Temporomandibular Disorders and Orthodontics: how to conduct a screening examination? / Dysfonctionnements temporo-mandibulaires et orthodontie : comment conduire un examen de dépistage ?

Introduction: Common Temporomandibular Disorders (TMD) involve the masticatory muscles, temporomandibular joints, and/or their associated structures. Clinical manifestations can vary, including sounds (cracking, crepitus), pain, and/or dyskinesias, often corresponding to a limitation of mandibular movements. Signs or symptoms of muscular or joint disorders of the masticatory system may be present before the initiation of orthodontic treatment, emerge during treatment, or worsen to the point of stopping treatment. How do you screen for common TMD in orthodontic treatment? Materials and Methods: The main elements of the interview and clinical examination for screening common TMD in the context of orthodontic treatment are clarified and illustrated with photographs. Moreover, complementary examinations are also detailed. Results: A clinical screening form for common TMD is proposed. A synthetic decision tree helping in the screening of TMD is also presented. Conclusion: In the context of an orthodontic treatment, the screening examination for common TMD includes gathering information (interview), a clinical evaluation, and possibly complementary investigations. The orthodontist is supported in this approach through the development of a clinical form and a dedicated synthetic decision tree for the screening of TMDs. Systematically screening for common TMD before initiating orthodontic treatment allows the orthodontist to suggest additional diagnostic measures, implement appropriate therapeutic interventions, and/or refer to a specialist in the field if necessary.

Introduction: Les dysfonctionnements temporo-mandibulaires (DTM) concernent les muscles masticateurs, les articulations temporo- mandibulaires et/ou leurs structures associées. Les manifestations cliniques peuvent être diverses : bruits (craquements, crépitements), algies et/ou dyscinésies correspondant le plus souvent à une limitation des mouvements mandibulaires. Or, des signes ou symptômes de troubles musculaires ou articulaires de l'appareil manducateur peuvent être présents avant le début de la prise en charge orthodontique, voire apparaître en cours de traitement ou s'aggraver au point de remettre en question la poursuite du traitement engagé. Comment conduire un dépistage de DTM communs dans le cadre d'une prise en charge orthodontique ? Matériel et méthodes: Les éléments essentiels de l'entretien et de l'examen clinique d'un dépistage des DTM communs dans le cadre d'une consultation d'orthodontie sont clarifiés et illustrés à l'aide de photographies. Le recours aux examens complémentaires a également été détaillé. Résultats: Une fiche clinique de dépistage des DTM communs est proposée. Un arbre décisionnel synthétique aidant au dépistage des DTM est présenté. Conclusion: Dans le cadre d'une consultation d'orthopédie dento-faciale, l'examen de dépistage des DTM communs inclut un recueil d'informations (entretien), une évaluation clinique et éventuellement des examens complémentaires. L'orthodontiste est soutenu dans cette démarche par la création d'une fiche clinique et d'un arbre décisionnel synthétique dédiés au dépistage des DTM. Effectuer systématiquement un dépistage des DTM communs avant d'initier un traitement orthodontique permettra à l'orthodontiste de proposer des moyens diagnostiques supplémentaires si nécessaire, et de mettre en place la prise en charge adéquate et/ou de référer à un spécialiste du domaine pour démarrer le traitement orthodontique dans les meilleures conditions.

Accuracy and reliability of magnetic resonance imaging in orthodontic diagnosis and treatment planning-a systematic review and meta-analysis.

BACKGROUND: Magnetic resonance imaging (MRI) is a non-ionizing imaging technique. Using MRI in dentistry may potentially lower the general radiation dose of the examined population, provided MRI can replace various radiation-based images. Furthermore, novel MRI imaging modalities for three-dimensional and two-dimensional cephalometrics have recently been developed for orthodontic diagnosis. OBJECTIVES: This systematic review aimed to determine the diagnostic accuracy and reliability of MRI in orthodontic diagnosis and treatment planning. SEARCH METHODS: An electronic search was conducted on 20 November 2022 in the following databases: PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane. The search was updated on 30 August 2023. Furthermore, a grey literature search was performed in Google Scholar and Open-Grey. SELECTION CRITERIA: This review included descriptive, observational, cohort studies, cross-sectional, case-control studies, and randomized/non-randomized trials related to the research question. The study excluded studies related to patients with syndromes, chronic diseases, craniofacial anomalies, or bone diseases. DATA COLLECTION AND ANALYSIS: The included studies were quality assessed using the "Joanna Brigg's Critical Appraisal Tool for diagnostic test accuracy". The GRADE approach for non-randomized studies was used for strength-of-evidence analysis. RESULTS: Eight of the 10 included studies compared MRI with either cone beam computed tomography or lateral cephalogram and found a high intra- and inter-rater agreement for landmark identification. The risk of bias was high in four studies, moderate in three, and low in three studies. Homogeneity was lacking among the included studies in terms of MRI imaging parameters and sample characteristics. This should be taken into consideration by future studies where uniformity with respect to these parameters may be considered. CONCLUSIONS: Despite dissimilarity and heterogeneity in the sample population and other methodological aspects, all the included studies concluded that MRI enjoyed considerable intra- and inter-examiner reliability and was comparable to current diagnostic standards in orthodontics. Furthermore, the studies agreed on the innovative potential of MRI in radiation-free diagnosis and treatment planning in orthodontics in the future. REGISTRATION: CRD number: CRD420223XXXXX.

