Orthodontic and orthopedic management of dentofacial deformity from juvenile idiopathic arthritis: a systematic literature review.

BACKGROUND: An update on the knowledge regarding the orthopedic/orthodontic role in treating JIA-related dentofacial deformities is relevant. OBJECTIVES: This systematic review aimed to assess the level of evidence regarding the management of dentofacial deformity from juvenile idiopathic arthritis (JIA) with orthodontics and/or dentofacial orthopedics. SEARCH METHODS: The following databases were searched without time or language restrictions up to 31 January 2024 (Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Latin American and Caribbean Health Sciences Literature). SELECTION CRITERIA: Inclusion criteria were studies dealing with JIA subjects receiving treatment with orthodontic and/or dentofacial orthopedic functional appliances. DATA COLLECTION AND ANALYSIS: After the removal of duplicate studies, data extraction, and risk of bias assessment according to ROBINS-I guidelines were conducted. Data extraction was conducted by two independent authors. RESULTS: The electronic database search identified 397 eligible articles after the removal of duplicates. Following the application of the pre-defined inclusion and exclusion criteria, 11 articles were left for inclusion. Two trials were associated with a severe risk of bias, four trials were at moderate risk of bias, and the other five presented a low risk of bias. Various research groups employed and documented the effects of different types of appliances and methodologies. The study heterogeneity did not allow for meta-analyses. In addition, a lack of uniformity in treatment objectives was observed across the included studies. After treatment with dentofacial orthopedics skeletal improvement was demonstrated in 10 studies, and a decrease in orofacial signs and symptoms was reported in 7 studies. CONCLUSIONS: Across the available literature, there is minor evidence to suggest that dentofacial orthopedics may be beneficial in the management of dentofacial deformities from JIA. There is little evidence to suggest that it can reduce orofacial signs and symptoms in patients with JIA. Based on current evidence, it is not possible to outline clinical recommendations for specific aspects of orthopedic management in growing subjects with JIA-related dentofacial deformity. REGISTRATION: PROSPERO (CRD42023390746).

Resorptions and orthodontics / Résorptions et orthodontie

Introduction: It's generally accepted that one of the risks associated with orthodontic treatment is apical root resorption, even though this may occur outside orthodontic treatment. In any case, it causes root shortening. Orthodontists are probably the only dental surgeons who use the inflammatory process as a therapeutic tool. They need to be aware of the risk factors for root inflammation. Along with recurrence, leukemia and periodontal problems, resorption is one of the "inconveniences" of orthodontics, which, if not inevitable, must at least be minimized. Material and Method: At present, the orthodontic literature on root resorption provides some clues as to the factors associated with the onset, severity and management of root resorption, although the complexity of this phenomenon does not allow us to arrive at a clear and unequivocal consensus. For this reason, it is important to identify potential risk factors for resorption, to take them into account before/during and after treatment, and to know what attitude to adopt in the event of resorption appearing, all in order to minimize this phenomenon, as everyone agrees that it can be a source of harm and stress for both patient and practitioner. Conclusion: There are still many grey areas in our understanding of the phenomenon, including how the elements of orthodontic treatment influence orthodontic resorption. Irreversible in nature, resorption can be sufficiently extensive to cast doubt on the benefit of successful orthodontic treatment.

Introduction: Il est généralement admis que l'un des risques associés au traitement orthodontique est la résorption radiculaire apicale même si elle peut se produire en dehors de tout traitement orthodontique. Quoi qu'il en soit, elle provoque le raccourcissement radiculaire. Les orthodontistes sont sans doute les seuls spécialistes de la chirurgie dentaire qui utilisent le processus inflammatoire en tant que moyen thérapeutique. Ils doivent connaître les facteurs de risque de cette inflammation sur la racine. La résorption fait partie, au même titre que la récidive, les leucomes et les problèmes parodontaux, des « inconvénients ¼ de l'orthodontie qui, à défaut d'être inévitables, doivent au moins être minimisés. Matériels et méthode: Actuellement, la littérature orthodontique sur la résorption radiculaire fournit quelques pistes sur les facteurs associés à l'apparition, la gravité et la gestion de la résorption radiculaire, même si la complexité de ce phénomène ne nous permet pas d'en dégager un consensus clair et équivoque. Pour cette raison, il est important d'identifier les facteurs de risque de résorption potentiels pour en tenir compte avant/pendant et après le traitement et connaître l'attitude à adopter en cas d'apparition de résorptions, tout ceci afin de minimiser ce phénomène, car tout le monde s'accorde sur le fait qu'elle peut être source de préjudice et de stress pour le patient et le praticien. Conclusion: De nombreuses zones d'ombres subsistent dans la compréhension du phénomène, notamment sur comment les éléments du traitement orthodontique influencent la résorption orthodontique. De nature irréversible, la résorption peut être suffisamment étendue pour jeter un doute sur le bénéfice apporté au succès du traitement orthodontique.

Prognostic risk factors for apical root resorption in orthodontic patients - Are the Kjær's morphologic characteristics of clinical relevance?

