Relación del plano oclusal con la altura del ángulo goníaco y proyección del mentón / Relation of the occlusal plane with the height of the gonial angle and projection of the chin

Introducción: hemos observado en nuestra práctica ortodóncica una gran cantidad de pacientes con plano oclusal inclinado, con un ángulo goníaco alto y postero-rotación mandibular. Todo parece indicar que el plano oclusal juega un papel muy importante en el desarrollo de las maloclusiones. Objetivo: mostrar en el presente caso clínico de un niño, si existe una correlación entre la inclinación del plano oclusal, la altura del ángulo goníaco, la longitud de la rama mandibular y la proyección del mentón antes y después, al corregirlo y hacerlo más horizontal con tratamiento ortodóncico. Caso clínico: paciente masculino de 11 años de edad, hiperdivergente, clase II esquelética severa, perfil convexo, apiñamiento dental superior e inferior, clase II molar, incompetencia labial severa, mordida profunda, overjet aumentado, mentón retrusivo, cervicales rectificadas y anterorotación de cabeza. El tratamiento de ortodoncia se realizó con brackets Roth slot 22 y extracciones de primeros premolares superiores e inferiores y primeros molares superiores (siendo reemplazados por los terceros molares superiores), curvas inversas, cierre de espacios con pérdida de anclaje y ajuste oclusal. Resultados: al finalizar el tratamiento, se logró mejorar la estética facial, un ángulo goníaco más desarrollado con mayor crecimiento vertical, mayor proyección del mentón, un plano oclusal más horizontal, un adecuado overbite y overjet, clase I molar y canina, antero-rotación mandibular, buena intercuspidación, oclusión funcional y excelente estabilidad oclusal sin retención, mejoría en lordosis cervical y posición de la cabeza. Conclusiones: la corrección de un plano oclusal inclinado en niños y adolescentes hiperdivergentes, puede mejorar de manera importante el vector de crecimiento, ayudar a un mayor desarrollo en la altura del ángulo goníaco y longitud de la rama mandibular, proyección del mentón al corregirlo y hacer el plano oclusal más horizontal con la mecánica ortodóntica de curvas inversas; por lo tanto, en el presente caso clínico: sí existe una correlación muy importante entre la inclinación del plano oclusal, la altura del ángulo goníaco y la proyección del mentón antes y después del tratamiento ortodóncico (AU)

Introduction: we have observed in our orthodontic practice a large number of patients with inclined occlusal plane, with a high goniac angle and posterior mandibular rotation. Everything seems to indicate that the occlusal plane plays a very important role in the development of malocclusions. Objective: to show in the present clinical case of a child, if there is a correlation between the inclination of the occlusal plane, the height of the goniac angle, the length of the mandibular branch and the projection of the chin before and after, when correcting it and making it more horizontal with orthodontic treatment. Case report: an 11 year old male patient, hyperdivergent, severe skeletal class II, convex profile, upper and lower dental crowding, molar class II, severe labial incompetence, deep bite, increased overjet, retrusive chin, rectified cervicals, and anterorotation of the head. Orthodontic treatment was performed with Roth slot 22 brackets and extractions of upper and lower first premolars and upper first molars (being replaced by upper third molars), inverse curve, space closure with loss of anchorage and occlusal adjustment. Results: at the end of the treatment, it was possible to improve facial aesthetics, a more developed gonial angle with greater vertical growth, greater chin projection, a more horizontal occlusal plane, an adequate overbite and overjet, molar and canine class I, mandibular anterorotation, good intercuspidation, functional occlusion and excellent occlusal stability without retention, improvement in cervical lordosis and head position. Conclusions: the correction of an inclined occlusal plane in hyperdivergent children and adolescents can significantly improve the growth vector, help further development in the height of the gonial angle and length of the mandibular ramus, chin protection when correcting it and making the most horizontal occlusal plane with the orthodontic mechanics of inverse curves; therefore, in the present clinical case: there is a very important correlations between the inclination of the occlusal plane, the height of the gonial angle and chin projection before and after orthodontic treatment (AU)

Uso de overlays controlados electromiográficamente y su combinación con el tratamiento con alineadores / Use of electromyographically controlled overlays and their combination with and its combination with treatment with aligners

