Does the composite attachment of clear aligners compromise the effectiveness of dental bleaching? An in vitro study.

INTRODUCTION: This study aimed to evaluate the effectiveness of dental bleaching with hydrogen peroxide 35% on the surface below the attachments. METHODS: Twenty-four blocks of bovine incisors were equally divided into 2 groups. The control group comprises the enamel surface free of attachments, whereas the attachment group comprises the enamel surface with attachment. Initial staining of samples was performed with black tea for 7 days; then, an attachment was made in the attachment group with Z250 resin and new staining for another 7 days in all samples. After staining, in-office bleaching was performed in both groups, and the attachments from the attachment group were removed. Color reading was performed with a spectrophotometer at all stages: initial (baseline), after 7 days of staining, after 14 days of staining, after immediate bleaching, and after 24 hours of bleaching. The color difference was calculated, and data analysis was performed using the t test for intergroup analysis. RESULTS: The results showed effective bleaching in both groups; however, there was a statistically significant difference in color change between them 24 hours after bleaching. CONCLUSION: It was concluded that the presence of attachment did not impair the action of the bleaching agent on the tooth surface.

Effectiveness and predictability of treatment with clear orthodontic aligners: A scoping review.

INTRODUCTION: In an ideal clinical setting, orthodontic therapy with clear aligners (CA) should improve the patients' initial malocclusion and must guarantee equivalence between the results predicted and those obtained clinically to be considered an effective treatment. Therefore, this scoping review aimed to identify the orthodontic literature concerning the effectiveness and predictability of CA treatments. METHODS: A systematic computerized search was performed in 3 databases: PubMed, Scopus, and Embase. Inclusion criteria selected observational and clinical studies performed in at least 10 adult orthodontic patients, whose results of CA treatment's effectiveness and/or predictability were assessed. RESULTS: The 3 database computerized searches resulted in 1,553 articles, and 169 full texts were considered potentially relevant. After applying the eligibility criteria, 33 studies were included. Most studies (76%) were designed as cohort studies and have been published in the last 5 years (79%). The majority included only non-extraction treatments (73%), and 79% reported results achieved with the Invisalign® system. The most predictable movement was the buccolingual tipping, while the least predictable movements were rotation, intrusion, and extrusion. Aligner treatment was effective for mild to moderate crowding resolution, and the success of overbite correction still seems to be limited. CONCLUSIONS: The studies have demonstrated improvement of initial malocclusion through CA treatments. Still, predictability degree is overestimated and does not accurately reflect the occlusion immediately at the end of treatment. In future studies, there should be an effort to broaden the utilization of alternative aligner systems beyond Invisalign® and broadly disseminate their outcomes to strengthen clear aligners evidence base.

Finite element analysis of two skeletally anchored maxillary molar distalisation methods.

OBJECTIVE: To compare two methods of maxillary molar distalisation with skeletal anchorage using finite element analysis (FEA). METHODS: Two digitised models were created: the miniscrew-anchored distaliser, which consisted of a distalisation method anchored in a buccal miniscrew between the first molar and second premolar (Model 1), and the miniscrew-anchored palatal appliance, which consisted of a distalisation method anchored in a miniscrew on the anterior region of the palate (Model 2). FEA was used to simulate both methods, assessing teeth displacements and stress concentration. RESULTS: The miniscrew-anchored distaliser showed greater buccal than distal displacement of the first molar, while the opposite was observed in the miniscrew-anchored palatal appliance. The second molar responded similarly in the transverse and anteroposterior perspectives with both appliances. Greater displacements were observed at crown level than in apical regions. Greater stress concentration was observed at the buccal and cervical regions of the crown in the miniscrew-anchored distaliser and the palatal and cervical regions in the palatal appliance. The stress progressively spread in the buccal side of the alveolar bone for the miniscrew-anchored distaliser and in the palatal root and alveolar bone for the palatal appliance. CONCLUSION: FEA assumes that both appliances would promote maxillary molar distalisation. A skeletally anchored palatal distalisation force seems to provide a greater molar bodily movement with less undesirable effects. Greater stress is expected at the crown and cervical regions during distalisation, and the stress concentration in the roots and alveolar bone depends directly on the region the force was applied.

Three-dimensional changes after maxillary molar distalization with a miniscrew-anchored cantilever.

