Comparison of maxillary transversal changes between auxiliary beta-titanium expansion arch and miniscrew-assisted rapid palatal expansion.

OBJECTIVE(S): This study compared buccal bone thickness, dental inclinations and maxillary transverse width dimensions changes between auxiliary beta-titanium expansion arch (AEA) and miniscrew-assisted rapid palatal expansion (MARPE). MATERIALS AND METHODS: The sample consisted of 29 patients, aged between 18 and 40 years, with transverse maxillary deficiency and treated without extractions, divided into two groups: group AEA: comprised 13 individuals (initial mean age: 29.23 ± 9.13 years) treated using auxiliary beta-titanium expansion arch; group MARPE: comprised 16 patients (initial mean age: 24.92 ± 7.60 years) treated with miniscrew-assisted rapid palatal expansion. Buccal bone thickness, dental inclinations and transverse width dimensions (dental, nasal base and jugular) were measured in cone-bean computed tomographies at pre- and post-treatment stages. The variables were compared using the independent t-test. RESULTS: The buccal bone thickness was similar for both groups at the post-treatment stage. The second premolars were significantly more buccal inclined in the AEA group and the right maxillary first molars in the MARPE group. The intercanine and intermolar distances were statistically significantly greater in the MARPE group. Changes in dental arch transverse dimensions were significantly greater for the MARPE group. CONCLUSION: Both treatment protocols corrected the maxillary transverse discrepancy; however, MARPE provided greater correction.

Comparison of the efficiency of initial dental alignment with Invisalign® aligners changed every 7 or 14 days in mature adults: Randomized clinical trial.

OBJECTIVE: To compare the anterior crowding correction after sequential use of the first 5 aligners between two aligner exchange protocols (7 and 14 days) in mature adult patients. MATERIALS AND METHODS: Thirty-six patients over 35 years who received orthodontic treatment with Invisalign® were randomly allocated to two different aligner replacement sequence protocols: Group 1: exchange every 7 days (n = 18); and Group 2: exchange every 14 days (n = 18). All patients were scanned with iTero Element 5D® (Align Technology) in two treatment times: at pre-treatment (T1) and after using the first five aligners (T2). Little's Irregularity Index (LII) and arch widths were evaluated with OrthoCAD software. Intra and intergroup comparisons were performed with the dependent and independent t-tests. The results were considered significant for P < .05. RESULTS: Thirty-five patients completed the study. Both groups' maxillary and mandibular Irregularity Indexesi were significantly lower at T2. There was no significant difference in inter-canine, inter-premolar, and intermolar distances. G2 (14 days) presented a greater decrease in mandibular irregularity than G1 (7 days). CONCLUSION: Both exchange protocols (7 and 14 days) effectively correct anterior crowding in the initial phase of orthodontic treatment with aligners in mature adult patients. However, the 14-day exchange protocol provided a greater correction in mandibular anterior crowding in the evaluated period than the 7-day exchange protocol.

Stability of Class II malocclusion treatment with Class II elastics.

INTRODUCTION: The objective of this study was to compare the long-term cephalometric stability after successful therapy of nonextraction Class II malocclusion with elastics and with headgear. METHODS: The sample comprised 43 patients with Class II malocclusion and was divided into 2 groups. The elastic group (EG) consisted of 20 patients treated with fixed appliances associated with Class II elastics, and the headgear group (HG) consisted of 23 patients treated with fixed appliances and extraoral headgear. Pretreatment, posttreatment, and long-term posttreatment lateral radiographs were evaluated; t tests were used to compare the long-term posttreatment changes between the groups. RESULTS: The groups were matched regarding initial age, time of long-term posttreatment evaluation, initial malocclusion severity, quality of treatment result, and all pretreatment cephalometric variables. Intergroup comparisons of long-term posttreatment changes showed that the HG group presented significantly greater mandibular protrusion, occlusal plane angle decrease, and maxillary molar mesialization. However, long-term posttreatment stability was similar in overjet, overbite, and molar relationships. CONCLUSIONS: Nonextraction Class II malocclusion treatment with elastics or extraoral headgear have similar long-term posttreatment stability.

3D morphometric evaluation of the dental arches in children with cleft lip and palate submitted to different surgical techniques.

