Influence of facial pattern in smile attractiveness regarding gingival exposure assessed by dentists and laypersons.

INTRODUCTION: The present study aimed to assess the influence of facial pattern in smile attractiveness on different levels of gingival exposure evaluated by dental specialists and laypersons. METHODS: Frontal photographs of 2 white Brazilian women, one with a long face and the other with a balanced face, were acquired and subsequently modified to simulate gingival exposure from 0 to 6 mm. Four groups of evaluators of both sexes (mean age 34 y), including laypersons (n = 24) and dental specialists (n = 72; 24 orthodontists, 24 periodontists, and 24 maxillofacial surgeons), used a Likert-type scale to evaluate the attractiveness of the smiles of these subjects with different levels of gingival exposure. Kruskal-Wallis and Friedman tests were used to compare the perceptions of the dental specialists and laypersons. Spearman rank correlation coefficient was used to associate the age of the examiners with their rating outcomes. Statistical significance was set at P < 0.05. RESULTS: Statistically significant differences were observed for the following levels of exposure for the long-faced subject: 0 mm, 4 mm, 5 mm, and 6 mm. Laypersons were less critical than dental specialists. In the balanced-face subject, statistically significant differences were observed between laypersons and dental specialists for gingival exposure levels of 4 mm, 5 mm, and 6 mm. Laypersons perceived gingival exposure to a lesser extent for the balanced-face subject than for the long-face subject. The balanced face was better rated than the long face by dental specialists and laypersons for all levels of gingival exposure. CONCLUSIONS: Facial patterns influenced the smile attractiveness evaluation. The facial characteristics of a balanced facial pattern attenuated the perception of gingival exposure.

Agenesis of maxillary second premolar--diagnosis and clinical management.

Controlling the eruption and development of dentitions is fundamental for a good oral health. The early diagnosis and adequate treatment of occasional developmental disorders are essential to achieve occlusal, functional and esthetic harmony. Abnormality is the term used for classification of alterations and is the most common developmental anomaly in humans. Even though several factors causing tooth malformations have been identified, many are still partially understood, thus requiring a more thorough study. Anyway, the available knowledge provides bases to attempt the early diagnosis of tooth abnormalities, to allow the adoption of preventive and effective therapeutic approaches.

Preventive orthodontic management of tooth transposition.

The contemporary orthodontics should highlight the periodical control of growth and dental development in order to intercept possible disorders in facial growth and tooth eruption. This may allow avoidance or simplification of corrective orthodontic treatment, making it faster and less aggressive. Tooth transposition, a genetically determined eruptive disturbance, presents a relatively low prevalence in the world population and primarily affects maxillary canines and premolars. This paper presents an option for interceptive treatment of bilateral transposition of maxillary canine and premolar diagnosed early in a young individual. Longitudinal follow-up of RME performed in adequate timing to redirect the eruption pathway of permanent maxillary canines is presented.

Prevalence of condylar morphological changes in individuals with class II malocclusion.

This observational, cross-sectional study with retrospective collection was aimed to evaluate the prevalence of morphological changes in mandibular condyles in individuals with class II malocclusion, classified according to different vertical growth patterns (brachyfacial, mesofacial, and dolichofacial), through cone beam computed tomography (CBCT). Seventy CBCT images (140 mandibular condyles) were selected from individuals without orthodontic treatment, of both sexes, aged between 25 and 50 years. No statistically significant differences were found between facial patterns; however, there was a higher relative prevalence of bone changes in dolichofacial individuals with flattening (62%), sclerosis (44%), and subchondral bone cyst (20%). Erosion and osteophytes prevailed in mesofacial (39%), and brachyfacial individuals (32%), respectively. Thus, there was no statistically significant difference in the prevalence of degenerative changes between the vertical skeletal patterns. Flattening was the most prevalent change, whereas subchondral bone cyst was the least prevalent among the three groups studied. The observational design of this study makes it possible to analyze image banks to verify the correlation of morphological changes in the temporomandibular joint in different facial patterns in patients with class II malocclusion. A limitation of the study is that clinical characteristics were not evaluated.

Do submerged roots hinder orthodontic treatment or the use of implants?

