Estimation of the predictive effect of body mass index-percentile on skeletal maturation in a Nigerian population

To determine the predicting the effect of BMI-index percentile on the skeletal maturation of Nigerian children. Design: A prospective cross-sectional study. Setting: This study was conducted in a tertiary health care facility in North-Central Nigeria. Participants: Children between the ages of 5-17 years consisting of 44 males and 30 females that presented in the Child Dental clinic over a period of eight months were recruited for the study. Main outcome measured: Skeletal maturation was assessed using the middle phalanx of the third finger (MP3) while the standard WHO growth chart specific for age (2-20 years) and gender was used for grading BMI-percentile. The unpaired t-test was used to compare mean chronological age of the stages of MP3 according to gender. Multinomial logistic regression used to determine the predictive effect of age, gender and BMI percentile on pubertal growth spurt. Results: The BMI-percentile had weak correlation with the pubertal growth spurt (r=0.089, p=0.448). Gender (p=0.004) and chronological age had significant (p<0.001) predictive effect on the skeletal maturation. A one-percentile increase in the BMI-percentile decreases the likelihood of healthy children to be in the peak-pubertal by 1.504 when compared to obese children (p=0.305). Conclusions: This study showed that BMI-percentile is a weak predictor of skeletal maturation. However, obese children had a tendency towards advanced skeletal maturation than healthy participants. It is therefore suggested that orthodontists should consider early implementation of jaw modification treatments among obese children.

Smile esthetic: comparison of perception amongst orthodontists, dental students, orthodontic patients and surgical orthodontic patients

Most patients require orthodontic treatment to improve the esthetics of their smile. Orthodontists must consider how some parameters of mini-esthetics can influence the patient's esthetic perception. Methods: A photograph of the smile of a young female was taken and some modifications were made to the buccal corridor, gingival exposure, smile arc and midline position to assess the influence of these variables on smile attractiveness. Two hundred examiners were selected from four groups: orthodontists (O), dental students (DS), orthodontic patients (OP) and surgical-orthodontic patients (SOP). Each examiner was asked to complete the questionnaire with an approval rating from 1 to 10. Significant level was set at P ≤ 0.05. Results: Only orthodontists considered buccal corridors of 4mm and midline deviation of 1mm as non-esthetic; all other examiners considered gingival exposures ≥3 mm and midline angulation as non-esthetic. All examiners assigned higher satisfaction values to the photo with the concordant smile arc and defined as non-esthetic the covered smile and the reverse smile arc. Patients perceived as non-esthetic only midline deviations of 4mm. The surgical orthodontic patients assigned lower values to the photos and showed greater attention to evaluating the esthetics of the smile than the orthodontic patients. Conclusion: Smile arc, gingival exposure and midline angulation influence smile esthetics; the role of buccal corridors and midline deviation is dependent on the type of examiner

Are We Hearing Right? The Negative Impact of New SARS-CoV-2 Preventive Measures and Prolonged Use of Treatment Modalities during Orthodontic Treatment

Abstract Since the dental treatment involves the use of various instruments and machines, there is ample presence of both distracting as well as destructive noise, and these are defined based on various parameters. With an increase in safety measures incorporated into dental practices, such as extra-oral suction devices and respirators, there has also been a corresponding rise in noise levels usually present in a clinic. Previous clinical experiments and trials have shown that the noise in a dental office can permanently bring about hearing damage. In addition to this, working with added safety measures during the pandemic, such as the use of personal protective equipment, respirators, and face shields can decrease operator efficiency and the ability to communicate normally. Dentistry has already been demonstrated to be one of the most hazardous occupations because of the high risk of infections. An Orthodontist must protect their eyes and mouth from potentially hazardous situations and the ears to prevent hearing damage.

La maloclusión clase III esquelética grave mediante abordaje primario de cirugía ortognática: informe de caso / Severe skeletal class III malocclusion by surgery-first orthognathic approach: a case report

Class III malocclusion is a relevant public health problem. The management of severe skeletal class III malocclusion in non-growing patients requires properly planned and well-executed orthognathic surgery by a team of at least an orthodontist and a maxillofacial surgeon. For these cases, there are two approaches to the surgery. One of them is the conventional three-stage method, which includes preoperative orthodontic treatment, orthognathic surgery, and postoperative orthodontic treatment. The other is the surgery-first orthognathic approach, which is performed without pre-surgical orthodontic treatment and should present some advantages compared to the conventional technique. However, at present, evidence on the management of class III malocclusion still needs to be expanded. In this paper, we present the management of a case of severe skeletal class III malocclusion by surgery-first orthodontic approach, based on the experience of the Tamil Nadu Government Dental College and Hospital, Chennai, India.

