Treatment effects of the MARA appliance and Activator-Headgear combined with fixed appliances in Class II division 1 malocclusion patients: A retrospective longitudinal study.

INTRODUCTION: Class II division 1 malocclusion treatment with functional devices offers acceptable results. These devices can be removable or fixed, and the essential difference between them is the need for compliance. It is clinically important to investigate if there are differences in the treatment effects of these devices that present different characteristics. OBJECTIVE: This retrospective longitudinal study compared the treatment effects of Class II correction with the MARA appliance, Activator-Headgear (AcHg) combination, both followed by multibracket fixed appliances, and an untreated control group. MATERIAL AND METHODS: Each experimental group was composed of 18 patients, with a baseline mean age of 11.70 and 10.88 years, treated for 3.60 and 3.17 years. The control group consisted of 20 subjects with baseline mean age of 11.07 years. The groups were evaluated before (T1) and after (T2) treatment. Lateral radiographs were used to evaluate the treatment changes with treatment (T2-T1), compared to the control group. Intergroup comparisons were performed using repeated-measures analysis of variance (ANOVA), followed by Tukey's test. RESULTS: The AcHg group showed significantly greater maxillary growth restriction than the MARA, while the mandibular changes were due to natural growth. Both devices promoted significantly greater maxillary incisors retrusion, mandibular incisors labial inclination, and improvement of overjet and molar relationships, compared to the control. CONCLUSIONS: Both functional devices followed by multibracket appliances were effective to correct Class II malocclusion. Nonetheless, the AcHg combination presents superior skeletal effects, due to significantly greater maxillary growth restriction compared to the MARA appliance. Moreover, the appliances presented similar dentoalveolar effects.

Psychological and financial impact of the COVID-19 pandemic during the first stages of the pandemic: Brazilian orthodontists´ perspective.

INTRODUCTION: Brazil faced a catastrophic situation in the coronavirus pandemic. Due to the high risk of contamination and spread of COVID-19, dentist have been attending only urgency and emergency services in Brazil at the beginning of the pandemic. OBJECTIVE: This research aimed to evaluate the psychological and financial impacts caused by the coronavirus pandemic in Brazilian orthodontists. METHODS: This population-based cross-sectional study collected demographic data and mental health measurements from 404 orthodontists. Depression, anxiety, insomnia, and distress were evaluated through Brazilian versions of the 9-item Patient Health Questionnaire (9-PHQ), the 7-item Generalized Anxiety Disorder scale and Mini-Tracking (GAD), the 7-item Insomnia Severity Index (ISI), and the 22-item Impact of Event Scale-Revised (IES-R), respectively. The demographic data of the sample was described using descriptive statistics. The data was analyzed according to sex, professional status, and economic income. Comparisons were performed using Chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis followed by post-hoc tests. RESULTS: Females, graduate students, and lower incomes subgroups showed higher levels of depression, anxiety, insomnia, and distress. Most orthodontists showed moderate to extreme financial and professional concerns during the pandemic. CONCLUSION: The coronavirus pandemic negatively affected the psychological health and increased the financial concerns of the Brazilian orthodontists, mainly female, graduate students, and with income below 10k participants.

Treatment effects of the MARA appliance and Activator-Headgear combined with fixed appliances in Class II division 1 malocclusion patients: A retrospective longitudinal study

ABSTRACT Introduction: Class II division 1 malocclusion treatment with functional devices offers acceptable results. These devices can be removable or fixed, and the essential difference between them is the need for compliance. It is clinically important to investigate if there are differences in the treatment effects of these devices that present different characteristics. Objective: This retrospective longitudinal study compared the treatment effects of Class II correction with the MARA appliance, Activator-Headgear (AcHg) combination, both followed by multibracket fixed appliances, and an untreated control group. Material and Methods: Each experimental group was composed of 18 patients, with a baseline mean age of 11.70 and 10.88 years, treated for 3.60 and 3.17 years. The control group consisted of 20 subjects with baseline mean age of 11.07 years. The groups were evaluated before (T1) and after (T2) treatment. Lateral radiographs were used to evaluate the treatment changes with treatment (T2-T1), compared to the control group. Intergroup comparisons were performed using repeated-measures analysis of variance (ANOVA), followed by Tukey's test. Results: The AcHg group showed significantly greater maxillary growth restriction than the MARA, while the mandibular changes were due to natural growth. Both devices promoted significantly greater maxillary incisors retrusion, mandibular incisors labial inclination, and improvement of overjet and molar relationships, compared to the control. Conclusions: Both functional devices followed by multibracket appliances were effective to correct Class II malocclusion. Nonetheless, the AcHg combination presents superior skeletal effects, due to significantly greater maxillary growth restriction compared to the MARA appliance. Moreover, the appliances presented similar dentoalveolar effects.