INTRODUCTION: In clinical practice, submerged roots are found with high frequency, and their presence can change the planning of dental movements and implant placement. OBJECTIVES: To provide explanations of possible developments in the area involved, according to the evolutionary stage of the process, at the time of diagnosis. DISCUSSION: After atrophy of the periodontal ligament and epithelial remnants of Malassez, ankylosis of the bone with the submerged root occurs, and initiates a process of replacement resorption. Until this process reaches the most advanced stage, this area represents an increased "bone" density, and if some care is not taken, this can generate resorption problems in the tooth to be moved. Whereas implants can be placed, despite the presence of the submerged root, irrespective of the stage of evolution. CONCLUSION: It is natural for the onset of alveolodental ankylosis and tooth replacement resorption to occur in submerged roots, and its stage of evolution will be decisive in the approach to be adopted in clinical planning.

What changes in the biology of bone movement induced with mini-implants/miniplates is the synchronicity.

INTRODUCTION: Induced tooth-bone movement occurs by a synchronicity of dental and bone phenomena, thanks to the osteocytic network, which is a three-dimensional network that controls the bone shape or design. OBJECTIVE: To describe the tooth-bone movement induced by enhanced anchorage, divided into three distinct moments: zero, start and stop. QUESTION: From this description, the main question arises: with the use of mini-implants/miniplates, what changes in the biology of induced tooth-bone movement? The answer is: nothing changes, either biologically or microscopically. CONCLUSION: This technique optimizes the treatment time, and the range of therapeutic possibilities is broadened, thanks to the synchronicity of phenomena - which remain the same, in all teeth and bones, yet in a synchronized manner. Bone anchorage represents synchronicity in induced tooth-bone movement.

Canines and inflammatory external apical resorption in healthy maxillary lateral incisors due to occlusal trauma: when to detect the position of maxillary canines, to prevent it?

JUSTIFICATION: Canines represent corners in the dental arch, and are important features in facial esthetics, as they support the upper lip, wing of the nose, and influence the nasolabial fold and the appearance of facial aging. In the laterality movements, the canines guidance coordinate the opening and closing of the teeth, saving the TMJ from sudden movements. DISCUSSION: As a result of the lack of eruption or the inadequate positioning of the maxillary canine, the loss of the laterality guide may occur, which will then occur in the maxillary lateral incisor, inducing lesions of "occlusal trauma", such as inflammatory root resorption. Likewise, without well positioned canines, there may be premature aging and change in facial esthetics. CONCLUSION: In order to avoid problems with eruption and positioning of the maxillary canines, early diagnosis is made by analyzing their position and their relationship with the other teeth, and in the three-dimensional context of the maxilla, between 8-10 years of age. Preventive measures can create bone space and direction so that the maxillary canines can occupy their position in the dental arch.

Aesthetic perception of smile in long face pattern patients who underwent maxillary impaction with miniplates or orthognathic surgery.

INTRODUCTION: The gummy smile is perceived in 10% of the population aged 20 to 30 years old, and it causes an aesthetic imbalance in the smile. This study investigated the existence of differences in the aesthetic perception of the smile after correcting the gummy smile using two different techniques: orthognathic surgery for maxillary impaction and miniplate-aided orthodontic impaction. METHODS: Photographs of 16 Long Face Pattern female patients were evaluated by 56 oral and maxillofacial surgeons, 56 orthodontists, and 56 laypeople before and after the treatment with one of the two techniques. These photographs were standardized using the Photoshop program, randomly organized, and then presented to the evaluators via the Google Meeting® application in the PowerPoint® program. To evaluate the attractiveness of the smile, the Visual Analogue Scale (VAS) was used. To analyze the intra and inter-examiner concordances, Spearman's correlation and Kendall's concordance tests were used, respectively. For intergroup comparison, the Friedman test was used, with a 5% significance level. RESULTS: For all three groups of evaluators, the post-treatment evaluation results were superior to the results before the treatment: surgeons and orthodontists assigned higher scores for surgical cases and laypeople for orthodontic cases. CONCLUSION: From a clinical point of view, there was no difference between the results of both techniques with regard to the aesthetic perception of smiles. A gingival exposure ranging from zero to two millimeters was considered the most aesthetic for all evaluators.

