Resorptions and orthodontics / Résorptions et orthodontie

Introduction: It's generally accepted that one of the risks associated with orthodontic treatment is apical root resorption, even though this may occur outside orthodontic treatment. In any case, it causes root shortening. Orthodontists are probably the only dental surgeons who use the inflammatory process as a therapeutic tool. They need to be aware of the risk factors for root inflammation. Along with recurrence, leukemia and periodontal problems, resorption is one of the "inconveniences" of orthodontics, which, if not inevitable, must at least be minimized. Material and Method: At present, the orthodontic literature on root resorption provides some clues as to the factors associated with the onset, severity and management of root resorption, although the complexity of this phenomenon does not allow us to arrive at a clear and unequivocal consensus. For this reason, it is important to identify potential risk factors for resorption, to take them into account before/during and after treatment, and to know what attitude to adopt in the event of resorption appearing, all in order to minimize this phenomenon, as everyone agrees that it can be a source of harm and stress for both patient and practitioner. Conclusion: There are still many grey areas in our understanding of the phenomenon, including how the elements of orthodontic treatment influence orthodontic resorption. Irreversible in nature, resorption can be sufficiently extensive to cast doubt on the benefit of successful orthodontic treatment.

Introduction: Il est généralement admis que l'un des risques associés au traitement orthodontique est la résorption radiculaire apicale même si elle peut se produire en dehors de tout traitement orthodontique. Quoi qu'il en soit, elle provoque le raccourcissement radiculaire. Les orthodontistes sont sans doute les seuls spécialistes de la chirurgie dentaire qui utilisent le processus inflammatoire en tant que moyen thérapeutique. Ils doivent connaître les facteurs de risque de cette inflammation sur la racine. La résorption fait partie, au même titre que la récidive, les leucomes et les problèmes parodontaux, des « inconvénients ¼ de l'orthodontie qui, à défaut d'être inévitables, doivent au moins être minimisés. Matériels et méthode: Actuellement, la littérature orthodontique sur la résorption radiculaire fournit quelques pistes sur les facteurs associés à l'apparition, la gravité et la gestion de la résorption radiculaire, même si la complexité de ce phénomène ne nous permet pas d'en dégager un consensus clair et équivoque. Pour cette raison, il est important d'identifier les facteurs de risque de résorption potentiels pour en tenir compte avant/pendant et après le traitement et connaître l'attitude à adopter en cas d'apparition de résorptions, tout ceci afin de minimiser ce phénomène, car tout le monde s'accorde sur le fait qu'elle peut être source de préjudice et de stress pour le patient et le praticien. Conclusion: De nombreuses zones d'ombres subsistent dans la compréhension du phénomène, notamment sur comment les éléments du traitement orthodontique influencent la résorption orthodontique. De nature irréversible, la résorption peut être suffisamment étendue pour jeter un doute sur le bénéfice apporté au succès du traitement orthodontique.

Orthognathic surgery: a significant tool for reassessment / La chirurgie orthognathique : un outil à ne pas oublier dans la réévaluation

Introduction: More than 15 years of experience in orthodontic-surgical collaboration has allowed the authors to identify some situations in which a new perspective is needed. Although it may seem easy to refer a patient to a maxillo-facial surgeon in cases of major dysmorphoses, this can lead to yet other dilemmas: a loss of results at the end of a developmental growth stage, an adult requesting a return to treatment after a camouflage orthodontic treatment or a non-cooperative child in an interceptive and preventive treatment phase. Then, a comprehensive process of reassessment becomes compulsory. Material and Method: In the form of an editorial, this article describes various cases encountered in the authors' practice. Discussion: The aim is not to point out the imperfections of our humanity, but simply to open our eyes to diagnostic elements that are missed, whether in the initial phase or during reassessment. Conclusion: As it is far from ideal to keep offering similar therapies that lead to the same pitfalls, it is time for a shift in the paradigm.

Introduction: Plus de 15 ans de recul en collaboration orthodontico-chirurgicale ont permis aux auteurs d'identifier un certain nombre de situations dans lesquelles un regard différent est devenu opportun. S'il est aisé d'orienter un patient vers un(e) chirurgien(ne) maxillo-facial(e) en cas de dysmorphoses majeures, les orthodontistes sont régulièrement confrontés à d'autres dilemmes : une perte de résultat en fin de croissance, un adulte demandeur d'une reprise après un traitement en compensation ou encore un enfant non-coopérant en phase interceptive. Une phase de réévaluation exhaustive devient alors nécessaire. Matériel et méthode: Sous la forme d'un éditorial, cet article expose différentes situations cliniques auxquelles les auteurs ont été confrontés lors de leur pratique. Discussion: Le propos n'est pas de pointer les imperfections de notre humanité mais seulement d'ouvrir les yeux sur des éléments diagnostiques qui échappent, que ce soit en phase initiale ou en réévaluation. Conclusion: Offrir une thérapeutique identique conduisant aux mêmes écueils n'est pas acceptable : il est temps de changer de paradigme.

Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children.

