Impact of orthodontic treatment with aligners on the oral health-related quality of life of patients with trisomy 21.

OBJECTIVE: To assess the impact of treatment with orthodontic aligners (OA) on oral health-related quality of life (OHRQoL) in patients with trisomy 21 (T21) compared to non-syndromic patients. MATERIALS AND METHODS: The sample consisted of 30 patients, both sexes, aged between 11 and 35 years, divided into two groups: T21 (n = 10, patients with T21, treated prospectively) and CONTROL (n = 20, control group, non-syndromic patients, from the Orthodontic Laboratory of UNOPAR). In both groups, patients were treated with Invisalign orthodontic aligners (Align Technology), following the same treatment parameters. Participants, assisted by their caregivers, when necessary, answered Oral Health Impact Profile (OHIP-14) instrument and the patient's guardians answered the Oral Health Scale for People with Down's syndrome (OHDS) instrument, before (T0) and after 30 (T1), 180 (T2), and 365 (T3) days from the start of treatment. Friedman tests with Bonferroni correction and Mann-Whitney tests were used (p < .05). RESULTS: For the OHDS instrument, it was observed that for the eating and communication domains and an overall score, the treatment with OA positively impacted the lives of T21 patients (p < .05). Regarding the OHIP-14 instrument, the intragroup evaluation showed that in the CONTROL group, there was no significant difference between the evaluated times; while for the T21 group, there was a significant positive impact (p < .05). CONCLUSION: The results showed that the treatment with aligners positively impacted the OHRQoL of T21 patients, and these results were perceived by caregivers, mainly in relation to issues related to eating and communication.

Compensation in Class III Malocclusions: Analysis of Tooth Crown Inclination on Digital Dental Casts / Compensação da Má Oclusão de Classe III: Análise da Inclinação das Coroas dos Dentes em Modelos Digitais

The objective of this study was to evaluate the tooth crown inclination in maxillary and mandibular arches in Class III malocclusion individuals, to identify the presence and magnitude of compensation. The study was conducted on 46 plaster casts of individuals with Class III malocclusion, of both genders (25 males and 21 females), with mean age 21 years and 1 month, with indication for compensatory orthodontic treatment. The dental casts models were scanned and the tooth crown inclinations were measured and compared with standard values by the independent t test. All tests considered a significance level of 5% (p<0.05). According to the results there was extensive variation in tooth inclination in Class III malocclusions. Values distribution for incisors highlighted the significant concentration of maxillary incisors in the area of positive values, compared with a very expressive concentration of mandibular incisors in the area of negative values. Compared with normal standards, in Class III malocclusions, the maxillary posterior teeth exhibited smaller palatal inclination than normal, while the mandibular incisors and second molars presented greater lingual inclination. It was concluded that the analysis of inclinations of all crowns of both dental arches in Class III malocclusions, compared with normal standards, evidenced the presence of natural compensation for maxillary posterior teeth, with reduced palatal inclination, as well as increased lingual inclination in mandibular incisors. The parameters of compensation naturally present in Class III malocclusions described, especially in lower incisors, would help clinicians when compensatory treatment is considered. (AU)

O objetivo deste estudo foi avaliar a inclinação das coroas dentárias nas arcadas superior e inferior em indivíduos com má oclusão de Classe III, para identificar a presença e a magnitude da compensação. O estudo foi realizado em 46 modelos de gesso de indivíduos com má oclusão de Classe III, de ambos os sexos (25 homens e 21 mulheres), com média de idade de 21 anos e 1 mês, com indicação de tratamento ortodôntico compensatório. Os modelos de gesso foram digitalizados e as inclinações da coroa dos dentes foram medidas e comparadas com os valores de normalidade pelo teste t independente. Todos os testes estatísticos adotaram um nível de significância de 5% (p <0,05). De acordo com os resultados, houve grande variação na inclinação dentária nas más oclusões de Classe III. A distribuição dos valores para os incisivos destacou a concentração significativa de incisivos superiores na área de valores positivos, em comparação com uma concentração muito expressiva de incisivos inferiores na área de valores negativos. Comparados aos padrões de normalidade, nas más oclusões de Classe III, os dentes posteriores superiores exibiram inclinação palatina menor que o normal, enquanto os incisivos e segundos molares inferiores apresentaram inclinação lingual maior. Concluiu-se que a análise das inclinações de todas as coroas de ambas as arcadas dentárias nas más oclusões de Classe III, comparadas aos padrões de normalidade, evidenciou a presença de compensação natural para os dentes posteriores superiores, com diminuição da inclinação palatina, bem como aumento da inclinação lingual dos incisivos inferiores. Os parâmetros de compensação naturalmente presentes nas más oclusões de Classe III descritos, especialmente nos incisivos inferiores, podem auxiliar o clínico quando o tratamento compensatório é considerado. (AU)

External apical root resorption 6 months after initiation of orthodontic treatment: A randomized clinical trial comparing fixed appliances and orthodontic aligners.

