Association between sex of the individual with untreated cleft lip and social judgement made by lay persons: A cross-sectional study.

OBJECTIVE: To assess whether there is an association between an individual's sex and social judgements made by lay persons regarding untreated cleft lip. MATERIALS AND METHODS: Lay individuals over 18 years old were recruited through an application to respond online to two questionnaires: a sociodemographic survey and the Brazilian Version of Lay Persons' Social Judgements about Cleft-lip Scale (B-LSojCleft-S). B-LSojCleft-S comprises 14 items evaluating social judgements made by laypersons concerning different types of untreated cleft lips in teenagers. The 14 items are linked to 8 images featuring untreated cleft lips and 1 image without a cleft (control). Higher scores represented more favourable social judgements. Independent samples t-test, paired, and multiple linear regression were conducted (P < 0.05). The study assessed judgements of untreated cleft lips in male and female adolescents using the B-LSojCleft-S. RESULTS: The mean age of the 217 participants was 37.78 ± 12.39 years, predominantly women (72.7%), married (47.7%), with a monthly income below three minimum wages (35.6%) in the majority of cases. Significantly higher social judgement scores were observed in the control group (no cleft) compared to any type of cleft (P < 0.001), with similar scores obtained for the same types of clefts with female or male images (P > 0.05). The participant's sex is associated with social judgement scores (F [1, 214] = 6.318, P = 0.013; adjusted R2 = 0.024), with females making more favourable judgements than males (P < 0.05). CONCLUSIONS: Individuals with cleft lips receive more negative social judgement scores, regardless of their own sex. Women make better social judgements than men.

Can rapid maxillary expansion affect speech sound production in growing patients? A systematic review.

Rapid maxillary expansion (RME) may change speech sound parameters due to the enlargement of oral and nasal cavities. This study aimed to systematically review the current evidence on speech changes as a side effect of RME. An electronic search was conducted in nine databases, and two of them accessed the 'grey literature'. The eligibility criteria included clinical studies assessing orthodontic patients with maxillary transverse deficiency and the relationship with speech alterations without restricting publication year or language. Only interventional studies were included. The JBI Critical Appraisal Tool assessed the risk of bias. The initial search provided 4853 studies. Seven articles (n = 200 patients) met the inclusion criteria and were analysed. The primary source of bias was the absence of a control group in four studies. RME altered speech production by changing vowel fundamental frequency and fricative phoneme formant frequency. Shimmer and jitter rates changed in one and two studies, respectively. Two studies presented deterioration during orthodontic treatment, but speech improved after appliance removal. Despite the limited evidence, RME affects speech during and after treatment.

Evaluation of the impact of orthodontists' smile with malocclusions on social media and professional credibility.

OBJECTIVES: This study assessed laypeople's perceptions of orthodontist credibility based on malocclusions and whether these views affect their choice to seek treatment. Eye-tracking technology and questionnaires were utilized. MATERIALS AND METHODS: Ninety-five lay raters, through eye tracking and a questionnaire, assessed 12 images of orthodontists with malocclusions. Malocclusions were categorized by the Index Of Treatment Need (IOTN) as grade 1 (near ideal), 3 (anterior crowding), and 5 (with diastemas). Fixation points were recorded, and credibility was gauged via questionnaires. A Mentimeter word cloud was generated. RESULTS: IOTN 1 orthodontists were viewed as more credible than IOTN 3 (p < 0.001) and 5 (p < 0.001). Raters were more willing to receive treatment from IOTN 1 orthodontists. The focus for IOTN 1 was between eyes and mouth, while IOTN 3 and 5 were on the mouth. "Crooked teeth" and "spacing" were predominant in word clouds for IOTN 3 and 5. CONCLUSION: Orthodontists with an IOTN grade 1 rating were perceived as more competent, reliable, and professional, thus making it more likely for laypeople to choose them as their preferred providers. CLINICAL RELEVANCE: The smiles of professionals play a significant role in laypeople's decision to choose them as their orthodontist, and strategic utilization of social media can effectively deliver health information to a larger audience in a faster and more direct manner.

Development and psychometric properties of a questionnaire about knowledge of lay people about traumatic dental injury.