BACKGROUND: Prominent lower front teeth (Class III malocclusion) may be due to jaw or tooth position or both. The upper jaw (maxilla) can be too far back or the lower jaw (mandible) too far forward; the upper front teeth (incisors) may be tipped back or the lower front teeth tipped forwards. Orthodontic treatment uses different types of braces (appliances) fitted inside or outside the mouth (or both) and fixed to the teeth. A facemask is the most commonly reported non-surgical intervention used to correct Class III malocclusion. The facemask rests on the forehead and chin, and is connected to the upper teeth via an expansion appliance (known as 'rapid maxillary expansion' (RME)). Using elastic bands placed by the wearer, a force is applied to the top teeth and jaw to pull them forwards and downward. Some orthodontic interventions involve a surgical component; these go through the gum into the bone (e.g. miniplates). In severe cases, or if orthodontic treatment is unsuccessful, people may need jaw (orthognathic) surgery as adults. This review updates one published in 2013. OBJECTIVES: To assess the effects of orthodontic treatment for prominent lower front teeth in children and adolescents. SEARCH METHODS: An information specialist searched four bibliographic databases and two trial registries up to 16 January 2023. Review authors screened reference lists. SELECTION CRITERIA: We looked for randomised controlled trials (RCTs) involving children and adolescents (16 years of age or under) randomised to receive orthodontic treatment to correct prominent lower front teeth (Class III malocclusion), or no (or delayed) treatment. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Our primary outcome was overjet (i.e. prominence of the lower front teeth); our secondary outcomes included ANB (A point, nasion, B point) angle (which measures the relative position of the maxilla to the mandible). MAIN RESULTS: We identified 29 RCTs that randomised 1169 children (1102 analysed). The children were five to 13 years old at the start of treatment. Most studies measured outcomes directly after treatment; only one study provided long-term follow-up. All studies were at high risk of bias as participant and personnel blinding was not possible. Non-surgical orthodontic treatment versus untreated control We found moderate-certainty evidence that non-surgical orthodontic treatments provided a substantial improvement in overjet (mean difference (MD) 5.03 mm, 95% confidence interval (CI) 3.81 to 6.25; 4 studies, 184 participants) and ANB (MD 3.05°, 95% CI 2.40 to 3.71; 8 studies, 345 participants), compared to an untreated control group, when measured immediately after treatment. There was high heterogeneity in the analyses, but the effects were consistently in favour of the orthodontic treatment groups rather than the untreated control groups (studies tested facemask (with or without RME), chin cup, orthodontic removable traction appliance, tandem traction bow appliance, reverse Twin Block with lip pads and RME, Reverse Forsus and mandibular headgear). Longer-term outcomes were measured in only one study, which evaluated facemask. It presented low-certainty evidence that improvements in overjet and ANB were smaller at 3-year follow-up than just after treatment (overjet MD 2.5 mm, 95% CI 1.21 to 3.79; ANB MD 1.4°, 95% CI 0.43 to 2.37; 63 participants), and were not found at 6-year follow-up (overjet MD 1.30 mm, 95% CI -0.16 to 2.76; ANB MD 0.7°, 95% CI -0.74 to 2.14; 65 participants). In the same study, at the 6-year follow-up, clinicians made an assessment of whether surgical correction of participants' jaw position was likely to be needed in the future. A perceived need for surgical correction was observed more often in participants who had not received facemask treatment (odds ratio (OR) 3.34, 95% CI 1.21 to 9.24; 65 participants; low-certainty evidence). Surgical orthodontic treatment versus untreated control One study of 30 participants evaluated surgical miniplates, with facemask or Class III elastics, against no treatment, and found a substantial improvement in overjet (MD 7.96 mm, 95% CI 6.99 to 8.40) and ANB (MD 5.20°, 95% CI 4.48 to 5.92; 30 participants). However, the evidence was of low certainty, and there was no follow-up beyond the end of treatment. Facemask versus another non-surgical orthodontic treatment Eight studies compared facemask or modified facemask (with or without RME) to another non-surgical orthodontic treatment. Meta-analysis did not suggest that other treatments were superior; however, there was high heterogeneity, with mixed, uncertain findings (very low-certainty evidence). Facemask versus surgically-anchored appliance There may be no advantage of adding surgical anchorage to facemasks for ANB (MD -0.35, 95% CI -0.78 to 0.07; 4 studies, 143 participants; low-certainty evidence). The evidence for overjet was of very low certainty (MD -0.40 mm, 95% CI -1.30 to 0.50; 1 study, 43 participants). Facemask variations Adding RME to facemask treatment may have no additional benefit for ANB (MD -0.15°, 95% CI -0.94 to 0.64; 2 studies, 60 participants; low-certainty evidence). The evidence for overjet was of low certainty (MD 1.86 mm, 95% CI 0.39 to 3.33; 1 study, 31 participants). There may be no benefit in terms of effect on ANB of alternating rapid maxillary expansion and constriction compared to using expansion alone (MD -0.46°, 95% CI -1.03 to 0.10; 4 studies, 131 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: Moderate-certainty evidence showed that non-surgical orthodontic treatments (which included facemask, reverse Twin Block, orthodontic removable traction appliance, chin cup, tandem traction bow appliance and mandibular headgear) improved the bite and jaw relationship immediately post-treatment. Low-certainty evidence showed surgical orthodontic treatments were also effective. One study measured longer-term outcomes and found that the benefit from facemask was reduced three years after treatment, and appeared to be lost by six years. However, participants receiving facemask treatment were judged by clinicians to be less likely to need jaw surgery in adulthood. We have low confidence in these findings and more studies are required to reach reliable conclusions. Orthodontic treatment for Class III malocclusion can be invasive, expensive and time-consuming, so future trials should include measurement of adverse effects and patient satisfaction, and should last long enough to evaluate whether orthodontic treatment in childhood avoids the need for jaw surgery in adulthood.