OBJECTIVE: To compare the magnitude of external apical root resorption (EARR) 6 months after starting orthodontic treatment using orthodontic aligners (OAs) and fixed appliances (FAs). METHODS: This parallel randomized clinical trial included 40 patients randomized into two groups: OA group (n = 20, 160 incisors) and FA group (n = 20, 160 incisors). For evaluation of the tooth length, periapical radiographs and standardized linear measurements of the maxillary and mandibular incisors were acquired before (T0) and 6 months after treatment initiation (T1). EARR was calculated through the difference in length between the two time points (T1-T0). Statistical comparisons were performed by means of using t-tests, chi-squared test and covariance analysis (a = 5%). RESULTS: Rounding of the root apex was observed in both groups; the resorption involved 2.88% of the root length, so 97.12% of the tooth length remained intact. Intragroup comparisons between the two time points revealed a significant difference, with (T1-T0) ranging from -0.52 to -0.88 mm in the FA group and from -0.52 to -0.85 mm in the OA group. In the intergroup comparisons, only tooth #21 presented a statistically significant difference (OA: -0.52 ± 0.57 mm, FA: -0.86 ± 0.60 mm); however, the overall differences between groups were not clinically relevant, ranging from 0.03 to 0.35 mm. CONCLUSIONS: OA and FA treatment resulted in a similar degree of EARR in the maxillary and mandibular incisors at 6 months after treatment initiation. However, the amount of resorption was small and does not impair tooth longevity.

Interdisciplinary Orthodontic Treatment to Reestablishment Smile Function and Aesthetics / Tratamento Ortodôntico Interdisciplinar Para o Reestabelecimento da Função e Estética do Sorriso

Extrusive tooth movements are an important resource in orthodontic treatment and allow the manipulation of teeth and periodontal tissues. They can be performed quickly or slowly, depending on the patient's need. Rapid extrusion is indicated for cases in need of prosthetic preparation or restoration, where the bone and gingival tissues are intact, such as horizontal and oblique fractures, coronary or external root resorption, iatrogenic perforations (trepanations) and the presence of subgingival caries. The aim of this study is to describe the treatment of a patient who had a coronary fracture of the right upper central incisor, with a limit located 1 mm above the level of the bone crest. Rapid orthodontic extrusion was performed, to restore biologic distances and allow the preparation for prosthesis. It started with partial differentiated bonding of a fixed orthodontic appliance to the upper arch, to allow for a 3mm orthodontic extrusion. At the end of the extrusion, periodontal surgery was performed to increase the clinical crown and endodontic treatment. After these procedures, the case was concluded with the fixed prosthesis installation. The realization of an integrated planning allowed the restoration of aesthetics, with preservation of the functional periodontal limits for the patient.(Au)

Os movimentos dentários extrusivos constituem um recurso importante no tratamento ortodôntico e permitem a manipulação dos dentes e dos tecidos periodontais. Eles podem ser realizados de forma rápida ou lenta, dependendo da necessidade do paciente. A extrusão rápida está indicada para casos com necessidade de preparo protético ou restauração, onde os tecidos ósseo e gengival encontram-se íntegros, tais como fraturas horizontais e oblíquas, reabsorções coronárias ou radiculares externas, perfurações iatrogências (trepanações) e presença de cárie subgengival. O objetivo deste trabalho é descrever o tratamento de uma paciente que apresentava fratura coronária do incisivo central superior direito, com limite localizado 1mm acima do nível da crista óssea. Realizou se extrusão ortodôntica rápida, com a finalidade de restabelecer as distâncias biológicas e permitir o preparo para prótese. Iniciou-se com colagem diferenciada parcial de aparelho ortodôntico fixo no arco superior, para permitir a extrusão ortodôntica de 3mm. Ao término da extrusão, realizou-se cirurgia periodontal para aumento da coroa clínica e tratamento endodôntico. Após esses procedimentos, o caso foi finalizado com a instalação da prótese fixa. A realização de um planejamento integrado permitiu o restabelecimento da estética, com preservação dos limites periodontais funcionais para a paciente. (Au)

Orthodontists' and patients' perceptions regarding techniques to reduce the orthodontic treatment duration.

