Cross-cultural adaptation of a questionnaire assessing the child and parents' expectations of orthodontic treatment in Brazil

ABSTRACT Introduction: The Sayers and Newton questionnaire was developed in England to assess the child's and parent's expectations about orthodontic treatment. Objective: The aim of this study was to carry out the cross-cultural adaptation of the questionnaire for the Brazilian Portuguese language, to test its reliability, and to compare patients' and their parents' expectations of orthodontic treatment. Methods: After translation and cross-cultural adaptation, the questionnaire was applied to 98 patients (12-14 years), who had been referred for treatment, and their caregivers. The internal consistency of the instrument was assessed by Cronbach's Alpha Coefficient and the test-retest reliability, by Intraclass Correlation Coefficient (ICC). Results: Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.75. Test-retest reliability revealed satisfactory reproducibility (ICC = 0.85). The results showed some significant differences between the expectations of the patients and their caregivers (p < 0.05). There were no significant gender differences (p > 0.05). Conclusions: The process of cross-cultural adaptation of the Sayers and Newton questionnaire for the Brazilian Portuguese was concluded. This study demonstrated that this instrument is reliable and applicable to assess the child's and parent's expectations about orthodontic treatment in Brazil, and it has acceptable psychometric properties.

RESUMO Introdução: O questionário de Sayers e Newton foi desenvolvido na Inglaterra para avaliar as expectativas dos pacientes e de seus responsáveis quanto ao tratamento ortodôntico. Objetivo: O objetivo do presente estudo foi realizar a adaptação transcultural do questionário para a língua portuguesa do Brasil, testar sua confiabilidade e comparar as expectativas de pacientes e responsáveis em relação ao tratamento ortodôntico. Métodos: Após tradução e adaptação transcultural, o questionário foi aplicado a 98 pacientes (12-14 anos), encaminhados ao departamento de Ortodontia da PUC-MINAS para tratamento e de seus responsáveis. A consistência interna do instrumento foi avaliada pelo coeficiente alfa de Cronbach, e a confiabilidade teste-reteste, pelo coeficiente de correlação intraclasse (ICC). Resultados: A confiabilidade interna foi confirmada pelo coeficiente alfa de Cronbach de 0,75. A confiabilidade teste-reteste revelou reprodutibilidade satisfatória (ICC = 0,85). Os resultados mostraram algumas diferenças significativas entre as expectativas dos pacientes e de seus responsáveis (p < 0,05). Não houve diferenças significativas quanto ao sexo (p > 0,05). Conclusões: Foi concluído o processo de adaptação transcultural do questionário de Sayers e Newton para o português brasileiro. Esse estudo demonstrou que esse instrumento é confiável e aplicável para avaliar as expectativas dos pacientes e dos pais sobre o tratamento ortodôntico no Brasil e possui propriedades psicométricas aceitáveis.

Williams-Beuren Syndrome: What Orthodontists Need to Know / Síndrome de Williams-Beuren: Lo que los Ortodoncistas Deben Saber

ABSTRACT: Williams-Beuren syndrome is a rare disease with manifestations such as cardiovascular changes, distinct facial features, mental retardation, and learning disabilities. Oral manifestations are not commonly described and can often be misdiagnosed. This report describes the case of a male patient diagnosed with Williams-Beuren syndrome presenting classic clinical features that affect the face as a convex profile, with maxillary protrusion and mandibular retrusion, a discreetly acute nasolabial angle, passive labial sealing, and an open mandibular angle characteristic of Class II skeletal pattern. In addition, the patient has oral manifestations such as the absence of some dental elements, a Class II of Angle 1st division, dental cross bite, and atresic arches. The periodontal condition presents with generalized gingivitis. Knowledge about the possible manifestations of Williams-Beuren syndrome is important to improve the ability of orthodontists to better serve these patients.

