Comparação da degradação da força de elásticos ortodônticos intermaxilares de látex e sintéticos quando submetidos à distensão em saliva artificial / Comparison of force degradation intermaxilary latex and synthetic orthodontic elastics distended in artificial saliva

Introdução: os elásticos intermaxilares sintéticos surgiram como uma alternativa para uso ortodôntico em pacientes com sensibilidade ao látex, porém, diferenças podem ser observadas quando comparados aos elásticos naturais de látex. Objetivo: comparar a quantidade de degradação de força dos elásticos intermaxilares sintéticos e de látex quando distendidos em saliva artificial, a fim de buscar parâmetros clínicos para o uso de um protocolo sobre a frequência de troca desses elásticos nas terapias ortodônticas em pacientes com sensibilidade ao látex ou não. Metodologia: foram utilizados dois grupos contendo 30 elásticos cada. O grupo 1 com 30 elásticos de látex da marca Morelli de força média e diâmetro de 5/16" e o grupo 2, 30 elásticos sintéticos, sem látex, também da marca Morelli de força média e diâmetro de 5/16". Eles foram distendidos 4cm e submersos em saliva artificial a 37 graus Celsius e tiveram força mensurada com dinamômetro ortodôntico ao início e nos intervalos de 24, 48, 72 e 120 horas após a imersão. A avaliação da degradação da força foi realizada calculando o percentual de força perdida em relação à força inicial em cada intervalo de tempo, para cada grupo testado separadamente e também entre eles. Resultados e Discussão: a média de valores dos elásticos tanto de silicone quanto de látex teve um percentual parecido quanto à degradação de forças, visto que após as primeiras 24 horas ocorreu o maior declínio de força, de aproximadamente 11% ambos os elásticos. Após 48 horas esse percentual não se alterou significativamente. Conclusão: elásticos devem ser trocados em até 48 horas para que a força aplicada se mantenha em índices aceitáveis.

Introduction: synthetic intermaxillary elastics have emerged as an alternative for orthodontic use in patients with latex sensitivity, but differences can be observed when compared to natural latex elastics. Objective: compare the amount of force degradation of synthetic intermaxillary elastics and latex when distended in artificial saliva in order to find clinical parameters for the use of a protocol on the frequency of exchange of these elastics in orthodontic therapies in patients with latex sensitivity or not. Method: for this, two groups containing 30 elastics were used. Group 1 with 30 medium strength and diameter 5/16 "Morelli latex elastics and group 2, 30 synthetic latex-free elastics, also of the medium strength and 5/16" diameter Morelli brand. They were stretched 4cm and submerged in artificial saliva at 37 degrees Celsius and had strength measured with orthodontic dynamometer at the beginning and at the intervals of 24, 48, 72 and 120 hours after immersion. The force degradation assessment was performed by calculating the percentage of force lost in relation to the initial force at each time interval, for each group tested separately and also between them. Results and discussion: the mean elastic values of both silicone and latex had a similar percentage for the degradation of forces, since after the first 24 hours the greatest force decline occurred, of approximately 11% both elastics. After 48 hours this percentage did not change significantly. Conclusion: elastics should be changed within 48 hours so that the force applied remains at acceptable rates.

Tomographic Analysis of the Impact of Mandibular Advancement Surgery on Increased Airway Volume.

PURPOSE: This study aimed to quantify, using cone-beam computed tomography (CBCT) in patients who underwent a mandibular advancement surgery associated with genioplasty, three-dimensional changes in airway space and to evaluate whether these changes differ between men and women. MATERIALS AND METHODS: Preoperative and 8-month postoperative CBCT scans of 38 patients aged 18-45 years of either sex and any ethnicity who underwent mandibular advancement surgery associated with genioplasty were analyzed using the Xoran software (Xoran Technologies, Ann Arbor, MI, USA). The linear distances gonion-gnathion (Go-Gn) and condylion-menton (Co-Me) were obtained. Airway volume was measured using the Dolphin Imaging software, version 11.0. Then, data were tabulated and analyzed using Student's t-test. RESULTS: Mean patient age was 30.3 years; 39.47% were men and 60.63% were women. The mean Go-Gn distance was 72.05 mm before surgery and 78.56 mm after surgery, with a mean gain of 6.51 mm. The mean Co-Me distance was 113.47 mm before surgery and 119.89 mm after surgery, with a mean increase of 6.42 mm. Both differences were statistically significant. The mean volume of airway space was 17,272.92 mm3 before surgery and 24,173.74 mm3 after surgery, with a statistically significant mean increase of 6900.82 mm3. There was no statistically significant difference in mean volumetric gain between men (7566.69 mm3) and women (7456.69 mm3). CONCLUSION: Mandibular advancement surgery results in significant increase of airway space, and there is no difference in airway volume between men and women.