BACKGROUND: Patients undergoing orthodontic treatment (OT) face an increased risk of developing external apical root resorption (EARR). A prognostic risk assessment prior to OT can potentially be conducted through anatomical features in panoramic radiography. This retrospective study aimed to assess the significance of Kjær's morphological characteristics in analyzing the risk of EARR. METHODS: Panoramic radiographs of 1,156 patients (624 females, 532 males) were retrospectively analyzed. Anamnestic and treatment-related data were extracted from patient records. The mean age at the start of OT was 12.8 ± 2.2 years (min. 6.4 years, max. 22.3 years) and at the end of OT 15.9 years (min. 8.5 years, max. 24.1 years). The mean treatment duration was 3.1 ± 1.6 years. Panoramic radiographs with a minimum of two per patient were examined for the presence of Kjær's characteristics. The degree of EARR was registered defining resorption in four degrees of severity. Bivariate analysis and multivariate Poisson regression were performed to assess the association between Kjær's characteristics and EARR patient- and tooth- related (α = 0.05). RESULTS: In total, 72.8% of the patients showed EARR at the end of OT with lateral maxillary incisors most frequently affected. Short roots (p < 0.001) were significantly associated with EARR in patients. Tooth-related microdontia (#12, #22, lower second premolars), narrow crowns (#11, #21, lower incisors), short roots (upper incisors, lower first molars) and ectopia (#11, #21, #13), such as shorter distal roots of the mandibular first molar showed a significant association with EARR depending on severity degree. The type of orthodontic appliance (fixed: p < 0.001, fixed and removeable: p = 0.008), as well as treatment duration (p < 0.001) were also identified as risk factors for EARR. CONCLUSIONS: Although the risk assessment for EARR development through panoramic radiography analysis is limited, predisposition appears to be present in specific dental characteristics and treatment-related factors.

The effect of physical interventions on pain control after orthodontic treatment: A systematic review and network meta-analysis.

OBJECTIVE: Pain is a frequent adverse reaction during orthodontic treatment, which can significantly reduce treatment compliance and compromise the expected treatment effect. Physical interventions have been used to alleviate pain after orthodontic treatment, but their effectiveness is controversial. This study used a network meta-analysis to assess the efficacy of various physical interventions typically used in managing pain after orthodontic treatment, with a view to provide evidence-based recommendations for representative interventions for orthodontic pain relief during peak pain intensity. METHODS: A systematic search of six electronic databases, from their respective inception dates, was conducted to identify relevant literature on the efficacy of various typical physical interventions for managing pain after orthodontic treatment. Literature screening was performed according to the Cochrane System Evaluator's Manual. Stata 16.0 was used to assess heterogeneity, inconsistency, publication bias, and sensitivity to generate an evidence network diagram and conduct a network meta-analysis. RESULTS: In total, 771 articles were reviewed to collect literature on interventions, including low-level laser therapy (LLLT), vibration, acupuncture, and chewing. Of these, 28 studies using a visual analog scale (VAS) as an outcome indicator were included. The results showed that LLLT, vibration, acupuncture, and chewing effectively relieved the pain symptoms in patients after orthodontic treatment. At 24 h post-treatment, LLLT (surface under the cumulative ranking curve [SUCRA] = 80.8) and vibration (SUCRA = 71.1) were the most effective interventions. After 48 h of treatment, acupuncture (SUCRA = 89.6) showed a definite advantage as the best intervention. CONCLUSION: LLLT, vibration, acupuncture, and chewing can alleviate pain associated with orthodontic treatment. Among these interventions, acupuncture was found to be the most effective at 48 h after orthodontic treatment. In addition, acupuncture demonstrated long-lasting and stable pain-relieving effects. However, further studies are needed to determine the most suitable equipment-specific parameters for acupuncture in relieving pain associated with orthodontic treatment.

Manejo de defectos tipo recesiones múltiples luego de la terapia de ortodoncia: un caso reportado basado en la evidencia científica / The management of multiple recession like defects after orthodontic therapy: report of a case based on scientific evidence

Por qué en este caso hay nueva in- formación? - Este caso demostró métodos basado en la evidencia para el manejo de severas recesiones gingivales luego de la terapia or- todóntica. - La modificación del grosor gin- gival lleva a resultados estables a largo plazo estéticos y funcio- nales. - Este caso demostró beneficios clínicos usando injertos tomados desde el mismo sitio donador en diferentes momentos de tiempo. Cuales son las claves de éxito para manejar este caso? - Sólidos conocimientos de la anatomía periodontal - Identificación de las caracterís- ticas de RC relacionadas con las causas de la terapia ortodóntica. - ITCSE su toma del paladar. - Uso de colgajos sin tensión. - Incremento del grosor gingival para promover resultados a largo plazo. Cuales son las limitaciones prima- rias del éxito en este caso? - Necesidad de tomas de paladar en ambos lados - Anatomía de las RG y la fina en- cía que puede limitar la extensión del colgajo - Experiencia clínica (AU)

Endodoncia y ortodoncia. Parte 2: casos clínicos / Endodontics and orthodontics. Part 2: clinical cases

