An alternative approach for the surgical correction of unilateral crossbite.

This case report aims to describe a modified surgically assisted rapid palatal expansion technique to treat an asymmetrical posterior crossbite with no mandibular shift without causing an interincisal diastema. A clinical patient with an asymmetrical crossbite, large tooth-size-arch length, and Bolton discrepancy is used to illustrate the modified technique. Instead of traditional osteotomies, in this technique, the osteotomy is done between the maxillary right canine and lateral incisor (connecting the piriform aperture to the alveolar process) along with a unilateral LeFort I osteotomy. The expansion forces are produced by the activation of a conventional hyrax appliance. The skeletal unilateral crossbite was corrected without major changes to the opposite side and without causing an anesthetic diastema between the maxillary central incisors. A mandibular incisor extraction produced the space needed to treat the tooth size-arch length and corrected the Bolton discrepancy. This allowed a successful treatment of the problems initially presented by the patient.

Loads of continuous mechanics for uprighting the second molar on the second molar and premolar.

INTRODUCTION: This paper aims to evaluate the effect of tube height on uprighting a mandibular second molar with a continuous arch, specifically the main effects on the molar tube and the side effects on the second premolar bracket. METHODS: Slot brackets (0.18-in) and tubes were passively bonded from the left second molar to the right second premolar of the patient's cast and fixed to an orthodontic force tester. A mesially tipped second molar along with its tube was positioned at 5 different heights in relation to the bracket slots of the remaining appliance: 2 mm below (group -2), 1 mm below (group -1), leveled (group 0), 1 mm above (group 1) and 2 mm above (group 2). Each group had 10 different 0.016 × 0.022-in superelastic nickel-titanium wires tied one at a time to the appliance to register the vertical forces (Fz) and tipping moments (Mx) produced at the molar tube and the premolar bracket, statistically. Analysis of variance was used to identify differences of load among the groups for wire response to the position of the tube in relation to the other brackets' slots. RESULTS: As the molar tube was positioned more occlusally, Fz and Mx decreased at the molar tube from 1.31 N to 0.75 N and 13.98 N.mm to 11.84 N.mm, respectively, whereas at the premolar bracket, Fz and Mx decreased from 1.52 N to 0.88 N and 8.77 N.mm to 1.05 N.mm, respectively. CONCLUSIONS: In all groups, the load system at the molar tube (the main effects) registered a distal tipping moment and an extrusive force, whereas at the premolar bracket, the load system (side effects) included a distal tipping moment and an intrusive force. As the tube moved occlusally, the extrusive force and the uprighting moment decreased, along with the side effects at the premolar bracket. Attempting to bond the molar tube more occlusally (within reasonable intraoral dimensions) when trying to upright a molar does not appear to be sufficient to keep a molar from extruding.

Expansion with transpalatal arch or continuous arch mechanics.

INTRODUCTION: This study aimed to compare the 3-dimensional force system produced by transpalatal arch (TPA) mechanics with that produced by a continuous arch (CA) on the expansion of maxillary first molars. METHODS: A patient's model with 2 molars in 4-mm crossbite had orthodontic appliances bonded to all teeth. The first and the second molars were connected to two 3-dimensional load cells to compare the forces in the transverse and anteroposterior planes (Fx and Fy) and the rotational moments (Mz) produced in both molars by the expanded TPA and by 0.016-in nickel-titanium CA. The data were evaluated using 6 independent t tests, and the net moment at the molar's center of resistance was also calculated. RESULTS: All forces and moments were different at both molars. At the first molar, CA produced Fx of 2.60 N, Fy of -0.08 N, Mz of -5.16 N·mm, and Net Mz of -5.68 N·mm, whereas the TPA produced Fx of 2.87 N, Fy of -0.60 N, Mz of -22.08 N·mm, and Net Mz of -25.09 N·mm. At the second molar, the TPA did not produce significant forces and moments, whereas the CA produced Fx of -1.00 N, Mz of 3.95 N·mm, Fy of -0.84 N, and Net Mz of -0.67 N·mm. CONCLUSIONS: Based on our findings in a clinical set up with the specific horseshoe TPA and archwire tested, with the TPA used only on the first molars and the CA used from one second molar to the other, the mechanics produced different expansion forces at the first molar. The TPA produced a larger rotational side effect on the first molar, whereas the CA produced side effects on the second molar.