BACKGROUND: The purpose of this study was to evaluate patients' and orthodontists' perspectives on knowledge of techniques for reducing orthodontic treatment time and acceptance of these techniques. METHODS: A total of 200 individuals were interviewed and equally divided into two groups: orthodontist group (62 female and 38 male; mean age, 38.07 years) and patient group (52 female and 48 male; mean age, 22.61 years; in the active stage of fixed orthodontic treatment). One questionnaire for each group was administered, including questions about the duration of orthodontic treatment and techniques used for treatment optimization, such as corticotomy, distraction osteogenesis, vibration, and laser therapy. The associations between variables were analyzed by the χ2 test at a significance level of 5%. RESULTS: Among orthodontists, 76% knew at least one technique to reduce the treatment duration, with corticotomy being the most frequently cited (66%); however, only 12% used one or more of these techniques. Laser therapy was the most frequently implemented technique (7%). Regarding the duration of orthodontic treatment, the mean time reported by orthodontists was 19 to 24 months, regardless of the technique or the experience of the orthodontist. Furthermore, 39% of patients expected their treatment to last for more than 24 months, with 50% accepting to undergo further procedures to reduce this duration. CONCLUSIONS: Patients are willing to undergo additional procedures to reduce the treatment duration and to bear additional costs. However, despite their knowledge, orthodontists do not apply or offer these techniques to the patients.

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

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

Protocolo de Tratamento Orto-Cirúrgico da Má Oclusão de Classe II em paciente com Sindrome da Apnéia e/ou Hipoapnéia Obstrutiva do sono: relato de caso / Ortho-surgical treatment protocol for Class II malocclusion in a patient with obstructive sleep apnea and/or hypopnea syndrome: case report

Introdução: A Síndrome de apnéia e/ou hipopnéia obstrutiva do sono (SAHOS) é caracterizada pela obstrução repetida das vias aéreas ou redução da respiração durante o sono. Esta síndrome é causada por colapso faríngeo contra aumento do esforço espiratório durante o sono. A SAHOS leva à deterioração da qualidade do sono associado à queixa de sonolência diurna excessiva e a efeitos desfavoráveis no sistema cardiovascular. Características orofaciais como retrognatismo mandibular e/ou associado a retrognatismo maxilar, má oclusão de Classe II, com ou sem mordida aberta, e diminuição das vias aéreas orofaríngeas fazem parte do seu quadro. Objetivo: Relato do tratamento ortocirúrgico de um paciente com 31 anos de idade com caraterísticas de SAHOS, má oclusão de Classe II, deficiência mandibular, mordida cruzada posterior e aberta anterior, diminuição da altura facial anteroinferior, aprofundamento do sulco mentolabial, pouca exposição do lábio inferior e nítido desequilíbrio facial. Relato e Resultados: Tratamentos não invasivos para SAHOS passam pelos dispositivos de pressão nasal contínua positiva nas vias aéreas ou aparelhos intra-bucais com o objetivo de manter a mandíbula em posição anteriorizada durante o sono. Nos tratamentos invasivos, a cirurgia de avanço mandibular evita a rotação no sentido anti-horário do complexo maxilomandibular com aumento do espaço orofaríngeo das vias aéreas médias e inferiores. Nas situações com grande impacto esquelético dentofacial associado ao grau de obstrução das vias aéreas será necessário um tratamento descompensatório ortocirúrgico, permitindo assim um restabelecimento respiratório e estético da face. Conclusão: O tratamento descompensatório com avanço cirúrgico bimaxilar foi responsável pela correção da má oclusão e aumento do espaço aéreo, contemplando a expectativa respiratória, funcional e estética.