BACKGROUND/AIMS: The level of knowledge about traumatic dental injuries (TDI) of lay people from a national point of view has never been studied and there is currently a lack of validated research instruments on this issue. The present study aims to develop and validate a questionnaire (TDI-Q) to assess the knowledge of lay people about TDI, including participants from the five regions of Brazil. MATERIAL AND METHODS: TDI-Q was drafted, in Brazilian Portuguese, based on the recommendations of the International Association of Dental Traumatology (IADT). Before its application, TDI-Q was evaluated by dentists, lay people, linguists, and psychometrists. The questionnaire was applied to measure temporal stability at two distinct times, with an interval of 15-20 days between the two applications: test (n = 110) and retest (n = 50). The presence of floor and ceiling effects were investigated by analyzing the frequency of responses of the questionnaire; convergent construct validity was tested through Spearman's correlation; the Mann-Whitney test was applied to discriminant construct validity. Temporal stability and internal consistency were evaluated through intraclass correlation coefficient and Cronbach's alpha, respectively. RESULTS: The floor and ceiling effects were not observed (0.9% and 2.7%, respectively); convergent validity analysis indicated a positive and strong correlation (r = 0.50; p < .001). Significant discriminant construct validity (p < .05) was observed. Satisfactory internal consistency (α = 0.7) and temporal stability (ICC = 0.82, p < .001) were also achieved. CONCLUSION: TDI-Q proved to have good psychometric properties and to be a reliable tool for evaluating the knowledge of lay people regarding TDI in the Brazilian population.

Did the Use of Minimum Interventions for Caries Management Change during the COVID-19 Pandemic? A Cross-Sectional Study.

The aim of this study was to evaluate changes in the frequency of use of minimum intervention (MI) techniques for caries management during the COVID-19 pandemic. A questionnaire was applied through the SurveyMonkeyTM platform to evaluate changes in the dentist's frequency of use of noninvasive, microinvasive, minimally invasive, and mixed interventions, nonaerosol or aerosol productive, to manage dental caries before and during COVID-19 pandemic. Differences in the use of MI techniques were analyzed by Wilcoxon test, and the effect size (ES) was calculated. An α = 0.05 was adopted. A total of 781 dentists answered the questionnaire; most of them were female (76.4%), with 30s (76.4%), graduated over 10-24 years ago (38%) in public dental schools (62%), graduated in southwest of Brazil (38%), that work in clinical environment (66.8%) and in private jobs (53.4%). During COVID-19, among the sample, 91 respondents were not working. In relation to the noninvasive techniques, only the use of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) decreased during the COVID-19 pandemic (p < 0.01; ES = 0.11). The frequency of sealants to repair defective restorations was the only microinvasive technique that increased during the pandemic (p < 0.01; ES = 0.03). Among the minimally invasive techniques, the use of atraumatic restorative treatment increased significantly (p < 0.01; ES = 0.06), while the use of air abrasion decreased (p = 0.02; ES = 0.04) during COVID-19 pandemic. Moreover, nonrestorative cavity control (mixed intervention) increased during pandemic period (p < 0.001; ES = 0.11). Although the results demonstrated differences in the use of some procedures, a very small magnitude of the effect was perceived, demonstrating that the influence of COVID-19 pandemic was very little, if any, in the use of MI techniques for caries management. Moreover, the use of MI strategies was already well established between Brazilian dentists before the pandemic period.

Patient perception of orthodontists with different stereotypes: development, psychometric properties, and application of an assessment instrument.

INTRODUCTION: This research aimed to develop and validate a questionnaire that considers social judgments and, through its application, assesses whether the presence of piercings, tattoos, beards, and loose hair visible in the face and neck region reflect on the patient perception regarding characteristics of the orthodontist's professional scope. METHODS: The developed questionnaire had its psychometric properties evaluated and was applied to 220 young people and adults, aged 18-70 years, who responded according to their perception of 12 manipulated images of orthodontists with different stereotypes, considering the following items: hygiene, care, punctuality, experience and knowledge in orthodontics. RESULTS: The developed questionnaire showed high acceptability, confirmed reliability and validity of the construct, and satisfactory internal consistency. The stereotype interfered with the perception of professionalism (P <0.01), in which the orthodontist with combined characteristics (beard/loose hair, piercing, earrings, and tattoo) obtained the lowest mean scores, both for each item of the questionnaire individually (P <0.01) and in total (P <0.01). Health professional (P = 0.427) and educational level (P = 0.285) status did not influence the perception; however, there was a significant difference for the age groups (P = 0.041). CONCLUSIONS: The developed questionnaire proved to be valid and reliable for application. Orthodontists with piercings and tattoos on the face and neck were considered less professional. Being a health professional and educational level status did not influence the perception. However, older subjects (aged 51-70 years) were more critical in judging stereotypes than younger subjects (aged 18-30 years).