Resorptions and orthodontics / Résorptions et orthodontie

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

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

The use of CBCT in orthodontics with special focus on upper airway analysis in patients with sleep-disordered breathing.

Applications of cone-beam CT (CBCT) in orthodontics have been increasingly discussed and evaluated in science and practice over the last two decades. The present work provides a comprehensive summary of current consolidated practice guidelines, cutting-edge innovative applications, and future outlooks about potential use of CBCT in orthodontics with a special focus on upper airway analysis in patients with sleep-disordered breathing. The present scoping review reveals that clinical applications of CBCT in orthodontics are broadly supported by evidence for the diagnosis of dental anomalies, temporomandibular joint disorders, and craniofacial malformations. On the other hand, CBCT imaging for upper airway analysis-including soft tissue diagnosis and airway morphology-needs further validation in order to provide better understanding regarding which diagnostic questions it can be expected to answer. Internationally recognized guidelines for CBCT use in orthodontics are existent, and similar ones should be developed to provide clear indications about the appropriate use of CBCT for upper airway assessment, including a list of specific clinical questions justifying its prescription.

Effect of attachment type on distal bodily movement of the maxillary canine in aligner orthodontics: a finite element study.

OBJECTIVES: To clarify the effect of attachment types on bodily movement of the maxillary canine in aligner orthodontics. MATERIALS AND METHODS: Using an aligner, the canine was moved bodily by 0.1 mm distally as a target position. Orthodontic tooth movement was simulated using the finite element method (FEM). The alveolar socket was displaced in the same manner as the initial movement caused by elastic deformation of the periodontal ligament. First, the initial movement was calculated, and then the alveolar socket was displaced in the same direction and with the same magnitude as the initial movement. These calculations were repeated to move the teeth after placement of the aligner. The teeth and the alveolar bone were assumed to be rigid bodies. A FEM model of the aligner was made based on the crown surfaces. The thickness of the aligner was 0.45 mm, and its Young's modulus was 2 GPa. Three types of attachments-semicircular couple, vertical rectangular, and horizontal rectangular-were placed on the canine crown. RESULTS: Regardless of the type of attachment, upon placement of the aligner on the dentition the crown of the canine moved to the target position, while the apex hardly moved. That is, the canine tipped and rotated. After repeating the calculation, the canine became upright and moved bodily regardless of the attachment type. In the aligner without an attachment, the canine did not become upright. CONCLUSIONS: There was almost no difference among attachment types in terms of achieving bodily movement of the canine.

Interdisciplinary treatment to replace missing upper lateral incisors, 4.5 years follow up / Tratamiento interdisciplinario para reposición de incisivos laterales superiores faltantes, seguimiento de 4,5 años

Introduction: Multidisciplinary diagnosis and planning are essential to define the treatment option that will provide the best individual results for patients with congenitally missing upper lateral incisors. Objective: To determine the function and aesthetics after the therapeutic use of osseintegrated implants to replace congenitally missing upper lateral incisors in a young female at 4.5 years follow-up. Case report: The patient was a 13 years old female (at beginning of treatment) with congenitally missing upper lateral incisors condition. Five months after the orthodontic active treatment, the space for placing the implants was achieved. After 2 years of Orthodontic treatment and the evaluation of the craniomandibular growth term by hand radiography, two implants were placed with an expanded bone technique in the position of the upper lateral incisors. After 4 months, osseointegration was clinically confirmed and two screw retained temporary crowns were performed using temporary plastic abutments and acrylic teeth and recalled at 4.5 years to control. Conclusions: Our results showed predictable esthetics and functional results in a patient with congenitally missing upper lateral incisors. This was possible due to a multidisciplinary approach between the diagnosis and treatment performed (Orthodontics, Implantology and Prosthodontics(AU)