Introduction: Obstructive sleep apnea and/or hypopnea syndrome (OSAHS) is characterized by repeated obstruction of the airway or reduction of breathing during sleep. This syndrome is caused by pharyngeal collapse against increased respiratory effort during sleep. SAHOS leads to deterioration of sleep quality associated with clinical complaints of excessive daytime sleepiness and unfavorable effects on the cardiovascular system. Orofacial features such as mandibular retrognathism and/or associated maxillary retrognathism, Class II malocclusion, with or without open bite and reduction of the oropharyngeal airway characterize this syndrome. Objective: It is reported an orthosurgical treatment of a 31 years old male patient, with OSAHS characteristics, Class II malocclusion, mandibular deficiency, posterior crossbite and anterior open bite, lower anterior facial height decrease, deepening of the labial sulcus, little exposure of the lower lip and unbalanced face. Report and Results: Non-invasive treatments for OSAHS pass through positive continuous nasal pressure devices in the airways or intra-oral appliances in order to maintain the mandible in an anterior position during sleep. In the invasive treatments protocol, mandibular advancement surgery prevents rotation in the anti-clockwise direction of the maxillomandibular complex with an increase in the oropharyngeal space of the middle and lower airways. In cases with great skeletal dentofacial impact associated with the degree of obstruction of the airway will be necessary an ortho-surgical decompensatory treatment, to allow a respiratory and aesthetic restoration of the face. Conclusion: The decompensatory treatment with bimaxillary surgical advancement corrected the malocclusion, increasing the air space contemplating the respiratory, functional and aesthetic expectation.

Comparação da degradação da força de elásticos ortodônticos intermaxilares de látex e sintéticos quando submetidos à distensão em saliva artificial / Comparison of force degradation intermaxilary latex and synthetic orthodontic elastics distended in artificial saliva

Introdução: os elásticos intermaxilares sintéticos surgiram como uma alternativa para uso ortodôntico em pacientes com sensibilidade ao látex, porém, diferenças podem ser observadas quando comparados aos elásticos naturais de látex. Objetivo: comparar a quantidade de degradação de força dos elásticos intermaxilares sintéticos e de látex quando distendidos em saliva artificial, a fim de buscar parâmetros clínicos para o uso de um protocolo sobre a frequência de troca desses elásticos nas terapias ortodônticas em pacientes com sensibilidade ao látex ou não. Metodologia: foram utilizados dois grupos contendo 30 elásticos cada. O grupo 1 com 30 elásticos de látex da marca Morelli de força média e diâmetro de 5/16" e o grupo 2, 30 elásticos sintéticos, sem látex, também da marca Morelli de força média e diâmetro de 5/16". Eles foram distendidos 4cm e submersos em saliva artificial a 37 graus Celsius e tiveram força mensurada com dinamômetro ortodôntico ao início e nos intervalos de 24, 48, 72 e 120 horas após a imersão. A avaliação da degradação da força foi realizada calculando o percentual de força perdida em relação à força inicial em cada intervalo de tempo, para cada grupo testado separadamente e também entre eles. Resultados e Discussão: a média de valores dos elásticos tanto de silicone quanto de látex teve um percentual parecido quanto à degradação de forças, visto que após as primeiras 24 horas ocorreu o maior declínio de força, de aproximadamente 11% ambos os elásticos. Após 48 horas esse percentual não se alterou significativamente. Conclusão: elásticos devem ser trocados em até 48 horas para que a força aplicada se mantenha em índices aceitáveis.

Introduction: synthetic intermaxillary elastics have emerged as an alternative for orthodontic use in patients with latex sensitivity, but differences can be observed when compared to natural latex elastics. Objective: compare the amount of force degradation of synthetic intermaxillary elastics and latex when distended in artificial saliva in order to find clinical parameters for the use of a protocol on the frequency of exchange of these elastics in orthodontic therapies in patients with latex sensitivity or not. Method: for this, two groups containing 30 elastics were used. Group 1 with 30 medium strength and diameter 5/16 "Morelli latex elastics and group 2, 30 synthetic latex-free elastics, also of the medium strength and 5/16" diameter Morelli brand. They were stretched 4cm and submerged in artificial saliva at 37 degrees Celsius and had strength measured with orthodontic dynamometer at the beginning and at the intervals of 24, 48, 72 and 120 hours after immersion. The force degradation assessment was performed by calculating the percentage of force lost in relation to the initial force at each time interval, for each group tested separately and also between them. Results and discussion: the mean elastic values of both silicone and latex had a similar percentage for the degradation of forces, since after the first 24 hours the greatest force decline occurred, of approximately 11% both elastics. After 48 hours this percentage did not change significantly. Conclusion: elastics should be changed within 48 hours so that the force applied remains at acceptable rates.