OBJECTIVES: To evaluate the changes after maxillary molar distalization in Class II malocclusion using the miniscrew-anchored cantilever with an extension arm. MATERIALS AND METHODS: The sample included 20 patients (9 male, 11 female; mean age 13.21 ± 1.54 years) with Class II malocclusion, treated with the miniscrew-anchored cantilever. Lateral cephalograms and dental models obtained before (T1) and after molar distalization (T2) were evaluated using Dolphin software and 3D Slicer. Superimposition of digital dental models using regions of interest on the palate was performed to evaluate three-dimensional displacement of maxillary teeth. Intragroup change comparisons were performed using dependent t-test and Wilcoxon test (P < 0.05). RESULTS: The maxillary first molars were distalized to overcorrected Class I. The mean distalization time was 0.43 ± 0.13 years. Cephalometric analysis demonstrated significant distal movement of the maxillary first premolar (-1.21 mm, 95% confidence interval [CI]: -0.45, -1.96) and maxillary first (-3.38 mm, 95% CI: -2.88, -3.87) and second molars (-2.12 mm, 95% CI: -1.53, -2.71). Distal movements increased progressively from the incisors to the molars. The first molar showed small intrusion (-0.72 mm, 95% CI: 0.49, -1.34). In the digital model analysis, the first and second molars showed a crown distal rotation of 19.31° ± 5.71° and 10.17° ± 3.84°, respectively. The increase in maxillary intermolar distance, evaluated at the mesiobuccal cusps, was 2.63 ± 1.56 mm. CONCLUSIONS: The miniscrew-anchored cantilever was effective for maxillary molar distalization. Sagittal, lateral, and vertical movements were observed for all maxillary teeth. Distal movement was progressively greater from anterior to posterior teeth.

Post-COVID-19 influence in orthodontic care from the patient's perspective / Influência nos cuidados ortodônticos, pós-COVID 19, na perspectiva do paciente

Objective: considering the behavioral and paradigm changes due to the social isolation imposed by the new coronavirus pandemic, patients and orthodontists also have anxieties and insecurities in face of the new reality in dental clinics and educational institutions. This study aimed to evaluate, by means of an online questionnaire, the applicability of tele-orthodontics and tele-assistance, the behavior of patients regarding the initiation of or return to orthodontic treatment, and the new changes in clinical care. Material and Methods: the questionnaire was based on the Google Forms platform and consisted of three parts: the first one involved study presentation and informed consent form; the second one involved demographic data collection and characterization of the respondents, and the third one was the questionnaire itself. The questionnaire was sent by email and instant-messaging apps, with data being submitted for descriptive analyzis. Results: a total of 116 replies were returned, and most of the respondents were aged between 18 and 30 years old, female, and residents of the Southeast region. The results showed that tele- orthodontics is still unknown to a significant number of patients (66.4%) and almost half of them (41.4%) want their treatments to be monitored in person, even those whose devices do not require activation. They also prefer the first consultation and diagnosis to be done in person (55.2%). However, they are receptive to the idea of having their data and images transmitted via the Internet, including some remote consultations interspersed with in-person ones, understanding that costs can be lowered. Conclusion: tele-orthodontics is a reality, but for orthodontic patients, its applicability remains restricted to sending images and records (AU)

Objetivo: considerando as mudanças comportamentais e de paradigmas decorrentes do isolamento social imposto pela pandemia do novo coronavírus, pacientes e ortodontistas também apresentam ansiedades e inseguranças diante da nova realidade nas clínicas odontológicas e instituições de ensino. Este estudo teve como objetivo avaliar, por meio de questionário online, a aplicabilidade da teleortodontia e da teleassistência, o comportamento dos pacientes quanto ao início ou retorno do tratamento ortodôntico e as novas mudanças no atendimento clínico. Material e Métodos: o questionário baseou-se na plataforma 'Google Forms" e foi constituído por três partes: a primeira envolveu a apresentação do estudo e o termo de consentimento livre e esclarecido; a segunda envolveu a coleta de dados demográficos e caracterização dos respondentes, e a terceira foi o próprio questionário. O questionário foi enviado por e-mail e aplicativos de mensagens instantâneas, sendo os dados encaminhados para análise descritiva. Resultados: foram devolvidas 116 respostas, sendo a maioria dos respondentes com idade entre 18 e 30 anos, do sexo feminino e residentes na região Sudeste. Os resultados mostraram que a teleortodontia ainda é desconhecida por um número significativo de pacientes (66,4%) e quase metade deles (41,4%) deseja que seus tratamentos sejam acompanhados presencialmente, mesmo aqueles cujos aparelhos não requerem ativação. Preferem também que a primeira consulta e diagnóstico seja presencial (55,2%). No entanto, eles estão receptivos à idéia de ter seus dados e imagens transmitidos pela Internet, incluindo algumas consultas à distância intercaladas com as presenciais, entendendo que os custos podem ser reduzido. Conclusão: a teleortodontia é uma realidade, mas para os pacientes ortodônticos sua aplicabilidade permanece restrita ao envio de imagens e registros (AU)

