Reconsidering the role of nasolabial angle in premolar extraction decision-making: A case-series study.

OBJECTIVES: To evaluate the impact of changes in upper incisor inclination and position on the alteration of the nasolabial angle (NLA) in a series of cases involving the extraction of four first premolars. MATERIALS AND METHODS: The study included 41 patients who underwent orthodontic treatment with premolar extractions. The patients were divided into two groups based on their pretreatment NLA values: Group 1 (NLA ≤ 100°) and Group 2 (NLA > 100°). Measurements of NLA, U1.NA and U1-NA were obtained before and after treatment and U1-Ls pretreatment measure was registered. Statistical analyses were performed to compare the differences in NLA, U1.NA and U1-NA between the two groups and to evaluate the influence of these variables added to U1-Ls (T1) on NLA changes. RESULTS: The results showed that Group 1 exhibited significant changes in NLA, while Group 2 did not. However, both groups showed significant changes in U1.NA and U1-NA. In Group 1, 80% of the individuals presented an increase in NLA and 20% no changes. In Group 2, 10% presented a decrease, 57% no changes and 33% an increase in NLA values. Multiple linear regression analysis indicated that the group factor had a statistically significant influence on NLA variation. Additionally, in Group 2, a negative correlation was observed between changes in U1.NA and NLA. CONCLUSIONS: The findings suggest that individuals with higher pretreatment NLA values tend to maintain their NLA values even after the correction of upper incisor inclination.

Superimposition of dental models to determine orthodontic tooth movements : Comparison of different superimposition methods in vitro and in vivo.

PURPOSE: Using a commercial orthodontic treatment planning system, tooth movements were simulated to analyse how precise predefined movements can be determined by three different superimposition methods. Additionally, a retrospective analysis on clinical patient models before and after orthodontic treatment was performed to analyse possible differences in determination of clinical tooth movements with these methods. METHODS: (1) A hexapod system was used to perform the tooth movements in physical maxillary dental models (N = 70). The initial and final situations were scanned, superimpositions executed, movements calculated, and their accuracy compared to the predefined movements was determined. (2) Digital three-dimensional (3D) maxillary dental models representing pre- and postorthodontic treatment situations (N = 100 patients) were superimposed. Selected tooth movements were calculated (N = 3600), and the results of the different superimposition methods were compared pairwise. RESULTS: (1) The experimental study delivered only small location and scale shifts. Furthermore, concordance correlation coefficients above 0.99 for all three methods. This verified that all methods deliver values corresponding well to the predefined movements. (2) The retrospective analysis of the clinically performed orthodontic tooth movements comparing pairwise the three different methods intraindividually also showed small location and scale shifts. Furthermore, concordance correlation coefficients between 0.68 and 0.98 were observed, with only three of them below 0.8. This verified that the applied superimposition methods delivered values sufficiently close to each other. CONCLUSIONS: As the experimental study showed very good agreement between the predefined and determined movements, and as the retrospective clinical study showed that the methods compared pairwise delivered values close to each other for the performed orthodontic tooth movements, it can be concluded that orthodontic tooth movements can be determined adequately correct by each of the examined methods.

Class II subdivision treatment and stability with asymmetric Herbst appliance: A case report.

Non-surgical treatment of Class II subdivision may involve complex mechanics or asymmetric tooth extraction in its resolution. This report demonstrates the result and the short-term stability of Class II subdivision treated with asymmetrically installed Herbst appliance followed by conventional fixed orthodontic appliance. The approach allowed the correction of the unilateral Class II molar relationship and increased overjet, as well as the deviation of dental midlines, with improvement in lip posture and facial profile. The results remained stable two years after treatment, confirming the treatment success.

Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Predictability and Effectiveness of Nuvola® Aligners in Dentoalveolar Transverse Changes: A Retrospective Study.

