Psychological and financial impact of the COVID-19 pandemic during the first stages of the pandemic: Brazilian orthodontists´ perspective.

INTRODUCTION: Brazil faced a catastrophic situation in the coronavirus pandemic. Due to the high risk of contamination and spread of COVID-19, dentist have been attending only urgency and emergency services in Brazil at the beginning of the pandemic. OBJECTIVE: This research aimed to evaluate the psychological and financial impacts caused by the coronavirus pandemic in Brazilian orthodontists. METHODS: This population-based cross-sectional study collected demographic data and mental health measurements from 404 orthodontists. Depression, anxiety, insomnia, and distress were evaluated through Brazilian versions of the 9-item Patient Health Questionnaire (9-PHQ), the 7-item Generalized Anxiety Disorder scale and Mini-Tracking (GAD), the 7-item Insomnia Severity Index (ISI), and the 22-item Impact of Event Scale-Revised (IES-R), respectively. The demographic data of the sample was described using descriptive statistics. The data was analyzed according to sex, professional status, and economic income. Comparisons were performed using Chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis followed by post-hoc tests. RESULTS: Females, graduate students, and lower incomes subgroups showed higher levels of depression, anxiety, insomnia, and distress. Most orthodontists showed moderate to extreme financial and professional concerns during the pandemic. CONCLUSION: The coronavirus pandemic negatively affected the psychological health and increased the financial concerns of the Brazilian orthodontists, mainly female, graduate students, and with income below 10k participants.

Psychological and financial impact of the COVID-19 pandemic during the first stages of the pandemic: Brazilian orthodontists´ perspective

ABSTRACT Introduction: Brazil faced a catastrophic situation in the coronavirus pandemic. Due to the high risk of contamination and spread of COVID-19, dentist have been attending only urgency and emergency services in Brazil at the beginning of the pandemic. Objective: This research aimed to evaluate the psychological and financial impacts caused by the coronavirus pandemic in Brazilian orthodontists. Methods: This population-based cross-sectional study collected demographic data and mental health measurements from 404 orthodontists. Depression, anxiety, insomnia, and distress were evaluated through Brazilian versions of the 9-item Patient Health Questionnaire (9-PHQ), the 7-item Generalized Anxiety Disorder scale and Mini-Tracking (GAD), the 7-item Insomnia Severity Index (ISI), and the 22-item Impact of Event Scale-Revised (IES-R), respectively. The demographic data of the sample was described using descriptive statistics. The data was analyzed according to sex, professional status, and economic income. Comparisons were performed using Chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis followed by post-hoc tests. Results: Females, graduate students, and lower incomes subgroups showed higher levels of depression, anxiety, insomnia, and distress. Most orthodontists showed moderate to extreme financial and professional concerns during the pandemic. Conclusion: The coronavirus pandemic negatively affected the psychological health and increased the financial concerns of the Brazilian orthodontists, mainly female, graduate students, and with income below 10k participants.

RESUMO Introdução: O Brasil enfrentou uma situação catastrófica durante a pandemia do coronavírus. Devido ao alto risco de contaminação e disseminação do vírus da COVID-19, os cirurgiões-dentistas passaram a realizar apenas atendimentos de urgência ou emergência no início da pandemia. Objetivo: O presente estudo teve como objetivo avaliar o impacto financeiro e psicológico causado pela pandemia do coronavírus nos ortodontistas brasileiros. Métodos: Este estudo transversal de base populacional coletou os dados demográficos e o impacto da pandemia em 404 ortodontistas. Depressão, ansiedade, insônia e angústia foram avaliadas, respectivamente, por meio da versão em português do Questionário de Saúde do Paciente (PHQ-9), do módulo de transtorno de ansiedade generalizada (GAD) do Mini-Tracking (GAD/Mini-Tracking), do Índice de Severidade de Insônia (ISI) e o do Impact of Events Scale-Revised (IES-R). As características demográficas da amostra foram apresentadas por meio de estatística descritiva. Os dados foram analisados de acordo com o sexo, situação profissional e renda econômica. As comparações foram realizadas utilizando os testes de Qui-quadrado, Mann-Whitney U e Kruskal-Wallis, seguidos de testes post-hoc (p<0,05). Resultados: Mulheres, estudantes de pós-graduação e profissionais com menores rendas apresentaram níveis mais altos de depressão, ansiedade, insônia e angústia. A maioria dos ortodontistas mostrou preocupação financeira e profissional moderada a extrema durante a pandemia. Conclusão: A pandemia do coronavírus afetou negativamente a saúde psicológica dos ortodontistas brasileiros e aumentou as preocupações financeiras desses profissionais. As mulheres, os estudantes de pós-graduação e os participantes com renda mensal menor que R$10 mil foram os grupos mais afetados.