OBJECTIVES: This study aimed to compare dimensional alterations of dental arches in children with unilateral complete cleft lip and palate before and after different techniques of primary plastic surgeries. MATERIALS AND METHODS: The sample was divided into two groups: group 1-cheiloplasty by Millard's technique and one-stage palatoplasty by von Langenbeck's technique; group 2-cheiloplasty by Millard's technique and two-stage palatoplasty: anterior palatoplasty by Hans Pichler's technique and posterior palatoplasty by Sommerlad's technique. Dental arches were evaluated before (T1), after the first phase (T2), and 1 year after the second phase (T3) of primary surgeries. Linear measurements and palatal area were assessed. To analyze the method's error, interclass correlation coefficient was applied. ANOVA (followed by Tukey test), dependent, and independent t-test were used (p < 0.05). RESULTS: At T1, the intertuberosity distance was statistically greater in G2 (p = 0.004). At T2, the anterior length of the dental arch was statistically greater in G2 (p = 0.025), while the area of the smaller palatal segment (p = 0.001), cleft area (p = 0.014), and total area (p = 0.002) were statistically smaller in G2. At T3, the intertuberosity distance was statistically greater in G2 (p = 0.017). CONCLUSION: This study suggests that cheiloplasty and one-stage palatoplasty resulted in smaller growth of maxilla than cheiloplasty and two-stage palatoplasty in the linear measurements (T-T' and I-CC') and total area of the dental arches. CLINICAL RELEVANCE: Surgical protocols need to be evaluated to verify their effects aiming at improving the clinical practice of the interdisciplinary team, determining new parameters for the rehabilitation of individuals with cleft lip and palate.

Evaluation of enamel deproteinization in bond strength of orthodontic accessories: A split-mouth randomized clinical trial.

INTRODUCTION: This split-mouth randomized clinical trial aimed to evaluate the influence of dental enamel deproteinization with sodium hypochlorite on orthodontic accessories breakages using 2 orthodontic adhesives. METHODS: Forty patients with indications for orthodontic treatment with fixed appliances were randomly divided into 2 groups according to the orthodontic adhesive used: Transbond XT (3M Unitek, Monrovia, Calif) (n = 20) and Orthocem (FGM Dental Products, Joinville, Santa Catarina, Brazil) (n = 20). A split-mouth trial was conducted in the maxillary teeth; the deproteinization process with 5% sodium hypochlorite was performed on the experimental side. The opposite side served as a control without deproteinization. The primary outcome was the number of orthodontic accessories breakages. The randomization was performed using the BioStat software (AnalystSoft Inc, Walnut, Calif). Single-blind was applied for patients. Orthodontic accessories were bonded according to the manufacturer's instructions. The accessories breakages were followed during the first 6 months of treatment. Intergroup comparisons were performed with t tests and 1 and 2-way analysis of variance. RESULTS: Thirty-nine patients concluded the trial. The Transbond XT group comprised 20 patients (9 male, 11 female), with a mean age of 20.77 ± 6.44 years. The Orthocem group included 19 patients (9 male, 10 female), with a mean age of 23.14 ± 7.98 years. The application of sodium hypochlorite before bonding did not influence the number of orthodontic accessories breakages (P = 0.867). The type of adhesive used, associated or not with the deproteinization, did not affect the number of orthodontic accessories breakages (P = 0.929). CONCLUSIONS: Enamel deproteinization with 5% sodium hypochlorite did not impact the number of orthodontic accessories breakages. In addition, the 2 bonding adhesives used showed similar clinical results, with or without the enamel deproteinization. REGISTRATION: The trial was registered at ensaiosclinicos.gov.br, ReBEC (no. RBR-39ntmjk). PROTOCOL: The protocol was not published before trial commencement. FUNDING: This research did not receive any grant from funding agencies.

Gingival recession in mandibular anterior teeth in patients with Class II malocclusion treated with elastics and Twin Force appliance.

INTRODUCTION: This study aimed to compare the early results of gingival recession in patients with Class II malocclusion treated with Class II intermaxillary elastics and the Twin Force appliance. METHODS: The sample comprised 55 patients with Class II malocclusion treated without extraction and divided into 2 groups. Group 1 consisted of 23 patients treated with fixed appliances and Class II elastics, with mean initial age of 15.41 ± 5.65 years and a mean treatment time of 3.11 ± 0.91 years. Group 2 consisted of 32 patients treated with fixed appliances and the Twin Force mandibular protraction appliance, with a mean initial age of 18.45 ± 6.63 years and a mean treatment time of 3.17 ± 1.59 years. Dolphin software measured gingival recession in initial and final intraoral photographs. Initial and final lateral cephalograms were used to measure the position of the mandibular incisors. Intragroup and intergroup comparisons were performed by dependent and independent t tests, respectively. RESULTS: In both groups, there was no significant increase in gingival recession with orthodontic treatment, and there was significant protrusion and buccal inclination of the mandibular incisors. When changes with treatment were compared between the groups, there was no statistically significant difference in gingival recession and mandibular incisor position. CONCLUSIONS: There was no significant increase in gingival recession immediately after orthodontic treatment performed with intermaxillary elastics and the Twin Force appliance.