Avaliação da influência de diferentes configurações de bases de bráquetes na força de remoção e remanescente de resina / Evaluation of the influence of different bracket bases designs on debonding force and resin remnant

Resumo A produção contemporânea de bráquetes ortodônticos inclui tecnologia de injeção, com diferentes desenhos de base de colagem que interferem, diretamente, na força de adesão ao esmalte e na facilidade de remoção posterior. O objetivo foi avaliar a resistência ao cisalhamento de bráquetes metálicos de três diferentes bases de colagem, verificando a força necessária para descolagem e o remanescente de resina na base do bráquete. Foram utilizados 30 dentes bovinos, colados com bráquetes U-Clip (Orthometric, Marília, SP, Brasil); ID-ALL (ID-Logical, São José do Rio Preto, SP, Brasil) e Mini Twin, (3M ESPE, St Paul, Minnesota, EUA). Todos os bráquetes foram colados com a resina Transbond XT®, (3M ESPE, St Paul, Minnesota, EUA). Após a colagem, os corpos de prova foram submetidos ao teste de cisalhamento, com registro das forças de descolagem e, posteriormente, foram avaliados o adesivo remanescente e o padrão de falha em um estereomicroscópio óptico. As forças de cisalhamento foram semelhantes entre os grupos U-Clip e ID-ALL, que foram estatisticamente diferentes do grupo Mini-Twin. Os bráquetes U-Clip e Mini-Twin apresentaram todo o remanescente de resina aderido à base do bráquete, enquanto o bráquete ID-ALL apresentou mais da metade do remanescente aderido à base do bráquete, resultado estatisticamente significante. Conclui-se os bráquete nacionais apresentam menor força de cisalhamento, estatisticamente significante quando comparados ao bráquete Mini-Twin. O bráquete ID-ALL apresentou o menor remanescente de resina, denotando que a fratura ocorreu na camada de resina, enquanto que nos grupos U-Clip e Mini-Twin, a fratura ocorreu na interface resina/esmalte. (AU)

Abstract The contemporary production of orthodontic brackets includes injection technology, with different designs of bonding bases that interfere directly with the bond strength to enamel and the ease of subsequent removal. The aim was to evaluate the shear bond strength of metal brackets of three different bonding bases, checking the force required for debonding and the rates of resin remaining on the bracket base. The sample consisted of 30 bovine teeth bonded with brackets U-Clip (Orthometric, Marília, SP, Brazil), ID-ALL (ID-Logical, São José do Rio Preto, SP, Brazil), and Mini Twin (3M ESPE, St Paul, Minnesota, USA). All brackets were bonded with Transbond XT resin (3M ESPE, St Paul, Minnesota, USA). After bonding, the specimens were subjected to a shear bond test. The forces required for debonding were recorded. Posteriorly, the remaining adhesive and failure patterns were evaluated in an optical stereomicroscope. The shear forces were similar for U-Clip and ID-ALL, which were significantly different from the Mini-Twin group. The U-Clip and Mini-Twin brackets showed the resin remnant totally adhered to the bracket base, while the ID-ALL bracket had more than half of the resin remnant attached to the bracket base, a statistically significant result. It was concluded that shear forces were lower for the national brackets, statistically significant. Bracket ID-ALL had the least resin remnant in the base, denoting that the fracture occurred in the resin layer. In contrast, in the U-Clip and Mini-Twin brackets groups, the fracture occurred at the resin/enamel interface (AU)

