Impact of orthodontic treatment on OHRQoL of adolescents: a longitudinal study

ABSTRACT Objective: The aim of this study was to evaluate the extent to which orthodontic treatment need is perceived by the patients and by the orthodontist, as well as the possible impacts on the OHRQoL (Oral Health-Related Quality of Life) over the course of conventional orthodontic treatment in adolescent patients. Methods: The sample consisted of 55 adolescents. The perception of patients and orthodontists relative to the malocclusion was evaluated by the IOTN (Index of Orthodontic Treatment Need). The OHRQoL was evaluated by the Child-OIDP (Child-Oral Impacts on Daily Performances) questionnaire before the conventional orthodontic appliance was bonded (T0); and at the following time intervals: after one week (T1), one month (T2), three months (T3), six months (T4), and after the end of orthodontic treatment (T5). Results: Adolescents who had large orthodontic treatment needs had a poor OHRQoL, according to their self-perception (p=0.003) and according to the orthodontist's perception (p<0.001), when compared with patients with small and moderate needs. There was statistically significant difference in the OHRQoL between the time intervals T0 and T1 (p=0.021), T2 and T3 (p<0.001), T3 and T4 (p=0.033), and T0 and T5 (p<0.002). At the end of treatment, all evaluated participants reported an improvement in OHRQoL. Conclusions: It was concluded that adolescents and orthodontists agreed with regard to the perception of orthodontic treatment need. In the first week and in the first month of orthodontic treatment, there was a negative impact on the OHRQoL. After three months, an improvement of OHRQoL was detected, which has progressed over time.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o quanto a necessidade de tratamento ortodôntico é percebida pelos pacientes e pelo ortodontista, bem como os possíveis impactos na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) ao longo do tratamento ortodôntico convencional em pacientes adolescentes. Métodos: A amostra foi composta por 55 adolescentes. A percepção dos pacientes e ortodontistas em relação à má oclusão foi avaliada pelo Índice de Necessidade de Tratamento Ortodôntico (IOTN). A QVRSB foi avaliada pelo questionário Child-OIDP (Child-Oral Impacts on Daily Performances) antes da colagem do aparelho ortodôntico convencional (T0); e nos seguintes intervalos de tempo: após uma semana (T1), um mês (T2), três meses (T3), seis meses (T4) e após o término do tratamento ortodôntico (T5). Resultados: Adolescentes que apresentavam grandes necessidades de tratamento ortodôntico apresentaram baixa QVRSB, segundo sua autopercepção (p=0,003) e segundo a percepção do ortodontista (p<0,001), quando comparados com pacientes com necessidades pequenas e moderadas . Houve diferença estatisticamente significativa na QVRSB entre os intervalos de tempo T0 e T1 (p=0,021), T2 e T3 (p<0,001), T3 e T4 (p=0,033) e T0 e T 5 (p<0,00 2 ). Ao final do tratamento, todos os participantes avaliados relataram melhora na QVRSB. Conclusões: Concluiu-se que adolescentes e ortodontistas concordaram quanto à percepção da necessidade de tratamento ortodôntico. Na primeira semana e no primeiro mês de tratamento ortodôntico, houve impacto negativo na QVRSB. Após três meses, foi detectada uma melhora na QVRSB, que progrediu ao longo do tempo.

Effect of peracetic acid on orthodontic elastics: an in vitro experiment / Efeito do ácido peracético nos elásticos ortodônticos: um estudo in vitro

Objetivo: Este estudo teve como objetivo avaliar a elasticidade de elásticos ortodônticos após desinfecção e esterilização com ácido peracético 0,2%. Materiais e métodos: Neste estudo piloto in vitro, elásticos ortodônticos Morelli® e American Orthodontics™ nas cores cinza e cristal foram divididas em três grupos experimentais: Grupo 1, imerso em água destilada por 72 horas, Grupo 2, imerso em peracético 0,2% por 10 min (para desinfecção) e Grupo 3, imerso em ácido peracético 0,2% por 30 min (para esterilização). Após a imersão, os valores de resistência à tração dos elásticos foram analisados em uma máquina de ensaios universal (EMIC DL-1000) para avaliar a resistência, em Newtons, necessária para a ruptura dos mesmos. A normalidade dos dados foi avaliada pelo teste de Shapiro-Wilk e os dados dos diferentes grupos experimentais foram comparados pelo teste ANOVA. Resultados: Para ambas as marcas, não houve diferença estatisticamente significativa entre os grupos experimentais quanto à resistência à tração. Discussão: O estudo apresentou um método alternativo para a desinfecção e esterilização de materiais termossensíveis. Conclusão: Assim, podemos concluir que a desinfecção e esterilização dos elásticos ortodônticos com ácido peracético 0,2% não alterou seu módulo de elasticidade.