La maloclusión clase III es un problema de salud pública importante. El tratamiento de la maloclusión clase III esquelética grave en pacientes que no están en crecimiento, requiere una cirugía ortognática planificada de forma apropiada y bien ejecutada, por un equipo de al menos un ortodoncista y un cirujano maxilofacial. Para estos casos, existen dos enfoques para la cirugía: el método convencional de tres etapas, que incluye tratamiento de ortodoncia preoperatorio, cirugía ortognática y tratamiento de ortodoncia posoperatorio; y el abordaje primario de cirugía ortognática, que se realiza sin tratamiento de ortodoncia prequirúrgico y debe presentar algunas ventajas en comparación con la técnica convencional. Sin embargo, en la actualidad, las pruebas sobre el abordaje de la maloclusión clase III aún deben ampliarse. En este artículo, presentamos el abordaje de un caso de maloclusión clase III esquelética grave mediante el abordaje inicial con cirugía ortognática, basado en la experiencia del Hospital y Colegio Odontológico del Gobierno de Tamil Nadu, Chennai, India.

Spontaneous Transversal Changes of Lower Arch Following Palatal Skeletal Expansion

ABSTRACT Objective: To evaluate how the lower arch spontaneously change after upper rapid palatal expansion in a group of patients with transversal skeletal deficit. Material and Methods: Twenty-four patients treated by the same orthodontist with a rapid palatal expander (RPE) bounded on a deciduous molar have been selected. The sample was divided into two groups: no treatment was provided for group one, while group two was treated using a lip bumper or Schwarz appliance. For each patient, dental casts were collected when the RPE was bounded (T0) and at the end of treatment, 9 months ± 3 months later (T1). Each outcome was analyzed, providing descriptive statistics, main effects significance tests and post-hoc analyses with the objective to evaluate the variations between pre-treatment (TO) and post-treatment (T1) of each of them. Results: If the linear measurements are considered, a significant beneficial effect on both arches is observed. However, the upper arch always shows a major increase of all values at T1 with respect to the lower arch. Even though the post-hoc tables indicate that time differences are all statistically significant across considered partitions, the lower arch's increase is more pronounced in group two, where patients were treated in both arches. If the angular measurements are concerned, the increase of lingual crown inclination was found in all patients, independently from the type of treatment in lower arch. Conclusion: All patients show normalization of upper diameters, regardless of whether the lower arch was treated or not.

Factors associated to quality of life of orthodontists graduated from a public university (1993-2016): A mixed-methods approach

ABSTRACT Introduction: For dental professionals, including orthodontists, Quality of life (QOL) is a topic of growing concern and could be determined by objective and subjective complex factors. Objective: This study analyzed the factors that influence the QOL of orthodontists graduated between 1993 and 2016 of a public university (Medellín, Colombia). Methods: A mixed-methods study was conducted (cross-sectional survey; 88 participants; 3 focus groups, 21 participants). Quantitative analysis: the research included sociodemographic, labor and health characteristics as independent variables and the WHOQOL-BREF questionnaire as main outcome for QOL. Frequencies were calculated and the association between QOL and independent variables was estimated by bivariate analysis (Chi square tests) and a linear multivariate regression. Qualitative analysis: Narrative content analysis according to thematic categories. Mixed methods: a conceptual framework for QOL using the triangulation was developed. Results: All the scores surpassed 55 points on the 4 domains of WHOQOL-BREF. A lower value was found in the physical dimension (57.1±10.7) and a greater value in the psychological dimension (70.8±8.3). The variables associated positively to QOL were permanent contract, teaching/research activities, monthly income, resting days per week and sex. Factors associated negatively were low social support, mental health and rent housing. Discourses of participants allowed to identify the concept of QOL and the contextual and social determinants and satisfiers. Conclusion: QOL of orthodontists is influenced by sociodemographic, employment, working and health factors. Therefore, QOL is a multidimensional concept that recognizes the political and socio-economic context and personal and professional experiences.