Concomitant permanent maxillary canine agenesis and transposition treated with extractions and lingual brackets.

This case report describes the successful orthodontic treatment for a healthy woman with maxillary canine-premolar transposition associated with rare hypodontia of the contralateral canine. The treatment included extraction of the transposed maxillary right and deciduous maxillary left canines and 2 mandibular second premolars. The objectives of the treatment were to (1) correct the upper midline deviation and the occlusal plane cant, (2) move the maxillary first premolars into the canine position, (3) retract the mandibular incisors to improve the facial profile, and (4) reduce the labial protrusion. Orthodontic treatment was carried out with the lingual technique in the maxillary arch and esthetic ceramic brackets in the mandibular arch. The segmented mechanics were effective, fast, and consistently promoted the necessary movement without side effects. The smile line was improved, resulting in an ideal and esthetic gingival exposition, with the borders of the maxillary teeth following the lower lip smile curvature. The patient achieved ideal dentofacial esthetics, achieved better dental and functional occlusion, was pleased with her improved facial contour, and as a result, showed an improved self-image.

Low-level laser therapy (830 nm) on orthodontic pain: blinded randomized clinical trial.

The objective of this research was to compare the effect single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment in the clinic of orthodontics. Sixty-two patients were recruited to participate in this randomized, double-blinded, placebo-controlled study. The patients were assigned to four groups: group I-laser on the right side; group II-placebo on the right side; group III-laser on the left side; group IV-placebo on the left. The laser or placebo was applied before separation, 24 and 48 h after separation of their first permanent molars in the lower arch. Just after the separation, the average of the pain for the placebo group was 1.6, significantly greater than the average of 1.1 registered for the laser group (p = 0.013). After 24 h and before the new irradiation, the values registered among the different groups did not show any differences. In relation to the gender, only after the first irradiation in placebo group, the female had a level of pain (0.1) significantly higher (p = 0.04) compared to male, and after 48 h, the group where the laser was applied had a difference (p = 0.04) among the gender with a value of lower pain for men (0.6) than for women (1.6).The laser irradiation to minimize the pain was only effective when applied immediately after treatment and separation. In general way, there were no differences between the genders, except after the first placebo group irradiation in which the female had a significantly higher level of pain compared to male and after 48 h. The pain cycle observed in this study had its peak in 24 h, both for laser's and placebo's group.

Second molar intrusion: Continuous arch or loop mechanics?

INTRODUCTION: Our aim was to compare the load systems produced by rectangular loops and continuous arch mechanics on intrusion of a maxillary second molar. METHODS: An orthodontic appliance was passively bonded from second molar to second molar on a patient's model fixed to an orthodontic force tester. The second molars were extruded by 3 mm, and 2 mechanics systems were compared: beta-titanium rectangular loops and super-elastic nickel-titanium continuous arch. Vertical (Fz) and mesial (Fy) forces, and tipping moments around the buccal axis (Mx) at the tubes were collected at every 0.5 mm of deactivation. Repeated measures analysis of variance was used to detect differences between mechanics. The net Mx was also estimated at the center of resistance of each molar. RESULTS: Significant differences were found between the mechanics at the tubes, except for the Mx in the first molar, and more importantly, at the centers of resistance of the molars: Fz forces were greater in the continuous arch than in the rectangular loops, which, on the other hand, produced lower Fy forces than the continuous arch. In the second molar, net Mx was low initially and changed with deactivation. In the continuous arch, net Mx decreased from -3.6 N.mm of mesial crown tipping to clinically insignificant levels after 2 mm of deactivation. In the first molar, net Mx was lower on the rectangular loop than on the continuous arch during the first 2 mm of deactivation and became similar in the last millimeter of deactivation. Additionally, the net Mx decreased with deactivation with both mechanics. CONCLUSIONS: Both mechanics can intrude the second molars. Although the rectangular loop produced less tipping in large deflections, the continuous arch was a better approach when less intrusion was required.

Continuous arch and rectangular loops for the correction of consistent and inconsistent load systems in extruded and tipped maxillary second molars.

