Mandibular second premolar distoangulation: a longitudinal follow-up from the mixed to the permanent dentition.

OBJECTIVE: The aim of this study was to assess the frequency of mandibular second premolar (MnP2) distoangulation among orthodontic patients and the angular changes after a longitudinal follow-up. METHODS: The sample was collected from the orthodontic records of 865 patients. The distoangulation group was composed of 42 patients (mean age 9.29 ±â€…1.24 years, 16 male, 26 female) with distoangulation of MnP2. The control group was composed of 32 patients (mean age 9.38 ±â€…1.10 years, 15 male, and 17 female) without distoangulation of MnP2. Panoramic radiographs taken in the mixed (T1) and the early permanent dentition (T2) were analyzed in both groups. Longitudinal angular changes (distal angle θ and premolar-molar angle γ), degree of root formation, second premolar depth, and prevalence of associated dental anomalies were analyzed. Intergroup comparison was performed with Mann-Whitney, t-tests, and chi-square tests (P < 0.05). RESULTS: The prevalence of MnP2 distoangulation in the mixed dentition was 4.85%. The distoangulation group showed a smaller initial distal angle (59.34o ±â€…8.41) when compared to control group (79.88o ±â€…7.60). The spontaneous eruption of the MnP2 with distoangulation was observed in 76.57% of the sample. MnP2 distoangulation was significantly associated with agenesis of its antimere, small maxillary lateral incisors, and deciduous molar infraocclusion. LIMITATIONS: Severe cases of MnP2 distoangulation were absent in this study. CONCLUSIONS: The frequency of MnP2 distoangulation among orthodontic patients was 4.85%. Mild to moderate distoangulated Mnp2 spontaneously uprighted from the mixed to the permanent dentition. Small lateral incisors, second premolar agenesis, and infraocclusion of deciduous molar were frequently found in cases with MnP2 distoangulation.

Dentoskeletal comparison of miniscrew-anchored maxillary protraction with hybrid and conventional hyrax expanders: A randomized clinical trial.

INTRODUCTION: This randomized clinical trial aimed to compare the skeletal and dental effects of miniscrew-anchored maxillary protraction (MAMP) using hybrid hyrax (HH) and conventional hyrax (CH) expanders in growing patients with Class III malocclusion. METHODS: This was a randomized, parallel, controlled trial. Forty growing patients with Class III malocclusion and maxillary deficiency (Wits appraisal of less than -1 mm) were randomized into 2 groups. Patients were recruited at the Orthodontic Clinic of Bauru Dental School, University of São Paulo, Brazil. The HH group was composed of patients with Class III malocclusions in the late mixed or early permanent dentition treated with a HH expander with 2 miniscrews in the maxilla and 2 miniscrews in the anterior region of the mandible. Class III elastics were used from the maxillary first molars to the mandibular miniscrews placed between permanent canines and first premolars. The CH group was composed of patients treated with a similar protocol except for the use of a CH expander in the maxilla. The primary outcomes included the frequency of overjet correction and sagittal skeletal effects produced with treatment. Allocation was performed with a simple randomization process. Blinding was performed only during assessments. Data were analyzed blindly on an intention-to-treat basis. Intergroup comparison was performed using analysis of covariance. Mean differences (MD) and 95% confidence interval (CI) were obtained for all variables. RESULTS: The final sample for the HH group was 20 subjects (8 female, 12 male; initial age of 10.7 years), whereas the final sample for the CH group was 15 subjects (6 female, 9 male; initial age of 11.5 years). The frequency of overjet correction observed in the HH and CH groups was 94.4% and 71.4% (risk ratio, 1.32; 95% CI, 0.93-1.88), respectively. Both groups presented similar skeletal sagittal and vertical outcomes after maxillary protraction. The maxillary length (CoA) showed a similar increase in both groups (MD, 1.12 mm; 95% CI, -0.03 to 2.27). The CH group demonstrated a greater mesial displacement of maxillary first molars after treatment than the HH group (MD, 1.22 mm; 95% CI, 0.33-2.11). HH and CH groups produced 2.88 and 1.97 overjet corrections (MD, 0.53 mm; 95% CI, -0.52 to 1.59), respectively. CONCLUSIONS: MAMP using HH and CH expanders produced a frequency of overjet correction of 94.4% and 71.4%, respectively. Similar skeletal effects were observed between MAMP using HH and CH expanders. Greater control of the mesial displacement of maxillary first molar during maxillary protraction using hybrid expanders was observed. REGISTRATION: The trial was registered at http://ClinicalTrials.gov, under the identifier NCT03712007. PROTOCOL: This trial protocol was not published. FUNDING: This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Brasil (CAPES) - Finance Code 001, and by the São Paulo Research Foundation (FAPESP) - Grants nos. 2017/04141-9, 2017/24115-2, and 2019/03175-2.