RESUMO Introdução: Entre os profissionais da área odontológica, incluindo os ortodontistas, a Qualidade de Vida (QOL) é um tópico de interesse crescente, podendo ser determinada por meio de complexos fatores objetivos e subjetivos. Objetivo: O presente estudo analisou fatores que influenciam a QOL dos ortodontistas graduados entre 1993 e 2016 em uma universidade pública (Medelín, Colômbia). Método: Foi conduzido um estudo de metodologia mista (pesquisa transversal; 88 participantes; 3 grupos focais, 21 participantes). Análise quantitativa: foram incluídas características sociodemográficas, ocupacionais e de saúde como variáveis independentes e o questionário WHOQOL-BREF como resultado principal para QOL. As frequências foram calculadas e a associação entre QOL e as variáveis independentes foram estimadas por uma análise bivariada (teste qui-quadrado) e uma regressão linear multivariada. Análise qualitativa: análise do conteúdo narrativo de acordo com as categorias temáticas. Metodologia mista: foi desenvolvida uma estrutura conceitual para QOL utilizando a triangulação. Resultados: Todas as pontuações ultrapassaram 55 pontos nos 4 domínios do WHOQOL-BREF. Um valor mais baixo foi encontrado na dimensão física (57,1±10,7) e um valor mais alto, na dimensão psicológica (70,8±8,3). As variáveis associadas positivamente à QOL foram as seguintes: contrato permanente, atividades ensino/pesquisa, renda mensal, dias de descanso por semana e sexo. Os fatores associados negativamente foram baixo suporte social, saúde mental e morar de aluguel. O discurso dos participantes permitiu a identificação do conceito de QOL, dos determinantes contextuais e sociais, e os fatores motivacionais. Conclusão: A QOL dos ortodontistas é influenciada por fatores sociodemográficos, ocupacionais, ligados ao trabalho e à saúde. Dessa maneira, a QOL se apresenta como um conceito multidimensional, que reconhece o contexto político e socioeconômico, assim como as experiências pessoais e profissionais.

The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs

ABSTRACT Objective: To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis. Methods: 22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2). Results: The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001). Conclusions: Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS.

RESUMO Objetivo: Avaliar a habilidade de ortodontistas e cirurgiões bucomaxilofaciais (CBMF) em propor um prognóstico para terceiros molares inferiores. Métodos: Foram analisados 22 pacientes tratados ortodonticamente sem extração, cujos terceiros molares inferiores irrompidos espontaneamente (n= 44) foram avaliados por meio de radiografias panorâmicas seriadas. A primeira radiografia foi obtida logo após o tratamento ortodôntico (RX1), entre 13 e 19 anos de idade. A segunda radiografia (RX2) foi avaliada dois anos depois, em média. As radiografias foram analisadas aleatoriamente por 54 especialistas, 27 ortodontistas e 27 CBMFs, para obter sua opinião sobre a abordagem a ser adotada na RX1. Em seguida, outra opinião foi coletada adicionando-se a segunda radiografia seriada (RX1+2). Resultados: A concordância das respostas foi moderada para os CBMFs (Kappa = 0,44; p< 0,0001) e significativa para os ortodontistas (Kappa = 0,39; p< 0,0001). Após analisar apenas a primeira radiografia (RX1) dos molares antes deles irromperem espontaneamente, os CBMFs indicaram extração em 44,5% dos casos; enquanto os ortodontistas, em 42%, sem diferença entre os grupos (p= 0,22). Na análise de RX1+2, os ortodontistas mantiveram o mesmo nível de indicação de extração (45,6%, p= 0,08), enquanto os cirurgiões passaram a indicar mais extrações (63,2%, p< 0,0001). Conclusões: Ortodontistas e CBMFs não foram capazes de predizer a erupção de terceiros molares por meio da análise de uma única radiografia panorâmica, indicando extrações em cerca da metade dos terceiros molares examinados. Uma análise de acompanhamento, incluindo mais uma radiografia, não melhorou a precisão do prognóstico entre os ortodontistas, e piorou entre os CBMFs.