RESUMO Introdução: O tratamento da má oclusão de Classe II divisão 1 com dispositivos funcionais oferece resultados aceitáveis. Esses dispositivos podem ser removíveis ou fixos, e a diferença essencial entre eles é a necessidade de colaboração. É clinicamente importante investigar se existem diferenças nos efeitos do tratamento desses dispositivos que apresentam características diferentes. Objetivo: O presente estudo retrospectivo longitudinal comparou os efeitos do MARA e da combinação Aparelho Extrabucal-Ativador (AEB-At) no tratamento da Classe II, ambos seguidos por aparelho fixo, adicionando também um grupo controle não tratado. Métodos: Cada grupo experimental foi composto por 18 pacientes; respectivamente, com média de idade inicial de 11,70 e 10,88 anos, tratados por 3,60 e 3,17 anos. O grupo controle foi composto por 20 indivíduos, com idade média inicial de 11,07 anos. Os grupos foram avaliados antes (T1) e após (T2) o tratamento. Radiografias de perfil foram utilizadas para avaliar as alterações do tratamento (T2-T1), em comparação com o grupo controle. As comparações intergrupos foram realizadas por meio da análise de variância para medidas repetidas (ANOVA), seguida pelo teste de Tukey. Resultados: O AEB-At apresentou uma restrição do crescimento maxilar significativamente maior que o MARA, enquanto as alterações mandibulares foram decorrentes do crescimento natural. Ambos os dispositivos promoveram significativamente mais retrusão dos incisivos superiores, inclinação vestibular dos incisivos inferiores e melhora da sobressaliência e relação molar, em comparação com o controle. Conclusões: Ambos os dispositivos funcionais associados ao aparelho fixo foram efetivos na correção da má oclusão de Classe II. No entanto, a combinação AEB-At apresenta efeitos esqueléticos superiores, devido à restrição de crescimento maxilar significativamente maior do que com o aparelho MARA. Além disso, os aparelhos apresentaram efeitos dentoalveolares semelhantes.

Psychological and financial impact of the COVID-19 pandemic during the first stages of the pandemic: Brazilian orthodontists´ perspective

ABSTRACT Introduction: Brazil faced a catastrophic situation in the coronavirus pandemic. Due to the high risk of contamination and spread of COVID-19, dentist have been attending only urgency and emergency services in Brazil at the beginning of the pandemic. Objective: This research aimed to evaluate the psychological and financial impacts caused by the coronavirus pandemic in Brazilian orthodontists. Methods: This population-based cross-sectional study collected demographic data and mental health measurements from 404 orthodontists. Depression, anxiety, insomnia, and distress were evaluated through Brazilian versions of the 9-item Patient Health Questionnaire (9-PHQ), the 7-item Generalized Anxiety Disorder scale and Mini-Tracking (GAD), the 7-item Insomnia Severity Index (ISI), and the 22-item Impact of Event Scale-Revised (IES-R), respectively. The demographic data of the sample was described using descriptive statistics. The data was analyzed according to sex, professional status, and economic income. Comparisons were performed using Chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis followed by post-hoc tests. Results: Females, graduate students, and lower incomes subgroups showed higher levels of depression, anxiety, insomnia, and distress. Most orthodontists showed moderate to extreme financial and professional concerns during the pandemic. Conclusion: The coronavirus pandemic negatively affected the psychological health and increased the financial concerns of the Brazilian orthodontists, mainly female, graduate students, and with income below 10k participants.