Surgery-first in interdisciplinary class II cases.

OBJECTIVES: To present an interdisciplinary case treated with a surgery-first orthognathic approach, followed by orthodontic and prosthodontic treatment. CLINICAL CONSIDERATIONS: After an accurate pre-operative virtual planning, a young patient with skeletal class II, retrognathia, and an anterior open bite was treated with bimaxillary orthognathic surgery without pre-surgical orthodontic decompensation. Orthodontic treatment was carried out post-operatively. The treatment was completed with a prosthodontic phase to improve the final esthetic outcome of the smile. CONCLUSIONS: A surgery-first approach allowed to achieve esthetic and functional results in a reduced treatment duration that remained stable over the course of 1 year. The outcomes were consistent with prior research in terms of advantages brought by following an accurately planned surgery-first protocol. Nevertheless, longer-term follow-up was required to evaluate the treatment stability. CLINICAL SIGNIFICANCE: An accurately planned surgery-first approach significantly helped in shortening the duration of the treatment, while providing a stable, functional, and esthetic solution to the patient's problems.

Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities.

In the surgery-first approach (SFA), orthognathic surgery is performed without the need for presurgical orthodontic treatment. This study was aimed at assessing the treatment durations and occlusal outcomes for a consecutive cohort of patients, with a range of dentofacial deformities, who had completed orthognathic treatment using SFA. The duration of orthognathic treatment was measured. The overall change in occlusion, and the quality of the final occlusion, were evaluated using the patients' study casts. A single, independent, calibrated operator carried out the occlusal scores, using the validated Peer Assessment Rating (PAR) index. This was repeated to test intraoperator reliability. A total of 51 patients completed surgery-first treatment during the study period. The mean (range) age at surgery was 23.3 (15-47) years. The pre-treatment skeletal jaw relationship was Class III in 39 cases, and Class II in 12 cases. The mean (SD) overall treatment duration was 11.7 (5.7) months. The intraexaminer reliability of assessing the occlusion was high. The PAR scores confirmed a significant improvement in the quality of occlusion at the completion of treatment, which compares favourably with previous studies on the conventional orthodontics-first approach. The surgery first approach can be effective at correcting both Class II and Class III malocclusion types with reduced treatment times.

Effectiveness of pre-alveolar bone graft orthodontics for patients with non-syndromic complete unilateral cleft lip, alveolus and palate: A systematic review and meta-analysis.

The aim of this systematic review was to compare the effectiveness of pre-alveolar bonegraft (ABG) orthodontics with no orthodontic treatment for patients with non-syndromic unilateral cleft lip, alveolus and palate. All relevant studies from 1946 to October 30, 2022, were identified using several sources including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, Scopus, EMBASE, MEDLINE (Ovid) and EPUB ahead of publications and non-indexed citations. Randomized Controlled Trials (RCT) and Controlled Clinical Trials (CCT) were included. POPULATION: Non-syndromic complete unilateral cleft lip, alveolus and palate patients who have had ABG surgery. INTERVENTION: Orthodontics prior to ABG. Comparison: No orthodontic treatment prior to ABG. PRIMARY OUTCOME: Successful eruption of permanent canines. All articles were screened for the title, abstract and full text independently and in duplicate by 2 reviewers. The quality assessment of RCT was performed using Cochrane's risk of bias tool and the CCT was assessed using ROBINS-I tool. Of the 904 studies retrieved in the search, one RCT and one CCT were included. Both studies were judged as high risk of bias. The results from one study showed a statistically significant increase in bone volume and decreased bone defect post-ABG in the orthodontic treatment group. However, there was no difference with respect to other variables. Both included studies were of low quality. There is not enough evidence to recommend orthodontic treatment pre-ABG for patients with complete unilateral cleft lip, alveolus and palate. Future high-quality studies are required to inform patients and clinicians about the effectiveness of pre-graft orthodontic treatment.

Factors influencing treatment outcomes assessed by the American Board of Orthodontics Objective Grading System (ABO-OGS).

BACKGROUND: Treatment outcomes can be influenced by various factors. This study aimed to determine the association between predisposing patient- and treatment-related factors (demographic, cephalometric parameters, skeletal relationships, Discrepancy Index (DI), extractions, treatment type and duration) and treatment outcomes measures according to the American Board of Orthodontics Objective Grading System index (ABO-OGS). METHODS: Completed cases (N = 100) were included in this cross-sectional study. One calibrated examiner assessed DI, pretreatment lateral cephalometric parameters and ABO-OGS. Patient data, including sex, age, types of malocclusion, extractions, treatment type, and duration, were also collected. Intraexaminer reliability for each measurement was evaluated using the intraclass correlation coefficients. Multiple linear regression analysis, using the backward elimination method with a significance level (α) of 0.05, was used to determine which factors significantly influenced the ABO-OGS score. RESULTS: From the study, the overall mean ABO-OGS score was 11.36 points. Factors influencing the ABO-OGS score were pretreatment Wits values (p value = .000), L1-NB (°) (p value = .023) and treatment duration (p value = .019). Subjects with lower negative values of Wits and L1-NB (°) tended to have higher ABO-OGS scores. Additionally, the ABO-OGS score tended to be higher for subjects with longer treatment times. CONCLUSIONS: The majority of treated subjects had satisfactory orthodontic treatment outcomes assessed by the ABO-OGS. The pretreatment severity of skeletal discrepancies determined by the Wits parameter, the degree of retroclined lower incisors and longer treatment duration negatively impacted the treatment outcomes.