Space closure using aligners

ABSTRACT Introduction: Due to the search for more aesthetic and comfortable alternatives to perform orthodontic treatments and to the great technological development, orthodontic aligners have assumed great importance. More and more complex treatments have been carried out with these appliances without, however, having all aspects involved in their use being studied in depth. Its biomechanical planning requires different approaches than those used in fixed orthodontics, as the force systems involved in movements, responses and side effects are distinct, and the professional must be prepared when opting for the technique. Objective: The objective of this article is to perform an evaluation of the force systems created on the space closure with aligners, its characteristics, and problems, as well as make some suggestions to overcome the difficulties inherent to its use. Conclusion: Space closure with aligners is possible, but depends on the correct selection of the patient, in addition to requiring the proper planning of the applied forces. The use of auxiliary resources and overcorrections to address the deficiencies of the aligner systems should always be considered. Digital planning should be used as a map of the force systems that will be applied, and not just as a marketing tool, keeping in mind that determining the objectives and the way to achieve them is the responsibility of the orthodontist, and that treatment plans must be individualized for each situation, following appropriate biomechanical precepts.

RESUMO Introdução: Devido à busca por alternativas mais estéticas e confortáveis para realizar tratamentos ortodônticos e ao grande desenvolvimento tecnológico, os alinhadores ortodônticos assumiram uma grande importância. Tratamentos cada vez mais complexos vêm sendo realizados com esses dispositivos sem que, no entanto, sejam estudados em profundidade todos os aspectos envolvidos na sua utilização. Seu planejamento biomecânico requer abordagens diferentes da Ortodontia fixa, pois os sistemas de forças envolvidos nas movimentações, respostas e efeitos colaterais são distintos, e o profissional deve estar preparado ao optar por essa técnica. Objetivo: O objetivo deste artigo é fazer uma avaliação dos sistemas de forças envolvidos no fechamento de espaços com alinhadores, suas características e problemas, bem como apresentar algumas sugestões para contornar as dificuldades decorrentes de seu uso. Conclusão: O fechamento de espaços com alinhadores é possível, mas depende da correta seleção do paciente, além de exigir o adequado planejamento das forças aplicadas. O uso de recursos auxiliares e sobrecorreções para suprir as deficiências dos sistemas de alinhadores deve ser sempre considerado. O planejamento digital deve ser usado como um mapa dos sistemas de forças que serão aplicados, e não apenas como ferramenta de marketing, tendo em mente que a determinação dos objetivos e da maneira de atingi-los é de responsabilidade do ortodontista e que os planejamentos devem ser individualizados para cada situação, seguindo preceitos biomecânicos adequados.

Solutions for atypical problems in the incisors area: a transdisciplinary challenge

ABSTRACT Introduction: A significant increase in the number of adults in search of orthodontic treatment has raised a new challenge for orthodontists: the need to interact with other specialties to achieve excellent results, particularly when dealing with smile aesthetics and facial balance. Several factors should be considered to respond to their demand: adequate tooth leveling and alignment, individual tooth proportions between adjacent teeth and their contralateral teeth, shape and natural appearance of each tooth and gingival architecture, which should all be in agreement with facial harmony. Maxillary or mandibular incisors congenitally missing or lost due to caries or trauma and tooth-size discrepancies (Bolton) are some of the important aesthetic challenges for an integrated orthodontic treatment. Objectives: This study describes cases that illustrate the clinical challenges of treating the anterior area, as well as the multidisciplinary strategies required for their resolution. Conclusion: The increasingly frequent multidisciplinary orthodontic treatments of complex cases seem to effectively maximize aesthetic and functional results using a combination of procedures conducted by specialists in related areas, such as Surgery, Prosthetics, Implantology, Restorative Dentistry and Periodontics.

RESUMO Introdução: O aumento significativo de indivíduos adultos em busca de tratamento ortodôntico resultou em um novo desafio para o ortodontista: a necessidade de interação com outras especialidades, visando a excelência de resultados, principalmente quando o assunto é a estética do sorriso e o equilíbrio facial. Para atender a essa demanda, diversos fatores devem ser considerados: correto alinhamento e nivelamento dos dentes, proporções dentárias individuais entre dentes adjacentes e seus homólogos, forma e naturalidade de cada dente e arquitetura gengival - estando todos esses em consonância com a harmonia da face. Casos envolvendo ausência congênita ou perda de incisivos por cárie ou trauma, discrepância de tamanho dentário (Bolton), entre outras, constituem importantes desafios estéticos para o tratamento integrado em Ortodontia. Objetivos: apresentar casos que ilustram tais desafios envolvendo a região anterior, onde a abordagem transdisciplinar foi fundamental para sua resolução. Conclusão: O tratamento ortodôntico transdisciplinar, cada vez mais frequente, vem se mostrando eficiente na resolução de casos complexos, visando maximizar os resultados estéticos e funcionais, mediante a combinação de procedimentos realizados por especialidades afins, como a Cirurgia, Prótese, Implantodontia, Dentística e Periodontia.