Introducción: El diagnóstico y la planificación multidisciplinarios son esenciales para definir la opción de tratamiento que proporcionará los mejores resultados individuales para los pacientes con incisivos laterales superiores que faltan congénitamente. Objetivo: Fue determinar la función y la estética después del uso terapéutico de implantes osteointegrados para reemplazar los incisivos laterales superiores ausentes congénitamente en una mujer joven a los 4,5 años de seguimiento. Presentación del caso: La paciente, mujer de 13 años (al inicio del tratamiento) con una condición congénita de incisivos laterales superiores ausentes. Cinco meses después del tratamiento activo de ortodoncia, se logró el espacio para la colocación de los implantes. Después de 2 años de tratamiento de Ortodoncia y la evaluación del término de crecimiento cráneo-mandibular corroborado mediante radiografía de mano, se colocaron dos implantes con técnica de hueso expandido en la posición de los incisivos laterales superiores. Después de 4 meses, se confirmó clínicamente la osteointegración y se realizaron dos coronas provisionales atornilladas utilizando pilares de plástico provisionales y dientes acrílicos y se controlaron a los 4,5 años de seguimiento. Conclusiones: Nuestros resultados mostraron resultados estéticos y funcionales predecibles en un paciente con incisivos laterales superiores ausentes congénitamente. Esto fue posible gracias a un abordaje multidisciplinar entre el diagnóstico y el tratamiento realizado (Ortodoncia, Implantología y Prostodoncia(AU)

Congruencia entre modelos dentales impresos 3D y el archivo digital de origen: estudio in vitro comparativo de 5 impresoras 3D / Congruence between 3D printed dental models and the original digital file: comparative in vitro study of 5 3D printers

Este trabajo tuvo como objetivo conocer la fiabilidad de la impresora 3D (i3D) aditiva por Matriz de Proceso Digital de Luz (MDLP) Hellbot modelo Apolo®, a través de verificar la congruencia dimensional entre las mallas de modelos impresos (MMi) y su correspondiente archivo digital de origen (MMo), obtenido del software de planificación ortodontica Orchestrate 3D® (O3D). Para determinar su uso en odontología y sus posibilidades clínicas, fue comparada entre cinco i3D de manufactura aditiva, dos DLP, dos por estereolitografía (SLA) y una por Depósito de Material Fundido (FDM). La elección de las cinco i3D se fundamentó en su valor de mercado, intentando abarcar la mayor diversidad argentina disponible. Veinte modelos fueron impresos con cada i3D y escaneados con Escáner Intraoral (IOS) Carestream modelo 3600® (Cs3600). Las 120 MMi fueron importadas dentro del programa de ingeniería inversa Geomagic® Control X® (Cx) para su análisis 3D, consistiendo en la superposición de MMo con cada una de las MMi. Luego, una evaluación cualitativa de la desviación entre la MMi y MMo fue realizada. Un análisis estadístico cuidadoso fue realizado obteniendo como resultado comparaciones en 3d y 2d. Las coincidencias metrológicas en la superposición tridimensional permitieron un análisis exhaustivo y fácilmente reconocible a través de mapas colorimétricos. En el análisis bidimensional se plantearon planos referenciados dentariamente desde la MMo, para hacer coincidir las mediciones desde el mismo punto de partida dentaria. Los resultados fueron satisfactorios y muy alentadores. Las probabilidades de obtener rangos de variabilidad equivalentes a +/- 50µm fueron de un 40,35 % y de +/- 100µm un 71,04 %. Por lo tanto, te- niendo en cuenta las exigencias de congruencia dimensional clínicas de precisión y exactitud a las cuales es sometida nuestra profesión odontológica, se evitan problemas clínicos arrastrados por los errores dimensionales en la manufactura (Cam) (AU)

The objective of this study was to determine the reliability of the Hellbot Apollo® model additive 3D printer (i3D) by Matrix Digital Light Processing (MDLP) by verifying the dimensional congruence between the printed model meshes (MMi) and their corresponding digital source file (MMo), obtained from the Orchestrate 3D® (O3D) orthodontic planning software. A comparison was made between five i3D of additive manufacturing, two DLP, two by stereolithography (SLA), and one by Fused Material Deposition (FDM), to determine its use in dentistry and its clinical possibilities. The choice of the five i3D was based on their market value, trying to cover most of the Argentinean diversity available. Twenty models were printed with each i3D and scanned with Carestream Intraoral Scanner (IOS) model 3600® (Cs3600). The 120 MMi were imported into the reverse engineering program Geomagic® Control X® (Cx) for 3D analysis, consisting of overlaying MMo with each MMi. Then, a qualitative evaluation of the deviation between MMi and MMo. Also, a careful statistical analysis was performed, resulting in 3d and 2d comparisons. Metrological coincidences in three-dimensional overlay allowed a comprehensive and easily recognizable analysis through colorimetric maps. In the two-dimensional analysis, dentally referenced planes were proposed from the MMo, to match the measurements from the same dental starting point. The results were satisfactory and very encouraging. The probabilities of obtaining ranges of variability equivalent to +/- 50µm were 40.35 % and +/- 100µm 71.04 %. Therefore, considering the demands of clinical dimensional congruence, precision, and accuracy to which our dental profession it is subjected, clinical problems caused by dimensional errors in manufacturing (Cam) are avoided (AU)

Agreement of in vitro orthodontic measurements on dental plaster casts and digital models using Maestro 3D ortho studio software.