Aim: This study aimed to evaluate the elasticity of orthodontic elastics after disinfection and sterilization with 0.2% peracetic acid. Materials and methods: In this in vitro pilot study, Morelli® and American Orthodontics™ elastic bands in gray and crystal colors were divided into three experimental groups: Group 1, immersed in distilled water for 72 hours, Group 2, immersed in 0.2% peracetic acid for 10 min (for disinfection) and Group 3, immersed in 0.2% peracetic acid for 30 min (for sterilization). After immersion, the tensile strength values of the elastics were analyzed in a universal test machine (EMIC DL-1000) to evaluate the strength, in Newtons, necessary for their rupture. Normality of the data was assessed using the Shapiro-Wilk test, and data from the different experimental groups were compared using the ANOVA test. Results: For both brands, there was no statistically significant difference between the experimental groups regarding tensile strength. Discussion: This study presented an alternative method for the disinfection and sterilization of thermo-sensitive materials. Conclusion: Thus, it can be concluded that the sterilization of orthodontic elastics with 0.2% peracetic acid did not change their modulus of elasticity.

Improvement on oral health related quality of life after orthosurgical treatment: a mixed methods study

Abstract The aim of this study was to understand the influence of orthosurgical treatment on oral health-related quality of life (OHRQoL) in patients with Class II and III skeletal malocclusion by conducting a mixed method case series study. Nineteen patients submitted to orthosurgical treatment in a private practice in Brazil were included in the sample. Data were collected retrospectively and interviews were held from March 2020 to July 2021. Patients answered to the Oral Health Impact Profile (OHIP-14) in the first part of the interview and subsequently answered the qualitative questions. The overall mean of OHIP-14 after treatment was 4.21 (SD 4.68). The qualitative data were analyzed according to thematic analysis and four themes emerged from the interviews: a) concept of quality of life, b) pre-treatment life, c) post-treatment life, and d) positive and negative aspects of treatment. Quality of Life was reported by the patients as the absence of feeling pain, having emotional and physical health, having a satisfactory esthetic appearance and self-esteem. Before treatment, most Class II patients used to complain about breathing and sleeping problems, while Class III patients complained more intensely about esthetics. Pain was a common problem reported by both Class II and Class III patients. In general, improvement was perceived in self-esteem, esthetics, function and pain. Complaints about negative aspects of the treatment were restricted to the postoperative period. The orthosurgical treatment was important for improving the OHRQoL of patients in terms of esthetic, functional and psychosocial aspects.

Temporomandibular disorders and associated comorbidities among brazilian dental students during COVID-19

Aim: This study aimed to assess the prevalence of temporomandibular disorders (TMD) and psychosocial comorbidities in undergraduate dental students in a southern Brazilian university, during the COVID-19 pandemic. Also, it aimed to verify the association between psychosocial factors and TMD. Methods: Fonseca Anamnestic Index, Depression Anxiety Stress Scale (DASS-21), a socioeconomic questionnaire, and questions about academic performance and social distancing were applied. Poisson regression analysis was used to assess the association of predictive variables with TMD. Results: The prevalence of TMD was found to be 82.4%, and more than half of the students had some degree of stress, anxiety, and depression. Students who had symptoms of stress (RR 1.11; 95% CI 1.04-1.19), anxiety (RR 1.19; 95% CI 1.12-1.27) and reported academic performance worsening (RR 1.12; 95% CI 1.07-1.19) had higher TMD scores. Conclusion: The findings suggest that TMD was highly prevalent among dental students at a federal university in southern Brazil during the pandemic, being associated with high levels of stress, anxiety, poor academic performance, and greater social distancing