RESUMEN: El síndrome de Williams-Beuren es una enfermedad rara con manifestaciones tales como cambios cardiovasculares, diversas características faciales, retraso mental y problemas de aprendizaje. Las manifestaciones orales no se describen comúnmente y con frecuencia se pueden diagnosticar erróneamente. Este informe describe el caso de un paciente masculino diagnosticado con síndrome de Williams-Beuren que presentaba características clínicas clásicas que afectaban la cara como un perfil convexo, con protrusión maxilar y retrusión mandibular, un ángulo nasolabial discretamente agudo, sellado labial pasivo y un ángulo mandibular abierto característico del patrón esquelético clase II. Además, el paciente presentaba manifestaciones orales tales como, ausencia de algunos elementos dentales, una clase II de Angle 1ª división, mordida dental cruzada y arcos acrílicos. La condición periodontal se presentaba con gingivitis generalizada. El conocimiento sobre las posibles manifestaciones del síndrome de Williams-Beuren es importante ya que mejora la capacidad de los ortodoncistas para atender mejor a estos pacientes.

Effect of different enamel conditionings on the bond strength of glass ionomer cement and ceramic brackets

Aim: To evaluate the effect of different enamel conditionings on the shear bond strength (SBS) and bond failure patterns of a resin modified glass ionomer cement (RMGIC) used to bond ceramic brackets. Methods: 105 human premolars extracted for orthodontic reasons were divided into 7 groups according to the enamel surface treatments: conditioners (35% phosphoric acid and 10% polyacrylic acid), type of adhesive (Transbond(r) and Fuji Ortho LC Capsule(r)), washing time and drying of the surface. Results: A significant p<0.05 was observed among the shear bond strength values obtained with seven different types of enamel preparation prior to bonding. The group that had the tooth surface conditioned with polyacrylic acid and enamel surface slightly dried before bracket placement showed no significant difference (p>0.05) to the group that had brackets bonded with composite resin. The two groups that had enamel prepared with polyacrylic acid and brackets bonded with GIC on a wet surface showed significantly lower shear bond strength than the control group (p<0.05). Conclusions: Moisture contamination decreased SBS, but not enough to preclude the use of RMGIC as an alternative to composite resin (CR) for direct bonding of ceramic brackets.

Is there justification for prophylactic extraction of third molars? A systematic review

The present systematic review was performed to investigate if there is evidence justifying the prophylactic extraction of third molars, one of the most frequent procedures in oral surgery. A series of searches was carried out for randomized, clinical trials and systematic reviews in seven databases (MEDLINE, BBO, LILACS, Web of Science, EMBASE, BIREME and Cochrane Library), with no restrictions regarding year or language. A supplemental manual search of the references of retrieved articles was also performed. The search strategy resulted in 260 papers. Both the data extracted and the quality of each paper were evaluated independently by two reviewers. After selection based on the preestablished eligibility criteria, four papers qualified for the final analysis. A medium degree of quality and methodological consistency was found in three studies, and low quality was found in one study. No studies showed a high degree of consistency. The most significant flaw was an inadequate sample size. The results of the present review indicate a lack of scientific evidence to justify the indication of the prophylactic extraction of third molars.

Nickel: humoral and periodontal changes in orthodontic patients

INTRODUCTION: Although several studies have discussed nickel influence on the development of immunological reactions in orthodontic patients, it is noticed that the evidence towards the appliances, as well as towards the possible consequences of this material on the oral and general health of the individual are still inconsistent. OBJECTIVE: The aim of this article is to present the current stage of knowledge on this issue, highlighting the most recent findings considering the periodontal and humoral aspects of allergic subjects.

O impacto da duração do aleitamento materno no crescimento e desenvolvimento das estruturas dento esqueléticas / The impact of duration of breastfeeding on the growth and development of dentoskeletal structures