Nowadays, many people use clear aligners to address their dental issues. The efficacy of transparent dental aligners must be investigated even though they are more aesthetically pleasing, easy to use, and tidy than permanent tools. Thirty-five patients in this study's sample group who used Nuvola® clear aligners for their orthodontic therapy were prospectively observed. Initial, simulated, and final digital scans were analysed with a digital calliper. The actual results were compared with the prescribed ending position to evaluate the efficacy of transversal dentoalveolar expansion. Aligner treatments in Groups A (12) and B (24), particularly in the dental tip measures, demonstrated high adherence to the prescription. On the other hand, the gingival measures exhibited a greater level of bias, and the differences were statistically significant. However, there was no difference in the outcomes between the two groups (12 vs. 24). Within specific parameters, the evaluated aligners were shown to be helpful in predicting movements in the transverse plane, particularly when considering movements linked to the vestibular-palatal inclination of the dental elements. This article compares the expansion effectiveness of Nuvola® aligners compared with other work in the literature using competitor companies.

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.

Tratamento de má oclusão de Classe II por meio de distalização sequencial posterior com alinhadores ortodônticos ClearCorrect / Treatment of Class II malocclusion through upper distalization with ClearCorrect aligners

Resumo A segunda mais prevalente má oclusão de Angle na população é a de Classe II. Dentre as abordagens de tratamento consideradas pelos profissionais, está a distalização dos dentes posteriores superiores ou exodontias. A distalização, dependendo do nível de complexidade do caso, pode ser desafiadora e necessitar de mecânicas auxiliares para realizar movimentos translacionais e não somente de inclinação coronária. A escolha da abordagem para esses tratamentos depende diretamente da colaboração do paciente, severidade da má oclusão, caracterização da Classe II, idade do paciente e habilidade técnica do profissional responsável. Com o aumento da procura por tratamentos ortodônticos mais estéticos, os alinhadores ortodônticos têm sido frequentemente uma alternativa aos pacientes. Dependendo da severidade da má oclusão, pode-se associar aos auxiliares comumente utilizados na Ortodontia convencional fixa. Portanto, o objetivo deste trabalho é apresentar a resolução de uma má oclusão de Classe II, divisão 1, com impactação do canino superior direito e desvio de linha média superior para a direita tratada com alinhadores ortodônticos ClearCorrect. (AU)

Abstract The second more prevalent Angle's malocclusion on the population is Class II. Among the continuously considered treatment approaches by clinicians, is the distalization of upper teeth or extractions. The distalizations, depending on the case's complexity, can be challenging and need auxiliary mechanics to perform translation movements and not just crown tipping. The choose of the appliance for these treatments relies directly on the option/collaboration of the patient, malocclusion severeness, patient's age, and technical ability of the main professional taking care of the case. With the crescent search for more aesthetic orthodontic treatments, the clear aligners have been frequently looked for by the patients as an alternative and, regularly related to auxiliaries commonly associated to the conventional fixed appliances. Regarding this context, the objective of this study is to present the case report of a patient with Class II, division 1, upper midline deviation to the right and unerupted upper right canine through the ClearCorrect aligners' system. (AU)

Avaliação da padronização da força inicial liberada por elásticos ortodônticos em cadeia / Evaluation of the standardization of the initial released force by chain orthodontic elastics

Resumo Este trabalho avaliou a padronização da força inicial liberada por elásticos ortodônticos em cadeia em diferentes lotes de fabricação de três marcas comerciais. Foram testadas 762 amostras de elásticos em cadeia incolores, tamanho médio, das marcas Morelli®, Uniden® e Eurodonto®. Os elásticos foram distribuídos em 6 diferentes grupos: Grupo M (Morelli), Grupo U (Uniden) e Grupo E (Eurodonto), com 2 lotes para cada grupo. Os elásticos foram mantidos em um "jig" de acrílico de 07 X 07 cm que foi fixado em uma base de madeira de 55 X 15 cm. Os elásticos foram ativados em 50% de seus comprimentos iniciais e as forças iniciais liberadas foram mensuradas através de um dinamômetro digital de precisão. Foram utilizados os testes de Kolmogorov-Smirnov e "t" de Student com 5% de significância para ambos os testes. Os resultados evidenciaram diferença significativa entre a força inicial média liberada de 336,84g e 270,72g dos lotes 1 e 2, respectivamente, da marca U. Não houve diferença significativa entre os lotes da marca M apresentando força inicial média de 310,31g e 312,77g e da marca E com forças iniciais médias de 378,42 e 377,91. Os grupos M,U e E apresentaram os percentuais de 8,7%, 4,3% e 11,4%, respectivamente, de amostras elásticas liberando força inicial considerada padronizada. Pode-se concluir que as marcas Morelli® e Eurodonto® apresentaram força inicial padronizada quando variações entre os lotes foram investigadas. Porém, todas as marcas comerciais apresentaram percentual muito baixo de amostras elásticas com força inicial padronizada, considerando o intervalo de confiança (AU)