INTRODUCTION: The aim of this research was to compare the load systems produced by rectangular loops and continuous arches for the correction of extruded second molars with a mesial inclination (inconsistent system) and a distal inclination (consistent system). METHODS: The maxillary first molar of an acrylic model of a patient, with passive brackets and tubes bonded, was connected to a 3-dimensional load cell of an orthodontic force tester, and the second molar was replaced by its respective tube bonded to a second load cell. The second molar tube was moved 2.5 mm occlusally and tipped 20° mesially and distally, creating an inconsistent force system and a consistent force system. For each situation, ten 0.017 × 0.025-in beta-titanium, 8 × 10-mm rectangular loops were compared with 10 0.014-in nickel-titanium continuous arches. The vertical forces-F(z)-and tipping moments-M(x)-were compared using 4 t tests, at 5%. RESULTS: In the inconsistent group, the rectangular loop produced a larger M(x) in both molars: 2.11 N.mm in the second molar compared with the -0.15 N.mm of the continuous arches. On the first molar, the rectangular loops produced -5.58 N.mm against -2.08 N.mm produced by the continuous arches. The F(z) values produced at the second molar with each system were similar, whereas on the first molar they were different; the rectangular loops produced 0.41N, and continuous arches produced 0.53N. In the consistent group, the rectangular loops produced smaller M(x) values at the second molar (-3.06 N.mm) than did the continuous arch (-4.25 N.mm) (P = 0.01), as well as a smaller F(z) value (-0.52 vs -0.92 N, respectively). At the first molar, the rectangular loops produced smaller M(x) values (-2.32 N.mm) than did the continuous arch (-4.18 N.mm), as well as a smaller F(z) value (0.59 vs 1.10 N). CONCLUSIONS: In the inconsistent group, only the rectangular loop produced a system of force that could correct the second molar. In the consistent system, both group mechanics produced a system of force compatible with the correction of the second molar, but the continuous wire produced larger moments. Both groups showed a tendency for mesial crown tipping of the first molar.

A comparison of lower canine retraction and loss of anchorage between conventional and self-ligating brackets: a single-center randomized split-mouth controlled trial.

OBJECTIVE: To evaluate the rate of lower canine retraction, anchorage loss, and changes on lower canines and first molars axial inclination using self-ligating and conventional brackets. MATERIALS AND METHODS: Twenty-five adult patients with a treatment plan involving extractions of four first premolars were selected for this split-mouth trial and had either conventional or self-ligating brackets bonded to lower canines in a block randomization. Retraction was accomplished using 100-g nickel titanium closed-coil springs, which were reactivated each 4 weeks. Oblique radiographs were taken before and after total canine retraction and the cephalograms were superimposed on stable structures of the mandible. Cephalometric points were digitized twice by a single-blinded operator for error control and the average of the points were used to determine the following variables: canine cusp horizontal changes, molar cusp horizontal changes, and angulation changes in canines and molars. Paired t tests were used to analyze the blinded data for group differences. RESULTS: All patients reached final phase without bracket debonds. No differences were found between the two groups for all variables tested. No serious harm was observed. CONCLUSION: Both brackets showed the same rate of canine retraction and loss of anteroposterior anchorage of the molars. No changes were found between brackets regarding the inclination of canines and first molars. CLINICAL RELEVANCE: Using self-ligating brackets to retract lower canines will not increase the velocity of tooth movement, does not increase anchorage, and does not decrease tipping.

Assessing adhesive remnant removal and enamel damage with ultraviolet light: An in-vitro study.

INTRODUCTION: Our objective was to assess the amounts of adhesive remnant and enamel damage when removing composite under conventional lighting and ultraviolet (UV) light. METHODS: Thirty-eight premolars were divided into 2 groups according to the lighting used for adhesive removal. A multifluted tungsten-carbide bur at low speed was used for this process in both groups. The UV group received conventional lighting associated with UV light, and the conventional group received conventional lighting only. The amounts of adhesive remnant were calculated using images of the teeth taken under UV light with software. Scanning electron microscopy images of epoxy adhesive replicas of the teeth made before bonding and after adhesive removal were graded according to the enamel damage index (EDI), and the difference between the final and initial EDI scores was used for assessment of the enamel damage. To detect differences between the groups, the Mann-Whitney test was used to analyze the data from the adhesive remnant index and the EDI. RESULTS: The conventional group had more adhesive left on the enamel (P <0.001) than did the UV group. There was no difference between groups for the EDI (P = 0.729). CONCLUSIONS: UV lighting allows significantly more adhesive removal without increasing the damage caused to the enamel.