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.

Comparative study of root resorption of maxillary incisors in patients treated with lingual and buccal orthodontics.

OBJECTIVE: To compare the magnitude of external apical root resorption (EARR) of maxillary incisors in patients with mild to moderate anterior crowding, treated with lingual and conventional (labial) orthodontics. MATERIALS AND METHODS: The sample comprised 40 patients divided into two groups: lingual (20 patients) and conventional buccal brackets (20 patients). Patient ages ranged from 11 to 45 years, and the study included 12 men and 28 women. Apical root resorption was measured from periapical radiographs obtained at the beginning of treatment (T1) and at the end of the leveling phase (T2). Periapical radiographs were scanned and transferred to the CorelDraw X7 image-processing program, in which measurements of root lengths were performed. For intragroup and intergroup comparisons between the T1 and T2 phases, paired and independent t-tests, respectively, were used at 5% significance. RESULTS: There was significant apical root resorption for all teeth evaluated; the magnitude of the EARR (T2-T1) ranged from -0.35 mm to -0.63 mm in the lingual group, and from -0.66 mm to -0.85 mm in the conventional group. Although there was an intergroup variation in the magnitude of EARR observed, no statistically significant differences were found. Neither group presented any teeth with resorption ≥1 mm. CONCLUSIONS: The magnitude of apical root resorption in maxillary incisors in patients with anterior crowding was similar regardless of orthodontic technique, lingual or conventional. Both techniques resulting in an apical rounding considered clinically insignificant.

Evaluation of facial attractiveness in black people according to the subjective facial analysis criteria.

OBJECTIVE: The objective of this study was to evaluate the facial attractiveness in 30 black individuals, according to the Subjective Facial Analysis criteria. METHODS: Frontal and profile view photographs of 30 black individuals were evaluated for facial attractiveness and classified as esthetically unpleasant, acceptable, or pleasant by 50 evaluators: the 30 individuals from the sample, 10 orthodontists, and 10 laymen. Besides assessing the facial attractiveness, the evaluators had to identify the structures responsible for the classification as unpleasant and pleasant. Intraexaminer agreement was assessed by using Spearman's correlation, correlation within each category using Kendall concordance coefficient, and correlation between the 3 categories using chi-square test and proportions. RESULTS: Most of the frontal (53. 5%) and profile view (54. 9%) photographs were classified as esthetically acceptable. The structures most identified as esthetically unpleasant were the mouth, lips, and face, in the frontal view; and nose and chin in the profile view. The structures most identified as esthetically pleasant were harmony, face, and mouth, in the frontal view; and harmony and nose in the profile view. The ratings by the examiners in the sample and laymen groups showed statistically significant correlation in both views. The orthodontists agreed with the laymen on the evaluation of the frontal view and disagreed on profile view, especially regarding whether the images were esthetically unpleasant or acceptable. CONCLUSIONS: Based on these results, the evaluation of facial attractiveness according to the Subjective Facial Analysis criteria proved to be applicable and to have a subjective influence; therefore, it is suggested that the patient's opinion regarding the facial esthetics should be considered in orthodontic treatmentplanning.

Esthetic perceptions of facial silhouettes after treatment with a mandibular protraction appliance.