Cone-beam computed tomography study of mandibular morphology and tooth compensation in asymmetrical patients.

INTRODUCTION: This study evaluated mandibular morphology and transverse dental compensation between symmetrical and asymmetrical subjects, allocated according to sagittal skeletal patterns. In addition, the hypothesis that mandibular morphology and dental compensations differed between symmetrical/asymmetrical groups and also among the different types of sagittal skeletal patterns was tested. METHODS: Cone-beam computed tomography images of 96 patients were included in this study and were divided into 2 groups according to the degree of menton deviation: a symmetrical group with deviation up to 2.0 mm (n = 48; mean age, 15 ± 6 years), and an asymmetrical group with deviation from 3.5 mm (n = 48; mean age, 16 ± 8 years). The 2 groups were divided in accordance with the ANB angle: Class I, II, and III. Skeletal and dental measurements were performed. Intergroup and intragroup analyses were carried out, using a 2-way analysis of variance to assess the interaction of factors: symmetry and sagittal skeletal pattern; and the Student t test for differences between deviated (Dv) and nondeviated (NDv) sides. RESULTS: Symmetrical/asymmetrical groups and Class I, II, and III groups were similar in relation to demographic aspects (P = 0.412 and P = 0.357 for sex and age, respectively). Asymmetrical patients had higher values for body length and mandibular ramus and condyle height on the NDv side (P = 0.011, P = 0.024, and P = 0.001, respectively). When comparing the different skeletal patterns, patients with a Class III relationship demonstrated higher values for mandibular ramus height. Intergroup analysis showed no differences in dental parameters. In the comparison between the sides, the asymmetrical group showed a significant difference in canine inclination (P = 0.008), mandibular ramus height (P = 0.004), condyle height (P = 0.010) and gonion to midsagittal plane distance (P = 0.018). CONCLUSIONS: Asymmetrical subjects showed higher values for canine inclination and mandibular body, ramus and condylar height on the NDv side. The hypothesis was partially confirmed that mandibular morphology and dental compensations are different between symmetrical/asymmetrical groups and among different sagittal skeletal patterns.

Predictors of perceived stress and quality of life amongst dental master and doctoral students.

OBJECTIVES: This study aimed to identify predictors of perceived stress and quality of life (QoL) amongst dental master and doctoral students. MATERIALS AND METHODS: This is a cross-sectional study with Brazilian students as participants (n = 707). The following instruments were administered: Perceived stress scale (PSS), the WHOQOL-BREF and a socio-demographic questionnaire. A linear regression model was estimated. RESULTS: The results showed that female was associated with higher scores of PSS and lower scores of QoL. A negative correlation was observed between PSS and all four domains of QoL. Multivariate analysis revealed that the set of selected variables partially explained the variability of PSS score (28%) and the four QoL domains: physical (52%), psychological (62%), social relationships (25%) and environment (37%). The variable number of children, hours of sleep, concurrent work and study, leisure time and physical activity practice were associated with positive changes on QoL, whilst PSS and medication intake with negative. Lower PSS score was associated with the variables age, hours of sleep, leisure time and physical activity. CONCLUSIONS: Our findings suggest that perceived stress and medication intake due to study are important predictors of lower QoL in dental master and doctoral students, especially in the psychological domain. More hours of sleep, leisure time and physical activity improved both QoL and perceived stress scores and might be feasible coping strategies for these outcomes in this population.

Distalization of maxillary molars with Invisalign aligners in nonextraction patients with Class II malocclusion.