Objetivo: Describir el tratamiento endodóncico de cuatro casos clínicos de reabsorción radicular desarrollada durante o tras un tratamiento ortodóncico. Casos clínicos: Después de la preparación y la desinfección de los conductos radiculares, estos fueron obturados por un tiempo prudencial con una medicación intraconducto de hidróxido de calcio, que luego fue reemplazada por MTA. Luego de un período de entre uno y cuatro años, según el caso, los tratamientos fueron evaluados clínica y radiográficamente. Los dientes que debieron ser extraídos fueron analizados histológicamente. Según la evolución clínica y radiográfica de los casos presentados, el uso inicial de hidróxido de calcio y su posterior reemplazo por MTA parecería ser un protocolo adecuado para completar el proceso de reparación de los tejidos apicales y perirradiculares en casos de reabsorciones radiculares provocadas por fuerzas ortodóncicas excesivas. Las enfermedades sistémicas deben ser tenidas en cuenta para la elección de la terapéutica (AU)

Aim: To describe the endodontic treatment of four clinical cases of permanent teeth suffering root resorption during or after orthodontic treatment. Clinical cases: Four clinical cases of permanent teeth with root resorption were endodontically treated. After the root canals were prepared and disinfected, they were medicated with calcium hydroxide. After an appropriate observation period, the canals were finally filled with MTA. The treatment outcomes were clinically and radiographically assessed at an interval between one to four years according to the clinical case. The histological findings of teeth that required extraction was also described. Our clinical and radiographic observations suggest that a temporary filling with calcium hydroxide and further obturation with MTA can provide a favorable intracanal environment for apical and periradicular tissue reparation. The clinician needs a full medical history to be aware of the systemic diseases in patients with root resorption that will be of importance for the proper selection of treatment (AU)

Relación del tratamiento ortodóncico con el riesgo a la aparición o agravamiento de recesiones gingivales. Parte 1: bibliografía publicada / Relationship between orthodontic treatment and the risk of appearance or worsening of gingival recessions. Part 1: literature published

El objetivo del presente artículo es proveer un resumen ordenado de la bibliografía publicada en las últimas décadas, concerniente a la aparición o el agravamiento de las recesiones gingivales en relación a los tratamientos ortodóncicos. Diferentes estudios, en modelos animales, han demostrado que el movimiento ortodóncico hacia vestibular genera con bastante frecuencia dehiscencias óseas. En la mayoría de los casos, esto no se acompaña con la aparición de recesiones gingivales. Los estudios retrospectivos constituyen al momento la mejor evidencia disponible. Si bien se encuentran problemas metodológicos en los mismos, es posible establecer algunas conclusiones. El tratamiento ortodóncico puede contribuir a la aparición de recesiones gingivales o al agravamiento de las mismas. La prevalencia de las mismas es baja al terminar el tratamiento, pero se incrementa a medida que transcurren los años. Las piezas dentarias con mayor prevalencia son los incisivos inferiores, especialmente los centrales. El tratamiento con mayor asociación ha sido la vestibularización de los mismos, pero también se han encontrado asociaciones en pacientes de clase III cuando los incisivos son retrotraídos en un intento de camuflar su malposición. Son necesarios estudios prospectivos para evaluar esta asociación, en los cuales se midan variables como el biotipo gingival, o la presencia de crestas delgadas o dehiscencias óseas y se las relacione con diferentes movimientos y técnicas ortodóncicos a fin de establecer criterios de riesgo(AU)

The objective of this article is to provide an ordered summary of the literature published in recent decades, concerning the appearance or worsening of gingival recessions in relation to orthodontic treatments. Different studies, in animal models, have shown that the orthodontic movement toward the vestibular bone generates bone dehiscence quite frequently. In most cases, this is not accompanied by the appearance of gingival recessions. Retrospective studies are currently the best available evidence. Although methodological problems are found in them, it is possible to establish some conclusions. Orthodontic treatment can contribute to the appearance of gingival recessions or aggravation of them. The prevalence of them is low at the end of treatment, but increases as the years pass. The teeth with more prevalence are the lower incisors, especially the central ones. The treatment with greater association has been the proclination of them, but associations have also been found in class III Angle patients when the incisors are retruded in an attempt to camouflage their malposition. Prospective studies are needed to evaluate this association, in which variables such as the gingival biotype, or the presence of thin ridges or bone dehiscences are measured and related to different orthodontic movements and techniques in order to establish risk criteria (AU)

Cirugía plástica periodontal: reporte de un caso clínico / Periodontal plastic surgery: report of a clinical case

El abordaje terapéutico de las recesiones gingivales requiere un plan de tratamiento que involucre terapia básica, la cual tendrá como objetivo la resolución de la/las etiologías de la/las mismas y una terapia de cirugía plástica periodontal adecuada al caso específico. Los procedimientos quirúrgicos con injertos de tejido conjuntivo tomados principalmente del paladar son el gold standard en el tratamiento de las recesiones gingivales. El objetivo de este trabajo es exponer paso a paso el tratamiento de una recesión gingival post-terapia de ortodoncia y su evaluación a largo plazo (AU)

The therapeutic approach to gingival recession requires a treatment plan involving basic therapy, which will focus on its etiologies, and the most suitable periodontal plastic surgery therapy in each specific case. Surgical procedures with connective-tissue grafts, taken mainly from the palate, are the gold standard in gingival recession treatment. The aim of this paper is to present the step-bystep post-orthodontic therapy treatment of a case of gingival recession and its long-term evaluation (AU)