From ideal occlusion to dentofacial deformity and back to ideal: an osteochondroma treatment with lingual orthodontics.

This original case report describes the morphologic changes caused by a mandibular condylar osteochondroma (OC) on a female patient and its treatment. The changes were identified by comparing her final records from a previous orthodontic treatment, without the presence of OC, to records taken before a second treatment, with a developed OC. The diagnostics and treatment for the OC and its consequences were described and discussed in this paper. Treatment included orthodontics with a lingual appliance, low condylectomy on the affected side, high condylectomy on the contralateral side, bilateral disc repositioning and orthognathic surgery. It was concluded that the OC caused a Class III subdivision malocclusion, midline deviation and an edge-to-edge bite on the left side, a cant of the occlusal plane on the Z-axis and a deviation of the pogonion to the left. Treatment was successful and stable long term (36 months) with good occlusal, aesthetical and functional results.

Porous Polyethylene Implant as Aesthetic Complement in Orthognathic Surgery.

Porous polyethylene implants have been used as an alternative in the treatment of patients with zygomatic and paranasal projections deficiency. These implants promote a facial rejuvenating effect due to the attenuation of the nasal and chin prominences. The advantages of porous polyethylene include biocompatibility, dimensional stability, easy adaptation and fixation, low complication rate, and its availability in different sizes and shapes. A 27-year-old woman presenting vertical deficiency associated with midface hypoplasia was treated with orthognathic surgery. Clockwise rotation and genioplasty were performed. In order to improve facial aesthetics, porous polyethylene implants were placed in the paranasal area, optimizing the facial contour with the correction of the midface projection.

Effect of clinical use of nickel-titanium springs.

INTRODUCTION: Our objectives were to determine whether there are changes on the load deflection rate (L/DP) and the average force (FP) of the superelastic pseudoplateau, and whether permanent deformation is changed in nickel-titanium closed-coil springs (CCSs) after 6 months of clinical use. METHODS: Twenty-two nickel-titanium CCSs (Sentalloy 100 g; Dentsply GAC, York, Pa) were subjected to tensile mechanical testing at 37°C on activations varying from 3.2 to 16.0 mm before and after 6 months of clinical use. A regression line was fitted over the most horizontal area of the unloading part of the stress-strain graph of every CCS, and its slope was used as L/DP. The FP was determined by the midpoint of the longest segment of the curve that could be fit within the regression line with a R(2) of at least 0.999, and permanent deformation was determined graphically by obtaining the strain value when the measured stress reached zero. The data were analyzed by 3 analyses of variance at 2 levels, with 5% of significance. RESULTS: Time and activation significantly influenced the variables tested (P < 0.001). Time increased the L/DP and permanent deformation but decreased the FP. Activation decreased L/DP, FP, and permanent deformation. Significant interactions between time and activation were detected for FP (P = 0.013) and deformation (P < 0.001). CONCLUSIONS: After 6 months of active clinical use, the analyzed springs had a significant but small increase in their L/DP; FP dropped up to 88%, and the CCSs deformed up to 1.26 mm.

Head and neck cancers, Version 2.2014. Clinical practice guidelines in oncology.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Head and Neck Cancers focuses on glottic laryngeal cancer, which is the most common type of laryngeal cancer and has an excellent cure rate. The lymphatic drainage of the glottis is sparse, and early stage primaries rarely spread to regional nodes. Because hoarseness is an early symptom, most glottic laryngeal cancer is early stage at diagnosis. Updates to these guidelines for 2014 include revisions to "Principles of Radiation Therapy" for each site and "Principles of Surgery," and the addition of a new section on "Principles of Dental Evaluation and Management."

Time reduction of light curing: Influence on conversion degree and microhardness of orthodontic composites.