Este estudo teve o objetivo de avaliar o impacto da duração do aleitamento materno na prevalência de hábitos bucais deletérios e no crescimento e desenvolvimento das estruturas dento esqueléticas. A amostra foi constituída de 283 prontuários clínicos de crianças, pacientes da clínica de Ortodontia da PUC Minas - Belo Horizonte, MG, com idade entre 5 e 11 anos, sendo composta por 147 meninos e 136 meninas. Esta amostra foi dividida em dois grupos: Grupo 1: receberam aleitamento materno, de forma exclusiva ou não, por período menor do que seis meses (n=128) e Grupo 2: receberam aleitamento materno, de forma exclusiva ou não, por seis meses ou mais (n=155). Os dois grupos foram subdivididos de acordo com os estágios de desenvolvimento da oclusão (dentadura decídua completa; dentadura mista inicial; período intertransitório; dentadura mista final). As informações quanto ao tempo e tipo de aleitamento materno, bem como a presença dos hábitos bucais deletérios (mamadeira, sucção de chupeta e dedo, interposição lingual e labial) foram extraídas dos prontuários. Com o auxílio de modelos ortodônticos e telerradiografias laterais da cabeça, avaliou-se as medidas lineares e cefalométricas como: distâncias intercaninos e intermolares, comprimento e perímetro dos arcos, profundidade do palato, trespasses horizontal e vertical, SNA, SNB, ANB, NS-Gn, SN-GoGn e ArGoMe. Foram classificados os diagnósticos dentários (sagital, transversal e vertical) e esqueléticos (sagital e vertical). Foi utilizado o teste qui-quadrado de Pearson para testar a associação entre cada hábito bucal deletério com o gênero e também com o tempo de aleitamento materno e estimada a razão das chances entre o tempo de aleitamento e a presença destes hábitos. As variáveis contínuas foram comparadas aplicando-se os testes t de Student ou Mann-Whitney. Para a comparação entre os diagnósticos dentários e esqueléticos e o tempo de aleitamento materno foi utilizado o teste qui-quadrado de Pearson e o teste Exato de Fisher. Foi realizada uma análise multivariada para avaliar o uso da chupeta, gênero, tempo do aleitamento e as variáveis contínuas dentárias e esqueléticas. O hábito de sucção de chupeta foi o mais prevalente (59,4%), seguido pela mamadeira (57,9%), interposição de língua (21,9%), sucção de dedo (13,4%) e interposição de lábio (8,8%). Os hábitos de sucção de chupeta (p=0,000) e interposição de lábio (p=0,048) mostraram associação com os dois tempos de aleitamento materno avaliados. Quanto ao crescimento e desenvolvimento das estruturas dento esqueléticas, observou-se que as médias das medidas dentárias DICSD, DIMSD, CS, CI, PI e cefalométricas SNA e ANB, além do diagnóstico esquelético sagital mostraram associação estatisticamente significante com os dois tempos de aleitamento materno. Concluiu-se neste estudo que o tempo de aleitamento mínimo de seis meses foi fator de proteção contra o aparecimento de dois hábitos bucais deletérios: sucção de chupeta e interposição de lábio, e apresentou associação com o desenvolvimento dento esquelético em algumas das variáveis estudadas.

The purpose of this study was to evaluate the impact of the duration of breastfeeding on the prevalence of deleterious oral habits, and on the growth and development of dental and skeletal structures. The sample was comprised of 283 clinical charts of children, patients of the Orthodontic clinic PUC Minas ­ Belo Horizonte, MG, aged from 5 to 11 years old (147 boys and 136 girls). This sample was divided into 2 groups: Group 1: they were breastfed in an exclusive way or not, for a period of less than 6 months (n=128) and Group 2: they were breastfed, in an exclusive way or not, for 6 months or more (n=155). Both groups were subdivided according to the stages of development of occlusion (complete denture decidual, initial mixed denture; inter transitory period; final mixed denture). The information concerning time and the type of breastfeeding, as well as the presence of deleterious oral habits evaluated (nursing bottle, sucking of pacifier and finger, lingual and lips interposition) were extracted from charts. With the aide of orthodontic models and cephalometric radiographs, linear and cefalometric measures have been evaluated such as: intercanine distance and intermolar, length and perimeter of arches, depth of palate, overjet, overbite, SNA, SNB, ANB, NS-Gn, SN-GoGn and Ar-GoMe. The following dental diagnostic have been assorted (sagittal, transversal and vertical) and skeletal (sagittal and vertical). The test used was qui-square of Pearson to test the association also enters each deleterious oral habits with the time and type of breastfeeding and the reason of the possibilities between the time of breastfeeding and the presence of deleterious oral habits was esteem. The continuous variable had been compared applying tests t of Student or Mann-Whitney. For the comparison between the dental and skeletal diagnostics and the time of breastfeeding it was used the test qui-square of Pearson and the Accurate test of Fisher. A multivaried analysis was carried through to evaluate the use of pacifiers, sort, time of the breastfeeding and the dental and skeletal continuous variable. The habit of sucking a pacifier was the most prevailing (59,4%), followed by the nursing bottle (57,9%), tongue interposition (21,9%), sucking of the finger (13,4%) and lip interposition (8,8%). The habits of sucking of pacifier (p=0,000) and lip interposition (p=0,048) have shown association with both times of breastfeeding evaluated. About the growth and development of dental skeletal structures, the average of dental measures decidua upper intercanine distance and intermolar, length of the upper and lower arches, mandibular arch perimeter and cefalometric SNA e ANB were observed, furthermore the sagittal skeletal diagnostic showed an association statistically significant with both times of breastfeeding. In this study it has been concluded that the minimal time of breastfeeding was the factor of protection against the 2 deleterious oral habits: sucking of pacifier and lip interposition, and showed association with the dental skeletal development in some of the variables studied.