Manejo de analgésicos en ortodoncia / Analgesic management in orthodontics

Antecedentes: El dolor y el miedo al dolor durante el tratamiento odontológico son frecuentes tanto en la práctica general como en la especialidad de la ortodoncia. El dolor de variada intensidad se presenta en 94% de los pacientes durante el primer día del tratamiento ortodóncico y todavía al sexto día lo padece aproximadamente 50%. Sin embargo, en muchas ocasiones los pacientes no reciben una receta médica o medicamentos para el alivio del dolor y esto puede conducir a la automedicación. Objetivos: El propósito de este estudio fue determinar el manejo del dolor que el ortodoncista realiza durante el tratamiento dental. Material y métodos: Este estudio es de tipo transversal mediante una encuesta de respuesta inmediata a 51 odontólogos especialistas en ortodoncia egresados de diferentes universidades y en diferentes tiempos. Asimismo, fueron entrevistados 100 pacientes ortodóncicos portadores de brackets a quienes se les realizaron preguntas relacionadas con la percepción de dolor y el manejo farmacológico de éste durante la cementación de brackets, cambio del arco de alambre o activación de sus aparatos. Resultados: 35.3% (n = 18/51) de los ortodoncistas prescriben analgésicos de manera habitual, mientras que 64.7% (n = 33/51) no lo hacen y 29.4% (n = 15/51) los indican con horario fijo. El analgésico de elección fue el paracetamol (64.7%; n = 33/51). 51% (n = 26/51) de los ortodoncistas refieren que no emplean analgésicos porque no existe dolor durante el tratamiento dental, o si lo hay, es leve, transitorio y tolerable. 52% (n = 52/100) recibió la instrucción verbal de tomar analgésicos en caso de ser necesario, mientras que al resto no se le dio tal indicación. Del total de pacientes sólo 4% (n = 4/100) no percibió dolor durante el tratamiento, en tanto que el resto presentó dolor leve (19%), moderado (57%) y severo (20%). La frecuencia de días con dolor posterior a la cementación o activación de los brackets fue de 1-3 días (56%). El principal trastorno ocasionado por el tratamiento fue la alteración de la masticación, es decir, la incapacidad y/o dolor durante la masticación se presentó en 86%, y 42% se adaptó a la presencia de los brackets en su boca en un tiempo de entre dos a cuatro semanas. Conclusiones: La mayoría de los ortodoncistas encuestados afirman que el dolor producido por las fuerzas ortodóncicas es de baja intensidad y el paciente lo tolera muy bien, por lo que la administración de analgésicos es innecesaria y cuando tienen que recetar algún medicamento, el de su preferencia es el paracetamol; sin embargo, no lo recetan con dosis y horario fijo. La afirmación de parte de 51% de los ortodoncistas respecto a que el paciente no presenta dolor durante el tratamiento ortodóncico no se cumple, ya que se encontró que 77% de los pacientes presentaron dolor entre moderado y severo durante al menos 1-3 días posteriores a la cementación o activación de los aparatos (AU)

Background: Pain and fear of suffering during the orthodontic treatment, are still frequent in both general and specialty dental practice, including the orthodontics. The pain with different intensity, it is shown in the 94% of the patient, during the 1st day of the orthodontic treatment but still, during the 6th day, it appears to the 50% of the patients. Nevertheless, on many occasions, the patients do not receive any prescription or pain relief medication and this may lead to self-medication. Objectives: The purpose of this study was to determine the pain management that the orthodontist performs during dental treatment. Material and methods: This cross-sectional study was carried out by an immediate response survey to 51 orthodontic dentists graduated from different universities and at different times. We also interviewed 100 orthodontic patients who were asked questions related to their perception of pain and its pharmacological management during the activation of the devices. Results: 35.3% (n = 18/51) of orthodontists usually prescribe analgesics while the 64.7% (n = 33/51) they won't give any prescriptions; 29.4% (n = 15/51) indicating a specific time. The analgesic choice was paracetamol (64.7%; n = 33/51). 51% (n = 26/51) of the orthodontist they said that most of the time they won't give any prescription because there was no pain during the dental treatment, or in case that exists, they comment that is transitory or is a tolerated pain. The 52% (n = 52/100) they received the indication of taking analgesics in case they needed it, whereas the rest weren't receiving any indication. Of all patients only 4% (n = 4/100) did not feel pain during their treatment; meanwhile, the 19% felt a mild pain; 57% felt a moderate pain and 20% severe pain. The frequency with pain after the cementation or activation of the devices it is about 1 to 3 days (56%). The main disorder by the treatment was the chewing alteration (86%), and the 42% adapted to their braces in a time of 2-4 weeks. Conclusions: The majority of orthodontists enrolled, they had commented that the pain produced by the force of the braces is a low intensity and that the patient will tolerate without any problem, and because of that, there isn't a need to give them any prescription, and when there's a need the one of their preference is paracetamol, nevertheless they don't give the prescription with time and required doses. The affirmation from the 51% of the orthodontist about the patient that does not suffer any pain during their orthodontic treatment it's not according to the 77% who felt pain between moderate and severe during at least 1-3 days after the cementation or activation of devices (AU)

Perceptions of pain levels and chewing impairment among adolescents undergoing orthodontic treatment with fixed appliances