INTRODUCTION: In this retrospective study, we aimed to evaluate the effects on the facial silhouettes produced by a mandibular protraction appliance associated with corrective treatment in Class II patients. METHODS: The sample consisted of 54 (27 initial and 27 final) lateral radiographs from 27 patients. Of these patients, 14 were girls and 13 were boys, with a mean initial age of 12.27 years and a mean treatment period of 2.9 years. An album containing the silhouettes of the pretreatment and posttreatment profiles based on the lateral cephalograms of the patients was prepared. Then, 60 orthodontists and 60 laypeople chose the more esthetic facial silhouette (A or B) and the amount of alterations they perceived between the 2 silhouettes, according to a visual analog scale. A paired t test was used to compare the 2 groups of evaluators with a 5% significance level. RESULTS: Differences between the preferences regarding the pretreatment and posttreatment facial silhouettes were statistically significant for both groups. The posttreatment silhouettes were preferred by most evaluators. The visual analog scale scores showed that the lay evaluators identified greater differences between the pretreatment and posttreatment silhouettes than did the orthodontists (P <0.001). CONCLUSIONS: Based on the evaluators' judgments, treatment with the mandibular protraction appliance had a positive effect on the facial silhouette, and the laypeople better perceived this effect.

Evaluation of facial attractiveness in black people according to the subjective facial analysis criteria

ABSTRACT Objective: The objective of this study was to evaluate the facial attractiveness in 30 black individuals, according to the Subjective Facial Analysis criteria. Methods: Frontal and profile view photographs of 30 black individuals were evaluated for facial attractiveness and classified as esthetically unpleasant, acceptable, or pleasant by 50 evaluators: the 30 individuals from the sample, 10 orthodontists, and 10 laymen. Besides assessing the facial attractiveness, the evaluators had to identify the structures responsible for the classification as unpleasant and pleasant. Intraexaminer agreement was assessed by using Spearman's correlation, correlation within each category using Kendall concordance coefficient, and correlation between the 3 categories using chi-square test and proportions. Results: Most of the frontal (53. 5%) and profile view (54. 9%) photographs were classified as esthetically acceptable. The structures most identified as esthetically unpleasant were the mouth, lips, and face, in the frontal view; and nose and chin in the profile view. The structures most identified as esthetically pleasant were harmony, face, and mouth, in the frontal view; and harmony and nose in the profile view. The ratings by the examiners in the sample and laymen groups showed statistically significant correlation in both views. The orthodontists agreed with the laymen on the evaluation of the frontal view and disagreed on profile view, especially regarding whether the images were esthetically unpleasant or acceptable. Conclusions: Based on these results, the evaluation of facial attractiveness according to the Subjective Facial Analysis criteria proved to be applicable and to have a subjective influence; therefore, it is suggested that the patient's opinion regarding the facial esthetics should be considered in orthodontic treatmentplanning.

RESUMO Objetivo: avaliar, quanto à agradabilidade facial, uma amostra de 30 indivíduos negros, de acordo com os critérios da Análise Facial Subjetiva. Métodos: fotografias frontais e de perfil de 30 indivíduos negros foram avaliadas quanto à agradabilidade facial e classificadas como esteticamente desagradáveis, aceitáveis ou agradáveis, por 50 avaliadores, sendo: 30 indivíduos da amostra, 10 ortodontistas e 10 leigos. Além de avaliar a agradabilidade facial, os avaliadores tiveram que identificar as estruturas responsáveis pela classificação como desagradável ou agradável. A concordância intraexaminador foi avaliada por meio da correlação de Spearman. Já a correlação dentro de cada categoria foi analisada por meio do coeficiente de concordância de Kendall, e a correlação entre as três categorias foi estabelecida por meio dos testes qui-quadrado e de proporção. Resultados: a maioria das fotografias frontais (53,5%) e de perfil (54,9%) foi classificada como esteticamente aceitável. As estruturas mais identificadas como esteticamente desagradáveis foram: boca, lábios e rosto, na fotografia frontal; e nariz e queixo, na fotografia de perfil. As estruturas mais identificadas como esteticamente agradáveis foram: harmonia, rosto e boca, na fotografia de frente; e harmonia e nariz, na de perfil. As avaliações realizadas pelos examinadores nos grupos amostra e leigos mostraram uma correlação estatisticamente significativa em ambas as posições. Os ortodontistas concordaram com os leigos sobre a avaliação na perspectiva frontal e discordaram sobre a de perfil, especialmente no que diz respeito às imagens consideradas esteticamente desagradáveis ou aceitáveis. Conclusões: com base nesses resultados, a avaliação da agradabilidade facial, de acordo com critérios da Análise Facial Subjetiva, provou ser aplicável e ter uma influência subjetiva. Assim, sugere-se que a opinião do paciente sobre a estética facial seja considerada no planejamento do tratamento ortodôntico.