La dimensión vertical (DV) usualmente disminuye con el paso del tiempo y es uno de los objetivos más complicados en resolver en los casos de Ortodoncia, ya sea con brackets o con alineadores. Esta disminución de la DV tiene una influencia directa en el funcionamiento de la articulación temporomandibular (ATM). Las patologías de la ATM, que surgen por la pérdida de la DV, son usualmente tratadas en la fase I con placas que restablecen la posición articular y la función muscular. Luego de corregida la patología de la ATM, en la fase II hay que tratar en lo posible la oclusión, devolviendo al paciente un soporte fisiológico posterior. Aquí se presenta un caso clínico atendido con una Placa Neurofisiológica (PN) en la fase I, y en la fase II, el traslado de esta altura a los overlays (O) y su erupción posterior dentaria con alineadores. Controlando cada paso electromiográficamente para el restablecimiento y control de la función muscular.

The vertical dimension usually decreases over time and is one of the most complicated objectives to solve in Orthodontic cases, whether with braces or aligners. This decrease in vertical dimension has a direct influence on the physiology of the temporomandibular joint. TMJ pathologies that arise from the loss of vertical dimension are usually treated in Phase I with splints that restore joint position and muscle function. After correcting the TMJ pathology, in Phase II, the occlusion should be treated as much as possible, returning the patient to a physiological posterior support. A clinical case is presented involving treatment with a Neurophysiological Splint in the first phase, and in the second phase, the transfer of this height to overlays and subsequent dental eruption with aligners. Each step is electromyographically monitored for the restoration and control of muscle function.

Dentoalveolar effects of skeletally anchored extrusion arch in anterior open bite patients: A prospective clinical trial.

OBJECTIVE: The purpose of this prospective clinical trial was to explore the dental and soft tissue changes accompanying the use of skeletally anchored nickel-titanium (NiTi) extrusion arch in the correction of anterior open bite (AOB). MATERIAL AND METHODS: Twenty female patients with a mean age of 16.5 ± 1.5 years and a mean dentoalveolar AOB of 2.38±0.7 mm participated in this study. All patients were treated with an maxillary 0.017×0.025-in NiTi extrusion arch, with the aid of miniscrews inserted between the maxillary second premolars and first molars bilaterally, to act as indirect anchorage. Three-dimensional digital models and lateral cephalometric radiographs were taken just before the insertion of the extrusion arch (T0) and after 10 months (T1). Paired-sample t-tests were used in analyzing the data, to evaluate the changes after treatment (T1-T0). A significance level of p < 0.05 was used. RESULTS: AOB was successfully closed in all patients, with a 4.35 ± 0.61 mm increase in the overbite. Maxillary incisors significantly extruded (2.52 ± 1.02 mm) and significantly reclined (5.78 ± 0.77°), with a resultant decrease in the overjet of 1.58 ± 0.5mm. A significant intrusion of maxillary first molars with no change in their inclination was observed. The upper lip showed a significant retraction tendency to the E-plane, and a significant increase in the nasolabial angle was observed. CONCLUSION: The skeletally anchored NiTi extrusion arch was an effective technique in treating AOB, with no adverse effects on the molars.

Alinhadores ortodônticos para finalização de tratamentos ortodônticos e recidiva - relato de caso / Orthodontic aligners in the completion of orthodontic treatments and recurrence - case report

Nos últimos anos, os avanços na Odontologia têm proporcionado novas abordagens para o alinhamento dentário, visando não apenas a correção eficaz das más oclusões, mas também o conforto e a estética para os pacientes. Entre essas inovações, os alinhadores ortodônticos do tipo bolha e abaulamento emergiram como uma alternativa promissora aos aparelhos tradicionais. Este artigo visa explorar o histórico, as indicações clínicas, as vantagens estéticas e o conforto oferecido por esses dispositivos, destacando evidências tanto da literatura antiga quanto de estudos recentes.(AU)

In recent years, advances in dentistry have provided new approaches to dental alignment, aiming not only for effective correction of malocclusions but also for patient comfort and aesthetics. Among these innovations, bubble and bump orthodontic aligners have emerged as a promising alternative to traditional braces. This article aims to explore the history, clinical indications, aesthetic advantages, and comfort offered by these devices, highlighting evidence from both old literature and recent studies (AU)

Pathways between verbal bullying and oral conditions among school children.