Abstract This study evaluated the standardization of the initial strength delivered by elastomeric chains of different lots of fabrication of three commercial brands. 762 colorless middle size samples of elastomeric chains were tested of the brands Morelli®, Uniden® and Eurodonto®. The elastics were distributed in 6 different groups: Group M (Morelli), Group U (Uniden) and Group E (Eurodonto), with 2 lots for each group. The elastics were maintained in a "jig" of 07 x 07 cm acrylic one that was fixed in a 55 X 15 cm wooden base. The elastics were activated in 50% of his initial lengths and the released inicial force was measured through a digital precision dynamometer. Kolmogorov-Smirnov tests were used and Student "t" test with 5% of significantion for both tests. The results showed significant difference between the mean initial released force of 336.84g and 270.72g of lots 1 and 2, respectively, of brand U. There was no significant difference between lots of brand M presenting average initial force of 310.31g and 312.77g and brand E with initial forces of 378.42 and 377.91. Groups M, U and E presented the percentages of 8.7%, 4.3% and 11.4%, respectively, of elastic samples releasing initial strength considered standardized. It can be concluded that the Morelli® and Eurodonto® brands showed standardized initial strength when variations between lots were investigated. However, all commercial brands had a very low percentage of elastic samples with standardized initial strength, considering the confidence interval (AU)

Tratamento multidisciplinar de paciente adulto padrão face curta ­ relato de caso / Interdisciplinary treatment of short-face adult patient ­ case report

Resumo Introdução: As más-oclusões do Padrão Face Curta são responsáveis por prejuízos estéticos e funcionais, entretanto o diagnóstico tardio impede o tratamento ortopédico preventivo e a cirurgia ortognática pode ser uma opção para os pacientes desfuncionados. Objetivo: Descrever por meio de um relato de caso o tratamento ortodôntico descompensatório cirúrgico associado à reabilitação estética de um paciente Padrão Face Curta. Descrição: Paciente Padrão Face Curta, sexo masculino, 26 anos, leucoderma, relação de Classe II total de molar e canino, sobremordida e sobressalência aumentada, protrusão dentária superior, relação de lábio comprimido, terço inferior da face diminuído. O tratamento proposto foi o tratamento ortodôntico descompensatório cirúrgico associado à reabilitação estética, considerando a gravidade dos sinais apresentados e a queixa do paciente. No final do tratamento, houve o resgate do equilíbrio estético e oclusal, com a solução total das queixas do paciente. Conclusão: Neste relato de caso, pôde se verificar a necessidade da participação interdisciplinar para obter um melhor resultado em um paciente Padrão Face Curta. O diagnóstico e planejamento realizado pelo ortodontista e pelo cirurgião bucal foram essenciais para alcançar um bom acabamento estético e funcional. (AU)

Abstract Introduction: Short-face Pattern malocclusions are responsible for aesthetic and functional impairments; however, late diagnosis excludes preventive orthopedic treatment, and orthognathic surgery can be an option for dysfunctional patients. Objective: To describe through a case report the surgical decompensatory orthodontic treatment associated with aesthetic rehabilitation of a Short-faced Pattern patient. Description: Short-face Pattern patient, male, 26 years old, leucoderma, total Class II molar and canine relationship, increased overbite and overjet, maxillary teeth protrusion, compressed lip relationship, decreased lower third of the face. The proposed treatment was a surgical decompensatory orthodontic treatment associated with aesthetic rehabilitation, considering the severity of the signs presented and the patient's complaint. At the end of the treatment there was aesthetic and occlusal balance rescue, with total solution of the patient's complaints. Conclusion: In this case report, we can verify the need for interdisciplinary participation to obtain a better result in a Short-faced Pattern patient. The diagnosis and planning performed by the orthodontist and the oral surgeon were essential to reach a good aesthetic and functional finishing.(AU)