Effect of orthodontic maxillary posterior en masse intrusion anchored with miniplates on maxillary sinuses volume. Retrospective CBCT study.

OBJECTIVE: To evaluate, by means of cone beam computed tomography (CBCT), the volume change of maxillary sinuses in patients that underwent orthodontic maxillary posterior en masse intrusion anchored with miniplates. MATERIALS AND METHODS: The sample consisted of pretreatment (T1) and posttreatment (T2) CBCT scans obtained from 14 patients (4 male and 10 female), with a mean age of 32.4 years, that underwent orthodontic maxillary posterior en masse intrusion anchored with miniplates in the zygomatic crest. The mean treatment duration was 20 months and the mean intrusion movement was 2.4 mm. Maxillary sinus volume was measured by means of the software ITK SNAP (version 3.8.0) in T1 and T2 CBCT scans. The changes in sinuses volume were calculated by T1-T2 values. Data were analyzed statistically with Wilcoxon test at 5% of level of significance and the method error was analyzed with Wilcoxon test, intraclass correlation and Dahlberg's formula. RESULTS: The mean difference (T1-T2) was -242.85 mm³ (p = 0.396) for the right sinus and -32.5 mm³ (p = 0.875) for the left sinus. A slight increase in the volume of the sinuses was shown although these results were not statistically significant. CONCLUSION: The orthodontic maxillary posterior en masse intrusion anchored with miniplates did not influence significantly the maxillary sinus volume.

Intrusion of posterior teeth using miniplates: intrusive mechanics is not the same as intrusion force.

OBJECTIVE: Biologically explain some of the bone mechanisms involved in the intrusion, or intrusive effect, of teeth submitted to skeletal open bite correction using four miniplates. METHODS: The results of dental intrusion were measured and compared in 3D reconstructions of cone beam computed tomography scans taken before and after treatment of 20 patients with skeletal open bite, aged between 18 and 59 years. RESULTS: The results allow deducing that the compression and traction forces biologically promoted deformation or deflection of the osteocyte network that controls bone design, and these effects involved the external and internal surfaces of the bone, with the formation of new layers, including the cervical portion of the alveolar bone crest. This helps understanding how dental intrusion occurs in intrusive mechanics, whose forces are of inclination rather than intrusion. The root resorptions caused by the use of miniplates were insignificant, due to the more homogeneous distribution of forces in the several teeth simultaneously involved. CONCLUSION: Imaging studies in CT scans tend to capture in details the subperiosteal and endosteal phenomena of dental intrusion - before and after the application of intrusive mechanics -, in the form of a set of modifications called dental intrusion or intrusive effect .

A comparative study of the accuracy between two computer-aided surgical simulation methods in virtual surgical planning.

OBJECTIVE: The aim of this retrospective and observational study was to compare the accuracy of two different virtual surgical planning (VSP) protocols, namely, the CASS method and the modified CASS method. MATERIALS AND METHODS: The patients underwent bimaxillary orthognathic surgery, planned using either the CASS method or the modified CASS method. Linear and angular discrepancies between the VSP outcome and postoperative outcome for both groups were compared for maxilla, mandible, and chin segments. Aside from the comparison between both groups, additional criteria were used to determine the accuracy of the protocol based on a linear and angular difference between planned and actual outcomes of less than 2 mm and 4°, respectively. The intergroup comparisons were performed by one-way ANOVA, with the level of significance set at 5%. RESULTS: A total of 21 patients, of both genders, were assigned into group I (n = 11), planned with the CASS method, and group II (n = 10), planned with the modified CASS method. Both the CASS and modified CASS methods presented similar accuracy with regard to linear differences for the maxilla, mandible, and chin segments, except for ΔX for the mandibular segment, where the modified CASS method showed slightly better accuracy. However, there was a statistically significant difference with regard to angular differences in the chin segment, with the CASS method shown to be the more accurate. Aside from Δpitch for the chin segment, no linear or angular differences exceeded 2 mm or 4°. CONCLUSION: Although statistically significant differences were found with regard to angular measurements in the chin segment, the accuracy of the modified CASS method for virtual planning can be considered as clinically equivalent, with a performance comparable to that of the CASS method.