Confiabilidade do uso de modelos digitais tridimensionais como exame auxiliar ao diagnóstico ortodôntico: um estudo piloto / Reliability of three-dimensional digital casts as a diagnostic tool for orthodontic treatment planning: a pilot study

OBJETIVO: os rápidos e contínuos avanços nas Ciências da Computação resultaram no aumento significativo do emprego de novas tecnologias em todos os níveis da sociedade. Na Ortodontia, radiografias e fotografias digitais já são usadas de forma rotineira. A utilização de modelos de estudo digitais vem sendo anunciada como o novo componente da documentação ortodôntica computadorizada. Como acontece quando uma nova tecnologia se torna disponível, o uso de modelos ortodônticos digitais tem gerado controvérsias. Alguns ortodontistas questionam a aplicabilidade de imagens tridimensionais em substituição aos modelos tradicionais de gesso, pois não há na literatura número relevante de estudos que tenham testado adequadamente tal tecnologia. Diante disso, o objetivo desse estudo foi testar a confiabilidade do uso de modelos dentários digitais como exame complementar ao diagnóstico ortodôntico. METODOLOGIA: três examinadores mediram a largura dos dentes permanentes, quatro segmentos dos arcos superiores e inferiores, distâncias intercaninos, distâncias intermolares, trespasses horizontal e vertical em modelos de gesso e em seus correspondentes digitais de seis pacientes, utilizando um paquímetro digital e o programa eModel, respectivamente. RESULTADOS E CONCLUSÕES: diante dos resultados, observou-se que todas as medidas avaliadas foram estatisticamente semelhantes nos dois tipos de modelos testados, com exceção das médias encontradas para a largura do dente 45 (p<0,05). Entretanto essa diferença é considerada clinicamente aceitável. Comprova-se com esse estudo a confiabilidade do uso dos modelos dentários digitais como exame complementar ao diagnóstico ortodôntico. Além disso, a facilidade de armazenamento de informações, o menor risco de perda de dados durante sua manipulação e transporte, bem como a diminuição do tempo gasto para realizar as medições foram considerados vantagens do uso dessa nova tecnologia na Ortodontia.

AIM: the fast and continuous advances in computer sciences have resulted in an increased usage of new technologies in all levels of the modern society. Orthodontics has also been influenced by this phenomenon. Digital radiographs and photographs have been commonly used in Orthodontics offices. Recently, digital study models have been advertised as the latest component of fully digitized orthodontic records. When a new diagnostic technology becomes available it may initially generate controversy, and with digital orthodontic casts it has not been different. Some orthodontists may question the reliability of this new diagnostic tool since there is not enough literature to support the substitution from traditional stone casts to digital models. Therefore, the aim of the present study was to compare the reliability of digital orthodontic models and stone casts as a diagnostic aid. METHODS: three examiners measured the width of the permanent teeth, intercanine and intermolar distances, overbite and overjet of stone and the corresponding digital casts from six patients. A digital caliper was used for measuring the stone casts and the eModel software to evaluate the digital models. RESULTS AND CONCLUSIONS: the results of this study showed no statistically significant difference among any of the measurements tested, except by the width of the lower second right premolar (p<0.05). However, these differences were not considered clinically relevant. These findings show that digital orthodontic casts are as reliable as stone study models as a diagnostic tool for orthodontic treatment planning. The easy data storage, the lower risk of breakage during its handling and transportation, and also the shorter time needed to obtain the diagnostic information were considered additional advantages of this new technology.