Tratamento compensatório da má oclusão de Classe III esquelética com mini-implante ­ relato de caso / Compensatory treatment of skeletal Class III malocclusion with miniscrews ­ case report

Resumo O tratamento compensatório da má oclusão de Classe III esquelética representa uma opção para pacientes adultos que não desejam se submeter ao tratamento ortodôntico-cirúrgico e desejam melhorias na oclusão e estética facial. O sucesso do tratamento compensatório da má oclusão de Classe III depende de um correto diagnóstico e planejamento de tratamento que considere a gravidade das discrepâncias verticais e anteroposteriores e o padrão de crescimento do paciente. O objetivo deste estudo é apresentar o tratamento de um paciente adulto com má oclusão esquelética moderada de Classe III e protrusão mandibular tratada com ancoragem esquelética e sliding jig ancorado em mini implantes e elásticos intermaxilares de Classe III. Os resultados alcançados levaram a uma melhora significativa no perfil do paciente com a estética do sorriso. Relações de molares e caninos de Classe I foram alcançadas. O sucesso na correção da discrepância oclusal anteroposterior e a correção estética de uma má oclusão de Classe III através do tratamento compensatório com elásticos de Classe III e mini implantes podem ser alcançados se a adesão do paciente for satisfatória. (AU)

Abstract Compensatory treatment of skeletal Class III malocclusion represents an option for adult patients who do not want to undergo orthodontic-surgical treatment and wish occlusion and facial aesthetics improvements. The success of the compensatory treatment of Classe III malocclusion depend on a correct diagnosis and treatment planning that considers the severity of vertical and anteroposterior discrepancies and the patient growth pattern. The aim of this study is to present the treatment of an adult patient with moderate skeletal Class III malocclusion and mandibular protrusion treated with skeletal anchorage whit miniscrew-anchored sliding jig and Class III intermaxillary elastics. The results achieved led to a significant improvement in the patient profile whit smiles esthetics. Class I molar and canine relationships were achieved. Successful on the correction of the anteroposterior occlusal discrepancy and esthetic correction of a Class III malocclusion through compensatory treatment with Class III elastics and miniscrew can be achieved if patient's compliance is satisfactory. (AU)

Tratamento da má oclusão de Classe II com o propulsor mandibular PMW: acompanhamento de 4 anos / Treatment of CL II malocclusion with the PMW-type mandibular propulsion: 4-year follow-up

O presente artigo teve como objetivo descrever, por meio de um caso clínico, o manejo ortopédico com intenção corretiva de um paciente Padrão II por retrusão mandibular, má oclusão de Classe II divisão 1 e face aceitável. Relato do caso: O paciente foi submetido a um tratamento com o propulsor mandibular Westerich (PMW) associado à ortodontia fixa. Resultados: A terapia utilizada proporcionou a correção da relação sagital de Classe II, com considerável ganho estético no perfil facial em razão da suavização da ângulo mentolabial e da compensação com inclinação vestibular dos incisivos inferiores. No acompanhamento de 4 anos pôde-se observar excelente estabilidade do tratamento com manutenção dos efeitos dentoalveolares, boa qualidade da tábua óssea vestibular e da inserção gengival dos incisivos inferiores. Conclusão: o aparelho ortopédico fixo PMW é uma opção eficaz para o tratamento de paciente Padrão II por deficiência mandibular quando os objetivos, principalmente, de ordem dentoalveolares são almejados. O aparelho é de fácil instalação, confortável e depende minimamente da cooperação do paciente, além de proporcionar resultados extremamente satisfatórios com a correção das relações oclusais e estabilidade a longo prazo (AU)

Introduction: The paper describes, through a case report, an orthopedic management of a Pattern II with mandibular retrusion patient, associated with Class II division 1 malocclusion and an acceptable face. Case report: The patient underwent treatment with the Westerich fixed functional device (PMW) associated with fixed orthodontics. Results: The therapy provided correction of the Class II sagittal relationship, with considerable aesthetic improvement due to smoothing of the mentolabial angle and dental compensation by buccal inclination of the lower incisors. 4-year follow-up showed excellent stability and maintenance of dentoalveolar effects. Also, good quality of the buccal bone plate and gingival insertion of the lower incisors were observed. Conclusion: PMW is an effective option for the Pattern II patients with mandibular deficiency treatment when, mostly dentoalveolar effects, are pursued. The device has easy installation, is comfortable and depends minimally on the patient's cooperation. In addition, it provides satisfactory results with the correction of occlusal relationships and long-term stability.(AU)