Diagnosis of alveolodental ankylosis in unerupted canines: one of the answers to why the canine does not come.

INTRODUCTION: Teeth frequently fail to erupt and situations arise that prevent the canines from reaching the occlusal plane. OBJECTIVE: Discourse about the three situations in which the canine does not reach the occlusal plane, and remains unerupted; and at the same time, point how to make a safe diagnosis of alveolodental ankylosis - one of the three causes -, based on tomography. CONCLUSIONS: Ankylosis occurs in impacted teeth by atrophy of the periodontal ligament, including the epithelial rests of Malassez. The tomographic signs of alveolodental ankylosis in unerupted canines are the interruption of hypodense periodontal space, discontinuity of the lamina dura and its continuity with the root surface, which gradually loses its regular shape.

Negligible tooth resorptions after anterior open bite treatment using skeletal anchorage with miniplates.

INTRODUCTION: When miniplates are used as anchoring for orthodontic mechanics for anterior open bite correction by retraction of anterior teeth and posterior teeth intrusion and retraction, orthodontically induced inflammatory external apical root resorption is clinically negligible. METHODS: A homogeneous sample of 32 patients was used, and the roots of the teeth were compared on CT scans performed before and after orthodontic treatment. RESULTS: The observed root resorption was minimal, and this can be explained by the uniform distribution of forces in several teeth, simultaneously, in the set of the dental arch and in the bone that supports the teeth. CONCLUSION: The most important thing to prevent root resorption in orthodontic practice, besides being concerned with the intensity of the applied forces, is to be careful with its distribution along the roots of each tooth, in the dental arch and in the bone that supports the teeth.

Impacted teeth: Their place is in the dental arch.

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."

Reliability and reproducibility of the method of assessment of midpalatal suture maturation: A tomographic study.

OBJECTIVES: To assess reliability and reproducibility of the individual assessment of midpalatal suture maturation in computed tomography among orthodontists and radiologists for potential diagnosis application. MATERIALS AND METHODS: Sixty axial slices from cone-beam computed tomography and multi-slice CT scans of patients aged between 11 and 21 years old (33 females and 27 males) were selected. For the investigation of reliability and reproducibility of the method, two groups of examiners were established. The first group consisted of 11 orthodontists and the second consisted of 10 radiologists. Each group examined the images and performed individual assessment of the midpalatal suture maturation method twice within an interval of 21 days. During the first and second analyses, the sequence of images was randomized to reduce potential bias. Weighted Cohen's kappa was performed to assess inter- and intra-examiners' agreement. The percentage of perfect agreement and the number of stages apart for each disagreement were calculated. The significance level was P < .05. RESULTS: The overall inter-examiner agreement was satisfactory in the first (kappaw: 0.37) and the second (kappaw: 0.34) analyses. Intra-examiner agreement outcomes were similar between orthodontists (kappaw: 0.44) and radiologists (kappaw: 0.41). The percentage of perfect agreement was 43.2%. CONCLUSIONS: The method for individual assessment of midpalatal suture maturation revealed potential reliability and reproducibility. However, the agreement rate observed in the present study was not high enough for a method designed for routine clinical applications.

Mandibular anterior crowding: normal or pathological?

The teeth become very close to each other when they are crowded, but their structures remain individualized and, in this situation, the role of the epithelial rests of Malassez is fundamental to release the EGF. The concept of tensegrity is fundamental to understand the responses of tissues submitted to forces in body movements, including teeth and their stability in this process. The factors of tooth position stability in the arch - or dental tensegrity - should be considered when one plans and perform an orthodontic treatment. The direct causes of the mandibular anterior crowding are decisive to decide about the correct retainer indication: Should they be applied and indicated throughout life? Should they really be permanently used for lifetime? These aspects of the mandibular anterior crowding and their implication at the orthodontic practice will be discussed here to induct reflections and insights for new researches, as well as advances in knowledge and technology on this subject.

Maxillary canine--first premolar transposition.