RESUMO Introdução: O Brasil enfrentou uma situação catastrófica durante a pandemia do coronavírus. Devido ao alto risco de contaminação e disseminação do vírus da COVID-19, os cirurgiões-dentistas passaram a realizar apenas atendimentos de urgência ou emergência no início da pandemia. Objetivo: O presente estudo teve como objetivo avaliar o impacto financeiro e psicológico causado pela pandemia do coronavírus nos ortodontistas brasileiros. Métodos: Este estudo transversal de base populacional coletou os dados demográficos e o impacto da pandemia em 404 ortodontistas. Depressão, ansiedade, insônia e angústia foram avaliadas, respectivamente, por meio da versão em português do Questionário de Saúde do Paciente (PHQ-9), do módulo de transtorno de ansiedade generalizada (GAD) do Mini-Tracking (GAD/Mini-Tracking), do Índice de Severidade de Insônia (ISI) e o do Impact of Events Scale-Revised (IES-R). As características demográficas da amostra foram apresentadas por meio de estatística descritiva. Os dados foram analisados de acordo com o sexo, situação profissional e renda econômica. As comparações foram realizadas utilizando os testes de Qui-quadrado, Mann-Whitney U e Kruskal-Wallis, seguidos de testes post-hoc (p<0,05). Resultados: Mulheres, estudantes de pós-graduação e profissionais com menores rendas apresentaram níveis mais altos de depressão, ansiedade, insônia e angústia. A maioria dos ortodontistas mostrou preocupação financeira e profissional moderada a extrema durante a pandemia. Conclusão: A pandemia do coronavírus afetou negativamente a saúde psicológica dos ortodontistas brasileiros e aumentou as preocupações financeiras desses profissionais. As mulheres, os estudantes de pós-graduação e os participantes com renda mensal menor que R$10 mil foram os grupos mais afetados.

Effects of Class II division 1 malocclusion treatment with three types of fixed functional appliances.

OBJECTIVE: This study aimed at comparing the dentoskeletal changes in patients with Class II division 1 malocclusion, treated with three types of fixed functional appliances. METHODS: A sample comprising 95 patients with the same malocclusion, retrospectively selected, and divided into four groups, was used: G1 consisted of 25 patients (mean age 12.77 ± 1.24 years) treated with Jasper Jumper appliance; G2, with 25 patients (mean age 12.58 ± 1.65 years) treated with the Herbst appliance; G3, with 23 patients (mean age 12.37 ± 1.72 years) treated with the Mandibular Protraction Appliance (MPA); and a Control Group (CG) comprised of 22 untreated subjects (mean age 12.66 ± 1.12 years). Intergroup comparison was performed with ANOVA, followed by Tukey test. RESULTS: The Jasper Jumper and the Herbst group showed significantly greater maxillary anterior displacement restriction. The Jasper Jumper demonstrated significantly greater increase in the mandibular plane angle, as compared to the control group. The MPA group demonstrated significantly greater palatal inclination of the maxillary incisors. Vertical development of the maxillary molars was significantly greater in the Herbst group. CONCLUSIONS: Despite some intergroup differences in the amount of dentoskeletal changes, the appliances were effective in correcting the main features of Class II malocclusions.

A comparative study of the MARA appliance and the activator-headgear combination in the treatment of class II division 1 malocclusion / Estudo comparativo dos aparelhos MARA e ativador combinado com AEB no tratamento da má oclusão de classe II divisão 1

O tratamento da má oclusão de Classe II Divisão 1, usando aparelhos ortopédicos associados ao aparelho ortodôntico fixo, mostrou excelentes resultados, quando usado em pacientes em crescimento. Este estudo teve como objetivo comparar os efeitos do tratamento da correção de Classe II com os aparelhos MARA (G1) e o Ativador combinado ao AEB (G2) e um grupo controle não tratado (G3). Cada grupo experimental foi constituído por 18 pacientes, com idade média de 11,70 (G1) e 10,88 (G2), tratados por tempo médio de 3,60 (G1) e 3,17 (G2) anos. O grupo controle (G3) consistiu de 20 indivíduos com idade média de referência de 11,07 anos. Os grupos foram avaliados antes (T1) e após (T2) o tratamento. Telerradiografias laterais foram utilizadas para avaliar as alterações esqueléticas e dentoalveolares após o tratamento (T2-T1), sendo utilizado um período comparável para o grupo controle. As comparações intergrupos em relação às alterações do tratamento foram realizadas usando a Análise de Variância (ANOVA), seguidas pelo teste de Tukey. Os efeitos dentoalveolares e a restrição maxilar melhoraram a relação maxilomandibular em G1 e G2. As alterações mandibulares foram decorrentes principalmente do crescimento craniofacial natural, sem alterações significativas nos tecidos moles. Concluiu-se que ambos os aparelhos corrigiram similarmente a má oclusão de Classe II.(AU)