INTRODUCTION: The aim of this study was to assess the influence of curing time and power on the degree of conversion and surface microhardness of 3 orthodontic composites. METHODS: One hundred eighty discs, 6 mm in diameter, were divided into 3 groups of 60 samples according to the composite used-Transbond XT (3M Unitek, Monrovia, Calif), Opal Bond MV (Ultradent, South Jordan, Utah), and Transbond Plus Color Change (3M Unitek)- and each group was further divided into 3 subgroups (n = 20). Five samples were used to measure conversion, and 15 were used to measure microhardness. A light-emitting diode curing unit with multiwavelength emission of broad light was used for curing at 3 power levels (530, 760, and 1520 mW) and 3 times (8.5, 6, and 3 seconds), always totaling 4.56 joules. Five specimens from each subgroup were ground and mixed with potassium bromide to produce 8-mm tablets to be compared with 5 others made similarly with the respective noncured composite. These were placed into a spectrometer, and software was used for analysis. A microhardness tester was used to take Knoop hardness (KHN) measurements in 15 discs of each subgroup. The data were analyzed with 2 analysis of variance tests at 2 levels. RESULTS: Differences were found in the conversion degree of the composites cured at different times and powers (P <0.01). The composites showed similar degrees of conversion when light cured at 8.5 seconds (80.7%) and 6 seconds (79.0%), but not at 3 seconds (75.0%). The conversion degrees of the composites were different, with group 3 (87.2%) higher than group 2 (83.5%), which was higher than group 1 (64.0%). Differences in microhardness were also found (P <0.01), with lower microhardness at 8.5 seconds (35.2 KHN), but no difference was observed between 6 seconds (41.6 KHN) and 3 seconds (42.8 KHN). Group 3 had the highest surface microhardness (35.9 KHN) compared with group 2 (33.7 KHN) and group 1 (30.0 KHN). CONCLUSIONS: Curing time can be reduced up to 6 seconds by increasing the power, with a slight decrease in the degree of conversion at 3 seconds; the decrease has a positive effect on the surface microhardness.

Do microplastics and climate change negatively affect shredder invertebrates from an amazon stream? An ecosystem functioning perspective.

Pollution and climate change are among the main threats to the biodiversity of freshwater ecosystems in the 21st century. We experimentally tested the effects of microplastic and climate change (i.e., increase in temperature and CO2) on the survival and consumption by an Amazonian-stream shredder invertebrate. We tested three hypotheses. (1) Increased microplastic concentrations and climate change reduce shredder survival. We assumed that the combined stressors would increase toxic stress. (2) Increased concentrations of microplastics have negative effects on shredder food consumption. We assumed that blockage of the digestive tract by microplastics would lead to reduced ability to digest food. In addition, increased temperature and CO2 would lead to an increase in metabolic cost and reduced consumption. (3) The interaction between microplastics and climate change have greater negative effects on survival and consumption than either alone. We combined different concentrations of microplastic and climate change scenarios to simulate in real-time increases in temperature and CO2 forecast for 2100 for Amazonia. We found that both stressors had lethal effects, increasing mortality risk, but there was no interaction effect. Shredder consumption was negatively affected only by climate change. The interaction of microplastics and climate change on shredder consumption was dose-dependent and more intense in the extreme climate scenario, leading to reduced consumption. Our results indicate that microplastic and climate change may have strong effects on the consumption and/or survival of insect shredders in Amazonian streams. In addition, microplastic and climate change effects may affect not only populations but also ecosystem functioning (e.g., nutrient cycling). Integrative approaches to better understand and mitigate the effects of both stressors are necessary because plastic pollution and climate change co-occur in environments.

Biomonitoring of mutagenicity and cytotoxicity in patients undergoing fixed orthodontic therapy.

INTRODUCTION: The aim of the present study was to evaluate DNA damage (micronucleus) and cellular death (pyknosis, karyolysis, and karyorrhexis) in exfoliated buccal mucosa cells from adults after fixed orthodontic therapy. MATERIAL AND METHODS: A total of 23 healthy adults (10 men and 13 women) undergoing orthodontic therapy were included in this setting. RESULTS: The results pointed out no significant statistically differences (P >0.05) of micronucleated oral mucosa cells. In the same way, orthodontic therapy was not able to increase other nuclear alterations closely related to cytotoxicity such as karyorrhexis, pyknosis and karyolysis (P >0.05). CONCLUSION: In summary, these data indicate that orthodontic therapy may not be a factor that induces chromosomal damage, nor it is able to promote cytotoxicity. Since DNA damage and cellular death are important events during carcinogenic processes, especially in early phases, this study represents a correct evaluation with respect to real health risks induced by orthodontic devices.