Efeitos dentoalveolares da correção da classe ii por meio dos elásticos intermaxilares / Dentoalveolar effects of class ii correction with intermaxillary elastics

Os elásticos intermaxilares promovem a correção da Classe II por meio de efeitos dentoalveolares. Portanto conhecer os efeitos provocados na utilização dos elásticos intermaxilares é imprescindível para obtenção de melhores resultados, de forma a se favorecer dos efeitos ocorridos ou ainda controlar a movimentação não desejada. O objetivo deste trabalho foi relatar o tratamento de uma má oclusão de ¾ de Classe II utilizando elásticos intermaxilares. Por meio de um minucioso diagnóstico e adequado controle da mecânica ortodôntica foi possível observar correção satisfatória da má oclusão inicial.(AU)

The intermaxillary elastics promote a Class II correction through dentoalveolar effects. Therefore to know the effects caused by the use of intermaxillary elastics is essential to obtain better results, in order to benefit from the effects or to control unwanted movement. The aim of this study was to report the treatment of a Class II malocclusion using intermaxillary elastics. Through a meticulous diagnosis and adequate control of orthodontic mechanics it was possible to observe a satisfactory correction of the initial malocclusion.(AU)

Orthodontic Protocol Using Mini-Implant for Class II Treatment in Patient with Special Needs.

Improving facial and dental appearance and social interaction are the main factors for special needs (SN) patients to seek orthodontic treatment. The cooperation of SN patients and their parents is crucial for treatment success. Objective. To show through a case report the satisfactory results, both functional and esthetic, in patients with intellectual disability, congenital nystagmus, and severe scoliosis. Materials Used. Pendulum device with mini-implants as anchorage unit. Results. Improvement of facial and dental esthetics, correction of Class II malocclusion, and no root resorption shown in the radiographic follow-up. Conclusion. Knowing the limitations of SN patients, having a trained team, motivating and counting on the cooperation of parents and patients, and employing quick and low-cost orthodontic therapy have been shown to be the essential factors for treatment success.

Tratamento atípico da biprotrusão dentoalveolar / Atipical treatment of dentoalveolar biprotrusion ­ a case report

A biprotrusão dentoalveolar é caracterizada pelo posicionamento mais anterior dos incisivos superiores e inferiores, o que traz como consequência um selamento labial deficiente e um perfil convexo, comprometendo a estética facial do paciente e fazendo com que este busque no tratamento ortodôntico a sua correção. O plano de tratamento destes casos, na sua maioria, envolve a realização de extrações, porém, quando já previamente ao tratamento o paciente apresenta ausências dentárias, o planejamento é simplificado, já que a retração anterior necessária pode ser direcionada para estes espaços sem que haja necessidade de extrações nestas regiões. O objetivo deste trabalho foi apresentar um caso clínico que promoveu a correção da biprotrusão e, consequentemente, da estética do sorriso e facial da paciente, através da realização da exodontia de apenas dois primeiros pré-molares superiores e retração anteroinferior redirecionada para os espaços já existentes, em consequência da perda do molar inferior esquerdo e devido à agenesia do incisivo lateral inferior direito. Além disso, no controle de sete anos pós-tratamento, observou-se estabilidade oclusal e manutenção da estética facial.