OBJECTIVE: Diagnostic casts are one of the standard components of orthodontic records. But they have several drawbacks such as the need for physical space for storage and the risk of breaking due to their brittle composition. Today, the digitalization of orthodontic models is a progress in orthodontics. The purpose of this study was to compare and evaluate common orthodontic linear measurements on plaster casts and digital 3D models using Maestro 3D ortho studio® scanner and software (AGE Solutions®, Pontedera, Italy). MATERIALS AND METHODS: Study casts of 30 orthodontic patients were selected. Tooth width, space analysis, Bolton analysis, overjet, overbite, and linear measurements of dental arch dimensions were performed by two examiners on plaster casts and digital models. STATISTICAL ANALYSIS: Intra- and interexaminer agreements were evaluated in both manual and digital methods and paired t test was used for evaluating the agreement between the manual and digital measurement. The significance level was set at 0.05. RESULTS: The intraexaminer agreement was excellent (ICC > 0.75) for most variables in both manual and digital methods. The correlation between the two examiners was significant (p < .05) for most manual and digital measurements. The differences between the manual and digital measurements, although maybe statistically significant, were not clinically significant for most variables. CONCLUSION: The use of "Maestro 3D" (AGE Solutions, Pontedera, Italy) scanner and software was acceptable for orthodontic diagnostic measurements instead of study casts.

Oral health status after orthodontic treatment: a retrospective study / Estado de salud bucal después del tratamiento de ortodoncia: un estudio retrospectivo

ABSTRACT: Orthodontic appliances in the oral cavity may cause problems such as white spot lesions, dental plaque, periodontal disease and root resorption. The aim of this study was to investigate the association between orthodontic treatment and oral health parameters including visible dental plaque, gingival recession and white spot lesions (WSLs). A total of 170 patients (86 females, 84 males) were randomly selected to determine visible dental plaque, gingival recession and white spot lesions by using pre-treatment and post-treatment oral photographs. Except of previously extracted teeth, maxillary and mandibular incisors, canine, 1st and 2nd premolars and 1st molar were evaluated. There was a significant difference between the T0 (before treatment) and T1 (after treatment) groups in visible plaque (P< 0.001). The distribution of gingival recession frequencies according to Miller classification before treatment did not differ from the after treatment (P=082). A statistically significant increase in the severity of WSL was detected between the two time points (P< 0.001). Males have been shown to have higher WSL incidence after treatment. In conclusion, the present study showed that visible dental plaque and white spot lesions significant increase after orthodontic treatment. Considering the relationship between oral health and orthodontic treatment, clinicians and patients should know the risks and take precautions.

RESUMEN: Los aparatos de ortodoncia en la cavidad oral puede causar problemas como lesiones de mancha blanca, placa dental, enfermedad periodontal y reabsorción radicular. El objetivo de este estudio fue investigar la asociación entre el tratamiento de ortodoncia y los parámetros de salud bucal, incluida la placa dental visible, la recesión gingival y las lesiones de mancha blanca (LMB). Un total de 170 pacientes (86 mujeres, 84 hombres) fueron seleccionados al azar para determinar la placa dental visible, la recesión gingival y las lesiones de manchas blancas mediante el uso de fotografías orales antes y después del tratamiento. Excepto los dientes extraídos previamente, se evaluaron incisivos maxilares y mandibulares, caninos, premolares y primeros molares. Hubo una diferencia significativa entre los grupos T0 (antes del tratamiento) y T1 (después del tratamiento) en la placa visible (P<0.001). La distribución de las frecuencias de recesión gingival según la clasificación de Miller antes del tratamiento no mostraron diferencias significativas con respecto al postratamiento (P=0.082). Se detectó un aumento estadísticamente significativo en la gravedad de LMB entre los dos puntos de tiempo (P<0.001). Se ha demostrado que los hombres tienen una mayor incidencia de LMB después del tratamiento. En conclusión, el presente estudio mostró que la placa dental visible y las lesiones de manchas blancas aumentaron significativamente durante el tratamiento de ortodoncia. Teniendo en cuenta la relación entre la salud bucal y el tratamiento de ortodoncia, los médicos y los pacientes deben conocer los riesgos y tomar precauciones.