Passo a passo do planejamento digital para confecção de alinhadores ortodônticos in office / Step-by-step digital planning for in office orthodontic aligners

Resumo Nos últimos anos, a rotina dos ortodontistas vem sendo impactada com o desenvolvimento da tecnologia de softwares de planejamento ortodôntico digital. Por ser uma excelente ferramenta para diagnóstico e planejamento para qualquer técnica ortodôntica e ser um passo fundamental do tratamento ortodôntico com alinhadores transparentes, é importante a adequação a essa nova realidade e rotina clínica. Esse pode ser um processo lento e pode significar trabalho árduo e um grande sacrifício por parte de profissionais menos adeptos à tecnologia ou com pouca experiência e conhecimento dos processos necessários. Este estudo propôs orientar o ortodontista e conduzi-lo, por meio de um passo a passo, ao conhecimento e aplicação do fluxo de planejamento digital (workflow), tendo em vista que essas dificuldades podem representar uma barreira para o desenvolvimento profissional. Foram descritas as etapas que devem ser seguidas no processo de tratamento ortodôntico com alinhadores, explicando e elucidando as ferramentas de planejamento virtual utilizadas em softwares gratuitos ou pagos, disponíveis no momento de desenvolvimento desse trabalho. Concluiu-se que o workflow exige conhecimento ortodôntico, além de uma abordagem técnica e apresenta 9 estágios que devem ser rigorosamente seguidos e executados de maneira sequencial e com atenção.(AU)

Abstract Over the last years the orthodontist's routine has been impacted by the development of digital orthodontic planning software technology. As an excellent tool for diagnosis and planning for any orthodontic technique and as a fundamental step in orthodontic treatment with clear aligners, it is necessary to adapt to this new reality and clinical routine. However, this can be a slow process and may require demanding work and a great sacrifice on the part of professionals who are less adept at the technology or with little experience and knowledge of the necessary processes. This article aimed to guide orthodontists through a step-by-step approach to the knowledge and application of digital planning flow (workflow) since these difficulties can represent a barrier to professional development. The steps that should be followed in the process of orthodontic treatment with aligners were described, explaining, elucidating the virtual planning tools used in free or paid software, available at the time of developing this work. It was concluded that workflow requires orthodontic knowledge, in addition to a technical approach, and has nine stages which should be strictly followed and executed in a sequential and careful manner. (AU)

Sagittal, rotational and transverse changes with three intraoral distalization force systems: Jones jig, distal jet and first class.

BACKGROUND: To compare the maxillary dentoalveolar changes of patients treated with three distalization force systems: Jones Jig, Distal Jet and First Class appliances, using digitized models. MATERIAL AND METHODS: The retrospective sample comprised 118 digitized models of 59 patients with Class II malocclusion divided into three groups: Group 1 consisted of 22 patients treated with the Jones Jig appliance; Group 2 consisted of 20 patients treated with the Distal Jet, and Group 3 comprised 17 patients treated with the First Class appliance. Pretreatment and post-distalization plaster models of all patients were digitized and evaluated with OrthoAnalyzerTM software. The pretreatment and post-distalization variables regarding sagittal, rotational and transverse changes were compared by the One-way Analysis of Variance (ANOVA) and Kruskal-Wallis tests, depending on normality. RESULTS: All appliances presented similar amounts of distalization. The Distal Jet appliance promoted significantly smaller mesial displacement of premolars and greater expansion of posterior teeth. The First Class presented the smallest rotation of the maxillary molars and treatment time. CONCLUSIONS: The distalizers were effective in correcting Class II molar relationship, however, a palatal force seems to provide fewer undesirable effects. Additionally, the degree of rotation and expansion was associated with the side of force application. Key words:Malocclusion, Angle Class II, Orthodontics, Corrective, Distalizers.

Stability of class II treatment with Pendulum and Jones jig followed by fixed appliances.