Dental biprotrusion is characterized by greater buccal tipping of the upper and lower incisors, rendering poor lip closure and convex profile, compromising the patient's facial esthetics and making him/her to seek orthodontic treatment for correction. In these cases the treatment plan, mostly involves performing extractions, but when already prior to treatment the patient has missing teeth, the treatment plan becomes simplified, since the anterior retraction required might be directed to these areas with no need for removal. The goal of this study is to show a case that promoted the correction of biprotrusion and consequently the patient smile and facial esthetics by performing the extraction of only two first maxillary premolars and anterior retraction redirected for the existing spaces as a result of the mandibular left molar loss and due to agenesis of the right lateral incisor. In addition, the 7-year follow-up control demonstrated occlusal stability and maintenance of the facial esthetics.

Motivação dos pacientes para o tratamento ortodôntico / Patients motivation for orthodontic treatment

Os objetivos desta pesquisa consistiram em examinar os motivos que levaram os pacientes à busca de tratamento ortodôntico, e determinar se há influência da idade e sexo. A amostra constitui-se de 250 pacientes entre nove a 59 anos de idade, sendo 144 do sexo feminino e 106 do masculino, em fase ativa de tratamento ortodôntico fixo. Os pacientes foram divididos em dois grupos de acordo com a faixa etária: grupo dos jovens, de nove a 16 anos; e dos adultos, de 19 a 59 anos de idade. Estes responderam a um questionário, e suas respostas foram analisadas pela estatística indutiva, por meio do teste Qui-quadrado. Os resultados mostraram que a maioria dos pacientes busca pelo tratamento ortodôntico por que reconhecem que possuem má-oclusão (42,4%), sendo que os adultos (24,4%) citaram mais frequentemente esse motivo do que os jovens (18%). O segundo motivo apontado foi a busca pela melhora da aparência (24%), evidenciando diferenças entre as faixas etárias avaliadas, em que 15,6% dos adultos atribuíram o tratamento ortodôntico a razões estéticas. Os jovens apontaram a influência de um dentista ou outro profissional da saúde (9,6%) como o segundo motivo na busca de um tratamento ortodôntico. A porcentagem de pacientes, cuja decisão de se submeter ao tratamento foi direcionada pelos seus pais, diminuiu com o aumento da idade. Foi possível identificar os principais motivos que levam o paciente a buscar um tratamento ortodôntico, ressaltando a importância de se conhecer a queixa de acordo com a faixa etária, para alcançar resultados de excelência que atendam suas expectativas.

To assess patients' motivation seeking orthodontic treatment and its association with age and gender. The sample consisted of 250 patients from 9 to 59 years-old, 144 female and 106 male, in active phase of orthodontic treatment. Patients were divided into two groups according to age, being young people from 9-16 years and adults from 19-59 years old. They answered a questionnaire to assess the motivation for orthodontic treatment and their responses were analyzed by frequency distribution and percentage. The inductive statistics, by Chi-square test was used to determine association between age, gender and motivation for orthodontic treatment. The results showed that the majority of patients seek orthodontic treatment because they are aware of malocclusion (42.4%); adults (24.4%) cited more often this reason than young people (18%). The second reason was to improve their appearance (24%); and differences between age groups were observed, where 15.6% of adults attributed orthodontic treatment for aesthetic reasons. The young group showed the influence of a dentist or other healthcare provider (9.6%) as the second reason in the search for orthodontic treatment. The percentage of patients whose decision to undergo treatment was directed by their parents decreased with increasing age. It was possible to identify the main reasons for patients seeking orthodontic treatment emphasizing the importance to understand their chief complaint according to age, to achieve excellent results that meet their expectations.

Impact of orthodontic treatment on self-esteem and quality of life of adult patients requiring oral rehabilitation.