INTRODUCTION: This retrospective study aimed to evaluate whether the treatment of Class II malocclusion with Invisalign aligners with sequential distalization of posterior teeth in adult patients would meet the criteria of American Board of Orthodontics (ABO) standards for the treatment and assess the predictive value of ClinCheck Pro software with the final results comparing the initial time, predictive planning using ClinCheck Pro software, and the final time without any require refinement. METHODS: The sample consisted of 32 adult patients with Class II malocclusion (n = 32 [7 men and 25 women]; mean age 35.47 ± 9.61 years). All of them used a set of Invisalign aligners; no refinement set was evaluated. The 7 measurements of the ABO Model Grading System, the millimeter measurements for the anteroposterior ratios of maxillary first molars and the overbite were used in the evaluations and were compared in phases initial time, predictive planning using ClinCheck Pro software, and the final time. For the intraexaminer reliability test, the intraclass correlation coefficient was calculated to analyze the reliability of the measures. The Shapiro-Wilk normality test was used to examine whether the variables were normally distributed. The Wilcoxon nonparametric test for paired samples was applied for variables that did not show normal distribution. The parametric Student t test for paired samples was used for variables that presented normal distribution. The significance level adopted for this study was 0.05. RESULTS: In comparison between final ClinCheck and posttreatment results, the ABO index showed a statistically significant difference between the predictions and results for alignment and rotation, buccolingual inclination, overjet, occlusal contact, occlusal relationship, molar relationship, and overbite. The final score of the ABO scores did not meet the standards for Class II correction, contrary to what the ClinCheck Pro software predicted. CONCLUSIONS: The null hypothesis that distalization of the posterior teeth occurs in adult patients using Invisalign aligners was rejected. The treatment of Class II malocclusion with Invisalign aligners did not occur as estimated by the virtual planning prepared by ClinCheck according to the standards for evaluating occlusal results established by the ABO at the end of the use of a set of aligners with sequential distalization.

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial.

INTRODUCTION: This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children. METHODS: Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T1), at the end of RPE (T2), and 1 month after the appliance removal (T3). Generalized mixed models were used for data analysis (α = 0.05). RESULTS: Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T1 and T2, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T1 95% confidence interval [CI], 1.08-1.26; T2 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T3 are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T3 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T3 (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T1 and T2. CONCLUSIONS: Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement. FUNDING: This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001.

Impacts of using orthodontic appliances on the quality of life of children and adolescents: systematic review and meta-analysis.

BACKGROUND: Although there are previous systematic reviews about the oral health-related quality of life (OHRQoL) impact among children and adolescents after orthodontics treatment, there is no definition for the magnitude of these impacts during the therapy. OBJECTIVE: To systematically analyse the literature on changes in the quality of life of children and adolescents during orthodontic treatment. LIMITATIONS: Almost all the studies included in this review are non-randomized clinical trials, which are susceptible to several biases that affect the certainty of evidence obtained, especially by confounding factors and the lack of a control group. CONCLUSIONS AND IMPLICATIONS: Based on very low certainty of evidence, wearing appliances does not seem to have a significant negative impact during the first year of orthodontic treatment. However, the meta-analytic results suggest that functional limitations in the first 3 months of treatment can be slightly more critical for the impact on the oral health quality of life and consequent patient adherence to treatment. FUNDING: This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (CNPq), and Fundação de Amparo à Pesquisa do Estado de Minas Gerais - Brazil (FAPEMIG). REGISTRATION: CRD42021234407.

Deformation of the circummaxillary sutures during acute micro-implant assisted rapid palatal expansion and tooth-supported expansion: An ex vivo study.

INTRODUCTION: This study aimed to assess and compare the deformation that develops in the circummaxillary sutures during activation of micro-implant assisted rapid palatal expander (MARPE) and tooth-supported expander (Hyrax) s, in the rapid maxillary expansion. SETTINGS AND SAMPLE: 7 pigs Sus Scrofa received custom-made MARPE (n = 3) and Hyrax (n = 4) appliances. MATERIAL AND METHODS: The devices were activated 25 times with strain readings captured by strain gauges attached to the following regions: posterior midpalatal suture (MPS), maxilla-premaxilla suture (MPM), maxilla-zygomatic suture (MZ) and maxilla pterygoid-process suture (MPP). The intermolar distance and suture width were measured immediately before activation and at the 20th and 25th activation. ANOVA and Kruskal-Wallis test was applied. RESULTS: The MARPE group presented greater MPS displacement in all measured regions, and one of the devices produced a significant opening (1.7 mm) in the posterior region. The accumulated tension in the MPS was higher compared to the other sutures (P < .05). A MARPE animal presented higher median tension in the MPS region (294.77µÎµ) compared to all other animals except one Hyrax animal (P < .05). Regarding the median tensions of the different activation intervals, the median tension measured during the 16th to 25th activation interval in the Hyrax group was lower than that measured during the first 8 activations, in both the MPS and MZ (P < .05). CONCLUSIONS: MARPE expanders developed more constant tensions during all activations (MPS and MZ), while Hyrax showed lower tension in the 16th to 25th activation.