The treatment of Class II Division 1 malocclusion using orthopedic devices combined with fixed orthodontic appliances has shown excellent results when used in growing patients. This study aimed to compare the treatment effects of Class II correction with MARA appliance (G1), AcHg combination appliance (G2), and an untreated control group (G3). Each experimental group was composed of 18 patients, with a baseline mean age of 11.70 (G1) and 10.88 (G2) years, treated for a mean time of 3.60 (G1) and 3.17 (G2) years. The control group (G3) consisted of 20 individuals with a baseline mean age of 11.07 years. The groups were evaluated before (T1) and after (T2) treatment. Lateral cephalometric radiographs were used to evaluate skeletal and dentoalveolar changes upon treatment (T2-T1), and a comparable period was used for the control group. Intergroup comparisons regarding treatment changes were performed using repeated measures analysis of variance (ANOVA) followed by Tukey's test. The dentoalveolar effects and maxillary restriction improved the maxillomandibular relationship in G1 and G2. Mandibular alterations were mainly due to natural craniofacial growth, with no significant alterations of soft tissues. It was concluded that both the appliances corrected similarly the Class II malocclusion.(AU)

StudentÆs Perceptions about Pediatric Dental Behavior Guidance Techniques throughout a five-year Dental Curriculum

To compare studentsÆ views about behavior management techniques (BMT) in pediatric dentistry, besides to identify whether educational components of dental curriculum may influence their perceptions.Material and Methods:Questionnaires with 18 statements, describing the techniques and clinical situations were distributed to students (n=83) from first-(P1), third-(P2) and eighth-(P3) semesters. StudentÆs acceptability scores were measured with a Likert scale from 0 (total disagreement) to 10 (total agreement). Statistical analysis was performed using Mann Whitney U test.Results:P3 students agreed with most of BMTs. Pair comparisons between P1-P2 showed significant increase of means for Told treatment may involve pain and Sedative, besides significant decrease for Use of euphemisms. Comparisons between P2-P3 and P1-P3 indicated significant increase in the acceptability for: Voice control, Told not to be coward, Modeling, Blunting, Use of euphemisms, Parent not present, HOME, Active and Passive Immobilization and pharmacologic techniques. In all semesters, Verbal positive reinforcement, Distraction and Tell-show-do were the most accepted techniques, however, there was no consensus regarding to the least accepted one. Promising a toy became less acceptable throughout the semesters and Parent not present became more acceptable.Conclusion:These findings indicate that educational process may influence on the studentsÆ perceptions about BMTs...

Caracterização da oferta do serviço de radiologia odontológica no Estado da Paraíba: evidenciando desigualdades e sub-registros / Characterization of dental radiographic service in the state of Paraíba: highlighting inequalities and sub-records

Caracterizar o serviço de radiologia odontológica no estado da Paraíba. Os dados coletados, do Departamento de Informática do Sistema Único de Saúde, foram: população total, população cadastrada na Atenção Básica (AB), número e distribuição de aparelhos de Raios-X Odontológico (ARXO), e produção de radiografias odontológicas. As cidades que possuíam aparelho foram agrupadas e comparadas segundo as mesorregiões paraibanas. Calculou-se para cada cidade: a razão entre população total e quantitativo de aparelhos; a razão entre população cadastrada na AB e quantitativo de aparelhos públicos; produção semestral e média mensal de produção de radiografias. Das 223 cidades da Paraíba, 21,1% possuem ARXO, sendo 356 aparelhos em uso, 77,2% privados e 66,9% concentrados na Zona da Mata. A média de pessoas para cada ARXO do Estado é 16.609, enquanto a média de usuários cadastrados na AB para cada ARXO público é 20.922. A produção semestral e média mensal de radiografias ambulatoriais são, respectivamente, 1.272 e 212. Verificou-se que 36,2% das cidades não registraram produção de radiografias durante o último semestre de 2008. O serviço ofertado concentra-se em poucas cidades, sendo, majoritariamente, de caráter privado, com alta taxa de pessoas por aparelhos e distribuição desigual. Há, provavelmente, sub-registro da produção.

