Impact of orthodontic brackets on intraoral and extraoral scans.

INTRODUCTION: The purpose of this study was to evaluate whether the presence of orthodontic brackets influences the accuracy of digital models generated by intraoral and extraoral scanning from the same patients. METHODS: Eighteen orthodontic patients in permanent dentition underwent full-arch intraoral scanning with a CEREC Omnicam scanner (Dentsply Sirona, York, Pa). Alginate impressions from each patient's arch were taken, and plaster models were made and scanned. Intermolar, intercanine, and mesiodistal width of the incisors were measured on 2 digital and 1 plaster models. Analysis of variance or Friedman's test was used, with differences between pairs verified by the Bonferroni test or Wilcoxon test, respectively. Both digital models were superimposed using surface-based registration. RESULTS: Lin's lowest coefficient of agreement was 0.960 (95% confidence interval, 0.900-0.984), which was clinically adequate. No statistically significant differences between the 3 types of model measurements were observed, except for the mandibular left lateral incisor in which scanned intraoral digital models presented Δmedium of 0.05 mm, which was higher than the plaster model. The superimposition of the extraoral and intraoral digital models revealed a minimum difference between models with a mean of means of 0.12 ± 0.03 mm. CONCLUSIONS: Brackets bonded to teeth affected intraoral scanning; however, the intraoral digital models are clinically comparable and present fewer distortions than plaster models. Moreover, measurements on intraoral and extraoral digital models are excellent in terms of trueness and precision and can be used clinically and in plaster models.

A clinical approach to managing open-bite malocclusion associated with severe crowding.

Open bite has been identified as one of the most challenging malocclusions in orthodontics. The treatment approach is complex, the resulting esthetics may not meet the patient's expectations, and the chance of recurrence is high. A 13-year-old girl presented a skeletal Class II malocclusion associated with anterior and posterior open bite, maxillary transverse deficiency, severe anterior crowding, and a hyperdivergent facial pattern. Orthodontic treatment was performed with a Haas expander and subsequent standard edgewise appliances, and the 4 first premolars were extracted. The vertical control of facial growth was undertaken with vertical pull chincap therapy, mini-implants associated with a titanium-molybdenum alloy cantilever on the right and left buccal sides, and a stainless steel alloy transpalatal arch. Posttreatment records showed a bilateral Class I molar relationship, ideal overbite and overjet, and improved facial profile and gingival health. The cephalometric analysis revealed a good balance of the skeletal pattern and facial profile, with an appropriate inclination of the maxillary and mandibular incisors. After a 7-year retention period, the outcome was pleasant facial esthetics and smile and stability of the dental occlusion. This case shows that the clinical approach was adequate, with treatment outcomes achieving positive aspects of function, esthetics, and stability.

Clinical parameters in soft tissue adjunctive periodontal procedures for orthodontic patients: surgical laser vs scalpel.

OBJECTIVES: To systematically review existing literature regarding clinical parameters comparing surgical laser and conventional surgery with scalpel for soft tissue adjunctive periodontal procedures in orthodontic patients. METHODS AND MATERIALS: MEDLINE, Scopus, Web of Science, The Cochrane Library, LILACS, Bibliografia Brasileira de Odontologia (Brazilian Dental Literature - BBO), Embase, Open Grey, Portal de Periódicos da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination for the Improvement of Higher Education Personnel - CAPES), and Google Scholar were searched up to December 2020 without language restriction. Clinical trials comparing clinical parameters from surgical laser and conventional surgery with scalpel for soft tissue adjunctive periodontal procedures in orthodontic patients were selected. Risk of bias (RoB) assessments were performed using the Cochrane RoB2 tool. Narrative syntheses were performed, and the certainty of evidence was determined using the GRADE tool. RESULTS: Five randomized clinical trials were included. One study was rated as low RoB, whereas others presented some concerns or high RoB. The studies were highly heterogeneous in relation to the procedure performed, laser protocol, outcomes evaluated, and follow-up periods. In general, regardless of the procedure and laser protocol used, the studies did not show significant differences between laser and scalpel for the outcomes of probing pocket depth, clinical crown length, gingival index, and relapse rate. Pain and bleeding were significantly lower with the use of laser compared with the scalpel. The certainty of evidence ranged from moderate to very low. CONCLUSIONS: The existing literature on the subject is scarce and very heterogeneous and has methodological limitations. Based on the available evidence, it is not possible to draw definitive conclusions about the beneficial effect of laser use in orthodontic patients.