Versatilidade de ligaduras elastoméricas na correção de rotações unitárias / The versatility of elastomeric ligatures in the correction of single tooth rotations

Resumo Introdução: As ligaduras elastoméricas, também conhecidas popularmente como "elastics", são amplamente utilizadas na ortodontia fixa há bastante tempo. Contudo, além da função de apreender o arco aos slots dos bráquetes, elas também podem ser utilizadas para correção de pequenas giroversões dentárias. Diversas marcas comerciais já desenvolveram um modelo específico de acessório elastomérico para desempenhar essa função, nomeado como "rotator"; porém, por ter um tamanho padronizado, acabam provocando sobrecorreção do movimento em determinadas situações da prática clínica. Descrição da técnica: Desta maneira, o objetivo deste artigo é ilustrar a utilização e versatilidade dos famosos "elastics", posicionados de três formas diferentes nas aletas dos bráquetes, para realizar a correção de pequenas giroversões unitárias na ortodontia fixa. Conclusão: A versatilidade de seu uso permite diferentes magnitudes de correção com praticidade (AU)

Abstract Introduction: Elastomeric ligatures, popularly known as "elastics" have been widely used in orthodontic treatment with fixed appliances for a long time. However, in addition to the function of fixating the archwires to the bracket slots, they may also be used for the correction of minor tooth rotations. Various commercial brands have developed a specific model of elastomeric accessory to perform this function, known as "rotation wedge". However, as they are of a standardized size, they end up causing overcorrection of the movement in certain clinical situations. Technique description: This article aimed to illustrate the use and versatility of the famous "elastics", positioned in 3 different ways on the bracket tie wings to effectuate correction of small single tooth rotations in orthodontic treatment with fixed appliances. Conclusion: The versatility of their use allows different magnitudes of correction with practicality. (AU)

The impact of COVID-19 pandemic on total treatment time of fixed appliances.

BACKGROUND: Several aspects of the orthodontic routine seem to have been affected since the emergence of SARS-CoV-2. We aimed to evaluate the impact of the COVID-19 pandemic on the duration of fixed orthodontic treatment. METHODS: This retrospective study evaluated consecutive cases of patients undergoing fixed orthodontic treatment that completed treatment before (n = 37) or during (n = 26) the COVID-19 pandemic. The impact of the pandemic on treatment time was adjusted for the patient's initial age, sex, number of debonds/breakages, number of missing teeth, initial PAR (Peer Assessment Rating) index (T0) and operator (n = 2), through multiple linear regression. The impact generated by months of treatment conducted during the pandemic period was also examined. Seven poorly finished cases were previously excluded, including five finished during the pandemic. RESULTS: Although the number of absences/missed appointments of patients treated during the pandemic was four months more than those treated in the previous period (p < 0.001), there was no significant effect of the pandemic on total orthodontic treatment time for both operators. There was also an effect of operator (ß = 10.42, p < 0.001) and gender, which was lower in females (ß = 4.77, p = 0.03), on treatment time (R2 = 0.27). The other variables showed no significant association (p > 0.05). CONCLUSION: The COVID-19 pandemic did not have a significant effect on total orthodontic treatment time, although a greater number of absences/missed appointments were observed.

Treatment of Class III Malocclusion and Anterior Crossbite with Aligners: A Case Report.

The article describes the orthodontically treated case of a 25-year-old patient with skeletal and dental class III malocclusion, anterior crossbite, which caused functional and aesthetic problems, occlusal trauma, and incisor wear. Treatment with transparent aligners was proposed to meet the patient's needs, using the sequential distalization protocol. While sequential distalization is well documented for class II malocclusion treatment in maxillary arch teeth, further investigations are necessary for class III malocclusions. In fact, lower teeth movements are more complex due to mandibular bone density and the presence of the third molars, which are often extracted to perform distalization. In addition, the use of intermaxillary elastics helps control the proclination of the anterior teeth as a reaction to distalizing forces. At the end of the treatment, the patient reached molar and canine class I and positive overjet and overbite. The inclination of lower incisors and the interincisal angle have improved, resulting in aesthetic and functional enhancement.