Biomonitoring of children and adolescents using orthodontic appliances made of acrylic resins through micronucleus testing of exfoliated buccal and palatal mucosa cells.

INTRODUCTION: The present study aimed to investigate the occurrence of micronuclei and the degenerative nuclear alterations indicative of apoptosis and necrosis in the exfoliated buccal and palatal mucosa cells of children and adolescents using orthodontic appliances made of self-curing acrylic resins. METHODS: The micronuclei and nuclear alterations were evaluated in a minimum of 2000 cells collected from the cheeks and palates of 30 patients of both sexes, aged between 6 and 12 years. The cell evaluations were performed before appliance installation and 15 to 21 days after installation. A conditional test was used. In all analyses, the significance level was 5%. RESULTS: No differences in the occurrence of micronuclei or the nuclear degenerative changes indicative of apoptosis and necrosis were observed in the cheek cells between the 2 time points (P > 0.05). However, evaluation of the palate cells revealed a significant increase in the occurrence of micronuclei and the nuclear alterations indicative of apoptosis (P < 0.01) but not of karyolysis (P > 0.05). CONCLUSIONS: Direct contact of orthodontic appliances made of acrylic resins with the oral mucosa increases the incidence of chromosomal damage and degenerative nuclear alterations.

Impact of oral-health-related quality of life and self-esteem on patients with missing maxillary lateral incisor after orthodontic space closure: a single-blinded, randomized, controlled trial.

BACKGROUND: The maxillary lateral incisor is one of the teeth most likely to suffer agenesis, resulting in spacing between the central incisor and the canine. OBJECTIVE: To compare maxillary lateral incisor agenesis with space closure treatment versus non-treatment based on measurements of the self-perceived oral-health-related quality of life (OHRQoL) and self-esteem of the participants. SUBJECTS AND METHODS: A total of 44 people, aged 17-49 years, with missing lateral incisors were randomly assigned to two groups (n = 22 in each)-a treated group in which the space was orthodontically closed (TG) and a control group that remained untreated (CG). Randomization was performed by a researcher who was not involved in the clinical part of the study. The outcomes were assessed using the Oral Health Impact Profile and Rosenberg's Self-Esteem Scale, which were applied before (phase 1) and after (phase 2) the orthodontic treatment in the TG, and at baseline (phase 1) and 12 months after (phase 2) in the CG. All the data were blindly evaluated, supporting the single-blinded design of the study. RESULTS: All participants finished the randomized controlled trial, and the demographic characteristics were similar between the groups. In phase 1, the levels of self-esteem and OHRQoL at baseline were similar (P = 0.079, P = 0.693, respectively). In phase 2, the self-esteem scores of the CG decreased and the OHRQoL increased (P = 0.005, P < 0.001, respectively), while self-esteem increased in the TG and the OHRQoL decreased (P < 0.001). The CG had lower scores than the TG for self-esteem, but the opposite was observed for OHRQoL (P < 0.001). LIMITATIONS: Information bias may have occurred. Since the questionnaires could not have been applied at the same time in both groups, the time difference between the two assessments may have led to random and systematic error. CONCLUSIONS: The spacing resulting from missing maxillary lateral incisors had a negative impact on the OHRQoL and self-esteem of the participants, while orthodontically closing those spaces had a positive impact on those aspects. CLINICAL TRIAL REGISTRATION: This study was not registered. PROTOCOL: The protocol was not published before trial commencement.

Perception Regarding Pediatric Dentist's Appearance and Factors Influencing the Child's Responses.