PURPOSE: To investigate the direct and indirect pathways between verbal bullying and adverse oral conditions among school-aged children. METHODS: A cross-sectional survey was conducted with 8- to 10-year-old children, enrolled in public schools in Southern Brazil. Verbal bullying was collected by self-reports. Independent variables included sociodemographic characteristics (sex, age, household income, and caregivers' educational level) and oral conditions (anterior open bite, anterior teeth crowding, upper anterior diastema, large overjet, untreated dental caries, and PUFA index). The pathways between verbal bullying and the independent variables were analysed through structural equation modelling. RESULTS: 1369 children were included. The prevalence of verbal bullying was 26.2% (95% confidence interval [CI] 23.9-28.6%). Verbal bullying was directly influenced by large overjet (standard coefficient [SC] 0.13, P < 0.01), untreated dental caries (SC 0.63, P = 0.01) and PUFA index (SC 0.75, P = 0.02). Sex (SC - 0.005, P = .04) and age (SC - 0.006, P < 0.01) indirectly influenced verbal bullying via untreated dental caries. CONCLUSIONS: Verbal bullying was directly influenced by large overjet, untreated dental caries and PUFA index. Sex and age indirectly impacted verbal bullying through untreated dental caries.

Comparison between round multi-strand wire and rectangular wire bonded retainers: a randomized clinical trial.

OBJECTIVE: The primary objective was to compare round multi-strand wire and Ortho-Flex-Tech™ rectangular wire retainers in terms of gingival health. The secondary objectives were to assess plaque/calculus accumulation, and to determine the effectiveness of these retainers in maintaining tooth alignment and their failure rate. MATERIAL AND METHODS: This single-center study was a two-arm parallel randomized clinical trial and was conducted at the Orthodontic clinics in Dental Teaching Center/Jordan University of Science and Technology. Sixty patients, with bonded retention for the mandibular anterior segment after fixed orthodontic treatment, were randomly selected. The sample comprised Caucasian patients with mild to moderate pretreatment crowding in the mandibular anterior region, Class I relationship, treated without extraction of mandibular anterior tooth. In addition, only patients presenting normal overjet and overbite after treatment were included. INTERVENTION: One group received round multi-strand wire retainer (30 patients, average age: 19.7 ± 3.8 years), while the other group received Ortho-Flex-Tech™ retainer (30 patients; average age: 19.3 ± 3.2 years). In both groups, the retainers were bonded to all mandibular anterior teeth from canine to canine. All patients were recalled one year after bracket debonding. Randomization sequence was created using Excel 2010, with a 1:1 allocation, using random block size 4. The allocation sequence was concealed in sequentially numbered, opaque and sealed envelopes. Only participants were blinded to the type of bonded retainer used. The primary outcome was to compare the gingival condition between the two groups. The secondary outcomes were to assess plaque/calculus indices, irregularity index of the mandibular anterior teeth and retainers' failure rate. Comparisons were conducted using Mann-Whitney U test or chi-square test. Statistical significance was predetermined at the p≤ 0.05 level for all tests. RESULTS: Complete data were collected for 46 patients (round multi-strand wire retainer group, n=24 patients; rectangular Ortho-Flex-Tech™ retainer group, n=22 patients). No significant differences were found in the gingival health parameters between the two groups (p>0.05). Ortho-Flex-Tech™ retainers maintained the alignment of mandibular anterior teeth more than multi-strand retainer (p<0.05). No significant difference was found in the failure rate between the two groups (p>0.05). CONCLUSIONS: Gingival health parameters and failure rate were not different in both groups. However, Ortho-Flex-Tech™ retainers were more efficient to retain the mandibular incisors than the multi-strand retainers; nevertheless, the difference was not clinically significant.

Treatment effects and lip profile changes following premolars extraction treatment vs fixed functional treatment in Class II division 1 malocclusion: A randomized controlled clinical trial.