Aesthetic perception of smile in long face pattern patients who underwent maxillary impaction with miniplates or orthognathic surgery.

INTRODUCTION: The gummy smile is perceived in 10% of the population aged 20 to 30 years old, and it causes an aesthetic imbalance in the smile. This study investigated the existence of differences in the aesthetic perception of the smile after correcting the gummy smile using two different techniques: orthognathic surgery for maxillary impaction and miniplate-aided orthodontic impaction. METHODS: Photographs of 16 Long Face Pattern female patients were evaluated by 56 oral and maxillofacial surgeons, 56 orthodontists, and 56 laypeople before and after the treatment with one of the two techniques. These photographs were standardized using the Photoshop program, randomly organized, and then presented to the evaluators via the Google Meeting® application in the PowerPoint® program. To evaluate the attractiveness of the smile, the Visual Analogue Scale (VAS) was used. To analyze the intra and inter-examiner concordances, Spearman's correlation and Kendall's concordance tests were used, respectively. For intergroup comparison, the Friedman test was used, with a 5% significance level. RESULTS: For all three groups of evaluators, the post-treatment evaluation results were superior to the results before the treatment: surgeons and orthodontists assigned higher scores for surgical cases and laypeople for orthodontic cases. CONCLUSION: From a clinical point of view, there was no difference between the results of both techniques with regard to the aesthetic perception of smiles. A gingival exposure ranging from zero to two millimeters was considered the most aesthetic for all evaluators.

The effect of whitening toothpastes on polyurethane and silicone orthodontic clear ligatures: A clinical study.

BACKGROUND: This study aimed to verify the effects of bleaching toothpaste on colour stability, elastic properties, surface topography between aesthetic polyurethane and silicone elastomeric ligatures from different brands. METHODS: Elastomeric ligatures tested were: 1-Mini Single Case Ligature Stick (RMO-polyurethane); 2-Ligature "S" Shaped Dispenser (RMO-Silicone); 3-Sany-tie (GAC-translucent polyurethane); and 4-Sili-tie (GAC-translucent silicone). The ligatures were randomly assigned from the brackets of canines and lower incisors of 40 patients. The study had two phases of 30 days in which a different toothpaste was used, followed by a washout period of 30 days. After each phase, ligatures were submitted to colour checking, tensile strength, and SEM. RESULTS: The average of the ultimate tensile strength (m = 2.59; DP = 0.014) was higher in the control ligatures if compared to the tested ones (m = 2.24; DP = 0.014). There were no statistically significant differences between toothpastes regarding the type of ligature. Also, no interaction was observed between toothpastes in ligature's ultimate tensile strength and strain. The type of toothpaste did not minimize colour changes. CONCLUSION: In conclusion, there was no difference in colour stability and elastic properties between polyurethane or silicone aesthetic elastomeric modules. Whitening toothpastes had no impact on ligatures performance after 30 days in the oral cavity.

Effects of rapid maxillary expansion or alternating rapid maxillary expansion and constriction on nasal mucociliary clearance : A randomized clinical trial.

PURPOSE: This parallel trial aimed to evaluate the changes in nasal mucociliary clearance (MCC) after a rapid maxillary expansion (RME) protocol or an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol in orthodontic patients. METHODS: This trial included 36 patients with a mean age of 14.38 years, with a narrow maxillary arch, bilateral posterior crossbite, no narrowing of the mandibular arch, no previous orthodontic treatment, and no nasal or systemic disease. Patients were randomly distributed into two groups (n = 18 each)-one group was treated with the RME protocol and the other group was treated with the Alt-RAMEC protocol. MCC was evaluated using the saccharine transit time (STT) test, which was measured for each individual before expansion (T0), after expansion (T1), and after a 4-month retention phase (T2). The study was single blinded, and blinding was applied only to the outcome assessor. The primary objective was to evaluate the effect of the Alt-RAMEC and RME protocols on MCC. The secondary objective was to determine the relationship between age, sex, and MCC. The χ 2 test and independent samples t­test were used to evaluate the data. RESULTS: The STT decreased after expansion and retention in the RME group. In the Alt-RAMEC group, the STT decreased after expansion and slightly increased after retention. When the RME and Alt-RAMEC groups were compared, the STT showed a significant difference after expansion and retention (p < 0.05). No significant relationship was observed between age and sex and STT (p > 0.05). CONCLUSION: This study demonstrated that the Alt-RAMEC protocol improved MCC and had a positive effect on nasal physiology by increasing the nasal volume more than that achieved by RME.