Esthetic perception of facial profile changes after extraction and nonextraction Class II treatment

Abstract This retrospective study evaluated facial profile pleasantness determined by two protocols of Class II treatment. The sample comprised facial profile silhouettes obtained retrospectively from the pretreatment (T1) and posttreatment (T2) cephalograms of 60 patients (42 males and 18 females) divided into two groups. One group of 30 patients (mean age of 12.84 years) was treated with the extraction of maxillary first premolars (mean treatment time of 2.7 years), and the other group of 30 patients (mean age of 12.81 years) was treated with a mandibular advancement appliance (Forsus) (mean treatment time of 2.49 years). The facial profile silhouettes (T1 and T2) were randomly distributed in an album containing one patient per sheet. The examiners consisted of 60 orthodontists and 60 lay individuals, who analyzed the profiles in regard to facial pleasantness, using the Likert scale. A comparison between stages T1 and T2 of the two treatment protocols and between the examiners was performed by mixed-design analysis of variance at a significance level of 5%. The results demonstrated a significant difference between T1 and T2 (greater scores for T2 compared to T1), and between lay individuals and orthodontists (orthodontists assigned higher scores), but with no significant difference between the treatment protocols. Both protocols produced positive effects on the facial profile esthetics, from the standpoint of lay individuals and orthodontists.

Effect of Experience in Landmark Identification on 2D Lateral Cephalograms on Performance of Dental Students Concerning Landmark Identification on 3D Cone Beam Computed Tomography Scans

Abstract Objective: To assess the effect of experience in landmark identification on two-dimensional (2D) lateral cephalograms on performance of dental students concerning landmark identification on three-dimensional (3D) cone-beam computed tomography (CBCT) scans. Material and Methods: This quasi-experimental study evaluated 40 dental students in two groups (n=20). Group 1 included senior dental students who had experience in landmark identification on 2D lateral cephalograms and Group 2 included third-year dental students with no such experience. Both groups received instructions on identification of eight landmarks on 3D CBCT scans. The coordinates of the landmarks were determined in x, y and z axes. One orthodontist determined the mean coordinates of each landmark as a reference by twice measurements with a one-week interval. The mean distance from the identified points to the reference points was reported as the mean consistency (MC), and the standard deviation of the mean was considered as precision of landmark identification. Data were analyzed using independent samples t-test. Results: The mean distances from the points identified as nasion, point B, orbitale, anterior nasal spine (ANS), menton, coronoid process and pogonion in x, y and z axes and point A in x and z axes (p<0.001) to the reference points in Group 1 were greater than those in Group 2 with no such experience. Conclusion: Previous experience in landmark identification on 2D cephalograms does not help in landmark identification on 3D CBCT scans and may even adversely affect the results.

Impacted teeth: Their place is in the dental arch

ABSTRACT The starting point for the treatment of unerupted teeth should consider the fact that, biologically, the pericoronal follicle maintains the ability to release EGF and other mediators responsible for eruption over time. The eruptive events may be guided and directed, so that teeth may occupy the space prepared to receive them in the dental arch, as showed in the case presented to evidence the following principle to be considered in these cases: "Regardless of the position of an unerupted tooth, it may be biologically directed to its place in the dental arch. The orthodontist should apply a mechanics to guide it and park it at its site."

RESUMO Os dentes não irrompidos devem ter como ponto de partida, para seu tratamento, o fato de que biologicamente o folículo pericoronário mantém ao longo do tempo a capacidade de liberar o EGF e outros mediadores responsáveis pela erupção. Pode-se guiar e direcionar os eventos eruptivos para que os dentes ocupem o seu espaço preparado para recebê-los na arcada dentária, como revela o caso apresentado para sedimentar o seguinte princípio a ser considerado para esses casos: "Independentemente da posição que um dente não irrompido se apresente, há como, biologicamente, direcioná-lo para o seu local na arcada dentária. Cabe ao ortodontista aplicar uma mecânica que o leve até o local e lá o estacione."