OBJECTIVE: The objective of this two-arm parallel randomized controlled trial was to evaluate the treatment effects and lip profile changes in skeletal Class II patients subjected to premolars extraction treatment versus fixed functional treatment. METHODS: Forty six subjects fulfilling inclusion criteria were randomly distributed into Group PE (mean age 13.03±1.78 years) and Group FF (mean age 12.80±1.67 years) (n=23 each). Group PE was managed by therapeutic extraction of maxillary first premolars and mandibular second premolars, followed by mini-implant-supported space closure; and Group FF, by fixed functional appliance therapy. Skeletal, dental, and soft-tissue changes were analyzed using pre and post-treatment lateral cephalograms. Data obtained from this open label study was subjected to blind statistical analysis. RESULTS: Extraction treatment resulted in greater increase of nasolabial angle (NLA: 3.1 [95% CI 2.08, 4.19], p<0.001), significant improvement of upper lip (UL-E line: -2.91 [95% CI -3.54, -2.28], p<0.001, UL-S line: -2.50 [95% CI -2.76, -2.24], p<0.001, UL-SnPog': -2.32 [95% CI -2.90, -1.74], p<0.01) and lower lip position (LL-E line: -0.68 [95% CI -1.36, 0.00], p<0.01, LL-S line: -0.55 [95% CI -1.11, 0.02], p<0.01, and LL-SnPog': -0.64 [95% CI -1.20, -0.07], p<0.01), lip thickness (UL thickness: 2.27 [95% CI 1.79, 2.75], p<0.001; LL thickness: 0.41 [95% CI -0.16, 0.97], p<0.01), upper lip strain (UL strain: -2.68 [95% CI -3.32, -2.04], p<0.001) and soft tissue profile (N'-Sn-Pog': 2.68 [95% CI 1.87, 3.50], p<0.01). No significant difference was observed between the groups regarding skeletal changes in the maxilla and mandible, growth pattern, overjet, overbite, interincisal angle and soft tissue chin position (p>0.05). Premolar extraction treatment demonstrated significant intrusion-retraction of maxillary incisors, better maintenance of maxillary incisor inclination, and significant mandibular molar protraction; whereas functional treatment resulted in retrusive and intrusive effect on maxillary molars, marked proclination of mandibular anterior teeth, and significant extrusion of mandibular molars. Both treatment modalities had similar treatment duration. Implant failure was seen in 7.9% of cases, whereas failure of fixed functional appliance was observed in 9.09% of cases. CONCLUSIONS: Premolar extraction therapy is a better treatment modality, compared to fixed functional appliance therapy for Class II patients with moderate skeletal discrepancy, increased overjet, protruded maxillary incisors and protruded lips, as it produces better dentoalveolar response and permits greater improvement of the soft tissue profile and lip relationship.

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.

Critical appraisal of confounding factors of observational studies on the association between dentofacial features and dental trauma in a Brazilian population.

AIMS/OBJECTIVES: Dental trauma is a highly prevalent dental emergency. Children and adolescents without inadequate lip coverage, increased overjet, and anterior open bite are associated with the occurrence of traumatic dental injuries. Observational studies do not allow the inference of causality, one of the reasons being: the potential confounding factors. Therefore, this review aimed to critically appraise the confounding factors considered in epidemiological studies that associate dentofacial features with the occurrence of dental trauma in Brazilian children and adolescents. METHODS: Studies included in the qualitative synthesis of a recently published comprehensive systematic review and meta-analysis on the topic were screened. Studies that only mentioned the performance of bivariate analyzes or that did not mention the performance of multivariate analyzes were excluded. Evaluation of control statements for possible confounders and bias consideration was performed for each selected study. Confounding factors in these studies were also identified and categorized according to their domains. RESULTS: Fifty-five observational studies were screened, of which 11 were excluded due to the mention of only bivariate analyzes or the lack of multivariate analyses. The remaining 44 studies were critically appraised. Of these, 9 studies specifically mentioned the term confounding, and 12 studies mentioned the term bias. However, only 14 studies mentioned limitations on confounding factors in their findings. Among the 99 different variables identified, the most used were type of trauma, followed by sex and age. CONCLUSION: Most studies did not acknowledge the control for possible confounding factors and rarely stressed the need for caution in interpreting their results. Cross-sectional studies do not allow inferring a cause-and-effect relationship between dentofacial features and dental trauma.

Stability of Class II malocclusion treatment with Class II elastics.

INTRODUCTION: The objective of this study was to compare the long-term cephalometric stability after successful therapy of nonextraction Class II malocclusion with elastics and with headgear. METHODS: The sample comprised 43 patients with Class II malocclusion and was divided into 2 groups. The elastic group (EG) consisted of 20 patients treated with fixed appliances associated with Class II elastics, and the headgear group (HG) consisted of 23 patients treated with fixed appliances and extraoral headgear. Pretreatment, posttreatment, and long-term posttreatment lateral radiographs were evaluated; t tests were used to compare the long-term posttreatment changes between the groups. RESULTS: The groups were matched regarding initial age, time of long-term posttreatment evaluation, initial malocclusion severity, quality of treatment result, and all pretreatment cephalometric variables. Intergroup comparisons of long-term posttreatment changes showed that the HG group presented significantly greater mandibular protrusion, occlusal plane angle decrease, and maxillary molar mesialization. However, long-term posttreatment stability was similar in overjet, overbite, and molar relationships. CONCLUSIONS: Nonextraction Class II malocclusion treatment with elastics or extraoral headgear have similar long-term posttreatment stability.