Smile attractiveness in class III patients after orthodontic camouflage or orthognathic surgery.

OBJECTIVE: The study's objective was to compare the smile attractiveness in patients with class III malocclusion treated with orthodontic camouflage or orthognathic surgery. MATERIAL AND METHODS: The sample consisted of 30 patients with class III malocclusion treated without extractions divided into two groups, according to the treatment performed: G1, orthodontic camouflage, consisting of 15 patients (9 female; 6 male) with mean initial age of 21.26 years (SD = 7.39) and mean final age of 24.52 years (SD = 7.10). The mean treatment time was 3.26 years (SD = 1.50). G2, ortho-surgical, consisting of 15 patients (8 females; 7 males), with mean initial age of 23.12 years (SD=7.37), mean final age of 25.82 years (SD = 7.14) and mean treatment time of 2.71 years (SD = 0.90). The smile attractiveness was evaluated in black and white photographs of posed smiles taken before and after treatment, with a numerical rating scale from 1 to 10, with 1 being the least attractive and 10 the greatest smile attractiveness. The smiles were evaluated in a questionnaire by 111 participants, 67 orthodontists (mean age 41.31 years, SD = 9.44) and 44 laypeople (mean age 41.41 years, SD = 14.38). Intergroup comparison was performed with independent t test. RESULTS: There was a significant improvement in the smile attractiveness with both camouflage and ortho-surgical treatments. The smile attractiveness was similar between the camouflage and surgical groups at the beginning. There was a significantly greater improvement in smile attractiveness with treatment in the surgical group than in the camouflage group, and at the end of treatment, the surgical group showed greater smile attractiveness than the camouflage group. Orthodontists considered the smiles more attractive both at the beginning and the end of treatment when compared to the assessment made by laypeople. CONCLUSION: The ortho-surgical treatment promoted a greater improvement in the smile attractiveness, and at the final stage, a greater smile attractiveness than the orthodontic camouflage. CLINICAL RELEVANCE: Smile attractiveness is an important characteristic of the final result of orthodontic treatment. Knowing which treatment protocol will provide a better improvement and outcome regarding smile esthetics is essential.

Maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion.

INTRODUCTION: The objective of the present study was to compare the maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion (MARPE). METHODS: The sample comprised 37 patients with Class I malocclusion treated without tooth extraction, divided into 2 groups: group 1 comprises 21 patients with a mean age of 19.55 years (standard deviation = 1.31), submitted to orthodontic treatment with Damon self-ligating appliance, and evaluated until the end of the alignment and leveling stage. Group 2 comprises 16 patients with a mean age of 24.92 years (standard deviation = 7.60), with maxillary atresia, who underwent MARPE, and were evaluated after the removal of the expander. Buccal bone thickness; dental inclinations; and transverse distances of the maxillary arch, nasal base, and jugula widths were measured on cone-beam computed tomography scans before and after treatment. The intergroup comparison was performed with the independent t test. RESULTS: With treatment, there was a significantly greater decrease in buccal bone thickness of canines and premolars in the self-ligating group, the premolars presented a greater buccal inclination in the self-ligating group, and the intercanine and intermolar distances and nasal base and jugula widths showed significantly greater increases in the MARPE group than in the self-ligating group. CONCLUSIONS: MARPE treated more severe skeletal transverse maxillary discrepancies and obtained better results than self-ligating appliances in terms of buccal bone loss, tooth inclination, and transverse skeletal increase of the maxilla. MARPE presented more skeletal effects and self-ligating appliances, more dental effects.

Impact of coronavirus pandemic in appointments and anxiety/concerns of patients regarding orthodontic treatment.

OBJECTIVE: To evaluate the impact of the coronavirus pandemic and the quarantine in orthodontic appointments, and patients' anxiety and concerns about their ongoing orthodontic treatment. SETTINGS AND SAMPLE POPULATION: Patients from private dental clinics of two orthodontists that were undergoing active orthodontic treatment. MATERIAL AND METHODS: An online anonymous questionnaire regarding their anxiety about the coronavirus situation, availability/acceptance to attend an appointment, among others, was answered by orthodontic patients. Descriptive statistics with percentages was performed and responses were compared between sexes, cities, and association of the feelings/level of anxiety of patients and willingness to attend an appointment were performed with chi-square, independent t test, one-way ANOVA and Tukey's tests. RESULTS: The questionnaire was answered by 354 patients (231 female; 123 male) with mean age of 35.49 years. Most patients are respecting the quarantine, 44.7% related to be calm and 46.3% afraid or anxious. The level of anxiety was greater for females than males. There was significant association of the level of anxiety and the willingness to attend an appointment. The greatest concern of patients was delay in the end of treatment. CONCLUSION: The quarantine and coronavirus pandemic showed to have impact on orthodontic appointments and patients' anxiety. Patients willing to attend an orthodontic appointment presented significantly lower level of anxiety than patients that would not go or would go only in urgency/emergency. Females were more anxious than males about coronavirus pandemic, quarantine and impact on their orthodontic treatments. Delay in treatment was the greatest concern of patients undergoing orthodontic treatment.

