 4 months. The mesiodistal width of the maxillary and mandibular teeth, from the left first molar to the right first molar, was measured on each pre-treatment dental plaster cast using a digital caliper accurate to 0.01 mm resolution. Values were tabulated and the Bolton ratio was applied. The Kolmogorov-Smirnov test was used to verify if data were normally distributed (p>0.2). For comparison between the values obtained and those from the Bolton standard, Student's t test was used and one-way ANOVA was used for comparisons among the 3 groups, with a significance level of 5% (p<0.05). RESULTS: For groups 1, 2 and 3, respectively, the total ratio found was 90.36% (SD 1.70), 91.17% (SD±2.58) and 90.76% (SD±2.45); and the anterior ratio was 77.73% (SD 2.39), 78.01% (SD 2.66) and 77.30% (SD 2.65). CONCLUSIONS: There was no significant difference among the groups regarding the values indicated in the Bolton ratio.