Correlation between cortical bone thickness at mini-implant insertion sites and age of patient

ABSTRACT Introduction: Orthodontic mini-implants (MI) are a reliable alternative to provide temporary orthodontic anchorage. Prior to miniscrew insertion, the best approach would be to evaluate each possible insertion site and measure the cortical bone thickness, and verify whether it would provide adequate primary stability. Objective: This study aimed to evaluate the difference in cortical bone thickness in areas of mini-implants insertion in patients of different ages, by means of cone beam computed tomography (CBCT). Methods: The sample of this retrospective study was composed of 123 CBCT scans, which were used to measure cortical bone thickness in the buccal and palatal inter-radicular space in the mesial region of the first permanent molars. These measures were compared by using the Student's t-test, ANOVA/Tukey tests, and Linear regression between male and female subjects, from 12 to 30 years old. Results: No significant difference was found in cortical bone thickness between sex, race and sagittal facial patterns. Significantly higher measurement values were observed in patients older than 12 years of age at all sites evaluated. The coefficient β at the adjusted linear regression analysis showed that at each increment in age, mean cortical thickness values increased by 0.06mm in the mandible, 0.03mm in the buccal region and 0.02mm in the palatal region of the maxilla. Conclusions: The increase in cortical bone thickness was positively associated with age; that is, the more advanced the patient's age was, the less chance there was of failure due to primary stability.

RESUMO Introdução: Os mini-implantes ortodônticos (MI) são uma alternativa confiável para fornecer ancoragem esquelética temporária. Antes da inserção do mini-implante, a melhor abordagem seria avaliar cada local de inserção possível, medir a espessura do osso cortical e verificar se proporcionaria uma adequada estabilidade primária. Objetivo: O presente estudo teve como objetivo avaliar a diferença na espessura do osso cortical em áreas de inserção dos mini-implantes em pacientes de diferentes idades, por meio da tomografia computadorizada de feixe cônico. Métodos: A amostra desse estudo retrospectivo foi composta por 123 tomografias computadorizadas de feixe cônico, que foram utilizadas para medir a espessura do osso cortical nos espaços inter-radiculares vestibular e palatino na região mesial dos primeiros molares permanentes. Essas medidas foram comparadas por meio dos testes t de Student, ANOVA/Tukey e regressão linear entre os sexos masculino e feminino, de 12 a 30 anos. Resultados: Não houve diferença estatisticamente significativa na espessura cortical, quando comparados sexo, cor da pele e padrão facial sagital. Foram verificadas medidas significativamente maiores em pacientes com idade superior a 12 anos em todos os sítios avaliados. O coeficiente β da análise de regressão linear ajustada mostrou que, a cada incremento da idade, os valores médios da espessura cortical aumentaram 0,06 mm na mandíbula, 0,03 mm na região vestibular e 0,02 mm na região palatina da maxila. Conclusão: O aumento da espessura do osso cortical teve associação positiva com a idade, ou seja, quanto mais avançada a idade do paciente, menor a chance de falha, devido à estabilidade primária.

Association between malocclusion, tongue position and speech distortion in mixed-dentition schoolchildren: an epidemiological study

Abstract Background Malocclusions are highly prevalent in childhood and adolescence, being considered a public health problem worldwide, in addition to be considered an important predictor in the tongue position and speech disorders. Objective Evaluate the association of malocclusions with tongue position and speech distortion in mixed-dentition schoolchildren from the south of Brazil. Methodology This cross-sectional study was performed using a database of an epidemiological survey realized in the southern of Brazil, in 2015, for evaluating the dental and myofunctional condition of the mixed-dentition from 7-13 years' schoolchildren. The outcome variables were tongue position and speech distortion, evaluated by a trained and calibrated examiner. Characteristics regarding sociodemographic and oral health measures (Angle's classification of the malocclusion, overjet, overbite, posterior crossbite and respiratory mode) were also assessed. Poisson regression models with adjusted robust variance were used to evaluate the association among predictors variables in the outcomes. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI). Results A total of 547 children were evaluated. Schoolchildren who presented anterior open bite (PR 2.36 95%CI 1.59-3.49) and having oral/oral-nasal breathing (RP 2.51 95%CI 1.70-3.71) are more likely to have altered position of the tongue. Both deep bite and being male represent protection factors for the abnormal tongue position. Regarding speech distortion, deep overbite presents a protective relationship to speech distortion (PR 0.41; 95%CI 0.24-0.71), whereas schoolchildren with posterior crossbite were more likely to present this problem (PR 1.77; 95%CI 1.09-2.88). Conclusion Anterior open bite and posterior crossbite were the malocclusions related to speech distortion and/or altered tongue position. Oral/oral-nasal breathing was also related to myofunctional changes. Deep bite malocclusion was a protective factor for both speech problems and altered tongue position when compared to a normal overbite.