Normal occlusion in maturational life process.

INTRODUCTION: An increase in life expectancy was observed in the past years. Consequently, the knowledge of the maturational changes in the occlusion is highly important to guide clinicians during treatment planning. OBJECTIVE: In this article, the occlusal and facial aging changes occurred during almost 50 years of follow-up are described. A normal occlusion sample from Bauru Dental School, University of São Paulo, Brazil, was evaluated at 13 (T1), 17 (T2) and 60 (T3) years of age. The maturational changes observed in digital dental models and cephalometric radiographs were presented. A revision of the aging process, under the gerontology and psychology perspectives, was also explored. DISCUSSION: Maturational changes in non-treated individuals were very delicate. Mandibular crowding, decrease in the overbite, changes in the maxillary second molar position, increase in the clinical crown length, dental wear and discoloration were observed. CONCLUSION: Compared to the remarkable facial and skin changes during aging, the occlusion seems to be the most stable feature of the face during the aging process. FINAL CONSIDERATIONS: An adequate oral care throughout lifetime makes the smile the best memory of youth at mature ages.

Predictability of the deep overbite correction using clear aligners.

INTRODUCTION: The objective of this study was to investigate the predictability of overbite correction in patients with deepbite using the clear aligners (Invisalign, Align Technology, San Jose, Calif) and examine the accuracy of vertical movement and inclination change of individual teeth. METHODS: This retrospective study included 24 deepbite patients (10 males and 14 females; aged 32.8 ± 11.9 years; an initial overbite of 5.20 ± 0.95 mm; an average treatment period of 11.04 ± 4.14 months) consecutively treated from September 2016 and completed before August 2021. SmartTrack materials were used for all patients. The initial, predicted, and achieved final models were exported from ClinCheck and superimposed via best-fit surface-based registration using Slicer CMF (version 4.9.0; cmf.slicer.org). The overbite correction, changes in vertical movement, and inclination for individual teeth were measured. Descriptive statistics and a paired t test or Wilcoxon signed-rank test were performed. P <0.05 was considered statistically significant. RESULTS: Mean overbite correction was 33%, with a 1.15 mm improvement after the first set of aligners. All teeth demonstrated statistically significant differences between planned and achieved amounts in vertical movement and inclination change, with the largest difference in maxillary central incisors. Mandibular incisor intrusion and mandibular premolar extrusion had similar accuracies. Regarding inclination change, maxillary central incisors showed the lowest accuracy of 13.3%. CONCLUSIONS: Clear aligner treatment showed an average of 33% overbite correction. Overcorrection and additional refinement treatments are needed in most patients with a deepbite.

Dentoalveolar changes observed after the use of customized bonded Shark-Tooth-Like Spurs (JAWs) in adult patients with anterior open bite.

INTRODUCTION: Tongue spurs have been successfully used for the early treatment of anterior open bite (AOB). However, according to our knowledge, their effectiveness in the treatment of adults has not been evaluated. OBJECTIVES: The purpose of the study was to assess the dentoalveolar changes observed after the use of customized bonded shark-tooth-like spurs (JAWs) in adults with AOB. METHODS: Twenty-three adults (22.1±4.4 years) with AOB were selected for the treatment. JAWs made from compomer cement were bonded on the lingual surfaces of the maxillary and mandibular anterior teeth to correct tongue-thrusting. Lateral cephalograms and 3D digital models were obtained to evaluate dentoalveolar features observed before and at three time points after JAWs use. Paired t-test and repeated measure ANOVA tests were used to compare dentoalveolar changes, and Pearson's correlation was used to analyze the association of dentoalveolar changes and overbite changes. The significance level was set at p<0.05. RESULTS: Significant 3D dentoalveolar changes were observed after the three months of treatment with JAWs. Improvement of overbite (1.0±0.6 mm) and overjet (0.2±0.3 mm), combined with a retroclination of maxillary (3.0±3.0°) and mandibular (2.2±2.7°) incisors, were observed (p<0.05). Moreover, a significant decrease in anterior dental arch width in both maxillary and mandibular arches (0.4±0.4 mm; 0.3±0.3 mm, respectively), and an increase of posterior maxillary (0.1±0.2 mm) dental arch width were observed (p<0.05). These significant changes occurred in the first month after the JAWs use. A significant correlation was found between the initial arch length discrepancy and the amount of overbite correction (r=0.456, p<0.05). CONCLUSIONS: Dentoalveolar changes occurred after the first-month therapy with JAWs. The retroclination of the anterior teeth combined with the expansion of posterior teeth suggests a posterosuperior change in the tongue position. These changes were beneficial for the treatment of AOB in adult patients.