Evaluation of the influence of mandibular third molars on mandibular anterior crowding relapse.

Objective: To evaluate the influence of mandibular third molars on relapse of mandibular anterior crowding in orthodontically treated patients.Material and Methods: Sample included orthodontic records of 108 patients: Group 1: 72 patients (39 female; 33 male) with third molars present in the postretention evaluation stage. Group 2: 36 patients (18 female; 18 male) who did not present the third molars in the postretention evaluation stage. Panoramic radiographs and dental models were evaluated at three different stages: pre-treatment; posttreatment and postretention. Panoramic radiographs showed the presence or absence of third molars in the 3 evaluated stages and on the dental models, overbite and mandibular anterior crowding was measured by the Little Irregularity Index. For intergroup comparisons, t-tests and a multifactorial regression analysis were used.Results: There was no statistically significant difference in the relapse of mandibular anterior crowding among the groups with and without mandibular third molars at the postretention stage.Conclusion: The presence or absence of mandibular third molars did not influence the relapse of mandibular anterior crowding in orthodontically treated patients.

Urgencies and emergencies in orthodontics during the coronavirus disease 2019 pandemic: Brazilian orthodontists' experience.

INTRODUCTION: The present study aimed to evaluate the most common urgencies and emergencies in orthodontics during the coronavirus disease 2019 (COVID-19) pandemic and to assess how orthodontists in Brazil were dealing with patients and challenges. METHODS: Early in 2020, as the COVID-19 pandemic spread around the world, routine dental care was suspended in many countries, and only patients needing urgent or emergency care could be seen. During this period, orthodontists in Brazil were invited to participate in an anonymous online survey. Over 48 hours (May 1-3, 2020), 395 orthodontists (specialists, MScs, and PhDs) responded. They answered questions regarding dental office and appointments during the pandemic, the type of urgency or emergency care provided, the type of appliance and urgencies, etc. The level of concern about the impact of the pandemic on patients' orthodontic treatments and the financial impact on the dental office was also evaluated. Descriptive statistics were performed with percentages, and responses were compared between specialists, MScs, and PhDs, using chi-square tests. RESULTS: Specialists were the majority of respondents. Most orthodontists were handling only emergencies or urgencies. The most frequent urgencies were bracket breakage, archwire breakage, and breakage of molar tubes and/or bands. Stainless steel fixed appliances were the most common type of appliance related to unscheduled appointments. The majority of patients got in touch with the orthodontist using the professional WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif). Orthodontists were more concerned with the financial impact of the pandemic than with the orthodontic treatment itself. CONCLUSIONS: Breakage of brackets, archwires, or tubes and/or bands were the most common causes of urgency and/or emergency appointments during the pandemic. The level of concern about the financial impact of the stay-at-home orders and the COVID-19 pandemic was significantly greater for specialists and MScs than for PhDs.

Analysis of Dental Arch in Children With Oral Cleft Before and After the Primary Surgeries.

This study aimed to evaluate longitudinally the alteration of the dental arch dimensions of children with different oral cleft types, before and after the primary surgeries. Three-dimensional images of the maxillary dental casts of children with unilateral complete cleft lip (G1), unilateral complete cleft lip and palate (G2), and cleft palate (G3). The children were evaluated at pre-cheiloplasty (T1), pre-palatoplasty (T2), and 1 year after palatoplasty (T3). The measurements obtained: intercanine (C-C') and intertuberosity (T-T') distances, anterior (I-CC') and total (I-TT') arch lengths. To analyze the intraexaminer error, paired t-test was applied and Dahlbergh formula. The intragroups comparisons were applied: paired t-test, ANOVA followed by Tukey, Wilcoxon test, and Kruskal-Wallis test followed by Dunn test. The intergroup comparisons were performed by independent t-test and Mann-Whitney test. In G1, the C-C', T-T', and the I-TT' distances revealed a significant increase of the maxilla. In G2, the C-C' distance statistically decreased from T1 to T3, T-T' distance showed statistical increase from T1 to T3. The I-TT' length increased with statistically significant differences between T1 and T3, T2 and T3. In G3, the C-C', T-T', and I-TT' distance increased was statistically significant. The longitudinal evaluation of the changes occurred in the dental arches with different oral cleft types showed that cheiloplasty and palatoplasty caused the most alterations in the development of the maxillary dimensions of children with complete cleft lip and palate.