To characterize the dental radiology service in Paraíba State. From Department of Informatics of the Unified Health System, data collected were: total population, population covered by Primary Care (PC), number and distribution of dental X-ray equipment (DXRE), and dental radiographs production. The cities which had the equipment were grouped and compared according to Paraíba's regions. We calculated for each city: ratio between total population and amount of equipment; ratio between population covered by PC and quantity of public equipment; biannual and the monthly averages of radiographs production. Of the 223 cities, 21.1% are equipped with DXRE, which 356 are in use, 77.2% are private, and 66.9% concentrate in Zona da Mata region. The average of person per each DXRE is 16,609, while the average of people enrolled in PC for each public DXRE is 20,922. The biannual and the monthly production of radiographs are, respectively, 1,272 and 212. We found that 36.2% of the cities reported no X-rays production during the last half of 2008. The service is concentrated in a few cities, being mostly private, with a high rate of people per equipment and inequitable distribution. Probably, there is a production underreporting.

Efeito antimicrobiano de tinturas de produtos naturais sobre bactérias da cárie dentária / Antimicrobial effect of natural dyeing products upon decaycausing bacteria

Objetivo: Avaliar as atividades bacteriostática e bactericida de tinturas de Rosmarinus officinalis (Alecrim), Calendula officinalis(Calêndula) e Mikania glomerata (Guaco) sobre bactérias da cárie dentária e compará-las às da clorexidina. Métodos: A Concentração Inibitória Mínima (CIM) foi determinada pela técnica da microdiluição, utilizando microplacas de 96 furos. Em cada poço foram inseridos 10μL do inóculo (108células/mL), 100μL de caldo BHI duplamente concentrado e 100μL das tinturas, em concentrações que variaram de 100 a 0,78mg/mL, para T1, T2 e T3. Como controle positivo foi utilizado a Clorexidina 0,12%. A leitura foi feita após 24 horas, pelo método visual. Os ensaios foram realizados em triplicata. A Concentração Bactericida Mínima (CBM) foi obtida pela semeadura da última concentração bacteriostática e da sua anterior, para cada produto, em meio Ágar Sangue. Foram consideradas CBM as placas que não apresentaram crescimento bacteriano. Resultados: Sobre Streptococcus mutans, verificou-se CIM de 6,25mg/mL, para T1, T2 e T3 e CBM de 12,5mg/mL para T1 e T2 e de 6,25mg/mL para T3. Sobre Streptococcus oralis todos os produtos apresentaram CIM e CBM de 0,78mg/mL. Para clorexidina, a CIM e CBM foram 0,04mg/mL, sobre S. mutans e S. oralis. Conclusão: As tinturas de Alecrim, Calêndula e Guaco apresentaram ação bactericida e bacteriostática em baixas concentrações, sobre Streptococcus mutans e Streptococcus oralis, entretanto a atividade antimicrobiana da Clorexidina foi superior a das tinturas.

Objective: To evaluate the bacteriostatic and bactericidal activities of tinctures of Rosmarinus officinalis (Rosemary), Calendula officinalis (Marigold) and Mikania glomerata (Guaco) upon decay-causing bacteria and compare them to chlorhexidine’s. Methods: The Minimum Inhibitory Concentration (MIC) was determined by microdilution technique, using 96-well microplates. In each well were inserted 10μL of inoculum (108 cells/mL), 100μL of doubly concentrated BHI broth and 100μL of tinctures at concentrations that vary between 100 and 0.78 mg/mL for T1, T2 and T3. As positive control, Chlorhexidine 0.12% was used. Reading was performed after 24 hours, by visual method. The assays were realized in triplicate. Minimum Bactericidal Concentration (MBC) was obtained by seeding of last bacteriostatic and its preceding concentrations, for each product, on Blood Agar. The MBC was considered in the plates that did not present any bacterial growth. Results: Upon Streptococcus mutans, MIC was verified at 6.25mg/mL, for T1, T2, and T3 and MBC at 12.5mg/mL for T1 and T2, and at 6.25mg/mL for T3. Upon Streptococcus oralis, all products presented MIC and MBC at 0.78mg/mL. For Chlorhexidine, the MIC and MBC were 0,04mg/mL, upon S. mutans and S. oralis. Conclusion: The tinctures of Rosemary, Marigold and Guaco showed bactericidal and bacteriostatic activities at low concentrations, upon Streptococcus mutans e Streptococcus oralis. However, the antimicrobial activity of chlorhexidine was superior to the tinctures’.