INTRODUCTION: The present study aimed to evaluate and compare the long-term stability of Class II correction with the Pendulum or Jones jig followed by fixed appliances. SETTINGS AND SAMPLE POPULATION: Group 1 comprised 20 Class II malocclusion patients with a mean initial age of 13.97 years (SD = 1.57), treated with Pendulum and fixed appliances for a mean period of 4.72 years (SD = 0.98), and mean long-term post-treatment evaluation of 4.72 years (SD = 0.97). Group 2 consisted of 18 Class II patients with a mean initial age of 13.19 years (SD = 1.26), treated with Jones jig and fixed appliances for a mean period of 3.96 years (SD = 0.92). Mean long-term post-treatment time was 5.50 years (SD = 1.57). METHODS: Lateral cephalograms were evaluated at three stages: initial (T1), final (T2) and long-term post-treatment (T3). Intragroup comparisons were performed with repeated measures ANOVA and Tukey's test and intergroup comparisons with independent t test. RESULTS: Many treatment changes were observed in both groups. From the long-term post-treatment periods, there was stability for most of the variables. Maxillary second molars and mandibular first molars extruded in the Jones jig group and slightly intruded in the Pendulum appliance group. The nasolabial angle decreased in the Pendulum group and increased in the Jones jig group. CONCLUSION: The correction of a Class II malocclusion was shown to be stable with similar long-term post-treatment results with Pendulum or Jones jig followed by fixed orthodontic appliances.

Teeth angulations after class II treatment with the Jones Jig followed by fixed appliances: A retrospective panoramic analysis.

OBJECTIVE: The purpose of this study was to compare the maxillary mesiodistal dental angulations of Class II malocclusion patients treated with the Jones Jig, followed by fixed appliances, with normal values of a historical control group, on panoramic radiographs. MATERIAL AND METHODS: The sample comprised 80 panoramic radiographs of 40 patients divided into two groups. Eligibility criteria included patients with predominantly dental Class II malocclusion; the presence of all teeth up to the second molars and no previous orthodontic treatment. The experimental group was composed of 60 radiographs of 20 patients treated with the Jones Jig distalizer followed by fixed appliances. The radiographs were taken at pre-treatment (T0), post-distalization (T1), and post-treatment (T2). The historical control group comprised 20 radiographs of 20 subjects with untreated normal occlusion. The mesiodistal axial angulations of all maxillary erupted teeth were evaluated with the Dolphin Imaging software. Intragroup comparisons in the experimental group were performed with repeated measures analysis of variance (ANOVA), followed by Tukey tests. The experimental group at T2 versus the control group were compared with t tests. RESULTS: After distalization, significant distal angulation of the molars (110.58°±8.54, P<0.000) and mesial angulation of the second (86.43°±8.08, P<0.000) and first premolars (80.11°±8.01, P<0.000) was observed. However, this was corrected after comprehensive fixed orthodontics (100.54°±6.53; 98.95°±7.00; 94.92°±6.44; P<0.000, for these teeth, respectively). Intergroup comparisons resulted in first molars, premolars, canines, and central incisors significantly more distally angulated in the experimental group, when compared to the control. CONCLUSIONS: In general, at the end of orthodontic treatment, patients treated with the Jones Jig distalizer followed by fixed appliances presented more distally angulated maxillary teeth when compared to an untreated group with normal occlusion.

Comparison of the dentoskeletal and soft tissue changes with the cervical headgear and Jones Jig followed by fixed appliances in Class II malocclusion patients: A retrospective study.

OBJECTIVE: To retrospectively compare the dentoskeletal and soft tissue changes of patients with Class II malocclusion treated with cervical headgear and Jones Jig appliances, followed by fixed appliances. MATERIAL AND METHODS: The sample comprised 46 Class II malocclusion patients divided into two groups. Patients with Class II malocclusion based on the ANB angle and plaster model analyses, needing non-extraction orthodontic treatment, absence of mandibular crowding and no previous orthodontic treatment were eligible to be selected. Group 1 consisted of 25 patients treated with cervical headgear (CH) followed by fixed appliances for a mean period of 3.26 years and group 2 consisted of 21 patients treated with the Jones Jig (JJ) appliance for a mean of 4.29 years. Lateral cephalograms were evaluated at the beginning and at the end of orthodontic treatment. For intergroup comparisons, t and Mann-Whitney tests were performed. RESULTS: The cervical headgear group produced significantly greater maxillary anterior displacement restriction (SNA; CH: -0.97°±1.33; JJ: 0.07°±1.73; P=0.025), apical base discrepancy improvement (ANB; CH: -1.52°±1.25; JJ: 0.36°±1.46; P=0.006), FMA reduction (CH: -0.78°±2.68; JJ: 1.07°±2.84; P=0.028) and distal mandibular molar angulation (Md6.PM; CH: 6.97°±3.66; JJ: 2.77°±6.87; P=0.013) than the Jones Jig group. CONCLUSIONS: Both distalizers followed by fixed appliances were effective to correct Class II malocclusion. The cervical headgear group presented skeletal effects with less treatment time and there were no significant intergroup differences regarding soft tissue changes.