Estudio Comparativo de Ansiedad y Disfunción Temporomandibular en Cirujanos Dentistas Residentes de dos Universidades Mexicanas / Comparative Study of Anxiety and Temporomandibular Dysfunctio in Resident Dental Surgeons of Two Mexican Universities

RESUMEN: La ansiedad puede ser un detonante de la disfunción temporomandibular (DTM). Se ha mencionado que el trastorno psicológico más frecuente en México es la "ansiedad" con 14,3 %. El objetivo es correlacionar y comparar los niveles de ansiedad y los grados de DTM en cirujanos dentistas residentes (CDR) de dos universidades mexicanas: la Facultad de Odontología de la Universidad de la Salle Bajío León, Guanajuato (FOULSB), y de la Facultad de Odontología de la Universidad Autónoma (FOUADY) de Yucatán México durante el periodo de septiembre 2017 a febrero 2018. El tipo de estudio fue correlacional, comparativo de cohorte transversal, siendo las variables: ansiedad (niveles según cuestionario de autoevaluación de ansiedad estado/rasgo STAI); signos y síntomas clínicos para el diagnóstico de DTM, (CDI/TTM Grupo I Desórdenes Musculares; Grupo II Desplazamientos discales; Grupo III Artralgia, osteoartritis). El tamaño de la muestra y criterios de inclusión en ambas universidades fueron: CDR en Odontología; que aceptaron participar en el estudio, mediante la firma del consentimiento informado y voluntario; hombres y mujeres; entre 25 a 34 años de edad. Criterios de exclusión: con tratamientos ortodónticos, quirúrgicos, enfermedades sistémicas o neurológicas y que sólo el día que se tomó la muestra presentaron otalgia o cefalea. El tipo de muestreo, por conveniencia. Se utilizó estadística descriptiva e inferencial. Los resultados: 40 CDR de la FOULSB, donde el 92,5 % (n=37) manifestaron tener niveles de ansiedad bajos, y el 7,5 % (n=3) moderado. El 65,8 % (n=26) presentó diagnóstico de DTM. De los 40 CDR de la FOUADY, 97,5 % (n=39) declararon tener niveles de ansiedad bajos, y el 2,5 % (n=1) obtuvo un nivel alto. El 67,5 % (n=27) presentaron signos y/o síntomas de DTM. La conclusión fue que no existieron diferencias estadísticamente significativas, ya que los CDR de ambas universidades presentaron porcentajes de DTM similares y también tuvieron niveles de ansiedad similares.

ABSTRACT: Anxiety can be a trigger for temporomandibular dysfunction (TMD). It has been mentioned that the most frequent psychological disorder in Mexico is "anxiety" with 14.3 %. The objective is to correlate and compare the levels of anxiety and the degrees of TMD in resident dentists (CDR) of two Mexican universities: the Faculty of Dentistry of the University of La Salle Bajío León, Guanajuato (FOULSB), and the Faculty of Dentistry. Dentistry of the Autonomous University (FOUADY) of Yucatan Mexico during the period from September 2017 to February 2018. The type of study was correlational, comparative crosssectional cohort, the variables being: anxiety (levels according to questionnaire self-assessment of anxiety state / trait STAI); clinical signs and symptoms for the diagnosis of TMD, (CDI / TTM Group I Muscle Disorders, Group II Displacement discs, Group III Arthralgia, osteoarthritis). The size of the sample and inclusion criteria in both universities were CDR in Dentistry; who agreed to participate in the study, by signing the informed and voluntary consent; men and women; between 25 to 34 years of age. Exclusion criteria: with orthodontic, surgical treatments, systemic or neurological diseases and that only the day the sample was taken showed otalgia or headache. The type of sampling, for convenience. Descriptive and inferential statistics were used. The results: 40 CDR of FOULSB, where 92.5 % (n = 37) reported having low anxiety levels, and 7.5 % (n = 3) moderate. Sixty-five point eight percent (n=26) presented diagnosis of TMD. Of the 40 CDRs of FOUADY, 97.5 % (n = 39) reported having low anxiety levels, and 2.5 % (n = 1) had a high level. Sixtyseven point five percent (n=27) presented signs and / or symptoms of TMD. The conclusion was that there were no statistically significant differences, since the CDRs of both universities presented similar DTM percentages and had similar levels of anxiety.