Effect of drops containing Lactobacillus reuteri (DSM 17938 and ATCC PTA 5289) on plaque acidogenicity and other caries-related variables in orthodontic patients.

BACKGROUND: The purpose of the study was to investigate the effect of probiotics on biofilm acidogenicity and on the number of salivary Streptococcus mutans and lactobacilli in orthodontic patients. METHODS: This RCT was conducted on 28 young adults who were undergoing orthodontic treatment. The short-term prospective clinical trial lasted for three weeks. The test group rinsed daily with drops containing two Lactobacillus reuteri strains diluted in water, while the placebo group used drops without probiotics. The subjects were enrolled eight months since the beginning of orthodontic treatment. Plaque-pH, saliva and dental biofilm samples were obtained at baseline, one week and three weeks post intervention. RESULTS: Twenty-seven subjects successfully completed the trial period, only one drop out in the test group. No side effects were reported. A statistically significant increase in plaque pH at three weeks post-intervention was found for the test group (p < 0.05), while insignificant changes in the pH value were found for the placebo group in comparison to baseline (p > 0.05). In addition, the AUC7.0 showed a significant difference at three weeks between the test and placebo (p = 0.00002). The three-week samples of stimulated whole saliva showed a statistically insignificant difference in the number of S. mutans and lactobacilli between the two groups (p > 0.05). The qPCR analysis showed the ability of the two strains to get colonized in the dental biofilm without a significant effect on the microbial counts. CONCLUSION/CLINICAL IMPLICATIONS: A mixture of Lactobacillus reuteri has the ability to reduce the pH fall at the three-week follow-up. However, the short-term use of probiotics does not appear to have an effect on the number of salivary Streptococcus mutans and lactobacilli in saliva and on the dental biofilm. TRIAL REGISTRATION: Clinicaltrial.gov (Identifier: NCT04593017 / (19/10/2020)).

Ultra short time to Echo (UTE) MRI for cephalometric analysis-Potential of an x-ray free fast cephalometric projection technique.

OBJECTIVES: A novel magnetic resonance imaging (MRI) scan protocol is presented on the basis of ultra-short time to echo (UTE). By this MRI cephalometric projections (MCPs) can be acquired without the need of post processing in one shot. Different technical parameterizations of the protocol are performed. Their impact on the performance of MCPs is evaluated in comparison to the gold standard-the lateral cephalometric radiography (LCR) for cephalometric analysis (CA) in orthodontics. METHODS: Seven MCPs with various scan parameters influencing the scan duration and one LCR are used from one subject. 40 expert assessors performed CA for 14 predefined cephalometric landmarks. Relative metric distances and absolute angular measurements were calculated. Statistical analysis is presented and the deviations are highlighted to demonstrate the potential of the method for further analysis. RESULTS: The MCPs are acquired in 5-154 seconds, depending on resolution and contrast. Mean relative distances were 2.4-2.7 mm in MCPs and 1.6 mm in LCR, which demonstrate the accuracy and level of agreement of the expert assessors in identifying anatomical landmarks. In comparison to other studies, the presented MCP performed similar in angular analysis and demonstrated on average deviation of 1.2° ±1.1° in comparison to LCR. Despite the point articulare (Ar) and the related gonial angle the calculate distances and angles show outcomes in the range of ±2°/2mm. CONCLUSIONS: MCPs can be acquired much faster in comparison to other techniques known from literature for CA. This study demonstrated the potential of the new method and showed first feasible results. Further research is needed to analyze the performance on a broad range of patients.

Satisfacción con el servicio de posortodoncia de la Universidad Santo Tomás según métricas Lean-Six-Sigma / SatisfactionService Post-Orthodontic University Santo Tomas According ToLean-Six-Sigma Metrics