OBJECTIVE: To evaluate whether orthodontic treatment in adults requiring oral rehabilitation is effective for increasing patients' self-esteem and quality of life (QoL). MATERIALS AND METHODS: The sample consisted of 102 adult patients (77 women and 25 men) aged between 18 and 66 years (mean, 35.1 years) requiring oral rehabilitation and orthodontic treatment simultaneously. Rosenberg's Self-Esteem (RSE) Scale and a questionnaire about QoL based on the Oral Health Impact Profile (OHIP-14) were used to determine self-esteem and QoL scores retrospectively. Questionnaires were carried out in two stages, T1 (start of treatment) and T2 (6 months after). To compare score changes between T1 and T2, the data obtained from the RSE Scale were evaluated with paired t tests, and data from the quality-of-life questionnaire were assessed by applying descriptive statistics. RESULTS: The results showed a statistically significant increase in self-esteem (P < .001) and a great improvement on patients' QoL. CONCLUSIONS: Orthodontic treatment causes a significant increase in self-esteem and QoL, providing psychological benefits for adult patients in need of oral rehabilitation.

Avaliação do índice de insucesso em relação à estabilidade de mini-implantes no tratamento ortodôntico / Miniscrew failure rate in orthodontic treatment

O objetivo deste estudo foi avaliar o índice de insucesso quanto à estabilidade de mini-implantes, utilizados como ancoragem no tratamento ortodôntico e seus fatores. Para isso, foram selecionados aleatoriamente pacientes em três cursos de pós-graduação e em uma clínica privada, que utilizaram mini-implantes em alguma fase do tratamento ortodôntico. Foram analisados 282 mini-implantes de quatro marcas comerciais (Morelli, SIN, Neodent e Conexão) utilizados em 127 pacientes: 84 do sexo feminino e 43 do masculino, com média de idade de 38,88 anos. Foram analisados, dez variáveis que poderiam influenciar a estabilidade dos mini-implantes como a idade do paciente, o sexo, a base óssea, lado, tecido gengival, mecânica utilizada e a aplicação da força imediata, a marca e o comprimento do dispositivo e a proximidade com a raiz. Para avaliar a influência da idade do paciente na estabilidade do mini-implante foi utilizado o teste t, para avaliar a variável tecido gengival foi utilizado o teste exato de Fisher unilateral. As demais variáveis foram analisadas por meio do teste qui-quadrado. A média geral de insucesso foi de 12,76%. As variáveis comprimento do mini-implante e proximidade com a raiz mostraram influência estatisticamente significante nas taxa de insucesso. Concluiu-se que a instalação de mini-implantes entre raízes apresenta um índice de insucesso significantemente maior do que em área edêntula...

The aim of this study was to evaluate the failure rate in the stability of miniscrews used as anchorage in orthodontic treatment. Sample was randomly selected from three graduate courses and a private practice which used miniscrews at some stage of orthodontic treatment. In total, 282 miniscrews of 4 commercial brands (Morelli, SIN, Neodent and Connection) used in 127 patients (84 female and 43 male, with mean age of 38.88 years). Ten variables were considered when assessing miniscrew stability (age, gender, mini-implant length, brand, apical base, side, gingival tissue, root proximity and mechanical force applied). To evaluate the influence of patient age in the miniscrew stability, t test was used. All other variables were analyzed using the chi-square test. The overall average failure was 12.76%. The variables mini-implant length and root proximity showed statistically significant influence on the failure rate. It was concluded that miniscrews placed between roots present with a significantly higher failure rate than in edentulous area...

Tratamento multidisciplinar em paciente com má-oclusão de Classe II e comprometimento periodontal / Multidisciplinary treatment of a patient with Class II malocclusion and periodontal commitment

Devido às sequelas deixadas pela doença periodontal, um número maior de pacientes adultos tem procurado tratamento ortodôntico, seja por motivos estéticos, funcionais ou encaminhados por outras especialidades para melhorar a oclusão e a qualidade de vida. O objetivo deste trabalho foi apresentar o tratamento ortodôntico de um paciente adulto com pouco suporte ósseo, diastemas anteriores generalizados e ausência de dentes posteriores,o que causou um colapso oclusal. Após o controle da doença periodontal e uma rigorosa higiene bucal, realizou-se uma biomecânica simples por meio de forças leves, o que proporcionou melhora do defeito ósseo em algumas regiões, posicionando as raízes paralelamente a fim de possibilitar a reabilitação bucal com implantes e próteses. Ao final dos resultados, comprovou-se que é possível tratar ortodonticamente pacientes adultos com pouco suporte ósseo e melhorar a estética do sorriso, devolver a função, facilitar a higiene bucal e diminuir defeitos ósseos. Para tanto, é imprescindível um protocolo multidisciplinar, orientação ao paciente quanto às limitações do tratamento e à importância da proservação.