Dentoskeletal and soft-tissue changes of class II malocclusion treatment with modified first class appliances: a prospective clinical trial.

BACKGROUND/OBJECTIVES: Intraoral distalizers are effective and conservative alternatives for Class II malocclusion treatment. However, the literature is still controversial regarding the effects of using skeletal anchorage in intraoral distalizers with different designs. The aim of this study is to compare dentoskeletal and soft-tissue changes of Class II malocclusion patients treated with three types of First Class (FC) distalizers. MATERIALS/METHODS: The sample of this prospective clinical trial included 30 consecutive patients divided into three groups: G1-FC conventionally anchored; G2-FC skeletally anchored Type 1; G3-FC skeletally anchored Type 2. Each group consisted of 10 patients. Lateral cephalograms were analyzed in two stages: at pre-treatment (T0) and after distalization (T1). The radiographs were digitized and analyzed using the software Dolphin Imaging 11.5. Comparisons of treatment changes between groups (T1-T0) were performed using one-way analysis of variance (ANOVA), followed by the Tukey test. RESULTS: Patients treated with the conventionally anchored FC showed significantly greater incisors protrusion and labial inclination, second premolars mesial inclination and mesialization than the FCs skeletally anchored. No differences were observed regarding the amount of molar distalization and molar angulation between groups. LIMITATIONS: It can be considered that the limitation of this study lies in its non-randomized design. CONCLUSIONS/IMPLICATIONS: First Class distalizers with conventional and skeletal anchorage are effective alternatives for Class II molar distalization. Distalization associated with indirect skeletal anchorage reduce the undesirable effects observed in the incisors and premolars during distalization when compared to distalization conventionally anchored.

Should midline diastema in mixed dentition be an aesthetic concern?

BACKGROUND: Mixed dentition determines an important period of occlusion development in childhood. OBJECTIVE: This study aimed to evaluate the aesthetic impact of the midline diastema cut-off point in mixed dentition. DESIGN: A cross-sectional study was performed with 257 children aged 8-10 years in late mixed dentition, with midline diastema of 1-5 mm and normal maxillary overjet. Orthodontic Aesthetic Subjective Impact Score determined the aesthetic impact of the midline diastema. Four quartiles of diastema measurements and impact scores were considered as cut-off points. Receiver Operating Characteristic curves were constructed, and the distances representing the distances to the ideal point were calculated. The Yuden index determined the efficiency of measuring the diastema to assess the aesthetic impact. The Kruskal-Wallis test compared the groups of participants classified according to the diastema cut-off by the sample quartile regarding the impact score. The analyses were performed with a significance level of 5%. RESULTS: There was no significant difference between the four groups of measurement quartiles of the diastema regarding the aesthetic impact (P > .05). CONCLUSIONS: The perception of dental aesthetics in mixed dentition children was not affected by the midline diastema, regardless of the cut-off point.

Tratamento da atresia maxilar associada à sobremordida acentuada em paciente Classe II de Angle ­ relato de caso / Tratamento da atresia maxilar associada à sobremordida acentuada em paciente Classe II de Angle ­ relato de caso

Resumo O tratamento precoce das más oclusões é preconizado principalmente pela possibilidade de tratamento ortopédico. Uma Classe II não tratada pode trazer prejuízos na fala, deglutição, respiração e, consequentemente, na qualidade de vida do paciente. Quando há alterações transversais, verticais e anteroposteriores associadas, os tratamentos tornam-se mais desafiadores. O objetivo desse estudo foi apresentar um caso clínico de um paciente com má oclusão de Classe II em fase de crescimento, com mordida cruzada posterior unilateral, falta de espaço na arcada superior e sobremordida profunda associada à curva de Spee acentuada no arco mandibular. Com o tratamento planejado, foi alcançado um resultado estético e funcional adequado com correção da Classe II de Angle, criação de espaço no arco para alinhamento dos caninos, correção da mordida cruzada e da sobremordida acentuada. Concluiu-se que a disjunção palatina para correção de mordida cruzada posterior e o uso de mecânica com cantilevers para correção precoce da curva de Spee foram satisfatórios neste caso clínico. Conhecer biomecânica e seus efeitos otimizam o tratamento (AU)