Class II malocclusion treatment changes with the Jones jig, Distal jet and First Class appliances.

Objective Maxillary molar distalization with intraoral distalizer appliances is a non-extraction orthodontic treatment used to correct molar relationship in patients with Class II malocclusion presenting maxillary dentoalveolar protrusion and minor skeletal discrepancies. This study compares the changes caused by three distalizers with different force systems. Methodology 71 patients, divided into three groups, were included. The Jones jig group (JJG, n=30; 16 male, 14 female, 13.17 years mean age) was treated with the Jones jig for 0.8 years. The Distal jet group (DJG, n=25; 8 male, 17 female, 12.57 years mean age) was treated with the Distal jet for 1.06 years. The First Class group (FCG, n=16; 6 male, 10 female, 12.84 years mean age) was treated with the First Class for 0.69 years. Intergroup treatment changes were compared using one-way ANOVA, followed by post-hoc Tukey's tests. Results Intergroup comparisons showed significantly greater maxillary incisor protrusion in DJG than in FCG (2.56±2.24 mm vs. 0.74±1.39mm, p=0.015). The maxillary first premolars showed progressive and significantly smaller mesial angulation in JJG, FCG and DJG, respectively (14.65±6.31º, 8.43±3.99º, 0.97±3.16º; p<0.001). They also showed greater mesialization in JJG than FCG (3.76±1.46 mm vs. 2.27±1.47 mm, p=0.010), and greater extrusion in DJG compared to JJG (0.90±0.77 mm vs 0.11±0.60 mm, p=0.004). The maxillary second premolars showed progressive and significantly smaller mesial angulation and mesialization in JJG, FCG and DJG, respectively (12.77±5.78º, 3.20±3.94º, -2.12±3.71º and 3.87±1.34 mm, 2.25±1.40 mm, 1.24±1.26 mm, respectively; p<0.001). DJG showed smaller distal angulation of maxillary first molars (-2.14±5.09º vs. -7.73±4.28º and -6.05±3.76º, for the JJG and FCG, respectively; p<0.001) and greater maxillary second molars extrusion (1.17±1.41 mm vs -0.02±1.16 mm and 0.16±1.40 mm, for the JJG and FCG, respectively; p=0.003). Overjet change was significantly larger in DJG compared to FCG (1.79±1.67 mm vs 0.68±0.84; p=0.046). Treatment time was smaller in FCG (0.69±0.22 years vs 0.81±0.33 years and 1.06±0.42 years, comparing it with the JJG and DJG, respectively; p=0.005). Conclusion The three appliances corrected the Class II molar relationship by dentoalveolar changes. The Distal jet produced smaller molar distal angulation than the Jones jig and First Class. The First Class appliance showed less anchorage loss, greater percentage of distalization and shorter treatment time than the Jones jig and Distal jet.

A escolha do bráquete e a importância do seu posicionamento para o tratamento ortodôntico ­ relato de caso / Bracket choice and the importance of its placement for orthodontic treatment outcome ­ case report

Resumo O caso apresentado demonstra uma opção de posicionamento de bráquete que facilita e auxilia na obtenção de torque adequado, salientando a importância da escolha do bráquete para auxiliar na mecânica ortodôntica. A paciente reportada foi diagnosticada como face curta e apresentava espaços nos arcos superior e inferior para serem fechados e uma pronunciada inclinação lingual dos incisivos inferiores, que não seria beneficiada pela mecânica necessária para o fechamento dos espaços. Com uma combinação de bráquetes com torque negativo dos incisivos inferiores posicionados invertidos e mecânica de retração com fios de alto calibre e rígidos, os espaços foram fechados com melhora do torque dos incisivos, mesmo em situação adversa e uma boa oclusão e estética do sorriso foram possíveis de obter. Conclui-se que a individualização no posicionamento do bráquete ajuda sobremaneira na obtenção de um resultado satisfatório, compensando dificuldades de controle de torque pela combinação fio/bráquete (AU)