Force system evaluation of symmetrical beta-titanium T-loop springs preactivated by curvature and concentrated bends.

INTRODUCTION: The objective of this research was to compare the effect of preactivation on the force system of beta-titanium T-loop springs (TLSs). METHODS: Twenty TLSs with dimensions of 6 × 10 mm, of 0.017 × 0.025-in beta-titanium alloy, were randomly divided into 2 groups according to their preactivation. By using a moment transducer coupled to a digital extensometer indicator adapted to a testing machine, the amounts of horizontal force and moment produced were recorded at every 0.5 mm of deactivation from 5 mm of the initial activation in an interbracket distance of 23 mm. The moment-to-force ratio, the "neutral position" and the load-deflection ratio were also calculated. RESULTS: TLSs preactivated by curvature delivered horizontal forces significantly lower than those preactivated by concentrated bends. No differences were found in relation to the moments produced throughout the deactivation of both groups. The moment-to-force ratios were systematically higher on the TLSs preactivated by curvature than those preactivated by concentrated bends, except on 5 mm of activation. Significant differences were found in the load-deflection rates and "neutral position." CONCLUSIONS: The TLSs preactivated by curvature delivered lower horizontal forces and higher moment-to-force and load-deflection ratios than did those preactivated by concentrated bends.

Effects of stress relaxation in beta-titanium orthodontic loops.

INTRODUCTION: This study evaluates the changes in the force system of the beta-titanium T-loop spring (TLS) caused by stress relaxation. METHODS: Ninety TLSs with dimensions of 6 × 10 mm, made of 0.017 × 0.025-in beta-titanium alloy and preactivated by concentrated bends, were randomly distributed into 9 groups according to the time point of evaluation. Group 1 was tested immediately after spring preactivation and stress relief by trial activation. The other 8 groups were tested after 24, 48, and 72 hours, and 1, 2, 4, 8, and 12 weeks. By using a moment transducer coupled to a digital extensometer indicator adapted to a universal testing machine, the amounts of horizontal forces and moments and the moment-to-force ratios were recorded at every 0.5 mm of deactivation from 5 mm of the initial activation in an interbracket distance of 23 mm. RESULTS: The horizontal forces and moments were higher (P <0.001) for group 1 compared with the other 8 groups, which were not different among themselves. All groups produced similar moment-to-force ratios (P = 0.600), with no influence of time. CONCLUSIONS: The TLSs preactivated by concentrated bends had progressive load decreases over time, and this effect is critical in the first 24 hours.

Can we expect similar behavior among CuNiTi 35°C wires?

OBJECTIVE: This paper aims to verify the thermodynamic, mechanical and chemical properties of CuNiTi 35ºC commercial wires. METHODS: Forty pre-contoured copper-nickel-titanium thermodynamic 0.017 x 0.025-in archwires with an Af temperature of 35°C were used. Eight wires from five different manufacturers (American Orthodontics® [G1], Eurodonto® [G2], Morelli® [G3], Ormco® [G4] and Orthometric® [G5]) underwent cross-sectional dimension measurements, tensile tests, SEM-EDS and differential scanning calorimetry (DSC) tests. Parametric tests (One-way ANOVA and Tukey post-test) were used, with a significance level of 5%, and Pearson's correlation coefficient test was performed between the Af and chemical elements of the wires. All sample tests and statistical analyses were double-blinded. RESULTS: All wires presented standard dimensions (0.017 x 0.025-in) and superelastic behavior, with mean plateau forces of: G1 = 36.49N; G2 = 27.34N; G3 = 19.24 N; G4 = 37.54 N; and G5 = 17.87N. The Af means were: G1 = 29.40°C, G2 = 29.13°C and G3 = 31.43°C, with p>0.05 relative to each other. G4 (32.77°C) and G5 (35.17°C) presented statistically significant differences between each other and among the other groups. All samples presented Ni, Ti, Cu and Al in different concentrations. CONCLUSIONS: The chemical concentration of the elements that compose the alloy significantly influenced the thermodynamic and mechanical properties.