Due to the sequel caused by periodontal disease, a greater number of adult’s patients are seeking for orthodontic treatment, whether for aesthetic, functionality or referred by other specialties to improve the occlusion and quality of life. The aim of this work is to show orthodontic treatment in adult’s patient with little bone support with generalized previous interdental spaces and absence of posterior teeth, which caused an occlusal collapse. After periodontal disease control and a rigorous oral hygiene, was performed an easy biomechanics with light forces, which provided an improvement of other bone defects in some regions, positioning the root parallel, to enable oral rehabilitation with implants and prostheses. At the end the results it was proved that is possible to treat adult orthodontic patients with little bone support, aiming to improve the aesthetics, restore function, facilitate oral hygiene and reduce bone defects. Therefore, it is essential multidisciplinary protocol, patient education about the limitations of treatment and the importance of preservation.

Tratamento ortodôntico com extração de um canino impactado / Orthodontic treatment witn an impacted canine extraction

O presente relato clínico apresenta uma alternativa para o tratamento de um canino impactado. Considerando a má oclusão inicial, a idade do paciente e a localização desfavorável do canino, optou-se pela extração de três pré-molares e do dente impactado, a fim de corrigir a discrepância dentária e restabelecer uma oclusão adequada. O tratamento de escolha não prejudicou o perfil facial e proporcionou melhora oclusal, assim como a harmonia dos dentes e da face ao final da correção.

This clinical report presents an alternative for the treatment of an impacted canine. Considering the initial malocclusion, patient age, and unfavorable location of the canine, we opted for the extraction of three premolars and the impacted tooth in order to correct the dental discrepancy and restore a proper occlusion. The treatment of choice did not affect the facial profile and provided an occlusal improvement as well as the harmony of the teeth and face the end of correction.

Verticalização e mesialização de molar inferior com ancoragem em mini-implante / Mandibular molar uprighting and mesialization with mini-implant anchorage

A perda dos primeiros molares inferiores é um problema muito frequente, assim como a procura por tratamento ortodôntico com a intenção de se fechar os espaços dos dentes ausentes. Este trabalho tem como objetivo apresentar um caso clínico em que foi realizada a verticalização e mesialização de molares inferiores com ancoragem absoluta por meio de mini-implante associado à braços de força feitos com fios de TMA e elástico corrente. Foi demonstrado que é possível realizar o fechamento dos espaços desde que o paciente apresente condições biológicas favoráveis, eliminando assim, a necessidade de reabilitações protéticas.

Mandibular first molars loss is a very common problem, as the demand for orthodontic treatment with the intention of closing the spaces of missing teeth. This paper aimed at presenting a clinical case in which it was performed the verticalization and mesialization of the molars with absolute anchorage, using mini-implant associated with TMA cantilevers and elastic chain. It has been shown that it is possible to perform the space closure, since the patient presents favorable biological conditions, thereby eliminating the need for prosthetic rehabilitation.

Extrações estratégicas de segundos pré-molares superiores na má-oclusão de Classe II / Strategic second pre-molar extraction in Class II malocclusion treatment

Introdução: o controle da ancoragem consiste em um fator de extrema importância para o sucesso dos tratamentos ortodônticos, e pode ser influenciado pelos diferentes protocolos de tratamento da Classe II por meio de extrações dentárias. A utilização dos mini-implantes para a ancoragem durante a fase de retração anterior trouxe maior praticidade e previsibilidade, principalmente no tratamento de casos em que a severidade oclusal permite pouca ou nenhuma perda de ancoragem superior. Objetivo: apresentar um caso clínico em que a eficiência do controle de ancoragem e o sucesso do protocolo de tratamento adotado foram derivados do emprego racional da ancoragem esquelética por meio de mini-implantes. Conclusão: o protocolo de tratamento adotado foi eficaz, possibilitou melhora da oclusão, da estética e, principalmente, alcançou as expectativas iniciais da paciente.