Abstract This case report demonstrates an option to get the proper torque, by changing the bracket placement and highlight the importance of bracket choice for mechanics. The case reported is a short face patient with spaces to close and had a pronounced lingual inclination of the lower incisors that was not benefited by the necessary mechanics. Through the combined use of brackets with -6 degrees of torque, placed upside down and sliding mechanics with a rigid wire, the spaces were closed improving torque instead of worsening it, and a proper occlusion with a pleasant smile could be achieved. Some individualization on bracket placement can help mechanics to get the desired tooth position, overcoming an inadequate torque control by the bracket/archwire combination (AU)

Class II malocclusion treatment changes with the Jones jig, Distal jet and First Class appliances

Abstract Objective Maxillary molar distalization with intraoral distalizer appliances is a non-extraction orthodontic treatment used to correct molar relationship in patients with Class II malocclusion presenting maxillary dentoalveolar protrusion and minor skeletal discrepancies. This study compares the changes caused by three distalizers with different force systems. Methodology 71 patients, divided into three groups, were included. The Jones jig group (JJG, n=30; 16 male, 14 female, 13.17 years mean age) was treated with the Jones jig for 0.8 years. The Distal jet group (DJG, n=25; 8 male, 17 female, 12.57 years mean age) was treated with the Distal jet for 1.06 years. The First Class group (FCG, n=16; 6 male, 10 female, 12.84 years mean age) was treated with the First Class for 0.69 years. Intergroup treatment changes were compared using one-way ANOVA, followed by post-hoc Tukey's tests. Results Intergroup comparisons showed significantly greater maxillary incisor protrusion in DJG than in FCG (2.56±2.24 mm vs. 0.74±1.39mm, p=0.015). The maxillary first premolars showed progressive and significantly smaller mesial angulation in JJG, FCG and DJG, respectively (14.65±6.31º, 8.43±3.99º, 0.97±3.16º; p<0.001). They also showed greater mesialization in JJG than FCG (3.76±1.46 mm vs. 2.27±1.47 mm, p=0.010), and greater extrusion in DJG compared to JJG (0.90±0.77 mm vs 0.11±0.60 mm, p=0.004). The maxillary second premolars showed progressive and significantly smaller mesial angulation and mesialization in JJG, FCG and DJG, respectively (12.77±5.78º, 3.20±3.94º, -2.12±3.71º and 3.87±1.34 mm, 2.25±1.40 mm, 1.24±1.26 mm, respectively; p<0.001). DJG showed smaller distal angulation of maxillary first molars (-2.14±5.09º vs. -7.73±4.28º and -6.05±3.76º, for the JJG and FCG, respectively; p<0.001) and greater maxillary second molars extrusion (1.17±1.41 mm vs -0.02±1.16 mm and 0.16±1.40 mm, for the JJG and FCG, respectively; p=0.003). Overjet change was significantly larger in DJG compared to FCG (1.79±1.67 mm vs 0.68±0.84; p=0.046). Treatment time was smaller in FCG (0.69±0.22 years vs 0.81±0.33 years and 1.06±0.42 years, comparing it with the JJG and DJG, respectively; p=0.005). Conclusion The three appliances corrected the Class II molar relationship by dentoalveolar changes. The Distal jet produced smaller molar distal angulation than the Jones jig and First Class. The First Class appliance showed less anchorage loss, greater percentage of distalization and shorter treatment time than the Jones jig and Distal jet.

Tratamento da Classe II no perfil côncavo ­ reabilitaçao com implantes ou fechamento dos espaços? / Class II malocclusion treatment in concave profile ­ rehabilitation with implants or space closures?