Abstract The early treatment of malocclusions is recommended by the possibility of orthopedic treatment. An untreated Class II can impair speech, swallowing, breathing and, consequently, the patient's quality of life. When transverse, vertical, and anteroposterior changes are associated, treatments become more challenging. This study aimed to present a clinical case of a patient with Class II malocclusion in the growth phase, with unilateral posterior crossbite, lack of space in the upper arch, and deep overbite associated with the sharp Spee curve in the mandibular arch. With the planned treatment, an adequate aesthetic and functional result was achieved with Angle Class II correction, creating space in the arch for alignment of the canines, correction of the cross bite, and the marked overbite. It was concluded that the palatal disjunction for posterior crossbite correction and the use of cantilever mechanics for early correction of the Spee curve were satisfactory in this clinical case. Knowing biomechanics and its effects optimize the treatment (AU)

Correção da sobremordida profunda e Classe II subdivisão com alinhadores ortodônticos ­ relato de caso / Correction of deep overbite and Class II subdivision with orthodontic aligners ­ case report

Resumo A correção da sobremordida profunda com o uso de alinhadores ortodônticos é um desafio para o ortodontista. O sucesso do tratamento depende de mecânicas auxiliares para melhor controle dos movimentos desejados. O objetivo do presente artigo foi descrever um caso clínico sobre a correção da sobremordida profunda associada a má oclusão dentária de Classe II, tratada com alinhadores ortodônticos. A paciente adulta apresentava Classe II, divisão 2 e subdivisão direita, linha média inferior desviada para direita, sorriso gengival e sobremordida exagerada, com apinhamentos em ambos os arcos. Ao final do tratamento, correta relação de sobremordida e sobressaliência foi adquirida, assim como relação molar e canino de Classe I, linhas médias coincidentes e adequado arco do sorriso, mantendo simetria e estética facial. Considerando as limitações do uso de alinhadores para a correção da sobremordida profunda, o caso apresentou resultados satisfatórios, com oclusão, função e relação estética adequadas. O correto plano de tratamento auxiliado aos acessórios ortodônticos e colaboração do paciente, tornaram possível a correção da sobremordida e Classe II com alinhadores ortodônticos. (AU)

Abstract Correcting deep overbite using orthodontic aligners is a challenge for orthodontists. Successful treatment depends on auxiliary mechanics to a better control of the desired movements. The aim of this article was to describe a clinical case of deep overbite correction associated with Class II malocclusion, treated with orthodontic aligners. The patient presented with Class II, division 2, and right subdivision, lower midline deviated to the right, gummy smile, and exaggerated overbite, with crowding in both arches. At the end of treatment, a correct overbite and overjet relationship were achieved, as well as a Class I molar and canine relationship, coincident midlines and an adequate smile arch, maintaining facial symmetry and aesthetics. Considering the limitations of using aligners to correct deep overbite, the case presented satisfactory results, with adequate occlusion, function and aesthetic relationship. The correct treatment plan, aided by orthodontic accessories and the patient's cooperation, made it possible to correct the overbite and Class II with orthodontic aligners(AU)

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

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

Emoji as promising tools for emotional evaluation in orthodontics.

BACKGROUND: Emoji are pictograms frequently used in social networks capable of expressing emotions. These tools can provide insights into people's behavior that could not be obtained with the use of textual communication. Recently, emoji have been introduced to various research fields as successful alternatives to word-based questionnaires for measure emotional responses. The objective of this study was to preliminarily evaluate the discriminating ability and relationship of these tools with different occlusal conditions/malocclusions. METHODS: Online surveys were applied to adult individuals (n = 201; mean age = 27.4 ± 5.7; 37.3% males, 62.7% females). Subjects issued acceptance scores (10-point scale) and expressed their emotional status using a 30-emoji list in relation to nine occlusal conditions: C1-crowding, C2-anterior open bite, C3-interincisal diastema, C4-increased overjet + deep bite (Class II div. 1), C5-anterior crossbite (Class III), C6-ideal occlusion, C7-unilateral posterior crossbite, C8-anterior open bite plus bilateral posterior crossbite plus crowding, and C9-deep bite (Class II div. 2). Cochran's Q and McNemar tests were used to compare the frequencies of choice of emoji between conditions. Correspondence analyses were applied to assess the association between occlusal conditions and emoji. Kendall's correlation coefficient was calculated to evaluate the relationship between mean acceptance scores and frequency counts of each emoji. RESULTS: The frequency of choice between conditions showed a significant difference for 25 of the 30 emoji (P < 0.05), indicating an adequate discriminating ability of these tools. Emoji were grouped predominantly based on their emotional valence (positive/negative) and arousal/activation (high/low). Positive emoji were associated with the most accepted conditions (i.e., C6, C3), while negative emoji with the most rejected ones (i.e., C8, C1, C2). Although only weak, positive correlations between acceptance and positively valenced emoji, and negative correlations between acceptance and negatively valenced emoji were observed (P < 0.05). CONCLUSIONS: Emoji have an adequate discriminatory ability and would allow determining emotional profiles in the face of different occlusal conditions. Further research is necessary to consolidate the use of these tools in an instrument that allows measuring emotional responses.