Avaliação das medidas cefalométricas normativas para jovens amazonenses / Assessment of normative cephalometric measurements for young born in Amazon

A análise cefalométrica permite ao ortodontista investigar mais sobre a relação entre as bases ósseas, dentes e tegumento. Esse estudo objetivou determinar as principais variáveis cefalométricas esqueléticas e dentárias para jovens amazonenses. Foram empregadas telerradiografias de norma lateral de 38 jovens amazonenses e filhos de amazonenses, sendo 25 do gênero feminino (Grupo 1) e 13 do gênero masculino (Grupo 2), com média de idade de 14 anos e 1 mês. As telerradiografias foram traçadas e variáveis cefalométricas de McNamara10 (1984), Steiner16 (1953) e Tweed17 (1946), dentárias e esqueléticas, foram mensuradas por um único examinador previamente calibrado e comparadas aos valores normativos para indivíduos leucodermas. Para maior confiabilidade do método, 30% das medidas cefalométricas foram mensuradas novamente e o coeficiente de Pearson foi empregado para testar o erro intraexaminador. Também foi realizado ANOVA para comparação entre as médias das variáveis e teste t de Student para comparação dos valores obtidos e os valores padrão. Os resultados para cada grupo mostraram valores diferentes da normalidade em quase todas as variáveis, porém, ao analisar os valores médios da amostra total (G1 mais G2), houve diferença estatística significativa nas variáveis SNA, ANB, Co-Gn, AFAI, NS.Gn, SN-Go.Gn, 1.NB, 1-NB, 1.1, A-1 e AP-1-. Também foi encontrado dimorfismo sexual em várias das grandezas estudadas. Concluiu-se que existe a necessidade de um padrão cefalométrico específico a ser utilizado em amazonenses com o intuito de aprimorar o diagnóstico e plano de tratamento ortodôntico (AU)

Cephalometric analysis allows orthodontist to find harmony between the basal bones, teeth, and tissue. However, in a mixed country as Brazil, especially Amazonas State, where the diversity found in the country are still more than 30 species of indigenous tribes, it is necessary establish specific facial patterns for this population. The aim was to evaluate the main skeletal and dental cephalometric variables for young Amazon's. Thirty eight young's Amazon, 25 females (G-1) and 13 males (G-2), ±14.1years. Lateral radiographs were applied to evaluate dental and skeletal cephalometric variables from tree analysis by a single calibrated examiner. The variables were compared to normative values for caucasian individuals. In order to test intraexaminers error, 30% of the cephalometric measurements were measured again and the Pearson coefficient test was applied. The cephalometric variables between groups were compare by ANOVA and Student "t" test for comparison between the mean variables and the normal values. The significance level was set at 5%. The results from each group (females and males) showed statistically differences compared to the normal values in almost all variables, but when the total sample was compared to the normal values (G1 and G2), there were statistically significant differences only in the variables SNA, ANB, Co-Gn, AFAI, NS.Gn, SN-Go.Gn, 1.NB, 1-NB, 1.1, A-1, and AP-1-. It was also found sexual dimorphism in several of the measurements. It was concluded that there is a need for specific cephalometric pattern to be applied and for Amazonenses in order to improve orthodontic diagnosis and treatment planning.(AU)

Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation.

OBJECTIVE: The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. MATERIAL AND METHODS: Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). RESULTS: There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. CONCLUSIONS: Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.

Root length and alveolar bone level of impacted canines and adjacent teeth after orthodontic traction: a long-term evaluation

Abstract Objective The aim of this retrospective study was to evaluate the long-term effects of orthodontic traction on root length and alveolar bone level in impacted canines and adjacent teeth. Material and Methods Sample consisted of 16 patients (nine males and seven females), mean initial age 11 years and 8 months presenting with unilaterally maxillary impacted canines, palatally displaced, treated with the same surgical and orthodontic approach. Teeth from the impacted-canine side were assigned as Group I (GI), and contralateral teeth as control, Group II (GII). The mean age of patients at the end of orthodontic treatment was 14 years and 2 months and the mean post-treatment time was 5 years and 11 months. Both contralateral erupted maxillary canines and adjacent teeth served as control. Root length and alveolar bone level (buccal and palatal) were evaluated on cone-beam computed tomography (CBCT) images. The comparison of root length and alveolar bone level changes between groups were assessed by applying paired t-test, at a significance level of 5% (p<0.05). Results There were no statistically significant differences in root length and buccal and palatal bone levels of canines and adjacent teeth among groups. Conclusions Impacted canine treatment by closed-eruption technique associated with canine crown perforation, has a minimal effect on root length and buccal and palatal alveolar bone level in both canine and adjacent teeth, demonstrating that this treatment protocol has a good long-term prognosis.