Effect of etching with different hydrofluoric acid concentrations on bond strength between glazed feldspathic ceramic and metal brackets / Efeito de diferentes concentrações de ácido fluorídrico na resistência adesiva entre uma cerâmica feldspatica glazeada e bráquetes metálicos

Objetivo: O objetivo deste estudo foi avaliar o efeito do condicionamento com diferentes concentrações de ácido fluorídrico (AF) na resistência de união ao cisalhamento entre cerâmica feldspática glazeada e bráquetes metálicos. Material e Métodos: Setenta e cinco blocos de cerâmica feldspática glazeada foram produzidos e distribuídos aleatoriamente em 5 grupos: Ctrl- silano; HF1- AF 1% + silano; HF3- AF 3% + silano; HF5- AF 5% + silano; HF10- AF 10% + silano (procedimento padrão: condicionamento por 1 min + lavagem + secagem + silanização). Bráquetes metálicos de incisivo central superior (Edgewise Standard) foram colados sobre a superfície da cerâmica com o uso de um sistema adesivo e resina composta fotopolimerizável (Transbond TM XT, 3M). Os espécimes foram envelhecidos por 60 dias (termociclagem: 10000x a 5-55°C; estocados em água destilada a 37°C). O teste de cisalhamento foi realizado e espécimes foram classificados quanto ao seu Índice de Remanescente Adesivo (IRA). Inspeção topográfica e análise do ângulo de contato da superfície da cerâmica condicionada foram realizados. Dados de resistência adesiva foram analisados estatisticamente usando o teste de Kruskal-Wallis, enquanto os dados de ângulo de contato foram analisados com ANOVA 1-fator e teste de Tukey (p<0.05). Resultados: Nenhuma diferença significativa foi detectada para a resistência de união entre os grupos; mas o condicionamento da superfície teve uma influência significativa sobre os resultados de ângulo de contato (p<0.00001). O grupo controle apresentou a mais alta média de ângulo de contato (61,8± 17,2°). Todos os espécimes apresentaram falhas adesivas na interface cerâmica-resina. Conclusão: As concentrações de AF testadas não influenciaram significativamente a resistência de união de bráquetes metálicos aderidos na superfície de cerâmica feldspática glazeada

Objective: The aim of this study was evaluate the effect of etching with different hydrofluoric acid (HF) concentrations on the shear bond strength between glazed feldspathic ceramic and metal brackets. Material and Methods: –Seventyfive blocks of glazed feldspathic ceramic were produced and randomly allocated to 5 groups: Ctrl- silane application only; HF1- HF1%+silane; HF3- HF3%+silane; HF5- HF5%+silane; HF10 HF10%+silane (standard procedures: etching for 1 min + washing + drying + silanization). Metal brackets for upper central incisors (Edgewise Standard) were bonded on the ceramic surface with the use of an adhesive system and light-cured composite resin (TransbondTM XT, 3M). The specimens were aged for 60 days (thermocycling: 10000x at 5-55 °C; stored in distilled water at 37°C). Shear testing was performed, and specimens were classified for their AdhesiveRemnant-Index (ARI). Topographical inspectionand contact angle analysis of the etched ceramic surfaces were performed. Data were statistically analyzed using the non-parametric Kruskal-Wallis test. One-way ANOVA and post-hoc Tukey’s tests were applied to the contact angle data (p<0.05). Results: No significant difference was detected between the shear bond strength of the groups; but surface etching had a significant influence on the contact angle results (p<0.00001). The control group presented the highest mean contact angle (61.8±17.2°). All specimens showed adhesive failure at the resin ceramic interface. Conclusion The tested HF concentrations did not significantly influence the obtained shear bond strength of metal brackets adhered to glazed feldspathic ceramic surfaces.