Influence of maxillary canine torque variations on the perception of smile esthetics among orthodontists and laypersons

ABSTRACT Objective: The purpose of this study was to determine the perception of smile esthetics among orthodontists and laypersons with respect to unilateral maxillary canine torque variations in a frontal smile analysis. Methods: Full face and close-up smile photographs of two subjects (1 man and 1 woman) were used. Both smiles displayed healthy maxillary anterior dentitions. The images were digitally altered to obtain a bilateral 0° torque in the maxillary canines. From this image, unilateral variations of the left canine were made with -15°, -10°, -5°, 0°, +5°, +10° and +15°. Final images were randomly assembled into an album that was given to 53 orthodontists and 53 laypersons. Each rater was asked to evaluate the attractiveness of the images using visual analog scales. Data collected were statistically analyzed with one-way analysis of variance with Tukey post-hoc test and the unpaired Student t test. Results: For orthodontists, most attractive smiles were those with 0°, -5° and -10°. For laypersons, most attractive smiles were those with 0°, -5°, -10°, -15° and + 5°. For both groups, the lowest scores were given for the smiles with +10° and +15° torque. When comparing the perceptions of the orthodontists and laypersons, they did not show statistical differences in most situations. Moreover, in general, there was no significant difference between the full-face and close-up assessments of the smiles. Conclusions: The present findings indicated that smiles with unilateral palatal (negative values) maxillary canine torque variations were more tolerated than smiles with buccal crown torque (positive values) variations.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar a percepção estética do sorriso, por ortodontistas e leigos, em relação a variações unilaterais do torque do canino superior, em uma análise frontal do sorriso. Métodos: foram utilizadas fotografias de face total e de sorriso aproximado de dois indivíduos (1 homem e 1 mulher). Ambos os sorrisos exibiam dentição anterossuperior saudável. As imagens foram alteradas digitalmente para obtenção de um torque bilateral de 0° nos caninos superiores. A partir dessa imagem, variações unilaterais do canino esquerdo foram realizadas com -15°, -10°, -5°, 0°, +5°, +10° e +15°. As imagens finais foram montadas aleatoriamente em um álbum que foi entregue a 53 ortodontistas e 53 leigos. Cada avaliador foi orientado a avaliar a atratividade das imagens com escalas visuais analógicas. Os dados coletados foram analisados estatisticamente com análise de variância ANOVA com pós-teste de Tukey e teste t de Student não pareado. Resultados: para ortodontistas, os sorrisos mais atraentes foram aqueles com 0°, -5° e -10°. Para os leigos, os sorrisos mais atraentes foram aqueles com 0°, -5°, -10°, -15° e +5°. Para ambos os grupos, as pontuações mais baixas foram dadas para os sorrisos com torque de +10° e +15°. Ao comparar as percepções dos ortodontistas e leigos, não foram encontradas diferenças estatísticas na maioria das situações. Além disso, em geral, não houve diferença significativa entre as avaliações de face total e de sorriso aproximado. Conclusões: esses achados indicam que os sorrisos com variações unilaterais no torque do canino superior para palatino (valores negativos) foram mais tolerados do que os sorrisos com variações no torque da coroa para vestibular (valores positivos).

Evaluation of facial appearance in patients with repaired cleft lip and palate: comparing the assessment of laypeople and healthcare professionals / 대한악안면성형재건외과학회지

BACKGROUND: The present study aimed to determine whether laypeople and professionals rate the facial appearance of individuals with repaired complete unilateral or bilateral cleft lip and palate (UCLP, BCLP) similarly based on viewing full facial images. METHODS: The study followed a cross-sectional analytical design where five young patients aged 10 to 14 years, who had completed all stages of their unilateral or bilateral cleft lip and palate treatment (bilateral: three, unilateral: two), were evaluated by two groups. The assessment was done by laypeople and 97 qualified professionals (33 orthodontists, 32 plastic surgeons, and 32 oral and maxillofacial surgeons). Professionals were not involved in any stage of the patients’ treatment. RESULTS: The facial appearance assessment of the professional groups on different facial aesthetics was significantly lower than that of laypeople, and they had higher perceived need for further treatment. On the other hand, laypeople had higher aesthetic ratings and lower perceived need for further treatment. Differences were also observed between the assessments of the professional groups. Participants who had lower aesthetic assessments of the repair tended to report a higher influence of cleft lip and palate on social activities and professional life. CONCLUSION: Differences in perception exist between healthcare professionals and laypeople. The discrepancies between the professional groups could be attributed to different treatment modalities and protocols.