Diagnostic assessment of tooth maturation of the mandibular second molars as a skeletal maturation indicator: A retrospective longitudinal study.

INTRODUCTION: Our aim was to analyze the correlation between growth status in height and chronological age, carpal maturation, cervical maturation, and dental maturation, and assess the diagnostic performance of Demirjian's dental maturation as an indicator of the pubertal growth spurt, through a retrospective longitudinal study. METHODS: Records of 60 Canadian patients obtained from the Burlington Growth Centre, which included height and weight charts and a set of x-rays at 6 points in time, were analyzed. The images at each point in time included 1 hand and wrist radiograph, a lateral cephalometric x-ray, and one 45° oblique cephalometric radiograph of each side, which were analyzed using the methods of Fishman, Baccetti, and Demirjian on the mandibular left and right second molars, respectively. The onset of the pubertal growth peak in height (distance to growth peak [DGP]) was identified, and the correlation between methods with DGP was assessed. RESULTS: High levels of correlation were obtained between the methods of Fishman, Baccetti, and Demirjian with DGP. The cutoff point between prepubertal and postpubertal stages was F stage for women and G stage for men, with statistically significant levels of sensitivity and specificity for the test. CONCLUSIONS: The use of the method of Demirjian applied to mandibular second molars is plausible as a predictor of the occurrence of the DGP for the studied population.

Bone-anchored maxillary protraction therapy in patients with unilateral complete cleft lip and palate: 3-dimensional assessment of maxillary effects.

INTRODUCTION: The aim of this study was to 3-dimensionally assess the treatment outcomes of bone-anchored maxillary protraction (BAMP) in patients with unilateral cleft lip and palate. METHODS: The cleft group comprised 24 patients with unilateral cleft lip and palate and Class III malocclusion with mean initial and final ages of 11.8 and 13.2 years, respectively. The noncleft group comprised 24 noncleft patients with Class III malocclusion with mean initial and final ages of 11.9 and 12.9 years, respectively. Cone-beam computed tomography examinations were performed before and after BAMP therapy in both groups and superimposed at the cranial base. Three-dimensional displacements of maxillary landmarks were quantified and visualized with color-coded maps and semitransparent superimpositions. The t test corrected for multiple testing (Holm-Bonferroni method), and the paired t test was used for statistical comparison between groups and sides, respectively (P <0.05). RESULTS: BAMP produced anterior (1.66 mm) and inferior (1.21 mm) maxillary displacements in the cleft group with no significant differences compared with the noncleft group. The maxillary first molars of the cleft group showed significantly greater medial displacement than did those in the noncleft group. The zygoma showed significantly greater lateral displacement at the cleft side compared with the noncleft side. CONCLUSIONS: BAMP caused similar amounts of maxillary protraction in patients with and without unilateral cleft lip and palatem with discrete differences between the cleft side and the noncleft side.

Mesiodistal dental movement toward remodeled edentulous alveolar ridge: Digital model assessment.