Prevalence of extraction space reopening in different orthodontic treatment protocols.

INTRODUCTION: In this study, we aimed to compare the amount and frequency of extraction space reopening after 2- and 4-premolar extraction treatments in Class II and 4-premolar extractions in Class I malocclusion patients. METHODS: The sample comprised 105 subjects with full-cusp Class II and Class I malocclusions, divided into 3 groups. Group 1 consisted of 33 full-cusp Class II malocclusion patients treated with a 2-premolar extraction protocol. Group 2 had 34 full-cusp Class II malocclusion patients treated with 4-premolar extractions, and group 3 included 38 Class I malocclusion patients treated with 4-premolar extractions. The Peer Assessment Rating index was used to assess initial malocclusion severity and quality of the occlusal outcome, measured on dental casts. The amounts of extraction spaces were measured with a digital caliper on the final and long-term posttreatment dental casts, after an average of 9.79 years posttreatment. Intergroup comparisons were performed by analysis of variance, followed by Tukey tests and chi-square tests. RESULTS: There were no significant differences regarding the amount and frequency of extraction space reopening among the groups. CONCLUSIONS: Two- and 4-premolar extractions in Class II and 4-premolar extraction treatment in Class I malocclusion patients show similar reopening of extraction spaces in the long term.

Comparison of smile attractiveness in cases with gummy smile treated with botulinum toxin and maxillary impaction surgery: A retrospective study.

This study aimed to compare the smile's attractiveness in patients submitted to the treatment of gummy smiles with botulinum toxin or maxillary impaction surgery. The retrospective sample comprised 26 patients divided into two groups: Group 1 (BTX): 13 patients (12 females and 1 male) with a mean age of 28.06 years (s.d. = 6.09) and mean gingival exposure during smile of 5.18 mm (s.d. = 1.51) treated with botulinum toxin; Group 2 (SURGICAL): 13 patients (9 females and 4 males) with a mean age of 30.59 years (s.d. = 5.72) and mean gingival exposure during smile of 5.21 mm (s.d. = 1.55) treated with orthognathic maxillary impaction surgery. The group of evaluators comprised 317 participants, divided into 143 orthodontists (85 females and 58 males) with a mean age of 41.40 (s.d. = 9.30); 62 dentists (47 female and 15 male) with a mean age of 35.44 (s.d. = 10.44), and 112 lay people (74 female and 38 male) with a mean age of 46, 91 (s.d. = 10.11) in a questionnaire on Google Forms. Without knowing the therapy used, the evaluators assigned scores to the photographs of the posed smile taken before (T1) and after (T2) treatment. Intergroup comparison of smile attractiveness was performed using the t-independent, one-way ANOVA, and Tukey tests. There was a significant improvement in smile attractiveness with treatment in both groups; however, the improvement was significantly better in the surgical group than in the BTX group. Orthodontists rated smile attractiveness significantly higher than dentists and laypersons for the final phase of the BTX and surgical groups. There was a significant improvement in the smile attractiveness with botulinum toxin application and orthodontic-surgical treatment. However, orthognathic surgery promoted a greater improvement in smile attractiveness than the application of botulinum toxin.

Incisors' bone height and inclination changes after orthodontic treatment with a self-ligating passive system.

Background: This study aimed to evaluate changes in the alveolar buccal bone height of maxillary and mandibular incisors after orthodontic treatment with a self-ligating passive system and to assess the correlation between bone height and incisor inclination. Material and Methods: Pre (T1) and post-treatment (T2) cone-beam computed tomography images of patients treated with the Damon 3MX appliance system were measured to quantify the alveolar buccal bone height of the maxillary incisors. The incisor's inclination was measured in digital models. Paired t-test was used to evaluate the changes between T1 and T2, and Pearson's coefficient was used to test the correlation. Results: All teeth presented statistically significant alveolar buccal bone loss at T2. A statistically significant buccal inclination was observed only for the lower left lateral incisors. There was no correlation between bone height changes and incisor inclination. Conclusions: Orthodontic treatment with a self-ligating passive system showed changes in alveolar height, but these changes were not correlated with incisor inclination. Key words:Passive self-ligating brackets, orthodontics, corrective, treatment outcome, alveolar bone loss.