Facial morphology and obstructive sleep apnea

Objective: This study aimed at assessing the relationship between facial morphological patterns (I, II, III, Long Face and Short Face) as well as facial types (brachyfacial, mesofacial and dolichofacial) and obstructive sleep apnea (OSA) in patients attending a center specialized in sleep disorders. Methods: Frontal, lateral and smile photographs of 252 patients (157 men and 95 women), randomly selected from a polysomnography clinic, with mean age of 40.62 years, were evaluated. In order to obtain diagnosis of facial morphology, the sample was sent to three professors of Orthodontics trained to classify patients' face according to five patterns, as follows: 1) Pattern I; 2) Pattern II; 3) Pattern III; 4) Long facial pattern; 5) Short facial pattern. Intraexaminer agreement was assessed by means of Kappa index. The professors ranked patients' facial type based on a facial index that considers the proportion between facial width and height. Results: The multiple linear regression model evinced that, when compared to Pattern I, Pattern II had the apnea and hypopnea index (AHI) worsened in 6.98 episodes. However, when Pattern II was compared to Pattern III patients, the index for the latter was 11.45 episodes lower. As for the facial type, brachyfacial patients had a mean AHI of 22.34, while dolichofacial patients had a significantly statistical lower index of 10.52. Conclusion: Patients' facial morphology influences OSA. Pattern II and brachyfacial patients had greater AHI, while Pattern III patients showed a lower index.

Objetivo: o objetivo deste estudo foi avaliar a associação entre os padrões morfológicos faciais e tipos faciais (braquifacial, mesofacial e dolicofacial) com a Apneia Obstrutiva do Sono (AOS) em pacientes de um centro especializado em distúrbios do sono. Métodos: foram utilizadas fotografias faciais de frente, perfil e sorriso de 252 indivíduos, selecionados aleatoriamente entre pacientes que procuraram uma clínica especializada em polissonografia. Para o diagnóstico morfológico facial, a amostra foi enviada a três professores de Ortodontia treinados na classificação do padrão facial, e cada um recebeu a orientação para classificar o padrão facial da seguinte forma: 1 = Padrão I, 2 = Padrão II, 3 = Padrão III, 4 = Padrão Face Longa e 5 = Padrão Face Curta. A concordância interexaminadores foi avaliada por meio do Índice Kappa. O diagnóstico do tipo facial foi estabelecido por meio de um índice facial que leva em consideração a proporção entre a largura e altura da face. Resultados: no modelo de regressão linear múltipla, ficou evidenciado que o Padrão II teve a capacidade de agravar o índice de apneia e hipopneia (IAH) em 6,98, enquanto os pacientes do Padrão III tinham esse índice atenuado em 11,45. Para o tipo facial, os pacientes braquifaciais apresentaram um IAH médio de 22,34, enquanto o grupo classificado como dolicofacial mostrou um índice menor, de 10,52, com significância estatística. Conclusão: o desenho morfológico facial se mostrou um considerável fator de agravamento ou proteção da SAOS, onde os indivíduos Padrão II e braquifaciais tiveram IAH maiores, enquanto nos pacientes Padrão III esse índice foi reduzido.

Tratamento precoce da má-oclusão do padrão III classe III por meio de tração reversa da maxila / Early treatment of pattern III class III with face mask therapy

A má-oclusão esquelética padrão III classe III é considerada a alteração sagital mais difícil de ser tratada. Isso ocorre devido à natureza imprevisível dessa má-oclusão, caracterizada por um padrão de crescimento desfavorável que coloca em dúvida o prognóstico do seu tratamento, mesmo quando iniciado precocemente. Dessa forma, a literatura ortodôntica tem trazido discussão sobre esse tema, principalmente com relação à época oportuna de tratamento e seus resultados em longo prazo. A intervenção precoce tem sido indicada com maior frequência com o objetivo de eliminar fatores etiológicos primários, e evitar que a má-oclusão já instalada agrave-se com o crescimento. Nesse sentido, o crescimento intramembranoso maxilar favorece uma resposta ortopédica, comparado ao tratamento de restrição do crescimento mandibular. Resultados interessantes têm sido alcançados com a protração maxilar associada à expansão maxilar ortopédica. O impacto deste tratamento em longo prazo não apresenta previsibilidade, mas pode auxiliar o estabelecimento de uma oclusão normal, minimizando a discrepância maxilomandibular permitindo um crescimento e desenvolvimento mais harmonioso da face média do indivíduo. Este trabalho teve por objetivo discorrer sobre o diagnóstico e o tratamento precoce da má-oclusão padrão III classe III, por meio de tração reversa da maxila associada à expansão rápida da maxila...