Introducción: La metodología Lean-Six-Sigma es utilizada actualmente en el área de la salud con el objeto de mejorar la calidad y competitividad de los servicios; pero aún no se tienen reportes de su uso en el área de ortodoncia. Objetivo: Determinar la satisfacción posortodoncia por medio de niveles sigma de los pacientes que asisten a una clínica docente-asistencial en Bucaramanga, Colombia. Métodos: Estudio observacional, descriptivo, transversal. La población estuvo constituida por 100 pacientes de ambos sexos, que ya habían concluido el tratamiento de ortodoncia. Se seleccionó toda la población que hubiera finalizado el tratamiento entre julio de 2017 y junio 2018 de acuerdo con criterios de inclusión y exclusión. Se realizó una encuesta telefónica de 17 preguntas y siete dimensiones de satisfacción. La confiabilidad del cuestionario se evaluó con la consistencia interna del cuestionario mediante el alpha de Cronbach en el que se obtuvo 0,87, y para la validez se utilizó el método de Lawshe. Se usó la metodología Lean-Six-Sigma para evaluar la calidad de la satisfacción; se presentan los resultados en porcentaje y niveles sigma. Resultados: La calidad en satisfacción en el servicio fue de 91,27 por ciento (medido convencionalmente) y 1,36 sigmas; en el grupo de 16-19 años fue de 93,6 por ciento y 1,52 sigmas; y para el grupo de más de 27 años, 84,9 por ciento y 1,03 sigmas. El sexo femenino reportó un 88,57 por ciento y 1,2 sigmas, mientras que el masculino, 93,46 por ciento y 1,51 sigmas. Conclusiones: Los resultados de satisfacción en ortodoncia, medidos por métodos convencionales, mostraron porcentajes aceptables, pero mostraron resultados incompetentes al medirse con niveles sigma, lo cual indica que existen problemas ocultos por identificar y que corresponderían a una siguiente investigación(AU)

Introduction: The Lean-Six-Sigma methodology is currently used in the health area in order to improve the quality and competitiveness of services; but there are still no reports of its use in the orthodontic area. Objective : to determine the post-orthodontic satisfaction by means of sigma levels of the patients who attend a teaching-assistance clinic in Bucaramanga, Colombia. Methods: Observational descriptive cross-sectional study. Population: 100 patients (female and male) who finish orthodontic treatment. Sample selection method: the entire population that had completed the treatment between July 2017 and June 2018 was selected according to inclusion and exclusion criteria. A telephone survey of 17 questions and seven dimensions of satisfaction was carried out. The reliability of the questionnaire was evaluated with the internal consistency of the questionnaire by means of the Cronbach's alpha in which 0.87 was obtained, and the Lawshe method was used for validity. The Lean-Six-Sigma methodology was used to assess the quality of satisfaction; Results are presented in percentage and sigma levels. Results: The quality of service satisfaction was 91.27 percent (conventionally measured) and 1.36 sigmas; in the group of 16 to 19 years it was 93.6 percent and 1.52 sigmas; and for the group over 27 years old, 84.9 percent and 1.03 sigma. The female sex reported 88.57 percent and 1.2 sigmas, and the male reported 93.46 percent with 1.51 sigmas. Conclusions: The satisfaction results in orthodontics, measured by conventional methods, showed acceptable percentages, but showed incompetent results when measured with sigma levels, which indicates that there are hidden problems to be identified and that they would correspond to a subsequent investigation(AU)

The effect of genetic polymorphisms on treatment duration following premolar extraction.

To elucidate genetic factors affecting orthodontic treatment duration, we employed targeted next-generation sequencing on DNA from the saliva of 117 patients undergoing orthodontic treatment after premolar extraction. The clinical characteristics of patients are summarized, and the association of clinical variables with treatment duration was assessed. Patients whose treatment duration deviated from the average were classified into an extreme long group or an extreme short group. We identified nine single nucleotide polymorphisms (SNPs) of six genes that significantly differed in the two groups via targeted sequencing. The frequency of the CC genotypes of WNT3A, SPP1 (rs4754, rs9138), and TNFSF11, TT genotype of SPP1 (rs1126616), and GG genotype of SFRP2 was significantly higher in the extreme long group than in the short group. In the extreme short group, the TC genotype of SPP1, AA genotype of P2RX7, CT genotype of TNFSF11, and AG genotype of TNFRSF11A tended to exhibit higher frequency than in the long group. Taken together, we identified genetic polymorphisms related to treatment duration in Korean orthodontic patients undergoing premolar extraction. Our findings could lead to further studies predicting the prolongation of the orthodontic treatment duration, and will be of great aid to patients as well as orthodontists.

Robotic Applications in Orthodontics: Changing the Face of Contemporary Clinical Care.