Aim: the aim of this cohort study was to evaluate the perceptions of adolescents regarding pain levels and chewing impairment throughout the first 12 months of orthodontic treatment with fixed appliances. methods: a total of 120 adolescents aged 11 and 12 years undergoing orthodontic treatment at the faculty of dentistry of the Federal University of Minas Gerais participated in this study. malocclusion was evaluated by means of the dental aesthetic index. pain level and degree of chewing impairment were evaluated by means of two questions selected from the short form of the child perceptions questionnaire (CPQ11-14). each question had five response options with the following scoring system: never (0), once or twice (1), sometimes (2), often (3) and every day/almost every day (4). both questions were answered by the adolescents at four different times: before fixed appliances' placement (T1), one month after banding and fixed appliances' bonding (T2), four months after banding and fixed appliances' bonding (T3), and 12 months after banding and fixed appliances' bonding (T4). results: the mean age of adolescents was 11.39 (±0.68). significant differences were observed for pain levels (p=0.038) and chewing impairment (p=0.020) over the study period. pain levels at T1 were significantly lower than at T2 (p=0.038) and T4 (p=0.020). chewing impairment at T1 was significant lower than at T2 (p<0.001), T3 (p=0.014) and T4 (p=0.005). conclusion: adolescents undergoing orthodontic treatment with fixed appliances present an increase in pain levels and in chewing impairment.

Iatrogenics in Orthodontics and its challenges

ABSTRACT Introduction: Orthodontics has gone through remarkable advances for those who practice it with dignity and clinical quality, such as the unprecedented number of patients treated of some type of iatrogenic problems (post-treatment root resorptions; occlusal plane changes; midline discrepancies, asymmetries, etc). Several questions may raise useful reflections about the constant increase of iatrogenics. What is causing it? Does it occur when dentists are properly trained? In legal terms, how can dentists accept these patients? How should they be orthodontically treated? What are the most common problems? Objective: This study analyzed and discussed relevant aspects to understand patients with iatrogenic problems and describe a simple and efficient approach to treat complex cases associated with orthodontic iatrogenics.

RESUMO Introdução: a Ortodontia tem vivenciado momentos marcantes para quem a exerce com dignidade e qualidade clínica. Um deles é a chegada, sem precedentes, dos pacientes com algum tipo de iatrogenia, como: reabsorções radiculares pós-tratamento, alterações no plano oclusal, desvios de linha média, assimetrias, entre outras. Diversas questões permitem uma boa reflexão sobre esse constante aumento das iatrogenias. Qual o motivo? Acontecem com profissionais bem formados? Como receber, legalmente, esses pacientes? Como tratá-los ortodonticamente? Quais são os problemas mais comuns? Objetivo: o objetivo do presente trabalho é analisar e discutir pontos relevantes para melhor atender esse tipo de paciente e apresentar uma abordagem simples e eficaz na condução de casos complexos relacionados às iatrogenias ortodônticas.

Polimorfismo (+3954c>T) del gen IL-1B y su asociación con la resorción radicular apical externa post-tratamiento ortodóntico / IL-1B (+3954c>T) gene polymorphism and its association with external root resorption after orthodontic treatment

El objetivo fue determinar la presencia del polimorfismo rs1143634 (+3954C>T) del gen Interleuquina 1 Beta (IL-1B) y su asociación con la resorción radicular apical externa (RRE) post-tratamiento ortodóntico. Se realizó un estudio piloto de individuos tratados con aparatología ortodontica, 13 (casos) presentaron RRE posterior al tratamiento ortodóntico y 22 (controles) estaban clínicamente sanos. A partir de muestras de células epiteliales de mucosa bucal se extrajo ADN y se genotipificó el polimorfismo rs1143634 (+3954C>T) del gen IL-1B mediante la reacción en cadena de la polimerasa y digestión del producto con la enzima de restricción TaqI. Se estimaron las frecuencias alélicas y genotípicas del rs1143634; además, se evaluó la desviación del equilibrio de Hardy-Weinberg. Las frecuencias alélicas y genotípicas se compararon mediante la prueba de c2 con razón deverosimilitud (p <0,05). El promedio de edad de los participantes fue 28,1 (DE=11,5) años y el 68,6 % era mujeres. Al comparar la distribución de los genotipos del polimorfismo IL-1B (+3954C>T) entre grupos no se encontró una diferencia estadísticamente significativa (p=0,0926). Sin embargo, se observó una diferencia significativa en la distribución de alelos (p= 0,035), siendo el alelo T (alelo 2) más prevalente en el grupo control. El polimorfismo IL-1B (+3954C>T) se encontró presente en la población de estudio. Aunque no existieron diferencias en la distribución de los genotipos que apoyara una asociación entre este polimorfismo y la RRE, si hubo una diferencia en la distribución de los alelos, sugiriendo que el alelo T posiblemente actúa como factor protector contra el desarrollo de la RRE.