INTRODUCTION: The aims of this study were to compare the changes in posterior dental inclination and angulation, and the posterior tooth crown sizes and alveolar ridge thicknesses consequent to the orthodontic procedures of closing and opening of mandibular first molar edentulous spaces. METHODS: The sample comprised 16 patients (4 men, 12 women) with an initial mean age of 34.17 years and unilateral or bilateral absence of mandibular permanent first molars. The space closure group (SCG) comprised 12 hemiarches with a mandibular first molar edentulous space varying from 2 to 7 mm, orthodontically treated with space closure. The space opening group (SOG) comprised 14 quadrants with a mandibular first molar edentulous space varying from 7.1 to 12 mm, orthodontically treated with space reopening for prosthetic replacement. Digital dental models were obtained before treatment and after space closure or opening, and posterior tooth angulation and inclination, cervico-occlusal crown height, and alveolar ridge thickness were evaluated. Interphase and intergroup comparisons were performed with dependent t tests and t tests, respectively (P <0.05). RESULTS: Mandibular second molar uprighting and changes in buccolingual inclination of the posterior teeth were similar in the groups. The second molar cervico-occlusal crown height increased in the SCG and decreased in the SOG. The alveolar ridge thickness increased in the SCG and remained stable in the SOG. CONCLUSIONS: The only significant intergroup differences were that the second molar cervico-occlusal crown height and the alveolar ridge thickness increased in the SCG, and decreased and remained stable in the SOG.

Mandibular and glenoid fossa changes after bone-anchored maxillary protraction therapy in patients with UCLP: A 3-D preliminary assessment.

OBJECTIVE: To assess mandibular and glenoid fossa (GF) changes after bone-anchored maxillary protraction (BAMP) therapy in patients with unilateral complete cleft lip and palate (UCLP). MATERIALS AND METHODS: The cleft group (CG) comprised 19 patients with (mean initial age of 11.8 years). The noncleft group (NCG) comprised 24 patients without clefts (mean initial age of 11.7 years). Both groups had Class III malocclusion and were treated with BAMP therapy for 18 and 12 months, respectively. Cone-beam computed tomography (CBCT) exams were performed before and after treatment and superimposed on the anterior cranial fossa (ACF). Mandibular rotations and three-dimensional linear displacements of the mandible and GF were quantified. A t-test corrected for multiple testing (Holm-Bonferroni method) and a paired t-test were used to compare, respectively, the CG and NCG and cleft vs noncleft sides (P < .05). RESULTS: Immediately after active treatment, the GF was displaced posteriorly and laterally in both groups relative to the ACF. The overall GF changes in the CG were significantly smaller than in the NCG. Condylar displacement was similar in both groups, following a posterior and lateral direction. The gonial angle was displaced similarly posteriorly, laterally, and inferiorly in both groups. The intercondylar line rotated in opposite directions in the CG and NCG groups. In the CG, most changes of the GF and mandible were symmetrical. CONCLUSIONS: Overall GF and mandibular changes after BAMP therapy were similar in patients with and without clefts. The exception was the posterior remodeling of the GF that was slightly smaller in patients with UCLP.

Comparison between full face and hemifacial CBCT cephalograms in clinically symmetrical patients: a pilot study

INTRODUCTION: One of the advantages of cone-beam computed tomography (CBCT) is the possibility of obtaining images of conventional lateral cephalograms derived from partial or complete reconstruction of facial images. OBJECTIVE: This study aimed at comparing full face, right and left hemifacial CBCT cephalograms of orthodontic patients without clinical facial asymmetry. METHODS: The sample comprised nine clinically symmetrical patients who had pretreament full face CBCT. The CBCTs were reconstructed so as to obtain full face, right and left hemifacial cephalograms. Two observers, at two different times, obtained linear and angular measurements for the images using Dolphin 3D software. Dependent and independent t-tests were used to assess the reproducibility of measurements. Analysis of Variance and Kruskal-Wallis tests were used to compare the variables obtained in the CBCT derived cephalometric views. RESULTS: There was good reproducibility for CBCT scans and no statistically significant differences between measurements of full face, right and left hemifacial CBCT scans. CONCLUSIONS: Cephalometric measurements in full face, right and left hemifacial CBCT scans in clinically symmetrical patients are similar. .