The last decade (2010-2021) has witnessed the evolution of robotic applications in orthodontics. This review scopes and analyzes published orthodontic literature in eight different domains: (1) robotic dental assistants; (2) robotics in diagnosis and simulation of orthodontic problems; (3) robotics in orthodontic patient education, teaching, and training; (4) wire bending and customized appliance robotics; (5) nanorobots/microrobots for acceleration of tooth movement and for remote monitoring; (6) robotics in maxillofacial surgeries and implant placement; (7) automated aligner production robotics; and (8) TMD rehabilitative robotics. A total of 1,150 records were searched, of which 124 potentially relevant articles were retrieved in full. 87 studies met the selection criteria following screening and were included in the scoping review. The review found that studies pertaining to arch wire bending and customized appliance robots, simulative robots for diagnosis, and surgical robots have been important areas of research in the last decade (32%, 22%, and 16%). Rehabilitative robots and nanorobots are quite promising and have been considerably reported in the orthodontic literature (13%, 9%). On the other hand, assistive robots, automated aligner production robots, and patient robots need more scientific data to be gathered in the future (1%, 1%, and 6%). Technological readiness of different robotic applications in orthodontics was further assessed. The presented eight domains of robotic technologies were assigned to an estimated technological readiness level according to the information given in the publications. Wire bending robots, TMD robots, nanorobots, and aligner production robots have reached the highest levels of technological readiness: 9; diagnostic robots and patient robots reached level 7, whereas surgical robots and assistive robots reached lower levels of readiness: 4 and 3, respectively.

Monitoring Salivary Levels of Interleukin 1 Beta (IL-1ß) and Vascular Endothelial Growth Factor (VEGF) for Two Years of Orthodontic Treatment: A Prospective Pilot Study.

RESULTS: A gradual increase in IL-1ß and VEGF was observed at alignment, reaching significance at space closure (p = 0.002 and p = 0.025, respectively). At finishing, both IL-1ß and VEGF declined, however, without reverting to baseline values (p = 0.172 and p = 0.207, respectively). Bland-Altman analysis showed the agreement between IL-1ß and VEGF in terms of a systematic increase, with a higher percentage difference for VEGF. CONCLUSIONS: The salivary levels of both IL-1ß and VEGF increased following orthodontic treatment and reached their peaks during the treatment stage of space closure. This novel approach provides a hint on how and when to sample saliva during orthodontic treatment to analyse bone remodelling.

Investigation of Immediate Postoperative Pain following Orthognathic Surgery.

PURPOSE: The purpose of this study was to compare postintervention pain related to orthodontic treatment and orthognathic surgery. Material and Methods. One hundred patients who received only orthodontic treatment are the nonsurgical group. One hundred other patients were separated equally into the following four orthognathic surgical subgroups. The visual analog scale (VAS) score was used to measure postoperative pain. Patient- and operation-related factors were compared among the four surgical subgroups. The null hypothesis was that there was no difference between orthodontic treatment and orthognathic surgery in terms of posttreatment pain. RESULTS: There were no significant differences between the nonsurgical and surgical groups for gender (P = 0.780) or age (P = 0.473). The VAS scores of the nonsurgical group (mean: 3.59) were significantly (P = 0.007) higher than those of the surgical group (mean: 3.06). The null hypothesis was rejected. Within the surgical subgroups, no significant differences were observed between the men and women for age, operation time, blood loss volume, or blood laboratory values. CONCLUSIONS: The VAS scores of the orthodontic (nonsurgical) group were significantly higher than those of the surgical group. No significant differences in VAS scores were found between the four surgical subgroups.

Laserterapia de baixa intensidade no manejo da dor provocada por separadores elastoméricos: uma revisão integrativa / Low-level laser therapy in the management of pain evoked by elastomeric separators: an integrative review

Introdução: O uso de separadores elastoméricos durante o tratamento ortodôntico pode provocar dor e a laserterapia de baixa intensidade tem sido empregada no manejo deste desfecho. Objetivo: Apresentar as evidências sobre o efeito da laserterapia de baixa intensidade no manejo da dor provocada pelo uso de separadores elastoméricos. Métodos: Foi desenvolvida uma revisão integrativa de estudos clínicos nas bases de dados PubMed, Web of Science, Scopus, BVS, SciELO e clinicaltrials.gov utilizando uma estratégia PICo elaborada com descritores, incluindo estudos publicados nos últimos dez anos, sem restrição de idioma. Foram rastreados 68 artigos e 12 foram revisados. Revisão de literatura: Considerando a laserterapia, a maioria dos estudos utilizou arsenieto de gálio e alumínio (Ga-Al-As), com comprimento de onda entre 808nm e 940nm, bem como a potência entre 40.6mW e 200mW. A escala visual analógica (EVA) foi utilizada pela maioria dos estudos para mensurar a dor. Dois estudos não verificaram diferenças significativas da laserterapia de baixa intensidade na dor provocada pelos separadores elastoméricos, oito estudos encontraram diferenças significantes entre os grupos de intervenção, de controle e o placebo (quando utilizado) e dois estudos não foram totalmente conclusivos e apontaram diferenças estatística parciais entre os grupos em questão. As técnicas de aplicação foram demasiadamente heterogêneas nos estudos incluídos nesta revisão e não permitem uma síntese quantitativa. Conclusão: O laser de baixa intensidade pode demonstrar efeitos benéficos na redução da dor provocada por separadores elastoméricos. Entretanto, ainda não é possível determinar qual a melhor técnica de aplicação.