The objective of this study was to determine the presence of Interleukin 1 beta (IL-1B) rs1143634 (+3954C>T) gene polymorphism and its association with external apical root resorption (ERR) after orthodontic treatment. We conducted a pilot study of individuals treated with orthodontic treatment, 13 (cases) had ERR after orthodontic treatment and 22 (controls) were clinically healthy. DNA was extracted from samples of epithelial cells from the oral cavity and IL-1B rs1143634 (+3954C>T) gene polymorphism was genotyped by polymerase chain reaction and digestion product through the TaqI restriction enzyme. Genotype and allele frequencies of rs1143634 were estimated; in addition, the deviation from Hardy-Weinberg equilibrium was assessed. Allele and genotype frequencies were compared using the c2 test with likelihood ratio (p <0.05). The mean age of participants was 28.6 (SD= 11.5) years and 68.6 % were females. No statistically significant association was found between the genotypes distribution of IL-1B (+3954C>T) polymorphism with ERR (p= 0.0926). However, a significant difference in the alleles distribution (p= 0.035) was observed, where the allele T (allele 2) was more prevalent in the control group. IL-1B (+3954C>T) polymorphism was present in the study population. Although there were no differences in the genotypes distribution to support an association between this polymorphism with ERR, there was a difference in the alleles distribution, suggesting that the allele T possibly acts as a protective factor against the development of ERR.

Relação entre tratamento ortodôntico e disfunção temporomandibular / The relationship between orthodontic treatment and temporomandibular joint disfunction

A relação entre a Ortodontia e as disfunções temporomandibulares vem gerando muitas dúvidas e discussões dentro da classe ortodôntica nos últimos tempos. Ao analisar algumas publicações, observa-se que o tratamento ortodôntico tem sido contestado sobre vários aspectos com relação à sua atuação. Se para alguns autores a mecânica ortodôntica pode levar à cura da DTM, para outros, ela pode funcionar como fator etiológico das disfunções do sistema estomatognático. Com o intuito de sanar essas dúvidas, esta revisão da literatura foi realizada, porém, é visível a necessidade de mais pesquisas sobre esse assunto, uma vez que se mostra um tanto quanto controverso.

The relationship between orthodontic treatment and temporomandibular joint disfunction has been subjected to many questions and discussions within in orthodontic community for in the last years. The analysis of recent publication leads to the observation that orthodontic treatment has been in many ways refuted based on its course of action. While for some researchers, orthodontic treatment can lead to TMD cure, for others it can work as the etiologic factor. Aiming to shed some light in this topic, a literature review was performed. However, more studies are necessary since this question has brought some controversy.

Avaliação das reabsorções radiculares durante o tratamento ortodôntico / Radiographyc evaluation of root resorption during the orthodontic treatment

A terapia ortodôntica fatalmente traz um encurtamento radicular iatrogênico e irreversível em quase todos os dentes, variando quanto a sua gravidade. O objetivo deste trabalho foi avaliar radiograficamente a ocorrência de reabsorção radicular em pacientes que foram submetidos ao tratamento ortodôntico no Curso de Especialização de Ortodontia da Ciec – Uningá, em São Luís/MA. Foram realizadas duas séries de tomadas radiográficas periapicais, antes e após 12 meses de tratamento, pela técnica do paralelismo, de incisivos superiores de 42 pacientes, excluindo pacientes que já haviam sido submetidos a tratamento ortodôntico, com tratamento endodôntico, mordida aberta, dentes com rizogênese incompleta ou qualquer radiografia em que não fosse possível visualizar o ápice radicular. Foi utilizado o escore proposto por Levander e Malmgren, em 1988 (graus 0, 1, 2, 3 e 4), o qual se refere a uma quantidade específica de reabsorção, comparando-se o grau de reabsorção nas radiografias inicial e final. Não houve diferença estatisticamente significativa entre os elementos analisados, 88% (37) dos pacientes apresentaram algum grau de reabsorção, considerando antes e após 12 meses de tratamento. Porém, 66% (28) do total de pacientes apresentou aumento no grau de reabsorção nesse intervalo de tempo, sendo 86,9% (23) destes para o grau suave, reafirmando o caráter estimulador das forças ortodônticas na ocorrência de reabsorções radiculares, sendo estas, no geral, em nível leve, quando controladas. Ratifica-se, portanto, a importância do controle radiográfico periódico para identificar aqueles pacientes que apresentam risco de reabsorção, a ser controlada, sendo levado em consideração o custo-benefício de se prosseguir com o tratamento em determinados casos...

The orthodontic treatment brings a shortening and irreversible iatrogenic root, in almost all teeth, varying as to its severity. The aim of this study was to evaluate radiographically the occurrence of root resorption in patients who were under orthodontic treatment in the Specialization Course in Orthodontics Ciec – Uningá in São Luís/MA. We conducted two sets of periapical radiographs taken before and after 12 months of treatment, through the technique of parallelism, the maxillary incisors of 42 patients, excluding patients who have been under orthodontic treatment previously, endodontically treated teeth, open bite, teeth with incomplete root formation or any radiograph in which it was not possible to visualize the apex. We used the score proposed by Levander (grades 0, 1, 2, 3, 4), which refers to a specific amount of resorption, comparing degree of resorption in the initial and final radiographs. There was no statistically significant difference between the elements analyzed, 37 (88%) patients had some degree of resorption, whereas before and after 12 months of treatment. However 28 (66%) of all patients showed an increase in the degree of resorption in this time interval, and that 23 (86.9%) for the degree of soft, reaffirming the stimulator character of orthodontic forces on the occurrence of root resorption, that in general, in light level when controlled. Ratification is, therefore, the importance of periodic radiographic control to identify those patients at risk of resorption, to be controlled, being taken into account the cost-benefit of continuing treatment in certain cases...