The class III malocclusion, pattern III is considered the hardest sagittal harder to be treated. The diagnosis and early treatment are much discussed topics in the orthodontic literature. This kind of early intervation has been indicated more frequently, with the goal of eliminating primary etiological factors and avoid that an already installed malocclusion become serious. The impact of long-term treatment cannot be predicted clearly, but may help the development of a normal occlusion, normalizing the discrepancy maxillo-mandibular discrepancy, allowing a harmonious growth and development of the midface. The aim of this study is, through a literature review, discuss about class III diagnosis and early treatment by maxillary protraction associated with rapid maxillary expansion (RME)...

Tratamento ortocirúrgico de incisivo central superior impactado associado à presença de mesiodens / Surgical orthodontic treatment of impacted maxillary incisor associated with mesiodens: a case report

A prevalência de dentes supranumerários refere-se a aproximadamente 1,4 a 2,0% da população. Quando este se localiza na região anterior da maxila é denominado mesiodens. Sua presença pode trazer algumas sequelas, tais como formação de diastema e cistos, reabsorções radiculares, deslocamento do germe e impacção do dente permanente. O tratamento, quando há retenção do dente permanente, deve ser multifatorial, com o intuito de trazer o dente retido para o arco. O presente artigo teve como objetivo apresentar um caso clínico de um paciente do sexo feminino, com 14 anos de idade, que apresentou-se com a queixa da ausência do incisivo central superior direito. O diagnóstico, baseado na avaliação radiográfica, revelou a impacção deste dente associada à presença de um mesiodens. O plano de tratamento primeiramente consistiu na expansão rápida da maxila, seguida da remoção cirúrgica do dente supranumerário e colagem do acessório ortodôntico no dente impactado. Posteriormente, iniciou-se o tracionamento ortodôntico do incisivo, ancorado em uma placa de Hawley modificada removível, com auxílio de elásticos 1/8”. A segunda etapa do tratamento foi realizada com aparelho corretivo fixo no arco superior, para correto posicionamento do dente no arco. Devido à uma alteração de forma presente no incisivo tracionado, após seu correto alinhamento, sua coroa foi reanatomizada com resina composta. O protocolo de tratamento ortocirúrgico associado à intervenção estética devolveu um sorriso funcional e esteticamente agradável para a paciente, o que contribuiu para o aumento da sua autoestima...

The prevalence of impacted teeth in the general population is approximately 1,4 a 2,0%. When the tooth is located in the maxillary anterior area it is named mesiodens. The presence of this teeth is related to diastemas and cysts, root resorption, tooth germ displacement and permanent teeth impaction. The treatment protocol should be multidisciplinary when the teeth impaction is diagnosed because tractioning is required in order to bring and align the teeth in the arch. The aim of this study is to present and discuss a case report of a young girl, 14 years of age, presenting the absence of the upper right central incisor. The delayed eruption of the tooth was diagnosed as an impaction related to the presence of a mesiodens during the radiographic evaluation. The treatment protocol started with the rapid maxillary expansion to correct the posterior unilateral crossbite of the patient, which also could provide enough space for the proper alignment of the absent tooth. After that, the extraction of the supranumerary tooth, surgical exposure and bonding of an orthodontic accessory on the upper incisor were performed. The tractionning of the tooth was anchored on a removable splint by means of a 1/8” elastic ring. A corrective phase on the upper arch was necessary to the final alignment of the tooth. For a better esthetic result the tooth crown was reshaped with composite. The surgical orthodontic approach associated to the cosmetic treatment could provide a good functional and esthetic smile to the patient, which improved patient’s self esteem...

Management of the Class III malocclusion treated with maxillary expansion, facemask therapy and corrective orthodontic. A 15-year follow-up.