Avaliação da resistência à tração, em diferentes períodos de cicatrização, de mini-parafusos utilizados como ancoragem temporária em ortodontia: estudo em cães da raça Beagle / Pull-out strength of unloaded orthodontic mini-screws at different healing periods: in vivo study in Beagle dogs

Com o objetivo de avaliar a influência do processo de cicatrização óssea sobre o desempenho biomecânico de mini-parafusos utilizados como ancoragem em ortodontia, foram inseridos 60 mini-parafusos (1,6 x 6mm) auto-rosqueantes (Tomas® – Dentaurum / Germany) na maxila e na mandíbula de 5 cães adultos da Raça Beagle. Os pré-molares (P1, P2, P3, P4) superiores e inferiores foram extraídos três meses antes da inserção vertical dos mini-parafusos. Os cães foram sacrificados nos dias 0, 2, 7, 15 e 30 após a instalação dos mini-parafusos. Os maxilares foram dissecados e os corpos de provas contendo os mini-parafusos foram preparados para avaliação da resistência à tração na Máquina de Ensaios Universal EMIC® 2000, utilizando uma garra desenvolvida especificamente para este estudo. Os valores e gráficos correspondentes ao desempenho mecânico foram imediatamente gerados e registrados pelo programa de aquisição Tesc 3.01®. As possíveis diferenças entre os períodos de cicatrização foram avaliadas pela análise de variância (ANOVA) e pelo teste de comparações múltiplas de Bonferroni. Os resultados demonstraram um índice de sucesso de 100% dos mini-parafusos inseridos. Após a dissecação dos segmentos ósseos, verificou-se que em alguns casos a superfície da rosca ficou parcialmente exposta, razão pela qual o cálculo da resistência à tração (média na maxila de: 141,76 ± 92,82 Ncm a 237,02 ± 78,34 Ncme média na mandíbula de: 156,86 ± 75,55 Ncm a 328,76 ± 82,17 Ncm) foi feito em relação à área real de inserção (maxila: 24,01 ± 6,09mm² e mandíbula: 22,88 ±5,31mm²), observando-se um valor médio por mm² significativamente maior na mandíbula (11,60 ± 5,22 Ncm) quando comparado à maxila (8,22 ± 5,04 Ncm). A relação entre a intensidade da força de tração (Ncm), superfície inserida (mm²) e períodos de cicatrização não apresentaram diferenças significantes (p= 0,126). Com base nestes resultados podemos concluir...

With the purpose of evaluating the influence of bone healing process on the biomechanical performance of mini-screws used as anchorage in orthodontics, 60 self-tapping (Tomas® - Dentaurum / Germany) mini-screws were inserted (1.6 x 6mm) in the maxilla and in the mandible of 5 adult Beagle dogs. Upper and lower premolars (P1, P2, P3, P4) were extracted three months before the vertical insertion of mini-screws. The dogs were sacrified on days 0, 2, 7, 15 and 30 after the insertion of mini-screws. The jaws were dissected and the bone blocks, containing the miniscrews, were prepared to the axial pull-out strength in the Universal Testing Machine EMIC ® 2000, using a device developed specifically for this study. The values and graphics for the mechanical performance were immediately generated and recorded by the acquisition program. The clinical success rate of mini-screws was 100%. The possible differences between the healing periods were analyzed by Bonferroni's multiple test comparisons and variance analysis (ANOVA). After the dissection of the bone segments, it was found that in some cases, the mini-screw thread was not fully inserted into the bone, reason why the pull-out strength (average of the maxilla: 141.76 ± 92.82 Ncm to 237.02 ± 78.34 Ncm and average in the mandible of 156.86 ±75.55 Ncm to 328.76 ± 82.17 Ncm) was evaluated in relation to the real area of insertion (maxilla: 24.01 ± 6.09 mm2 and mandible: 22.88 ± 5.31 mm2). Mean value mm² were significantly higher in the mandible (11.60 ± 5.22 Ncm/mm2) than the maxilla (8.22 ± 5.04 Ncm/mm²). There was no statistically significant difference (p =0126) between pull-out strength (Ncm), surface inserted (mm2) and the observed healing periods. Based on these results it can be concluded that mini-screws evaluated in this study demonstrated an excellent biomechanical behavior in all different periods of healing, showing more resistance to traction in the mandibular bone.