O acesso ao cuidado em saúde bucal para crianças com deficiência motora: perspectivas dos cuidadores / Access to oral health care for children with motor disability: caregivers' perspectives

Objetivo: Avaliar o acesso e identificar as barreiras ao cuidado em Saúde Bucal de Crianças com Deficiência Motora (CDM) em João Pessoa - PB, a partir das perspectivas de seus cuidadores. Metodologia: Utilizou-se abordagem indutiva, procedimento descritivo e técnica de observação direta intensiva, por meio de entrevista. Participaram do estudo 43 dos 59 cuidadores de CDM de 0-12 anos identificados, selecionados por conveniência. As entrevistas, gravadas em áudio, foram transcritas e analisadas descritivamente e qualitativamente (técnica do Discurso do Sujeito Coletivo - DSC). Resultados: Segundo relato dos cuidadores, o diagnóstico das crianças foi Paralisia Cerebral (86%; n=36), Hidrocefalia (4%; n=2), Mielomenigocele (2%; n=2), Síndrome de West (2%; n=1), Síndrome de Down (2%; n=1) e Síndrome de Rett (2%; n=1). O acesso ao dentista foi obtido por 69% (n=30) das crianças, sendo 50% (n=15) no setor privado. Dificuldades para obter o acesso foram encontradas por 65% (n=28), entre elas, baixa oferta de dentistas para atender pacientes especiais (75%; n=21), demora no agendamento (18%; n=5) e indisponibilidade de realizar o procedimento com anestesia geral (7%; n=2). O DSC obtido da percepção sobre o cuidado em saúde bucal foi: O cuidado em Saúde Bucal é medidas de prevenção, promoção e controle, através da higienização e eliminação de hábitos deletérios, além do acompanhamento periódico com o dentista. Conclusão: A partir da percepção do cuidador, o acesso ao cuidado em saúde bucal das CDM é difícil, apresentando como barreiras: baixa oferta de dentistas para atender pacientes especiais, demora no agendamento e necessidade de anestesia geral.

Objective: To evaluate the access and identify obstacles for oral health care of Children with Motor Disability (CMD) in the city of Joao Pessoa - PB, from caregivers' perspectives. Methods: It was employed an inductive approach, descriptive procedure and intensive direct observation technique by means of interview. The study encompassed 43 out of the 59 caregivers of identified CMD aged 0-12 years, selected by convenience. Audio-recorded interviews were transcripted and analyzed descriptively and qualitatively (Collective Subject Discourse technique - CSD). Results: According to caregivers' reports, children's diagnoses were cerebral palsy (86%; n=36), hydrocephaly (4%; n=2), spina bifida (2%; n=2); West syndrome (2%; n=1), Down syndrome (2%; n=1) and Rett syndrome (2%; n=1). The access to dentist was achieved by 69% (n=30) children, from which 50% (n=15) was in the private practice. Difficulties in getting access were found by 65% (n=28); among those, are: low supply of dentists to support disabled patients (75%; n=21), delay in scheduling (18%; n=5) and unavailability to perform the procedure without general anesthesia (7%; n=2). The CSD gathered from the perception on oral health was: Oral health care is measures for prevention, promotion and control, through cleansing and elimination of harmful habits, besides being a regular follow-up by the dentist. Conclusion: From the caregiver's perception, access to oral health care by CMD is hard, presenting as obstacles: low supply of dentists to support disabled patients, delay in scheduling and need for general anesthesia.