Manejo odontológico en paciente con síndrome de Cornelia de Lange / Dental treatment of a patient with Cornelia de Lange syndrome

El síndrome de Cornelia de Lange (SCdL) es un trastorno genético poco frecuente y se atribuye principalmente a mutaciones en los genes NIPBL, SMC3 y SMC1A. Sus principales características clínicas son múltiples anomalías congénitas, dimorfismo facial, hirsutismo, hipertricosis, retraso psicomotor, discapacidad intelectual, restricción del crecimiento prenatal y postnatal, anomalías de manos y pies, así como malformaciones congénitas que afectan a distintos órganos. En pacientes con SCdL es necesario hacer hincapié en la higiene oral debido a la discapacidad intelectual que puede presentarse y asegurarse de que se realiza una adecuada valoración y saneamiento dental de forma periódica con el fin de prevenir enfermedades bucodentales. El objetivo de este reporte de caso es describir el manejo odontológico de un paciente de 10 años con SCdL y revisar las características clínicas y hallazgos radiológicos presentes en la cavidad oral (AU)

Cornelia de Lange syndrome (CdLS) is a rare genetic disorder and is principally attributed to mutations in the NIPBL, SMC3 and SMC1A genes. The main clinical characteristics are multiple congenital anomalies, facial dimorphism, hirsutism, hypertrichosis, psychomotor retardation, intellectual disability, prenatal and postnatal growth restriction, hand and foot anomalies, as well as congenital malformations affecting different organs. In patients with CDLS, it is necessary to focus on oral hygiene due to the intellectual disability that may be present and to ensure that adequate dental valuation and hygiene is routinely performed in order to prevent oral diseases. The aim of this case report is to describe the dental management of a 10-year-old patient with CDLS and review the clinical characteristics and radiological findings that are present in the oral cavity (AU)

Efficacy of an innovative Herbst appliance with TADs for patients with hyperdivergent class II malocclusion: study protocol for a randomised controlled trial.

INTRODUCTION: Class II treatment with mandibular retrusion often involves the Herbst appliance due to its efficiency and low requirement of cooperation. Despite its advantages, it causes side effects concerning the occlusal plane and pogonion in terms of clockwise rotation that hinder the desired mandibular advancement for hyperdivergent patients. In this study, we will use a newly designed Herbst appliance, and a protocol that is accompanied by TADs for vertical control to avoid maxillary clockwise rotation. We hypothesise that the effect of the Herbst appliance with the vertical control approach will be beneficial for maintaining or even decreasing the skeletal divergence in hyperdivergent class II patients compared with conventional Herbst treatment. METHODS AND ANALYSIS: This study is a randomised, parallel, prospective controlled trial that will study the efficacy of Herbst with or without vertical control in children with hyperdivergent skeletal class II malocclusion. A total of 44 patients will be enrolled and randomised in a ratio of 1:1 to either Herbst treatment or Herbst treatment with vertical control. Participants will be recruited at the Shanghai Stomatological Hospital, Shanghai, China. The primary endpoint is the change in the angle indicating the occlusal plane and Sella-Nasion plane from baseline (T0) to the primary endpoint (T2) on cephalometric measurements by lateral X-ray examination. Important secondary outcomes include the root length of the anterior teeth, and the assessment score of the Visual Analogue Scale Questionnaire, etc. Safety endpoints will also be evaluated. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of the Shanghai Stomatological Hospital (Approval No. (2021) 012). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ChiCTR2100049860, Chinese Clinical Trial Registry.

Novel Machine Learning Algorithms for Prediction of Treatment Decisions in Adult Patients With Class III Malocclusion.

BACKGROUND: Management of Class III (Cl III) dentoskeletal phenotype is often expert-driven. PURPOSE: The aim is to identify critical morphological features in postcircumpubertal Cl III treatment and appraise the predictive ability of innovative machine learning (ML) algorithms for adult Cl III malocclusion treatment planning. STUDY DESIGN: The Orthodontics Department at the University of Illinois Chicago undertook a retrospective cross-sectional study analyzing Cl III malocclusion cases (2003-2020) through dental records and pretreatment lateral cephalograms. PREDICTOR: Forty features were identified through a literature review and gathered from pretreatment records, serving as ML model inputs. Eight ML models were trained to predict the best treatment for adult Cl III malocclusion. OUTCOME VARIABLE: Predictive accuracy, sensitivity, and specificity of the models, along with the highest-contributing features, were evaluated for performance assessment. COVARIATES: Demographic covariates, including age, gender, race, and ethnicity, were assessed. Inclusion criteria targeted patients with cervical vertebral maturation stage 4 or above. Operative covariates such as tooth extraction and types of orthognathic surgical maneuvers were also analyzed. ANALYSES: Demographic characteristics of the camouflage and surgical study groups were described statistically. Shapiro-Wilk Normality test was employed to check data distribution. Differences in means between groups were evaluated using parametric and nonparametric independent sample tests, with statistical significance set at <0.05. RESULTS: The study involved 182 participants; 65 underwent camouflage mechanotherapy, and 117 received orthognathic surgery. No statistical differences were found in demographic characteristics between the two groups (P > .05). Extreme values of pretreatment parameters suggested a surgical approach. Artificial neural network algorithms predicted treatment approach with 91% accuracy, while the Extreme Gradient Boosting model achieved 93% accuracy after recursive feature elimination optimization. The Extreme Gradient Boosting model highlighted Wit's appraisal, anterior overjet, and Mx/Md ratio as key predictors. CONCLUSIONS: The research identified significant cephalometric differences between Cl III adults requiring orthodontic camouflage or surgery. A 93% accurate artificial intelligence model was formulated based on these insights, highlighting the potential role of artificial intelligence and ML as adjunct tools in orthodontic diagnosis and treatment planning. This may assist in minimizing clinician subjectivity in borderline cases.