Actualización en ortodoncia y bifosfonatos: consideraciones clínicas y experimentales / An update on biphosphonates: clinical and experimental considerations

Los bisfosfonatos son fármacos utilizados para el tratamiento de enfermedades que afectan al metabolismo óseo, principalmente para el tratamiento de la osteoporosis, siendo ésta la principal causa de prescripción médica de los mismos. Actualmente, no se encuentran esclarecidas las posibles complicaciones o riesgos implícitos del tratamiento ortodóntico aplicado a pacientes que reciben o han recibidobisfosfonatos. Dada la demanda actual, con un elevado número de pacientes que se encuentran en la búsqueda de un tratamiento ortodóntico muchos de los cuales son y/o han sido tratados con bisfosfonatos para la osteoporosis, es de relevancia conocer el efecto de laaplicación de fuerzas ortodónticas en un tejido óseo que ha sido tratado con dichas drogas. Por lo antedicho, el objetivo de este trabajo, ha sido realizar una actualización sobre los nuevos conocimientos emergentes de las últimas publicaciones científicas provenientes de trabajos clínicos como así también experimentales que asocien la ortodoncia y los bisfosfonatos. Para ello se realizó una exhaustiva búsqueda de información en la base de datos de Pubmed. La búsqueda obtenida reveló que en los pacientes que reciben y/o han recibido bisfosfonatos y son tratados ortodónticamente se observa una disminución del movimiento dentario, escasa obtención de paralelismo radicular y, en los casos con exodoncias previas aparición de áreas de esclerosis ósea. No fueron descriptos casos en los que se viera asociada la aparición de osteonecrosis de los maxilares. Por su parte, los estudios experimentales, obtuvieron resultados orientados en el mismo sentido, avalando los resultados clínicos...

Reabsorção radicular severa após tratamento ortodôntico com a técnica dos alinhadores / Severe root resorption following treatment with aligners

Resumo / Os alinhadores são aparelhos removíveis que vêm ganhando popularidade na Ortodontia contemporânea. Devido ao fato de serem aparelhos removíveis que liberam força leve de forma não contínua aos dentes, é lícito pensar que esses dispositivos seriam menos prejudiciais para as raízes dentárias do que os aparelhos fixos. No entanto, essa inferência não foi exaustivamente investigada e poucos trabalhos têm relatado problemas associados com a técnica dos alinhadores. / Objetivo / Assim, o objetivo desse artigo é apresentar um caso de uma paciente que sofreu reabsorção radicular apical dos incisivos superiores durante o tratamento com alinhadores e discutir alguns aspectos dessa modalidade de tratamento que podem levar à reabsorção radicular, como a suscetibilidade individual e a aplicação de forças intrusivas.

Association between post-orthodontic treatment gingival margin alterations and symphysis dimensions

Sabe-se que o tratamento ortodôntico está associado com odesenvolvimento de recessão gengival. Vários fatores podemestar envolvidos na cadeia causal deste desfecho, incluindoaspectos anatômicos e comportamentais. Dentre os aspectosanatômicos, as dimensões da sínfise mandibular poderia terum papel predisponente. O presente estudo avaliou a relaçãoentre as dimensões da sínfise mandibular prévias ao tratamentoortodôntico e o desenvolvimento de recessões gengivais nosincisivos e caninos inferiores. Prontuários de 189 adolescentestratados ortodonticamente foram avaliados, incluindo radiografias,modelos e fotografias intra-orais. Dimensões dasínfise foram determinadas em cefalogramas. Alterações damargem gengival foram observadas em fotografias e modelos.Associações entre alterações da margem gengival e dimensõesda sínfise foram testadas por qui-quadrado (α=0.05). A ocorrênciade recessão gengival aumentou após tratamentoortodôntico. Não foi observada associação entre as medidasmédias de sínfise e a ocorrência de recessões gengivais. Podeseconcluir que as dimensões da sínfise pré-tratamentoortodôntico não podem ser usadas como preditores de recessãogengival pós-tratamento ortodôntico...

Orthodontic therapy is known to be associated with the developmentof gingival recession. Several factors may be involved in thecausal chain of this outcome, including anatomical and behavioralaspects. Among the anatomical aspects, the dimensions ofthe mandibular symphysis could play a predisposing role. Thisstudy evaluated the relationship between the mandibular symphysisdimensions prior to orthodontic therapy and the developmentof gingival recessions on the lower incisors and cuspids. Recordsfrom 189 orthodontically treated adolescents were evaluated,including radiographs, casts and intra-oral photographs. Symphysisdimensions were assessed by cephalograms. Gingival marginalterations were determined in photographs and cast models.Association between gingival margin alterations and symphysisdimensions was tested by chi-square (α=0.05). Occurrenceof gingival recession increased after orthodontic therapy. No associationwas observed on average of symphysis dimensions and theoccurrence of gingival recessions. It may be concluded that pretreatmentsymphysis dimensions may not be used as predictors ofgingival recession after orthodontic therapy...