Esthetic evaluation of the facial profile in rehabilitated adults with complete bilateral cleft lip and palate.

PURPOSE: To assess the facial esthetics of patients with complete bilateral cleft lip and palate, and to compare the judgment of raters related and unrelated to cleft care. MATERIALS AND METHODS: The sample comprised 23 adult patients (7 women and 16 men) with a mean age of 26.1 years, rehabilitated at a single center. Standardized photographs of the right and left facial profile were taken of each patient and subjectively evaluated by 25 examiners: 5 orthodontists and 5 plastic surgeons with expertise in oral cleft rehabilitation, 5 orthodontists and 5 plastic surgeons without expertise in oral cleft rehabilitation, and 5 laypersons. The facial profiles were classified into 3 categories: esthetically unpleasant, esthetically acceptable, and esthetically pleasant. Intraexaminer and interexaminer agreements were evaluated with the Spearman correlation coefficient and Kendall coefficient of concordance. The differences between rater categories were analyzed using the Student-Newman-Keuls test (with P < .05 indicating a statistically significant difference). RESULTS: Most of the sample was classified as esthetically acceptable. Orthodontists and plastic surgeons related to oral cleft rehabilitation gave the best scores to the facial profiles, followed by layperson examiners and by orthodontists and plastic surgeons unrelated to oral cleft rehabilitation. The middle third of the face, the nose, and the upper lip were frequently pointed out as contributors to the esthetic impairment. CONCLUSIONS: The facial profile of rehabilitated adult patients with complete bilateral cleft lip and palate was considered esthetically acceptable because of morphologic limitations in the structures affected by the cleft. Laypersons and professionals unrelated to oral cleft rehabilitation seem to be more critical regarding facial esthetics than professionals involved with cleft rehabilitation.

Efferent inhibitory effect observed in otoacoustic emissions and auditory brainstem response in the neonatal population.

OBJECTIVE: To characterize the inhibitory effect (IE) in the otoacoustic emission (OAE) and auditory brainstem response (ABR) in newborns at high and low risk for hearing loss. DESIGN: Cross-sectional study. PATIENTS AND METHODS: Seventy-nine newborns at low risk for hearing loss and 46 at high risk underwent transient evoked OAE (TEOAE), distortion product OAE (DPOAE) and ABR testing with or without the presence of contralateral white noise presented at a level of 60 dB SPL. RESULTS: For both low- and high-risk newborns, there were no significant differences in IE between the left and right ears. There was a statistically significant difference in the right-ear IE between the low- and high-risk group for DPOAE and ABR testing. There was also greater agreement of the efferent system evaluation outcomes between TEOAE and ABR. CONCLUSIONS: ABR testing detected IE in a greater number of newborns in the low-risk, as compared to the high-risk group.

Fracture resistance of Class II glass-ionomer cement restorations.

PURPOSE: To investigate in vitro the effect of retentive grooves, GIC type and insertion method on the fracture resistance of Class II glass-ionomer cement (GIC) restorations. METHODS: Premolars were divided into 12 groups (n = 10) according to three variables: retentive grooves [presence (PR) or absence AR)], GICs type [Ketac-Molar (KM), Fuji VIII (F8) and RelyX Luting (RX)], and insertion method [syringe injector (SI) or spoon excavator (SE)]. The specimens were subjected to fracture resistance test. Data were submitted to three-way ANOVA and multiple comparisons were performed using a Tukey test (P < 0.05). RESULTS: Mean fracture resistance values (Kgf) +/- standard deviations (SD) were: KM (PR+SI) = 65.66 +/- 2.5; KM (PR+SE) = 62.58 +/- 2.1; KM (AR+SI) = 57.11 +/- 1.9; KM (AR+SE) = 51.94 +/- 2.3; F8 (PR+SI) = 63.05 +/- 2.1; F8 (PR+SE) = 60.12 +/- 2.3; F8 (AR+SI) = 55.11 +/- 1.9; F8(AR+SE) = 49.20 +/- 1.6; RX (PR+SI) = 50.99 +/- 2.4; RX (PR+SE) = 48.81 +/- 2.5; RX (AR+SI) = 45.53 +/- 2.6; RX (AR+SE) = 41.88 +/- 3.0. Statistically significant differences were observed among all the groups tested (P = 0.001). There was significant difference when pooled means for GIC type were compared with retentive grooves (P = 0.01) and when pooled means for retentive grooves were compared with insertion method (P = 0.01).