Harmonização do sorriso: aliando ortodontia e estética / Smile harmonization: combining orthodontics and aesthetics

Atualmente é evidente a demanda contínua por padrões de beleza, cada vez mais impecáveis, um sorriso alinhado e harmônico com dentes brancos para se sorrir com confiança. O tratamento odontológico interdisciplinar tem como intuito proporcionar uma boa saúde periodontal, restabelecer a estética e a função do sistema estomatognático. Objetivo: apresentar um relato de caso clínico envolvendo harmonização do sorriso como cirurgia plástica periodontal para alinhamento da margem gengival na região anterior e restaurações diretas em resina composta após a finalização do tratamento ortodôntico, evidenciando a importância da abordagem conservadora e multidisciplinar no âmbito do tratamento estético. Relato de caso: Realizamos o tratamento ortodôntico com aparelho autoligado cerâmico para alinhamento do arco dental e intrusão do elemento 13, em sequência executamos um recorte gengival nos elementos 12 e 22, clareamento dental associado após 15 dias, subsequentemente, reanatomização dentária no elemento 44 para que o elemento 13 não voltasse a extruir pela falta de contato oclusal, e por fim, remodelação dental fazendo uso de resina composta nos elementos 12, 21 e 22 devido a manchas de hipocalcificação dental. Conclusão: Contudo, a estética bucal tem a capacidade de possibilitar a melhoria na autoestima, devolvendo à função, proporcionando satisfação e bem-estar ao indivíduo, enaltecendo o sorriso.

Currently, the continuous demand for increasingly impeccable beauty standards is evident, an aligned and harmonic smile with white teeth to smile with confidence. Interdisciplinary dental treatment aims to provide good periodontal health, restore the aesthetics and function of the stomatognathic system. Objective: to present a clinical case report involving smile harmonization as periodontal plastic surgery for aligning the gingival margin in the anterior region and direct composite resin restorations after completion of orthodontic treatment, highlighting the importance of a conservative and multidisciplinary approach in the field of aesthetic treatment . Case report: We performed orthodontic treatment with a self-ligating ceramic appliance for aligning the dental arch and intruding element 13, then performed a gingival cutout on elements 12 and 22, associated tooth whitening after 15 days, subsequently, dental reanatomization on element 44 to that element 13 would not extrude again due to the lack of occlusal contact, and finally, dental remodeling using composite resin in elements 12, 21 and 22 due to dental hypocalcification stains. Conclusion: However, oral aesthetics has the ability to improve self-esteem, returning to function, providing satisfaction and well-being to the individual, enhancing the smile.

Management of Bimaxillary Protrusion.

Bimaxillary protrusion is a unique dentofacial deformity trait that can exist in an individual as an isolated problem or in combination with other skeletal and dental-related issues. Orthodontist and oral and maxillofacial surgeons are often the main primary team involved in the management of bimaxillary protrusion. Clinical dilemma often exists as cases can either be treated orthodontically or may require a combination of orthodontic and skeletal segmental orthognathic surgery. This article aims to help clinicians improve their approach to management of bimaxillary protrusion by creating a classification based on the severity that can guide treatment selection.

Craniofacial Characteristics and Orthodontic Treatment of Diamond Blackfan Syndrome: Two Case Reports.

Diamond Blackfan anemia (DBA) is a chronic congenital form of erythrocytic hypoplasia in which erythroid precursor cell levels are low. DBA reflects ribosomal dysfunction and is accompanied by hematopoietic cell apoptosis, anemia, and various somatic symptoms. We report the characteristic symptoms of the craniofacial region and the orthodontic treatments of two DBA cases. Case 1 was a 12-year-old female. The typical physical and facial characteristics of DBA were lacking. On initial examination, she exhibited a skeletal Class II jaw and end to end molar relationships and a large overjet. An edgewise appliance was placed after extraction of the first maxillary premolars. After 3 years and 11 months, an appropriate overjet and overbite, rigid intercuspation, and an acceptable profile were evident without any clinical adverse effects. Case 2 was a 13-year-old female. She exhibited a skeletal Class I jaw relationship, a spaced dental arch, the maxillofacial dysplasia characteristic of Binder syndrome, hypoplasia of the right mandibular condyle, and labial protrusions of the maxillary and mandibular incisors. We placed an edgewise appliance and after 1 year and 7 months, the occlusion was optimal in the absence of any adverse effects. Our two DBA cases exhibited a broad spectrum of physical and dentofacial symptoms. Patients with DBA are often prescribed combined steroid/bisphosphonate therapies. Both agents are likely to affect alveolar bone remodeling after tooth extraction and orthodontic tooth movement. Careful consideration of medication with reference to various dentofacial characteristics is necessary.