Introduction: The use of elastomeric separators during orthodontic treatment can cause pain and low-level laser therapy has been used to manage this outcome. Objective:To present the evidence on the effect of low-level laser therapy in the management of pain caused by the use of elastomeric separators. Methods: An integrative review of clinical studies was carried out in the PubMed, Web of Science, Scopus, BVS, SciELO and clinicaltrials.gov data-bases using a PICo strategy developed with descriptors, including studies published in the last ten years, without language restriction. 68 articles were tracked and 12 were reviewed. Literature review: Considering laser therapy, most studies used gallium and aluminum arsenide (Ga-Al-As), with a wavelength between 808nm and 940nm, as well as power between 40.6mW and 200mW. The visual analog scale (VAS) was used by most studies to measure the pain. Two studies did not find significant differences in low-level laser therapy in pain caused by elastomeric separators, eight studies found significant differences between the intervention, control and placebo groups (when used) and two studies were not fully conclusive and pointed out partial statistical differences between the groups in question. The application techniques were too heterogeneous in the studies included in this review and do not allow a quantitative synthesis. Conclusion: The low-level laser therapy can demonstrate beneficial effects in reducing pain caused by elastomeric separators. However, it is not yet possible to determine the best application technique.

The Use of Technology in the Management of Orthodontic Treatment-Related Pain.

Orthodontic pain is one of the negatives associated with fixed orthodontic treatment that cannot be avoided. This pain usually comes around the wire placement period and gradually decreases once the endogenous analgesic mechanisms start functioning. Over the years, several treatment modalities have been utilized for relief from orthodontic pain, and these include mechanical, behavior modification, and pharmacological methods. However, in the last decade, there are several newer methods employing the use of technology that have come up and are being used for alleviating pain. From computerized indirect bonding to virtual treatment planning, technology has slowly become a vital part of an orthodontist's repertoire. The digital age is here, and orthodontics must embrace the use of technology to help improve the quality of life of patients.

Is there any enhanced treatment effect on class II growing patients when Forsus Fatigue Resistant Device is reinforced by either miniplates or miniscrews? A systematic review and meta-analysis.

OBJECTIVE: To investigate the treatment effects, on skeletal class II growing patients, when miniplate-anchored Forsus Fatigue Resistant Device (MP-FFRD) and miniscrew-anchored Forsus Fatigue Resistant Device (MS-FFRD) were separately compared with conventional Forsus Fatigue Resistant Device (C-FFRD). Thus, distinguishing the differences between direct and indirect anchorages. MATERIALS AND METHODS: Comprehensive electronic and hand searching, without restrictions, were performed in CENTRAL, Scopus, Web of science, EMBASE via OVID, PubMed and ClinicalTrials.gov. Only randomized controlled trials (RCTs) and controlled clinical trials (CCTs) with patients receiving orthodontic functional treatment with MP-FFRD or MS-FFRD were included. Risk of bias was assessed using Cochrane's tools (RoB 2 and ROBINS-I). For quantitative synthesis, inverse variance method and standardized mean differences with 95% confidence intervals were chosen. RESULTS: Four RCTs and three CCTs were included. All reviewed articles included 101 patients in the experimental group and 103 patients in the control group. Regarding MP-FFRD, the analysis included data from 78 subjects (39 MP-FFRD, 39 C-FFRD). The pooled estimates showed an increase in SNB (SMD=0.7; 95% CI (0.21, 1.19); P=0.005) and in mandibular length (Co-Gn) (SMD=1.69; 95% CI (1.11, 2.27); P<0.001) in MP-FFRD compared with C-FFRD. Additionally, a reduction in lower incisors' inclination was observed in MP-FFRD group (SMD=-3.13; 95%CI (-3.83, -2.43); P<0.001). Concerning MS-FFRD, the analysis included data from 94 subjects (46 MS-FFRD, 48 C-FFRD). No significant improvement was achieved in SNB (SMD=0.19; 95% CI (-0.22, 0.60); P=0.36), yet two studies out of three reported a better control in the lower incisors' inclination. CONCLUSIONS: According to the available evidence, the direct loading of FFRD on bilateral miniplates enhanced the skeletal and dental corrections in class II growing patients; however, the clinical significance of the statistical results is questionable. The treatment effects of the indirect loading of FFRD on miniscrews were mainly dentoalveolar, yet with better control of lower incisors' inclination.