Is there variation in the depth of the curve of Spee in individuals with different dentoskeletal patterns? A systematic review with meta-analysis.

OBJECTIVE: To systematically evaluate all the evidence assessing variations in the depth of the curve of Spee (COS) according to the presence/absence of different dentoskeletal characteristics. SEARCH METHODS AND ELIGIBILITY CRITERIA: The eligibility criteria were outlined following the PECO framework, as follows: studies evaluating individuals with complete permanent dentition including second molars (P), which compared a group with a certain dentoskeletal variation (E) versus another group without the variation (C), regarding the depth of the COS (O). MEDLINE (via PubMed), Scopus, Web of Science, The Cochrane Library, LILACS and BBO (via Virtual Health Library), OpenGrey, and Google Scholar were searched up to September 2021 to identify eligible reports. DATA COLLECTION AND ANALYSIS: Duplicates were removed from all the records retrieved. The selection process and data collection were performed independently by two review members. The risk of bias was also assessed independently and in duplicate, using the guideline described by Fowkes and Fulton. Several meta-analyses (α = 0.05) were conducted to estimate the mean differences (MD) or standardized mean differences (SMD) in the depth of COS between individuals presenting or not certain dentoskeletal characteristics. The certainty of evidence was assessed using the GRADE tool. RESULTS: Thirty-five studies were selected for qualitative synthesis, and 29 of them for quantitative synthesis. All studies had methodological limitations that affected the risk of bias and increased the likelihood that results were due to chance. Syntheses showed that Class II malocclusion (SMD = 0.87; 95% CI: 0.61, 1.13; P < 0.00001; six datasets including 260 subjects analysed), Class II division 1 (SMD = 1.09; 95% CI: 0.62, 1.56; P < 0.00001; 14 datasets including 823 subjects analysed) and Class II division 2 (SMD = 2.65; 95% CI: 1.51, 3.79; P < 0.00001; eight datasets including 476 subjects analysed) had deeper COS than Class I malocclusion. The skeletal Class II also presented higher COS values than skeletal Class I (SMD = 0.57; 95% CI: 0.02, 1.12; P = 0.04; four datasets including 299 subjects analysed). Individuals with Class III malocclusion had flatter COS than the subjects having Class I malocclusion (SMD = -0.57; 95% CI: -1.07, -0.08; P = 0.02; nine datasets including 505 individuals analysed). No difference was shown in the COS depth between skeletal Class III and Class I (P > 0.05). Deep bite individuals had higher COS depth than those with normal overbite (MD = 0.61; 95% CI: 0.41, 0.82; P < 0.00001; two datasets including 250 subjects analysed). In addition, hypodivergent individuals presented deeper COS than normodivergents (SMD = 0.62; 95% CI: 0.37, 0.86; P < 0.00001; six datasets including 305 subjects analysed), and there was no significant difference in the COS depth between hyperdivergent and normodivergent individuals (P = 0.66). The certainty of evidence was rated as very low for all the syntheses. LIMITATIONS: All the quantitative syntheses included results from studies with methodological flaws. Therefore, they are potentially biased. Moreover, the evidence was also mainly affected in terms of the inconsistency of the results and the imprecision of the estimates. CONCLUSIONS: Although an apparent influence of dentoskeletal Class II, Class III malocclusion, deep bite, and the hypodivergent skeletal pattern on the depth of the COS is suggested, it is not possible to make definitive conclusions on the matter due to the very low certainty of the evidence. Further high-quality research is necessary.