Resumo Sabe-se que a má oclusão de Classe II é a mais frequente na clínica ortodôntica. Alguns casos se apresentam com um maior nível de complexidade devido à idade do paciente e seu comprometimento estético, oclusal e funcional. Este trabalho apresenta o relato de caso de uma paciente adulta com birretrusão, perfil côncavo e má oclusão de Classe II completa bilateral, sendo corrigida com o uso de elásticos intermaxilares. Ao final do tratamento observou-se a correção anteroposterior associada à reabilitação oclusal, proporcionando à paciente função mastigatória favorável com satisfatória estética do perfil facial e harmonia do sorriso (AU)

Abstract It is known that the Class II malocclusion is the most frequent in orthodontic practice. Some cases present a higher level of complexity due to the patient age and its aesthetic, occlusal and functional impairment. This article aims to describe a case report of an adult patient with bi-retrusion, concave profile and full bilateral Class II malocclusion which was corrected with intermaxillary elastics. At the end of the treatment, it was observed sagittal malocclusion correction, associated with occlusal rehabilitation, providing a favorable masticatory function with satisfactory facial profile aesthetic and smile harmony. (AU)

Class II malocclusion treatment effects with Jones Jig and Distal Jet followed by fixed appliances.

OBJECTIVES: To compare the skeletal, dentoalveolar, and soft tissue changes in Class II malocclusion patients treated with Jones Jig and Distal Jet distalizers followed by fixed appliances. MATERIALS AND METHODS: The experimental groups comprised 45 Class II malocclusion subjects divided into two groups. Group 1 consisted of 25 patients treated with the Jones Jig, and group 2 consisted of 20 patients treated with the Distal Jet. Group 3 comprised 19 untreated Class II subjects. Cephalograms were analyzed before and after orthodontic treatment. For intergroup comparisons, one-way analysis of variance and post hoc Tukey tests were performed. RESULTS: During treatment, the experimental groups exhibited significant increases in occlusal plane inclination and maxillary second molar mesial tipping. Additionally, the molar relationship improved and overjet decreased significantly in the experimental groups. The Jones Jig group showed greater mandibular incisor proclination and greater overbite reduction than the control group. No significant intergroup differences in nasolabial angle changes were found. CONCLUSIONS: Treatment protocols using the Jones Jig and Distal Jet followed by fixed appliances were effective in correcting Class II malocclusion by means of dentoalveolar changes without significant skeletal and soft tissue changes. The experimental groups showed occlusal plane clockwise rotation and greater mesial tipping of maxillary second molars when compared to the untreated group.

Treatment of a Class II Malocclusion with Deep Overbite in an Adult Patient Using Intermaxillary Elastics and Spee Curve Controlling with Reverse and Accentuated Archwires.

This paper aimed to describe the orthodontic treatment of an adult patient with the following characteristics: asymmetric Class II malocclusion, left subdivision, mandibular midline shifted to the left, mild mandibular anterior crowding, excessive overbite, 4-mm overjet, and a brachycephalic facial pattern. A 31-year-old male patient, treated with fixed preadjusted appliance with Roth prescription, with leveling and alignment NiTi archwire sequence. To correct the asymmetric Class II malocclusion, midline shift as well the overjet and overbite, intermaxillary elastics and accentuated and reversed stainless steel archwires were used, respectively. The posttreatment results showed a Class I molar relationship, as well the overjet and overbite correction. These results could be achieved due to a correct treatment plan and so to the patient cooperation.

Efeitos dentoalveolares da correção da classe ii por meio dos elásticos intermaxilares / Dentoalveolar effects of class ii correction with intermaxillary elastics

Os elásticos intermaxilares promovem a correção da Classe II por meio de efeitos dentoalveolares. Portanto conhecer os efeitos provocados na utilização dos elásticos intermaxilares é imprescindível para obtenção de melhores resultados, de forma a se favorecer dos efeitos ocorridos ou ainda controlar a movimentação não desejada. O objetivo deste trabalho foi relatar o tratamento de uma má oclusão de ¾ de Classe II utilizando elásticos intermaxilares. Por meio de um minucioso diagnóstico e adequado controle da mecânica ortodôntica foi possível observar correção satisfatória da má oclusão inicial.(AU)

The intermaxillary elastics promote a Class II correction through dentoalveolar effects. Therefore to know the effects caused by the use of intermaxillary elastics is essential to obtain better results, in order to benefit from the effects or to control unwanted movement. The aim of this study was to report the treatment of a Class II malocclusion using intermaxillary elastics. Through a meticulous diagnosis and adequate control of orthodontic mechanics it was possible to observe a satisfactory correction of the initial malocclusion.(AU)