Expression of metalloproteinase 2 in the cell response to porous demineralized bovine bone matrix.

The purpose of the study was to analyze the involvement of metalloproteinase 2 (MMP-2) and macrophages in the tissue and cell response to the organic graft material produced from bovine cancellous bone. Thirty adult male white Wistar rats (Rattus norvegicus) received implants of blocks of demineralized bovine bone matrix between the fasciae of the quadriceps muscle. The specimens collected at 3, 7, 14, 21 and 28 days after implantation (n = 6/period). Sections of 6 microm thick were stained with hematoxylin and eosin and immunolabeled with anti-MMP-2 and anti-CD68 using standard avidin-biotin-peroxidase method. The tissue response to the material was initially mediated by polymorphonuclear neutrophils, evolving to a mononuclear inflammatory infiltrate with macrophages and few lymphocytes and plasma cells and presence of inflammatory multinucleated giant cells (GC) in contact with the material that exhibited signs of resorption. The number of cells immunolabeled to MMP-2 was highest at day 7 (103.2 +/- 39.1), but significantly decreased (F = 3.67; p = 0.044) until day 28 (45.9 +/- 13.1). CD68 immunostaining also significantly decreased (F = 6.75; p = 0.007) from day 7 (49.5 +/- 10.4) to day 28 (19.5 +/- 8.9). A positive and statistically significant correlation was observed between the evolutions of these two variables. The material had been almost completely resorbed at day 28. Among cells present at the granuloma, anti-MMP-2 immunostaining was predominant and more intense in macrophages, yet lightly immunolabeled multinucleated giant cells were found in close contact with the material. Thus, considering the experimental limitations of this study, we concluded that MMP-2 produced by macrophages participates in the resorption of demineralized bovine bone.

Effect of the cavity configuration factor on the marginal microleakage of esthetic restorative materials.

PURPOSE: To evaluate the effect of the cavity configuration factor (CF) on the marginal microleakage of cervical restorations with four aesthetic restorative materials. MATERIALS AND METHODS: Conventional cavities, 2.9 mm in diameter and 1.5 mm deep, with CF=2.7 and "saucer"-shaped ones with CF=2 were created in 60 extracted premolars. The following groups were established: G1: Z100/Single Bond, G2: Freedom/Stae, G3: Vitremer/Primer and G4: Durafill/Durafill Bond, following each manufacturer's directions. Thermocycling of the specimens was performed in an aqueous solution of 2% buffered methylene blue, with the temperature varying between 5 to 55 degrees C, for a total of cycles of 60 minutes per day, for 7 days. The specimens were then sectioned and evaluated by two observers using photographs acquired from a stereomicroscope. The values were subjected to Kruskal-Wallis analysis and the Dunn and Wilcoxon test. RESULTS: The averages of the microleakage scores observed in the conventional and "saucer"-shaped cavities were respectively: G1: 0.66/0.46; G2: 0.92/0.69; G3: 1.8/1.86; G4: 3.54/2.3.

Clinical and radiographic evaluation of factors influencing the presence or absence of interproximal gingival papillae.

This study evaluated factors that may influence the presence or absence of interproximal papillae. Clinical evaluation consisted of visual determination, and quantitative analyses were made using millimeter grids on radiographs. Patients (n = 45) were divided into three groups according to age. Data were analyzed using the chi-square test followed by the Student t test (α = .05). The distance from the contact point to the bone crest had significant influence on papilla presence in both anterior and posterior sites (P < .05), whereas the width between roots of adjacent teeth did not. The papilla was missing more frequently in anterior sites. The presence of papillae was not age-dependent.

Nasalance during use of pharyngeal and glottal place of production / Nasalância durante produção de fricativa faríngea e oclusiva glotal

Purpose: This study obtained nasalance scores during use of compensatory articulation (CA) and compared nasalance between groups with and without hypernasality and with and without CA. Methods: Speech samples were obtained from 43 individuals with and without velopharyngeal dysfunction during repetition of 20 phrases originating 860 audio recordings and their respective nasometric values. After excluding 143 recordings due to low quality, the remaining 717 samples were rated by three speech language pathologists (SLPs), independently, for presence or absence of hypernasality and CA. Nasalance scores for the 553 samples rated with 100% agreement among the SLPs were grouped according to the auditory-perceptual ratings: Group 1 (G1) - included samples without hypernasality and without CA (n=191); Group2 (G2) - included samples with hypernasality and without CA (n=288); Group 3 (G3) - included samples with hypernasality and with pharyngeal fricative (n=33); Group 4 (G4) - included samples with hypernasality and with glottal stop (n=41). Results: Analysis of variance (ANOVA) revealed significant difference nasalance scores which were significantly higher for G2, G3, and G4 (p<0.0001) when compared to G1. The use of pharyngeal fricative (G3), particularly during /f/ (p=0.0018) and /s/ (p=0.0017) productions resulted in nasalance scores significantly higher than scores found for G2. Conclusion: Significantly higher nasalance values where identified during use of pharyngeal fricative.