Class II treatment effects with fixed functional appliances: Jasper jumper vs. Forsus fatigue resistant device.

OBJECTIVE: This study aimed to compare cephalometric changes of Class II malocclusion patients treated with Jasper Jumper and Forsus, associated with fixed appliances. METHODS: The sample consisted of 62 individuals divided into 3 groups: group 1 included 22 subjects with a mean initial age of 12.39 years, treated with Jasper Jumper associated with fixed appliances for a mean period of 2.43 years; group 2 included 19 subjects with a mean initial age of 12.43 years, treated with Forsus associated with fixed appliances for a mean period of 3.54 years; and group 3 included 22 Class II malocclusion untreated subjects at a mean age of 12.14 years, followed for a mean period of 1.78 years. Intergroup comparison was performed with one-way ANOVA, followed by Tukey test. RESULTS: Both treated groups had similar dentoskeletal changes: restrictive effect on the maxilla; clockwise rotation of the occlusal plane; mild increase in lower anterior facial height; limitation on the vertical development of the maxillary molars; labial tipping and intrusion of the mandibular incisors; extrusion of mandibular molars; improvements of the maxillomandibular relationship, overjet, overbite, molar relationship; and retrusion of the upper lip. The mandibular incisors exhibited greater protrusion in group 1 compared to the other groups. In addition, group 2 presented mild protrusion of the lower lip, and groups 1 and 3 showed mild retrusion. CONCLUSION: The Jasper Jumper and Forsus appliances were effective and showed similar changes in the treatment of Class II malocclusion.

Access and financial impacts of public orthodontic provision on global health systems: integrative review / Acesso e impactos financeiros da provisão ortodôntica pública nossistemas de saúde mundiais: revisão integrativa / Acceso e impactos financieros de la provisión pública de ortodoncia en los sistemas de salud globales: revisión integradora

Introduction:The supply of public orthodontic services is still unable to meet the demand for treatment of malocclusions. The resources available are sometimes mismanaged and significant financial impacts contribute to limited access to the services. Objective:To carry out an integrative review regarding the access and financial impacts of public orthodontic service among the various health systems worldwide, considering social inequalities and the referral and counter-referral systems for services. Methodology:A survey was conducted using the BVS (Biblioteca Virtual em Saúde / Virtual Health Library), PubMed, and Cochrane databases, including articles available from 1970 to 2019, which elucidated the guiding question "How does access work and what are the financial impacts of the provision of orthodontic services in different public health systems worldwide?". Results:211 articles were found, of which 20 were analyzed. The chronological distribution was relatively uniform. The topic 'access to orthodontic services' was most frequently reported and there was a predominance of studies addressing the provision of treatment for children and adolescents. Conclusions:There are significant financial impacts and demographics have a strong influence on access to services. The provision of orthodontic treatments by the private sector predominates, preventive approaches are scarce, and an optimization in the use of available resources is necessary. Primary Care has much to contribute in increasing access, reducing costs, and making the referral / counter-referral system effective (AU).