Class I and Class II Patients Treated with Damon System: A Study of Transversal, Sagittal and Torque Values Variations

ABSTRACT Objective: To analyze the transversal and anterior-posterior changes obtained in patients treated only with the Damon system. Material and Methods: 51 patients with either class I or class II division 1 sagittal relationship treated with the Damon system and the same archwire sequence were retrospectively selected. Dental casts of each patient before (T0) and after treatment (T1) were scanned and analyzed using NEMOCAST 3D software. Inter-molar, inter first-premolar, inter-second premolar and inter-canine distances were measured in both upper and lower arches. Initial and final lateral cephalograms were traced using the OrisCeph program. Pre and post-treatment measurements were compared using the t-test for repeated measurements. The Pearson Correlation Index and Linear Regression Analysis were used to determine the dependence between continuous variables. The significance level was set at 0.05. Results: Transversal diameters in the upper arch increase statistically significantly, especially in the bicuspid area. Initial intra-arch diameter was the only statistically significant variable correlated with the final expansion obtained. A linear negative correlation between the initial latero-posterior torque and the final expansion was observed in both arches. Conclusion: Using identical arches in patients with very different initial characteristics, the changes in bicuspids' diameters remain the most predominant. Patients with initial more negative torque in the posterior region had a higher expansion amount.

The Effect of Chlorhexidine on Bacterial Contamination of Hall Technique Elastomeric Orthodontic Separators and Gingival Health: A Pilot Study

ABSTRACT Objective: To study the effect of chlorhexidine on elastomeric orthodontic separators (EOS) bacterial-colonisation and gingival-health in Hall technique (HT) patients. Material and Methods: Prospective in-vivo pilot clinical study of EOS bacterial colonisation and primary-molar gingival health assessment in 20 patients (mean age 5.45±1.27 years) requiring bilateral HT crowns (40 teeth). One side received 1-minute 0.12% chlorhexidine-soaked-EOSs (Chx-EOSs), and the other side dry-EOSs (NoChx-EOSs). The EOSs were removed five-days later and underwent a bacterial enumeration technique. Plaque (PI) and Gingival (GI) indices were assessed pre-, five-days and three-months post-treatment. Wilcoxon-Signed-Rank/McNemar-Chi-square statistics were used (p<0.05). Results: Baseline unused/packaged EOSs' sterility check yielded zero colony-forming-units (CFU) per millilitre, but 100% of the used EOSs became colonised by oral-microorganisms. An overall trend of lower mean CFU count in Chx-EOSs (3.415± 0.78 x105 CFU/ml) compared to NoChx-EOSs (6.157±1.48 x105 CFU/ml) was observed (p=0.009). Both NoChx-EOSs and Chx-EOSs insertion sites showed evidence of gingivitis with no difference between PI and GI indices by site over time. Conclusion: There was a lower trend of bacterial colonization in chlorhexidine treated EOSs and an occurrence of gingivitis pre/post HT-treatment regardless of EOS type. The lack of difference in the gingival health may be inconclusive due to this pilot's low power suggesting the need for robust large scale studies.

Tratamiento integral de una adolescente con dentinogénesis imperfecta tipo I / Comprehensive treatment of an adolescent with type I dentinogenesis imperfecta

La dentinogénesis imperfecta (DI) es un desorden hereditario de carácter autosómico dominante, que se origina durante la etapa de histodiferenciación en el desarrollo dental y altera la formación de la denti-na. Se considera una displasia dentinaria que puede afectar ambas denticiones con una incidencia de 1 en 6000 a 8000 nacimientos. El tratamiento del pa-ciente con DI es complejo y multidisciplinario, supone un desafío para el odontólogo, ya que por lo general están involucradas todas las piezas dentarias y afec-ta no solo la salud buco dental sino el aspecto emo-cional y psicológico de los pacientes. Objetivo: des-cribir el tratamiento integral y rehabilitador realiza-do en una paciente adolescente con diagnóstico de DI tipo I. Relato del caso: Paciente de sexo femenino de 14 años, que concurrió en demanda de atención a la Cátedra de Odontología Integral Niños de la FOU-BA derivada del Hospital "Prof. Dr. Juan P. Garrahan" con diagnóstico de osteogénesis imperfecta tipo III (OI). Nunca recibió atención odontológica y el motivo de consulta fue la apariencia estética de sus piezas dentarias. Se realizó el examen clínico y radiográfico arrojando el diagnóstico de DI tipo I asociada a OI. Conclusión: El tratamiento rehabilitador de la DI tipo I en los pacientes en crecimiento y desarrollo debe estar dirigido a intervenir de manera integral y tem-prana para resolver la apariencia estética y funcio-nal, evitar las repercusiones sociales y emocionales y acompañar a los pacientes y sus familias (AU)