INTRODUÇÃO: uma das vantagens da tomografia computadorizada de feixe cônico (TCFC) é a possibilidade de obtenção da imagem da telerradiografia em norma lateral convencional, por reconstruir parcial ou totalmente a face em uma visão sagital. OBJETIVO: o presente estudo teve como objetivo comparar as imagens de cefalogramas obtidas da face total e das hemifaces direita e esquerda por meio de TCFC, em pacientes sem assimetria clinica. MÉTODOS: a amostra foi composta por nove pacientes, clinicamente simétricos, que tinham em seus prontuários TCFC de face total. Os exames tomográficos foram reformatados para a obtenção de cefalogramas de face total e hemifaces direita e esquerda. Dois observadores, em dois momentos diferentes, obtiveram medidas lineares e angulares dessas imagens, utilizando o software Dolphin 3D. Testes t dependentes e independentes foram utilizados para verificar a reprodutibilidade das medidas nas imagens. Análise de variância (ANOVA) e o teste de Kruskal-Wallis foram utilizados para comparar as variáveis obtidas nas análises cefalométricas. RESULTADOS: houve boa reprodutibilidade para as imagens de TCFC e não houve diferença estatisticamente significante entre as medidas cefalométricas obtidas de cefalogramas de face total, hemifaces direita e esquerda. CONCLUSÕES: medidas cefalométricas obtidas de cefalogramas de face total, hemifaces direita e esquerda em pacientes clinicamente simétricos são semelhantes. .

Uso seletivo dos músculos da mão e antebraço durante a inserção de mini-implantes: um torquímetro natural / Selective use of hand and forearm muscles during mini-implant insertion: a natural torque meter

Proposição: comparar o torque máximo produzido pelaação de dois diferentes grupos musculares e sua influência na limitaçãodo toque de inserção e prevenção à fratura dos mini-implantes. Materiale Métodos: uma amostra de 87 profissionais foi avaliada quanto àintensidade máxima do torque aplicado à chave de inserção pela açãoconjunta dos dedos polegar e indicador (torque digital máximo - TOM),e pela ação supinadora do antebraço (torque braquial máximo - TBM).Foram fraturados 90 mini-implantes igualmente distribuídos entrenove diferentes diâmetros, determinando o torque de fratura (TF). Oíndice de resistência à fratura (lRF)foi calculado a partir das relações:IRF_TOM= TF/TDM e IRF_TBM = TF/TBM. As variáveis foram comparadaspelos testes te Anova, utilizando-se um nível de significânciade 5%. Resultados: o valor de TDM foi significantemente menor queTBM, e ambos foram menores no sexo feminino. TF mostrou aumentosignificante para cada 0,1 mm de aumento do diâmetro. IRF_TOMfoi maior que IRF_TBM para todos os diâmetros de mini-implantes.Entretanto, IRF_TOM > 1 foi observado apenas para mini-implantescom diâmetro maior que 1,5 mm, enquanto IRF_TBM > 1 ocorreu apartir do diâmetro de 1,7 mm para o sexo feminino e 1,8 mm para omasculino. Conclusão: o valor médio do torque digital foi 42% menordo que o torque braquial e mostrou-se mecanicamente mais seguro ebiologicamente mais compatível, prevenindo a fratura de mini-implantescom diâmetro maior ou igual a 1,5 mm devido à limitação do torquemédio de inserção em 15 Nem.