Hypersensitivity to conventional and to nickel-free orthodontic brackets

The aim of this study was to evaluate the allergenic potential of orthodontic brackets, comparing the cutaneous sensitivity provoked by metals present in conventional metallic brackets to that provoked by brackets with a low concentration of nickel, known as "nickel-free". A sample was selected from 400 patients undergoing treatment in the orthodontic clinic of the Pontifical Catholic University of Minas Gerais (Belo Horizonte, MG, Brazil), in the period from the beginning of 2002 to the end of 2003. A cutaneous sensitivity patch test containing 5 percent nickel sulphate was used in 58 patients (30 males and 28 females), aged between 11 and 30, which were using fixed appliances with Morelli® brackets in both arches. In a second phase, 30 days later, a comparative test of cutaneous sensitivity was applied to the whole sample with two types of test specimens, in the form of a disc. Two alloys were tested: discs composed of the alloy used in the construction of conventional brackets and discs composed of a nickel-free alloy. The internal part of the forearm was chosen for testing, and 20 test specimens of each experiment (corresponding to the twenty brackets of a complete fixed appliance) were applied. Of the 58 patients evaluated, 16 patients were sensitive to the patch test with 5 percent nickel sulphate. Out of these 16 patients, 12 developed an allergic reaction to experiment 1 (test specimen with nickel), while in experiment 2, only 5 patients showed sensitivity to that sample. The McNemar test revealed that the nickel-free test specimens provoked less allergic reaction when compared with the conventional alloy (p = 0.016).

Este trabalho teve como objetivo avaliar a capacidade alergênica provocada pelos bráquetes ortodônticos, comparando a sensibilidade cutânea provocada pelos metais presentes nos bráquetes metálicos convencionais com a provocada por bráquetes com baixa concentração de níquel ("nickel-free"). A amostra foi selecionada dos 400 pacientes em tratamento da clínica de Ortodontia da Pontifícia Universidade Católica de Minas Gerais (Belo Horizonte, MG, Brasil), no período compreendido entre o início de 2002 e o final de 2003. A amostra consistiu de 58 pacientes (30 homens e 28 mulheres), com idades variando de 11 a 30 anos, os quais eram portadores de aparelho ortodôntico fixo Morelli® em ambos os arcos. Estes pacientes foram diagnosticados quanto à sensibilidade ao níquel, por meio da aplicação do "patch test" com sulfato de níquel a 5 por cento. Em uma segunda fase, trinta dias após o "patch test", comparou-se a sensibilidade cutânea provocada pelos metais presentes nos bráquetes convencionais e nos "Nickel Free", por meio de um teste de sensibilidade cutânea utilizando-se dois tipos de corpos-de-provas, em formato de disco, com a mesma composição destes bráquetes. A área de eleição para realização deste teste foi a parte interna do antebraço, sendo aplicados vinte corpos-de-prova de cada experimento (referente a uma boca completa de bráquetes). Dos 58 pacientes avaliados, 16 deles foram sensíveis ao "patch test" com sulfato de níquel a 5 por cento. Dentre estes 16 pacientes, 12 deles desenvolveram reação alérgica ao Experimento 1 (corpo-de-prova com níquel), enquanto que no Experimento 2 (corpo-de-prova "Niquel Free") apenas 5 pacientes apresentaram sensibilidade a esta amostra. O teste de McNemar revelou que os corpos-de-prova "nickel-free" provocaram menor reação alérgica quando comparados aos convencionais (p = 0.016).