Tooth transpositions present at a relatively low incidence in the world population and primarily affect maxillary canines and premolars. Treatment of this disturbance should take into account aspects such as facial pattern, age, malocclusion, tooth-size discrepancy, stage of eruption, and magnitude of the transposition. Mechanics for correction should be entirely individualized, reducing the risks and adverse effects. Practitioners often select simpler options, indicating extraction of permanent teeth, which is an irreversible procedure that may bring about damages to the patient. This study presents a case report and treatment of unilateral transposition of maxillary canine and premolar with repositioning of affected teeth to their respective normal positions.

What changes in the biology of bone movement induced with mini-implants/miniplates is the synchronicity

ABSTRACT Introduction: Induced tooth-bone movement occurs by a synchronicity of dental and bone phenomena, thanks to the osteocytic network, which is a three-dimensional network that controls the bone shape or design. Objective: To describe the tooth-bone movement induced by enhanced anchorage, divided into three distinct moments: zero, start and stop. Question: From this description, the main question arises: with the use of mini-implants/miniplates, what changes in the biology of induced tooth-bone movement? The answer is: nothing changes, either biologically or microscopically. Conclusion: This technique optimizes the treatment time, and the range of therapeutic possibilities is broadened, thanks to the synchronicity of phenomena - which remain the same, in all teeth and bones, yet in a synchronized manner. Bone anchorage represents synchronicity in induced tooth-bone movement.

RESUMO Introdução: A movimentação osseodentária induzida ocorre meio de uma sincronicidade de fenômenos dentários e ósseos, graças à rede osteocítica, uma rede tridimensional de controle do formato ou design ósseo. Objetivo: Descrever a movimentação osseodentária induzida com ancoragem ampliada, dividindo-a em três momentos distintos: zero, start e stop. Questionamento: Dessa descrição origina-se a principal pergunta: com o uso de mini-implantes/miniplacas, o que muda na biologia da movimentação osseodentária induzida? A resposta é: não muda nada, nem biologicamente, nem microscopicamente. Conclusão: O que se otimiza, com essa técnica, é o tempo de tratamento, e se amplia o leque de possibilidades terapêuticas, graças à sincronicidade dos fenômenos - que continuam sendo os mesmos, em todos os dentes e nos ossos, só que de forma sincronizada. A ancoragem óssea representa a sincronicidade na movimentação osseodentária induzida.

Do submerged roots hinder orthodontic treatment or the use of implants?

ABSTRACT Introduction: In clinical practice, submerged roots are found with high frequency, and their presence can change the planning of dental movements and implant placement. Objectives: To provide explanations of possible developments in the area involved, according to the evolutionary stage of the process, at the time of diagnosis. Discussion: After atrophy of the periodontal ligament and epithelial remnants of Malassez, ankylosis of the bone with the submerged root occurs, and initiates a process of replacement resorption. Until this process reaches the most advanced stage, this area represents an increased "bone" density, and if some care is not taken, this can generate resorption problems in the tooth to be moved. Whereas implants can be placed, despite the presence of the submerged root, irrespective of the stage of evolution. Conclusion: It is natural for the onset of alveolodental ankylosis and tooth replacement resorption to occur in submerged roots, and its stage of evolution will be decisive in the approach to be adopted in clinical planning.

RESUMO Introdução: A frequência, na prática clínica, das raízes submersas é elevada, e sua presença pode modificar o planejamento de movimentações osteodentárias e da instalação de implantes. Objetivo: Apresentar as explicações das possíveis evoluções na área envolvida, de acordo com o estágio evolutivo do processo, no momento do diagnóstico. Discussão: Depois da atrofia do ligamento periodontal e dos restos epiteliais de Malassez, o osso anquilosa-se com a raiz submersa, e se inicia a reabsorção por substituição. Até se chegar ao estágio mais avançado, essa área representa uma densidade "óssea" aumentada, o que pode gerar problemas reabsortivos no dente a ser movimentado, caso alguns cuidados não sejam tomados. Por outro lado, os implantes podem ser aplicados, apesar da presença da raiz submersa, independentemente da fase evolutiva. Conclusão: É natural que, em raízes submersas, se instale a anquilose alveolodentária e a reabsorção dentária por substituição, e o seu estágio evolutivo será determinante na conduta a ser adotada no planejamento clínico.