Objective: to compare the maximum torque producedby different muscular groups and its influence on mini-implant insertiontorque and fracture prevention. Materiais and Methods: eighty-sevenprofessionals were evaluated regarding the maximum torque producedon a screwdriver by a combined action between the thumb and indexfingers (Maximum Digital Torque - MDT), and by the forearm supinationmovement (Maximum Brachial Torque - MBT). Ninety mini-implantsdistributed in nine different diameters were fractured to determine thefracture torque (FT). The fracture resistance index (FRI) was obtainedfrom: FRI_MDT = FT/MDT and FRI_MBT = FT/MBT. Anova and t testswere used to compare the groups at a significance levei of 5%. Results:the MOT was smaller than MBr, and both were smaller in female. TheFT increased for each 0.1 mm in diameter incremento The FRI_MDT wasgreater than FRI_MBT for ali the diameters. The FRI_MDT> 1was foundwhen the diameter was greater than or equal to 1.5 mm. The FRLMBT> 1occurred with diameters equal or greater than 1.7mm for femalesand 1.8 mm for males. Conclusion: the digital torque was 42% smallerthan brachial torque, and it was mechanically safer and biologicallymore compatible, allowing fracture prevention of 1.5 mm or thickermini-implant diameter due to insertion torque limitation at 15 Ncm.

Influência do diâmetro do mini-implante no risco de fratura e na eficácia de autoperfuração / Mini-implant diameter influence on fracture risk and self-drilling efficacy

Proposição: avaliar a influência do diâmetro do mini-implante sobre o risco de fratura e a eficácia de autoperfuração. Material e Métodos: uma amostra padronizada de 405 mini-implantes com diâmetros de 1,2; 1,3; 1,4; 1,5; 1,6; 1,7; 1,8; 1,9 e 2 mm foi utilizada. Dez mini-implantes de cada diâmetro foram inseridos em osso artificial, enquanto 25 foram inseridos em osso de animal para avaliar o torque de inserção (TI) e a carga axial deinserção (CAI), a qual é representativa da eficácia da autoperfuração. A fratura de dez miniimplantes de cada diâmetro determinou o torque de fratura (TF). Os diferentes diâmetros de mini-implantes foram comparados quanto ao TI, TF e CAI. Em seguida, estas variáveis foramcorrelacionadas ao diâmetro. O risco de fratura em cada diâmetro foi avaliado pelo índice de resistência à fratura (lRF = TF/TI x (TF-TI)).A variação do TI durante os procedimentos de inserção foi correlacionada à variação da CAI. Resultados: apenas TI e TF mostraram diferença significante para todas as variações do diâmetro. O TI e o TF apresentaram forte correlação com o diâmetro, enquanto a CAIapresentou correlação de fraca a moderada. O IRFfoi notoriamente maior para cada 0,1 mm de aumento do diâmetro. Durante os procedimentos de inserção, o TI aumentou significantemente enquanto a CAI diminuiu progressivamente.Conclusão: o aumento do diâmetro do mini-implante influenciou significantemente o aumento de TI e TF em quantidades que reduziram progressivamente o risco de fratura. A eficácia da autoperfuração não foi fortemente influenciada pelo diâmetro.

Objectives: this study evaluated the mini-implant diameter influence on fracture risk and self-drilling etticacy. Material and Methods: a standardized sample composed by four hundred five mini-implants with diameter of 1.2; 1.3; 1.4; 1.5; 1.6; 1.7; 1.8; 1.9 and 2mm was used. Ten mini-implants of each diameter were inserted in artificial bone, while 25were inserted in animal bone to evaluate insertion torque (IT) and axial insertion load (AIL), which is representa tive of self-drilling etticacy. The intentional fracture of ten mini-implants foreach diameter determined the fracture torque (FT). The different diameters were compared regarding IT, FT and AIL. The fracture risk of each diameter was evaluated by fracture resistance index (FRI = FTIIT x (FT-IT)). The IT and AIL changes during insertion procedurewere correlated. Results: only IT and FT were significantly different for ali mini-implant diameter changes. The IT and FT showed a strong correlation with the mini-implant diameter, while theAIL was weakly to moderately correlated. The FRI was notoriously greater for each 0.1mm added in diameter. The IT increased significantly, while the AIL was progressively reducedduring insertion procedures. Conclusions: the increase in mini-implant diameter significantly influenced the IT and FT increase on quantities that progressively reduced the fracture risk. The self-drilling eiiicecv, represented by AIL, was not strongly influenced by mini-implant diameter.