Introdução:A oferta de serviços ortodônticos públicos ainda não consegue suprir a demanda de tratamento de má oclusões. Os recursos disponíveis, por vezes, mal alocados e os impactos financeiros significativos contribuem para a restrição do acesso aos serviços.Objetivo:Realizar uma revisão integrativa pertinente ao acesso e aos impactos financeiros da provisão ortodôntica pública nos diversos sistemas de saúde mundiais, sob a luz das iniquidades sociais e dos sistemas de referência e contrarreferência de serviços.Metodologia:Foi realizado um levantamento nas bases de dados BVS (Biblioteca Virtual em Saúde), PubMed e Cochrane Reviews, incluindo os artigos disponíveis no período de 1970 a 2019, que elucidavam a questão norteadora "Como se dá a provisão de serviços ortodônticos nos diversos sistemas públicos de saúde mundiais?".Resultados:Foram encontrados 211 registros, dos quais 20foram analisados. A distribuição temporal foi relativamente uniforme. A temática "acesso aos serviços ortodônticos" foi mais frequentemente relatada e houve um predomínio de estudos abordando a oferta de tratamentos a crianças e adolescentes. Conclusões:Há impactos financeiros significativos e os determinantes sociais exercem forte influência sobre o acesso aos serviços. Predomina a oferta de tratamentos ortodônticos pelo setor privado, abordagens preventivas são escassas e é necessária uma otimização no uso de recursos disponíveis. A Atenção Básica tem muito a contribuir para aumento do acesso, diminuição de custos e efetivação do sistema dereferência/contrarreferência dos serviços (AU).

Introducción: La provisión de servicios públicos de ortodoncia aún no puede satisfacer la demanda de tratamientos de maloclusión. Los recursos disponibles a veces están mal asignados y los impactos financieros significativos contribuyen a restringir el acceso a los servicios.Objetivo: Realizar una revisiónintegradora pertinente al acceso y los impactos económicos de la provisión pública de ortodoncia en los diferentes sistemas de salud a nivel mundial, a la luz de las inequidades sociales y los sistemas de derivación y contrarreferencia de servicios.Metodología: Se realizó una encuesta en las bases de datos de la BVS (Virtual Health Library), PubMed y Cochrane Reviews, incluidos los artículos disponibles desde 1970 hasta 2019, que dilucidó la pregunta orientadora "¿Cómo es la prestación de servicios de ortodoncia en los diferentes sistemas públicos?".Resultados: Se encontraron 211registros, de los cuales se analizaron 20.La distribución temporal fue relativamente uniforme. El tema "acceso a servicios de ortodoncia" fue el que se informó con mayor frecuencia y hubo un predominio de estudios que abordan la provisión de tratamientos a niños y adolescentes.Conclusiones: Hay impactos económicos significativos y los determinantes sociales tienen una fuerte influencia en el acceso a los servicios. Predomina la oferta de tratamientos de ortodoncia por parte del sector privado, los abordajes preventivos son escasos y es necesario optimizar el uso de los recursos disponibles. La Atención Primaria tiene mucho que contribuir para aumentar el acceso, reducir costos e implementar el sistema de derivación / contrarreferencia de servicios (AU).

Elásticos intermaxilares no tratamento de má oclusão Classe II divisão 1 ­ um enfoque clínico / Intermaxillary elastics in the treatment of Class II division 1 maloclusion ­ a clinical approach

Resumo As más oclusões têm etiologia multifatorial, são causadas por fatores ambientais e genéticos. Dentre os tipos de más oclusões existentes tem-se a Classe ll, que geralmente se caracteriza pela protrusão de dentes superiores, retrusão de dentes inferiores, prognatismo maxilar ou retrognatismo mandibular. Com o passar dos anos, os elásticos intermaxilares foram sendo desenvolvidos e melhorados, com isso houve um aumento em sua aplicabilidade na Ortodontia. Existem diversas situações clínicas em que se pode utilizar os elásticos, no entanto o profissional precisa entender seus riscos e limitações. Este artigo apresenta um relato de caso sobre o tratamento para Classe II com o uso de elásticos intermaxilares, cuja mecânica é de fácil manuseio e baixo custo.(AU)

Abstract Malocclusions have a multifactorial etiology, they are caused by environmental and genetic factors. Among the existing types of malocclusions there is Class II, which is generally characterized by upper teeth protrusion, lower teeth retrusion, maxillary prognathism or mandibular retrognathism. Over the years, intermaxillary elastics have been developed and improved, thus, there has been an increase in their applicability in Orthodontics. There are several clinical situations in which we can use elastics, however, the professional needs to understand their risks and limitations. This article presents a case report on the treatment of Class II with the use of intermaxillary elastics, whose mechanics are easy to handle and of low cost. (AU)