Objetivo: Este estudo obteve medidas de nasalância durante a produção de articulação compensatória (AC) e comparou a nasalância entre grupos com e sem hipernasalidade e com e sem AC. Métodos: As amostras de fala foram obtidas a partir de 43 indivíduos com e sem disfunção velofaríngea durante a repetição de 20 frases, originando um total de 860 gravações e respectivos valores nasométricos. Foram excluídas 143 gravações devido à baixa qualidade e as 717 amostras restantes foram avaliadas por três fonoaudiólogas, de forma independente, quanto à presença ou ausência de hipernasalidade e AC. As 553 amostras julgadas com 100% de concordância entre as fonoaudiólogas foram agrupadas de acordo com o julgamento perceptivo-auditivo: Grupo 1 (G1) - amostras sem hipernasalidade e sem AC (n=191); Grupo 2 (G2) - amostras com hipernasalidade e sem AC (n=288); Grupo 3 (G3) - amostras com hipernasalidade e com fricativa faríngea (n=33); Grupo 4 (G4) - amostras com hipernasalidade e com oclusiva glotal (n=41). Resultados: Análise de variância (ANOVA) revelou medidas de nasalância significativamente maiores para G2, G3 e G4 (p<0,0001) quando comparados ao G1. O uso de fricativa faríngea (G3), particularmente durante /f/ (p=0,0018) e /s/ (p=0,0017) resultou em valores de nasalância significativamente maiores que os valores encontrados para G2. Conclusão: Valores de nasalância significativamente mais elevados foram encontrados durante produção de fricativa faríngea.

Determinación de la edad ósea mediante los centros de osificación presentes en el 1º y 3º dedos – Estudio Comparativo / Determination of the bone age by the oss ification centers of the first and third fingers – A comparative study

El objetivo de este trabajo consistió en la comparación de las modificaciones epifisarias ocurridas en la falange proximal del 1º dedo y falanges media y distal del 3º dedo para la determinación de la edad ósea. La muestra se basó en 131 radiografías cárpales de pacientes de ambos sexos seleccionados de la clínica de ortodoncia de FOA-UNESP y HRAC-USP, Brasil. Los centros de osificación fueron analizados individualmente por un único examinador. La comparación entre los cambios óseos ocurridos en la falange proximal del 1º dedo y falanges media y distal del 3º dedo mostro una similitud del 91,6%. La evaluación de las radiografías que no presentaron similitud revelo que 1,5%presentaban el 1º dedo en una fase de maduración más avanzada al ser comparado son el 3º dedo. Ya el 6,8% exhibió un nivel más maduro del desarrollo óseo cuando el 3º dedo fue analizado. La comparación por el test de McNemar reveló un valor de p=0,07, reflejando que no hay diferencia estadísticamente significativa entre las diferencias presentadas en la determinación de la edad ósea por el 1º o 3º dedos. Los resultados mostraron que los estadios epifisarios en estos dos centros de referencia fueron coincidentes, y por tanto pueden ser utilizados de manera independiente en la evaluación de la fase de maduración (AU)

The purpose of this study was to compare the epiphyseal events of the proximal phalanx of the thumb with the medial and distal phalanxes of the third finger in the determination of the bone age. The sample comprised 131 hand-wrist radiographs of males and females selected from the archive of the Orthodontics Clinic of the School of Dentistry of Araçatuba – UNESP and from PROFIS/Hospital for Rehabilitation of Craniofacial Anomalies-USP. The ossification centers were analyzed by only one examiner. The comparison between the osseous events of the proximal phalanx of the thumb and the medial and distal phalanxes of the third finger has shown a 91.6% agreement. Evaluation of the radiographs that did not show any agreement revealed that 1.5%presented the thumb in a more advanced maturational stage when compared to the third finger, while 6.8% showed a more advanced level of bone development when the third finger was analyzed. Comparison using the McNemar test (p = 0.07) revealed no statistically significant difference in the determination of bone age when either the first or third fingers were used. The findings show that the epiphyseal stages are coincident and, therefore, can be used independently in the evaluation of maturational stage (AU)