Dentinogenesis imperfecta (DI) is an autosomal dominant inherited disorder that originates during the histodifferentiation stage of tooth development and alters dentin formation. It is considered a den-tin dysplasia that can affect both dentitions with an incidence of 1 in 6000 to 8000 births. The treatment of patients with DI is complex and multidisciplinary, it is a challenge for the dentist, since in general all the teeth are involved and it affects not only oral health but also the emotional and psychological aspect of the patients. Objective: To describe the comprehen-sive and rehabilitative treatment carried out in an adolescent patient with a diagnosis of DI type I. Case report: A 14-year-old female patient, who required dental attention at the Department of Pediatric Den-tistry of FOUBA and was referred from the Hospital "Prof. Dr. Juan P. Garrahan" with a diagnosis of os-teogenesis imperfecta type III (OI). The patient never received dental care and the reason for consultation was esthetic appearance of her teeth. A clinical and radiographic examination was performed, resulting in a diagnosis of DI type I associated with OI. Conclu-sion: Rehabilitative treatment of DI in growing and developing patients will be aimed at early and com-prehensive intervention to resolve esthetic and func-tional appearance, avoid social and emotional reper-cussions and accompany patients and their families (AU)

Fotobiomodulación con láser de baja intensidad en el tratamiento integral ortodóntico: reporte de un caso / Photobiomodulation with low intensity laser in comprehensive orthodontic treatment: report of a case

El apiñamiento dental es una maloclusión frecuen-te y junto con los requerimientos de estética dental son una causa habitual de la solicitud de tratamien-to ortodóncico. El tiempo que demanda y las moles-tias que pudiera ocasionar el tratamiento produce inquietud en los pacientes y un esfuerzo de los or-todoncistas para optimizar el tiempo y prevenir los efectos adversos. Los tratamientos odontológicos multidisciplinarios permiten una mejor respuesta estética, funcional y de estabilidad post tratamiento. El tiempo de alineación dentaria y finalización, en los pacientes tratados con láser de baja intensidad po-dría mejorar tanto los índices gingivales como la res-puesta al dolor. Adicionalmente, las corticales óseas de los pacientes con ortodoncia tratados con láser, podrían verse menos afectadas en comparación con las de los pacientes no tratados. Se presenta un caso de fotobioestimulación con láser de baja intensidad aplicado en un paciente en fase de alineación, que forma parte de un estudio prospectivo aleatorizado que se desarrolla en la FOUBA y fue aprobado por el comité de Ética de la institución. El paciente aceptó y firmó el consentimiento informado. Finalizada la etapa de alineación, se evaluó la efectividad de la te-rapia con láser de baja intensidad actualmente de-nominada fotobiomodulación en incisivos superiores en la fase de alineación para acelerar el movimiento dentario, la respuesta gingival, el dolor, el estado de la cortical alveolar vestibular y la estética del perfil (AU)

Dental crowding, which is a frequent malocclusion, and dental aesthetic requirements are a common cause for requesting orthodontic treatment. The time that the treatment requires and the inconvenience that it could cause worries the patient and makes orthodontists strive to optimize time and prevent adverse effects. Multidisciplinary treatments would allow a better aesthetic, functional and post-treatment stability response. The dental alignment and completion time in patients treated with low-intensity laser could improve both gingival indices and response to pain. Additionally, the bone cortical of orthodontic patients treated with laser could be less affected compared to those of untreated patients. A case of low-intensity laser photobiostimulation applied to a patient in the alignment phase is presented, which is part of a prospective randomized study carried out at FOUBA and was approved by the institution's Ethics Committee. The patient accepted and signed the informed consent. After the alignment phase, the effectiveness of low-level laser therapy actually called photobiomodulation in upper incisors in the alignment phase is evaluated to accelerate tooth movement; the gingival response; the pain; the vestibular alveolar cortical and the aesthetics of the profile (AU)

Correlação entre os estágios de maturação da sutura palatina mediana e das vértebras cervicais / Correlation between the maturation stages of the median palatal suture and cervical vertebrae

Introdução: Atualmente, a avaliação da maturação da sutura palatina mediana (MSPM) em pacientes que precisam ser submetidos à expansão rápida da maxila é realizada por meio de tomografias computadorizadas de feixe cônico (TCFC). No entanto, doses adicionais de radiação são induzidas ao paciente para a aquisição desse exame. Objetivo: Correlacionar os estágios de MSPM com os estágios de maturação das vértebras cervicais (MVC). Material e métodos: Um total de 268 TCFC da região da cabeça e do pescoço de indivíduos de ambos os sexos e com idades variando entre 5 e 76 anos foram analisadas de forma cega por uma única examinadora. O estágio de MSPM foi avaliado por meio da observação da maxila no corte axial e foi classificado como A, B, C, D ou E. Por outro lado, o estágio de MVC foi avaliado por meio do corte sagital das vértebras cervicais e foi classificado como CS1, CS2, CS3, CS4, CS5 ou CS6. A concordância intraexaminador foi avaliada por meio do Coeficiente Kappa. O teste de Correlação de Spearman foi utilizado para avaliar a correlação entre os estágios de MSPM e os estágios de MVC. Resultados: Uma correlação positiva forte foi encontrada entre os estágios de MSPM e MVC. Os estágios A e B mostraram correlação com os estágios CS1, CS2 e CS3. Diferentemente, o estágio C se correlacionou com maior frequência com os estágios CS4 e CS5. Por fim, os estágios D e E, se mostraram mais frequentes em indivíduos nos estágios CS5 e CS6 de forma similar. Conclusão: A predição da MSPM por meio da MVC em telerradiografias laterais pode ser uma alternativa viável à avaliação sutural na TCFC em pacientes nos estágios CS1, CS2 e CS3. A partir do estágio CS4, uma TCFC é recomendável para avaliar com maior segurança o estágio de MSPM e definir a melhor modalidade de expansão (AU).