Introduction: the orthodontic anchorage control consists in a crucial factor for the orthodontic treatment success and may be influenced by different extractions protocols for Class II malocclusion patients. The use of miniscrew implants for skeletal anchorage during retraction phase provided more practical and predictable results, particularly during treatment of severe cases in which the occlusal characteristics allows little or no anchorage loss. Objective: the objective is to present a case in which the anchorage control efficiency and the success of the treatment protocol adopted were derived from the rational use of the skeletal anchorage with miniscrew implants. Conclusion: the treatment protocol was effective, provided an improvement in occlusion and aesthetics and, especially, reached initial expectations of the patient.

Má oclusão de Classe II esquelética: tratamento em duas fases e estabilidade / Skeletal Class II malocclusion: a two-phase treatment and stability

Será apresentado o tratamento em duas fases de uma má oclusão de Classe II esquelética com trespasses horizontal e vertical aumentados. Na primeira fase do tratamento, foi utilizado o Ativador para correção da discrepância esquelética e normalização das relações oclusais do paciente. Na segunda fase do tratamento, foi instalado aparelho fixo nas arcadas superior e inferior para refinamento da oclusão. Quatro anos após o término do tratamento, observa-se estabilidade dos resultados oclusais e manutenção dos resultados ortopédicos e ortodônticos obtidos. Um correto diagnóstico para o estabelecimento de um plano de tratamento individualizado e a colaboração do paciente são variáveis de grande importância para o sucesso do tratamento da Classe II esquelética em duas fases

A estabilidade do tratamento compensatório da mordida aberta anterior no paciente adulto / The long-term of camouflage treatment of anterior open bite in adult patient

Na Ortodontia contemporânea é muito comum o ortodontista realizar tratamentos compensatórios, nos quais há necessidade de utilizar uma mecânica eficiente para a correção da má oclusão do paciente. O objetivo deste trabalho é descrever um caso clínico de uma paciente adulta, com má oclusão de Classe II bilateral e mordida aberta anterior que foi tratada ortodonticamente com extrações dentárias. A realização das extrações dentárias possibilitou uma retrusão e verticalização dos incisivos superiores e inferiores com grande estabilidade dos resultados após o final do tratamento. A retração dos incisivos superiores e inferiores resultou na diminuição da convexidade do perfil tegumentar promovendo maior harmonia facial.

In current Orthodontics is very common to carry out compensatory treatments, where there is need to use a efficient orthodontic mechanics for the correction of the patient malocclusion. The aim of this paper is to describe a clinical case of an adult patient with bilateral Class II malocclusion and anterior open bite that was treated orthodontically with extractions. The dental extractions provided a retraction and uprighting of the upper and lower incisors with great stability of the results after the end of treatment. The retraction of upper and lower incisors resulted in a decrease in soft tissue profile convexity promoting greater facial harmony.

Treatment times of Class II malocclusion: four premolar and non-extraction protocols.

The purpose of this study was to retrospectively compare the treatment times of Class II division 1 malocclusion subjects treated with four first premolar extractions or a non-extraction protocol and fixed edgewise appliances. Eighty-four patients were selected and divided into two groups. Group 1, treated with four first premolar extractions, consisted of 48 patients (27 males and 21 females) with a mean age of 13.03 years and group 2, treated without extractions, consisted of 36 patients (18 males and 18 females) with a mean age of 13.13 years. Group 2 was subdivided into two subgroups, 2A consisting of 16 patients treated in one phase and 2B consisting of 20 patients treated in two phases. The initial and final Treatment Priority Index (TPI), initial ages, initial mandibular crowding, and treatment times of groups 1 and 2 were compared with t-tests. These variables were also compared between group 1 and the subgroups with analysis of variance followed by Tukey's tests. The treatment times for groups 1 and 2 and subgroups 2A and 2B were 2.36, 2.47, 2.25, and 2.64 years, respectively, which were not significantly different. Treatment times with non-extraction and four premolar extraction protocols are similar.