The facial growth of Class III malocclusion worsens with age, in this case, the early orthopedic treatment, providing facial balance, modifying the maxillofacial growth and development. A 7.6-year old boy presented with Class III malocclusion associated with anterior crossbite; the mandible was shifted to the right and the maxilla had a transversal deficiency. Rapid maxillary expansion followed by facemask therapy was performed, to correct the anteroposterior relationship and improve the facial profile. The patient was followed for a 15-year period, after completion of the treatment, and stability was observed. Growing patients should be monitored following their treatment, so as to prevent malocclusion relapse.

Management of the Class III malocclusion treated with maxillary expansion, facemask therapy and corrective orthodontic. A 15-year follow-up

The facial growth of Class III malocclusion worsens with age, in this case, the early orthopedic treatment, providing facial balance, modifying the maxillofacial growth and development. A 7.6-year old boy presented with Class III malocclusion associated with anterior crossbite; the mandible was shifted to the right and the maxilla had a transversal deficiency. Rapid maxillary expansion followed by facemask therapy was performed, to correct the anteroposterior relationship and improve the facial profile. The patient was followed for a 15-year period, after completion of the treatment, and stability was observed. Growing patients should be monitored following their treatment, so as to prevent malocclusion relapse.

A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report.

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, posttreatment, and long-term follow-up records for the patient are presented.

Avaliação da prática de higiene bucal em pacientes ortodônticos / Evaluation of oral hygiene in orthodontic patients

Objetivo: identificar as condições de higiene bucal, principalmente em relação ao uso do fio dental, em pacientes submetidos ao tratamento ortodôntico fixo. Material e métodos: um questionário sobre as atuais práticas de higiene bucal foi respondido por 200 indivíduos entre 11 e 25 anos de idade, sendo 100 do sexo feminino e 100 do sexo masculino, em fase ativa de tratamento ortodôntico fixo. Resultados: os resultados avaliados pela estatística, por meio de teste de comparação entre as faixas etárias, correlação, associação e distribuição de frequência, revelaram que a maioria dos pacientes (66%) escova os dentes duas vezes ao dia; utiliza escovas de dente convencionais (100%), ao invés de escova elétrica, e apenas 35,55% utiliza rotineiramente fio dental.

Objective: this study analyzed the oral hygiene status, especially concerning the use of dental floss, in patients submitted to fixed orthodontic treatment. Material and methods: a questionnaire on the current oral hygiene practices was responded by 200 individuals aged 11 to 25 years, being 100 females and 100 males, in active stage of fixed orthodontic treatment. Results: the results were statistically analyzed by comparison between age ranges, correlation, association and frequency distribution, and revealed that; there is positive correlation between age and frequency of toothbrushing; there is association between age and use of dental floss. Conclusions: analysis of the oral hygiene practice of orthodontic patients revealed that most patients (66%) brush their teeth twice a day; use conventional toothbrushes (100%) rather than electric toothbrushes and only 35.55% make routine use of dental floss.

A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, posttreatment, and long-term follow-up records for the patient are presented.

From conventional to self-ligating bracket systems: is it possible to aggregate the experience with the former to the use of the latter?

INTRODUCTION: Orthodontics, just as any other science, has undergone advances in technology that aim at improving treatment efficacy with a view to reducing treatment time, providing patients with comfort, and achieving the expected, yet hardly attained long-term stability. The current advances in orthodontic technology seem to represent a period of transition between conventional brackets (with elastic modules) and self-ligating brackets systems. Scientific evidence does not always confirm the clear clinical advantages of the self-ligating system, particularly with regard to reduced time required for alignment and leveling (a relatively simple protocol), greater comfort for patients, and higher chances of performing treatment without extractions - even though the number of extractions is more closely related to patient's facial morphological pattern, regardless of the technique of choice. Orthodontics has recently and brilliantly used bracket individualization in compensatory treatment with a view to improving treatment efficacy with lower biological costs and reduced treatment time. OBJECTIVE: This paper aims at presenting a well-defined protocol employed to produce a better treatment performance during this period of technological transition. It explores the advantages of each system, particularly with regards to reduced treatment time and increased compensatory tooth movement in adult patients. It particularly addresses compensable Class III malocclusions, comparing the self-ligating brackets system, in which greater expansive and protrusive tooth movement (maxillary arch) is expected, with Capelozza Prescription III conventional brackets, in which maintaining the original form of the arch (mandibular arch) with as little changes as possible is key to yield the desired results.