Extrusão dentária com finalidade restauradora / Tooth extrusion for restorative purpose

O objetivo deste trabalho é revisar a literatura sobre o tracionamento dentário para fins restauradores, apresentar considerações biológicas e mecânicas sobre este procedimento e demonstrar através de casos clínicos a aplicabilidade das técnicas.

The objective of this work is to revise the literature about dental traction for restorative purposes, to present biological and mechanical considerations on this procedure and to demonstrate through clinical cases the applicability of the technique.

Formação tardia de pré-molares supranumerários em pacientes ortodônticos / Late formation of supernumerary premolars in orthodontics patients

A presença de pré-molares supranumerários, embora com baixa freqüência, exige a tomada de uma decisão apropriada entre monitorá-los ou removê-los. As características individuais de cada caso devem determinar essa decisão, com base no risco cirúrgico e. no beneficio da remoção. Especificamente em pacientes ortodônticos, a presença de pré-molares supranumerários pode impedir ou atrasar o fechamento de espaços ou eventualmente causar reabsorção das raízes adjacentes. No caso de optar-se por removê-los é necessário o controle radiográfico em longo prazo, considerando que têm sido relatadas recidivas e formações em épocas diferentes em casos de incidências múltiplas. O objetivo no presente trabalho foi revisar a incidência, etiologia, desenvolvimento, localização e tratamento de pré-molares supranumerários descritos na literatura e ilustrar com um caso clínico.

Although with low frequency, the presence of supernumerary bicuspids requires appropriate decision making between their extraction and preservation with monitoring. The individual characteristics that play a key role in each case are based on the surgical risk and on the benefit of tooth removal. The presence of supernumerary bicuspid can avoid or delay orthodontic space closure or, eventually, resorbe the roots of neighboring teeth. In case of 100th removal is also required a long-term radiographic, follow-up having been reported in the literature multiple supernumerary formations at different times of interval. The aims of this paper were a literature review on the incidence, etiology, development, localization and treatment of supernumerary premolars and to report a clinical case.

Caninos superiores impactados: revisão de literatura e relato de caso clínico / Impacted maxillary canines: a review of literature and clinical case report

O processo de desenvolvimento dos caninos é dentre todos os dentes o mais demorado e de trajeto mais longo. Dessa forma, não é raro que diversos fatores possam intervir na sua irrupção causando impactação dentária. A impactação de caninos superiores ocorre com certa freqüência e pode estar associada a causas sistêmicas e/ou locais. Quanto ao posicionamento do dente impactado, este pode ser por vestibular ou por palatino sendo este último mais comumente encontrado. O diagnóstico precoce dessa anomalia é fundamental para o correto desenvolvimento da dentição/oclusão e para um tratamento mais eficaz e menos prolongado. O objetivo deste trabalho é demonstrar um caso clínico de impactação de canino superior e realizar uma revisão de literatura sobre os diversos aspectos desta anomalia desde seu diagnósticoClínico e radiográfico até as diferentes alternativas de tratamento.

The canine development process is the most delayed process of all teeth and also the one that takes the longest path until its eruption. This is why it is not rare that many factors may interfere on canine eruption causing impaction. Maxillary canine’s impaction occurs with certain frequency and can De associated to systemic and/or- local factors. The impacted teeth may belocated in different positions and it is named according to it: buccal or palatal. The last one, palatal, is the most common. Early diagnosis of this anomaly is of major importance to have a proper occlusion development and to have a more efficient and short treatment. The aim of this paper is to show a clinical case of maxillary canine impaction and review the literature on different aspects from its clinical and radiographic diagnosis to different treatment alternatives.