Introduction: Currently, the assessment of maturation of the midpalatal suture (MPSM) in patients who need to undergo rapid maxillary expansion is performed using cone-beam computed tomography (CBCT). However, additional doses of radiation are induced to the patient for the acquisition of this exam. Objective: To correlate the stages of MPSM with the stages of maturation of the cervical vertebrae (CVM). Material and methods: A total of 268 CBCT of the head and neck of individuals of both sexes and aged between 5 and 76 years were analyzed blindly by a single examiner. The MPSM stage was assessed by observing the maxilla in the axial view and was classified as A, B, C, D or E. On the other hand, the CVM stage was assessed in the sagittal view of the cervical vertebrae and was classified as CS1, CS2, CS3, CS4, CS5 or CS6. Intraexaminer agreement was analyzed using the Kappa coefficient. Spearman's Correlation test was used to assess the correlation between MPSM and CVM stages Results: A strong positive correlation was found between MPSM and CVM stages. Stages A and B showed correlation with stages CS1, CS2 and CS3. Differently, stage C correlated more frequently with stages CS4 and CS5. Finally, stages D and E were more frequent in individuals in stages CS5 and CS6, similarly. Conclusion: The prediction of MPSM by assessing CVM in lateral cephalograms seems to be a viable alternative to the sutural evaluation in CBCT in patients in stages CS1, CS2 and CS3. From the CS4 stage onwards, a CBCT is recommended to assess the MPSM stage and define the most adequate expansion modality for patients (AU).

The effect of orthodontic treatment on facial attractiveness: a systematic review and meta-analysis.

BACKGROUND: Facial and smile attractiveness are significant motivating factor for patients to seek orthodontic treatment. Although there is a general belief that orthodontic treatment improves facial appearance, this has yet not been systematically evaluated. OBJECTIVE: The objective of this study was to assess the current evidence on the effect of orthodontic treatment on facial attractiveness. SEARCH METHODS: Systematic and unrestricted search of nine databases were performed up to January 2022. SELECTION CRITERIA: Studies evaluating facial attractiveness before and after orthodontic treatment. DATA COLLECTION AND ANALYSIS: Extracted data included study design and setting, sample size and demographics, malocclusion type, treatment modality, and method for outcome assessment. Risk of bias was assessed with the ROBINS-I tool for non-randomized studies and with RoB-2 for randomized controlled trials (RCTs). Random-effects meta-analyses of mean differences and their 95% confidence intervals (CIs) were performed. RESULTS: Twenty studies were included in data synthesis; three randomized controlled clinical trials and 17 non-randomized clinical studies of retrospective or prospective design. One of the RCTs was found to have low risk of bias, one presented some concerns and the third showed a high risk of bias. All non-randomized studies showed either unclear or high risk of bias. Data syntheses showed that orthodontic treatment improved facial attractiveness ratings by 9% when compared with untreated controls (MD: 9.05/95% CI: 4.71; 13.39). A combination of orthodontics and orthognathic surgery also showed a positive effect of 5.5% (MD: 5.51/95% CI: 1.55; 9.47) when compared with orthodontic treatment alone. There was no difference in effect between extraction and non-extraction treatments (MD: -0.89/ 95% CI: -8.72; 6.94) or between different types of Class II correctors (MD: 2.21/95% CI: -16.51; 20.93). LIMITATIONS: With the exception of two RCTs, included studies were of unclear or low quality. CONCLUSIONS: Orthodontic treatment has a clinically weak effect on facial attractiveness when compared to no treatment. The same is true when a combined orthodontic/surgical treatment is compared to orthodontics alone. REGISTRATION: PROSPERO #: CRD42020169904.

Effects of high-frequency near infrared laser irradiation on experimental tooth movement-induced pain in rats.

Discomfort and dull pain are known side effects of orthodontic treatment. Pain is expected to be reduced by near-infrared (NIR) lasers; however, the mechanism underlying effects of short-pulse NIR lasers in the oral and maxillofacial area remains unclear. This study aimed to examine the effects of high-frequency NIR diode laser irradiation on pain during experimental tooth movement (ETM) on 120 J. NIR laser with 910 nm wavelength, 45 W maximum output power, 300 mW average output power, and 200 ns pulse width (Lumix 2; (Lumix 2; Fisioline, Verduno CN, Italy) was used for the experiment. A nickel-titanium-closed coil was used to apply a 50-gf force between the maxillary left-side first molar and incisor in 7-week-old Sprague-Dawley rats (280-300 g) to induce ETM. We measured facial-grooming frequency and vacuous chewing movement (VCM) period between laser-irradiation and ETM groups. We performed immunofluorescent histochemistry analysis to quantify levels of Iba-1, astrocytes, and c-fos protein-like immunoreactivity (Fos-IR) in the trigeminal spinal nucleus caudalis (Vc). Compared with the ETM group, the laser irradiation group had significantly decreased facial-grooming frequency (P = 0.0036), VCM period (P = 0.043), Fos-IR (P = 0.0028), Iba-1 levels (P = 0.0069), and glial fibrillary acidic protein (GFAP) levels (P = 0.0071). High-frequency NIR diode laser irradiation appears to have significant analgesic effects on ETM-induced pain, which involve inhibiting neuronal activity, microglia, and astrocytes, and it inhibits c-fos, Iba-1, and GFAP expression, reducing ETM-induced pain in rats. High-frequency NIR diode laser application could be applied to reduce pain during orthodontic tooth movement.