Current status of the surgery-first approach (part I): concepts and orthodontic protocols / 대한악안면성형재건외과학회지

The “surgery-first” approach, defined as a team approach between surgeons and orthodontists for orthognathic surgery without preoperative orthodontic treatment, is aimed at dental decompensation. A brief historical background and indications for the surgery-first approach are reviewed. Considering the complicated mechanism of postoperative orthodontic treatment, the proper selection of patients is a vital component of successful surgery-first approach.

Biosafety conducts adopted by orthodontists

ABSTRACT Objective: This cross-sectional observational study was designed to assess the biosafety conducts adopted by orthodontists, and possible differences regarding training time. Methods: Both the application of methods for sterilization/disinfection of instruments and materials, and the use of personal protective equipment (PPE) were collected through questionnaires via e-mail. Results: The questionnaires were answered by 90 orthodontists with a mean age of 37.19 ± 9.08 years and mean training time of 13.52 ± 6.84 years. Regarding orthodontic pliers, 63.23% use an autoclave, except 1 who does not perform any procedure. All participants use autoclave to sterilize instruments, and 95.6% of respondents perform cleaning with chemicals prior to sterilization. Most of them (65.56%) use an autoclave to sterilize orthodontic bands, with some still associating disinfection methods, while few (18.89%) do nothing at all. There was a high incidence of the answer "nothing" for the methods used for elastic, accessories, bandages, metal springs, and arches. All respondents use mask and gloves in attendance, 78.92% use aprons, 58.92% use protective goggles, and 50.01% use cap. Training time significantly influenced (p = 0.003) only the use of glutaraldehyde for sterilization/disinfection of pliers. Conclusions: The sterilization and cleaning of pliers, instruments, and bands, besides the use of PPE, received more uniform and positive responses, while other items suggest disagreements and possible failures. Only orthodontists trained for more than 13 years choose using glutaraldehyde for pliers sterilization/disinfection, the only adopted method with a significant difference in relation to training time.

RESUMO Objetivo: o presente estudo observacional transversal foi delineado para avaliar as condutas de biossegurança adotadas pelos ortodontistas, e as possíveis diferenças em função do tempo de formação. Métodos: tanto as técnicas de esterilização e desinfecção de instrumentais e materiais quanto o uso de equipamentos de proteção individual da equipe foram coletados por meio de questionários via e-mail. Resultados: os questionários foram respondidos por 90 ortodontistas, com idade média de 37,19 ± 9,08 anos e tempo médio de formação de 13,52 ± 6,84 anos. Quanto aos alicates ortodônticos, 63,23% usam autoclave, exceto aqueles que não realizam nenhum procedimento. Houve total abrangência no uso da esterilização do instrumental por autoclave, sendo que 95,6% realizam a limpeza com substâncias químicas previamente à esterilização. A maioria (65,56%) utiliza autoclave para a esterilização de anéis ortodônticos e alguns associam métodos de desinfecção, mas 18,89% nada fazem. Houve alta incidência da resposta "nada" para os métodos utilizados em elásticos, acessórios, ligaduras, molas e arcos. Todos os questionados utilizam máscara e luva no atendimento ortodôntico, 78,92% incluem o uso do avental, 58,92% usam óculos de proteção e 50,01% vestem o gorro (50,01%). O tempo de formação influenciou significativamente (p= 0,003) apenas no uso do glutaraldeído para esterilização e/ou desinfecção dos alicates. Conclusões: a esterilização e limpeza de alicates, instrumental de exame, aplicador de elásticos e anéis ortodônticos, além do uso de equipamentos de proteção individual, receberam respostas mais uniformes e positivas, enquanto os outros itens sugerem falhas. Apenas os ortodontistas formados há mais de treze anos optaram pelo uso do glutaraldeído para esterilização/desinfecção dos alicates ortodônticos, sendo a única conduta que mostrou diferença significativa em relação ao tempo de formação.