OBJECTIVE: To develop, validate, and apply an instrument for assessing the children's perception regarding pediatric dentist's appearance, based upon the influence of age, gender, previous dental experience, and anxiety. STUDY DESIGN: Images and a nine-item questionnaire were developed. The acceptability, convergent-construct validity, and reliability based on reproducibility and internal consistency were evaluated. The validated instrument was applied in a cross-sectional study, with children (n=120) aged 7-12 years asked to evaluate images of pediatric dentists wearing different dental attire (A:all-white (control); B:printed coat and cap, colorful face mask; C:printed coat, cap and face mask; and D:white coat and cap, printed face mask). Children's age, gender, and previous dental experiences were collected with the guardians. The Children's Fear Survey Schedule-Dental Subscale assessed children's anxiety. Descriptive and inferential statistics were carried out (p<0.05). RESULTS: The instrument showed excellent acceptability, construct validity with moderate and strong correlations (>0.40), satisfactory reproducibility (ICC >0.70), and internal consistency (Cronbach's alpha coefficient >0.70). Considering only the attire, the children's perceptions were more positive with the use of attire C and D (p<0.05). Intergroup analysis of all the variables did not identify a statistically significant difference (p>0.05). In the intragroup analysis, compared to attire A: younger children have higher perception scores to attire D; girls, children with previous experience and without anxiety favored attire C and D; and children without previous experience showed no difference in comparison to A but did between B and C (p<0.05). CONCLUSION: The C and D attires promoted a more positive perception of the appearance of a pediatric dentist when compared to A; however, age, gender, previous dental experience, and anxiety did not influence the perception scores.

Laypeople's and dental students' perceptions of a diastema between central and lateral incisors: Evaluation using scanpaths and colour-coded maps.

OBJECTIVE: This study aimed to use eye tracking to analyse people's visual perceptions of smiles with a diastema between the maxillary central and lateral incisors, based on different categories of observers. SETTING AND SAMPLE POPULATIONS: An image of a diastema between the maxillary central and lateral incisors was shown to dental students and laypeople. MATERIALS AND METHODS: Our null hypothesis was that there would be no difference in the visual perception of the different graduations of diastemas between the two groups. The diastemas were edited in Photoshop® to gradually increase the distance between the maxillary central and lateral incisors from no diastema to 1.5 mm and 3.5 mm diastemas. These diastemas were evaluated by using a TheEyeTribe© tracker in conjunction with OGAMA© 5.0 software. A total of 37 dental students and 33 laypeople looked at eight randomly arranged images of smiles. The data were analyzed using color coded maps, scanpaths, and the Kruskal-Wallis test with a level of significance of 5%. RESULTS: Laypeople tended to observe the eyes, focusing more on the right than the left, and spent less time focusing on the diastema region than did the dental students. There were differences for the same magnitude of diastema within participant groups. As the width of the diastema increased, both students and laypeople focused more on the diastema region. CONCLUSIONS: The two groups of evaluators presented different perceptions of smiles in cases of diastema between the maxillary central and lateral incisors when evaluated using eye-tracking.

Long-term stability of a Class III malocclusion with severe anterior open bite and bilateral posterior crossbite in a hyperdivergent patient.

Anterior open bite malocclusion is generally associated with several causes. This case report describes the 2-phase treatment of a 13-year-old boy with a Class III malocclusion, severe anterior open bite, and bilateral posterior crossbite treated without surgical intervention. An orthopedic approach was performed in phase 1 with a hyrax-type palatal expander, followed by maxillary protraction with a facemask for a 10-month period to promote the correction of transverse and sagittal deviations. In phase 2, a comprehensive orthodontic approach using fixed preadjusted appliances associated with intermaxillary elastics was performed. These approaches, combined with good patient compliance, established a functional and esthetic occlusal relationship, normal overjet and overbite, and a well-balanced facial appearance. The 4.5-year follow-up indicated that treatment results were stable.

Distalization rate of maxillary canines in an alveolus filled with leukocyte-platelet-rich fibrin in adults: A randomized controlled clinical split-mouth trial.

INTRODUCTION: The objective of this study was to evaluate the distalization rate and changes in inclination of the maxillary canines in alveoli preserved with leukocyte-platelet-rich fibrin (L-PRF) membranes in adult patients. The null hypothesis was that there are no differences in the canine distalization movement rate between the treated and the control sides. METHODS: A total of 21 healthy adult patients with a minimum age of 20 years (mean age, 33 ± 5.9 years) and Angle Class I or Class II Division 1 malocclusion, who had an indication of extraction of the maxillary first premolars and orthodontic distalization of the maxillary canines were included in this study. A randomized controlled clinical split-mouth trial was conducted; the experimental maxillary side was treated with L-PRF membranes, and the other side served as the control. A randomization sequence of the experimental sides among patients was generated using the random number generation function of Microsoft Excel. Neither the patients nor the operators were blinded. Fifteen days after the extractions, distalization was initiated using an elastic chain applying 150 g of force to the canines on a 0.020-in stainless steel archwire. The distalization rate was the main outcome of the study, and it was assessed monthly for 5 months through the intraoral use of a flexible ruler. The degree of inclination of the canines was the secondary outcome, and it was evaluated through cone-beam computed tomography. A Shapiro-Wilk test was performed, and a Wilcoxon signed rank test was subsequently used to compare the experimental and the control group. Spearman rank correlation coefficient was calculated to evaluate the correlation between distalization and inclination for each side. RESULTS: Four of the subjects dropped out of the study, leaving a total of 17 patients (n = 17). The distalization rate and inclination of the canines were greater on the control side than on the side treated with L-PRF (P <0.05). A weak correlation was found between the distalization rate and inclination of the canines for both sides (control side, ρ = 0.17; experimental, ρ = 0.11). No harm was observed during the study. CONCLUSIONS: The null hypothesis was rejected. The use of L-PRF in young adult patients decreased the rate of distalization and changes in inclination of the maxillary canines compared with the control group. REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement.