Assessment of pain experience in adults and children after bracket bonding and initial archwire insertion

INTRODUCTION: Ninety five percent of orthodontic patients routinely report pain, due to alterations in the periodontal ligament and surrounding soft tissues, with intensity and prevalence varying according to age. OBJECTIVE: This study aimed to assess toothache and buccal mucosal pain in adults and children during two initial phases of the orthodontic treatment. METHODS: The intensity of toothache and buccal mucosal pain reported by 20 patients, 10 children (11-13 years) and 10 adults (18-37 years) was recorded with the aid of a Visual Analog Scale (VAS), during 14 days - 7 days with bonded brackets only and 7 days with the initial archwire inserted. RESULTS: There was no significant difference in pain intensity among adults and children. After bracket bonding, 50% of the children and 70% of the adults reported pain. 70% of both groups reported pain after initial archwire insertion. While adults reported constant, low intensity, buccal mucosal pain, the children showed great variation of pain intensity, but with a trend towards decreasing pain during the assessment period. After initial archwire insertion the peaks of toothache intensity and prevalence occurred 24 hours in children and 48 hours in adults. CONCLUSIONS: In general, children reported pain less frequently than adults did, though with greater intensity.

INTRODUÇÃO: durante o tratamento ortodôntico, os pacientes rotineiramente relatam situações de dor, que ocorrem em até 95% dos casos. Essa dor é proveniente de alterações no ligamento periodontal e nos tecidos moles circundantes, e a sua intensidade e prevalência variam de acordo com a faixa etária dos pacientes. OBJETIVO: o objetivo desse estudo foi avaliar a experiência de dor nos dentes e na mucosa bucal em pacientes adultos e crianças durante duas fases iniciais do tratamento ortodôntico. MÉTODOS: a intensidade de dor nos dentes e na mucosa bucal relatada por 20 pacientes, 10 crianças (11-13 anos) e 10 adultos (18-37 anos), foi registrada com uma Escala Visual Analógica (EVA) durante 14 dias, sendo 7 dias apenas com os braquetes colados e 7 dias com o arco inicial inserido. RESULTADOS: não houve diferença significativa na intensidade de dor entre adultos e crianças. Após a colagem dos braquetes, 50% das crianças e 70% dos adultos relataram dor; e, após a inserção do arco inicial, a prevalência de relatos foi de 70% para ambos os grupos. Os adultos relataram dores constantes e de baixa intensidade na mucosa bucal, enquanto as crianças mostraram grande variação na intensidade, porém com tendência de diminuição durante o período de avaliação. Os picos de intensidade e prevalência de dor nos dentes ocorreram, respectivamente para crianças e adultos, 24h e 48h após a inserção do arco inicial. CONCLUSÃO: de modo geral, as crianças exibiram menor prevalência de relatos de dor, porém com maior intensidade do que os adultos.

Comparison of the changes of alveolar bone thickness in maxillary incisor area in extraction and non-extraction cases: computerized tomography evaluation

OBJECTIVE: To compare, through computed tomography, alveolar bone thickness changes at the maxillary incisors area during orthodontic treatment with and without tooth extraction. METHODS: Twelve patients were evaluated. They were divided into 2 groups: G1 - 6 patients treated with extraction of right and left maxillary first premolars, with mean initial age of 15.83 years and mean treatment length of 2.53 years; G2 - 6 patients treated without extraction, with mean initial age of 18.26 years and mean treatment length of 2.39 years. Computed tomographies, lateral cephalograms and periapical radiographs were used at the beginning of the treatment (T1) and 18 months after the treatment had started (T2). Extraction space closure occurred in the extraction cases. Intragroup and intergroup comparisons were performed by dependent and independent t test, respectively. RESULTS: In G1, the central incisor was retracted and uprighted, while in G2 this tooth showed vestibularization. Additionally, G1 presented a higher increase of labial alveolar bone thickness at the cervical third in comparison with G2. The incidence of root resorption did not present significant differences between groups. CONCLUSION: There were no changes in alveolar bone thickness when extraction and nonextraction cases were compared, except for the labial alveolar bone thickness at the cervical third of maxillary incisors.

OBJETIVO: comparar, por meio de tomografia computadorizada, a alteração da espessura óssea alveolar na região de incisivos superiores durante o tratamento ortodôntico, com e sem extração dentária. MÉTODOS: foram avaliados 12 pacientes, divididos em dois grupos: G1, seis pacientes tratados com extrações de dois primeiros pré-molares superiores, com idade média inicial de 15,83 anos, e tratados por um tempo médio de 2,53 anos; G2, seis pacientes tratados sem extrações, com idade média inicial de 18,26 anos e tratados por um período de 2,39 anos. Foram utilizadas tomografias computadorizadas, telerradiografias em norma lateral e radiografias periapicais ao início (T1) e após 18 meses de tratamento (T2), desde que o espaço da extração já estivesse fechado nos casos tratados com extrações. A comparação intragrupo foi realizada por meio do teste t dependente, e a comparação intergrupos por meio do com o teste t independente. RESULTADOS: o grupo 1 apresentou uma retração e verticalização do incisivo central, enquanto o grupo 2 apresentou uma vestibularização desse dente. Além disso, o grupo 1 apresentou maior aumento da espessura óssea cervical vestibular durante o tratamento, quando comparado ao grupo 2. A incidência de reabsorção radicular não apresentou diferenças significativas entre os grupos. CONCLUSÕES: não houve alteração nas espessuras ósseas alveolares quando comparados casos tratados com e sem extrações, com exceção da espessura óssea vestibular na região cervical dos incisivos superiores.