Impact of crown fracture treatment on oral health-related quality of life of children, adolescents, and their families: A prospective clinical study.

BACKGROUND: Enamel-dentin fracture causes impact on the oral health-related quality of life (OHRQoL) of children. AIM: To evaluate the impact of treatment of crown fracture involving enamel and dentin (CFED) in the permanent dentition on the OHRQoL of children and adolescents (C/As) and their families. DESIGN: This prospective clinical study included C/As between 8 and 14 years who presented anterior CFED treated thought direct composite resin restoration. Their parents/caregivers (P/Cs) were also invited to take part of the study. The quality of life was evaluated thought the Child Perceptions Questionnaires (CPQ8-10  and CPQ11-14 ), Parental-Caregiver Perceptions Questionnaire (P-CPQ), and Familiar Impact Scale (FIS), applied before and 3 months after the restorative procedure. T test for dependent samples and Wilcoxon test were applied(P < 0.05). RESULTS: Of 32 C/As included, 30 completed the study. The treatment of CFED reduced the negative impact in OHRQoL of C/As (CPQ8-10 P = 0.0065; CPQ11-14 P = 0.0486; P-CPQ, P = 0.0259), specially for "oral symptoms" (CPQ8-10 , P = 0.0003; P-CPQ, P = 0.0455) and "emotional well-being" (CPQ11-14 , P = 0.0431). Concerning the families' perceptions, the treatment did not influence OHRQoL both in terms of the domains and total FIS score (P > 0.05). CONCLUSION: Restorative treatment of CFED increases the OHRQoL of C/As but not influence the OHRQoL of their families.

Does dental trauma influence the social judgment and motivation to seek dental treatment by children and adolescents? Development, validation, and application of an instrument for the evaluation of traumatic dental injuries and their consequences.

BACKGROUND: One's smile clearly plays a significant role in the perception and judgment that others have of one's appearance and personality. AIM: We sought to develop and validate a questionnaire related to the social judgment of children and adolescents and to evaluate, through its application, the perceptions and judgment of children and adolescents regarding their view of different traumatic dental injuries and their consequences (TDIs-Cs) as well as the motivation to seek dental treatment. DESIGN: The aspects of acceptability, discriminative properties, internal consistency, test-retest reliability, and construct validity were evaluated in the developed questionnaire. A cross-sectional study was conducted involving 100 boys and girls aged 10-15 years. Images of an adolescent male and female were either manipulated or not (control) to create different types of TDI-C (eg, enamel fracture, enamel and dentin fracture, crown colour change, and tooth loss/avulsion). These images were analysed by the participants, using a previously validated questionnaire with a six-positive-point and six-negative-point scale, in relation to their social physical and psychosocial characteristics. The data were analysed with the Friedman, Wilcoxon, and Mann-Whitney tests (P < 0.05). RESULTS: The developed questionnaire presented high acceptability, strong discriminative properties, satisfactory internal consistency, and satisfactory test-retest reliability, but weak construct validity. The presence of TDI-C had a negative effect on all characteristics evaluated (P < 0.001). Tooth loss had the highest level of rejection. Additionally, the presence of TDI-C had a greater negative impact on the aspects of 'starting fights', 'being given a nickname', and 'being ashamed to smile' in males than in females (P < 0.05). Children and adolescents with TDI-C were judged as needing to seek dental treatment (P < 0.001). CONCLUSION: The questionnaire developed showed properties of validity and reliability in its administration in a child and adolescent population. TDIs-Cs have a negative influence on the social judgment of children and adolescents.