Tomographic evaluation of dentoskeletal changes due to the treatment of class II malocclusion with Forsus appliance.

PURPOSE: This study evaluated dentoalveolar skeletal changes promoted by the Forsus appliance, associated to fixed orthodontic appliance, in the correction of Class II, division 1 malocclusion, from Computed Tomography (CT). METHODS: sample consisted of 10 youngsters (7 males and 3 females), with a mean age of 13.86 years. Two Forsus® models were installed after the alignment and leveling phase of the teeth. Two tomographic images of each patient, T1 and T2 (initial and immediately after removal of Forsus® appliance) were done to perform the anatomical tracings and obtain the variables of interest. The data were described by means and standard deviations. For the comparison between the initial and final phases, the paired "t" test was used and a significance level of 5% was considered (p < 0.05). RESULTS: small skeletal changes were observed, such as posterior maxillary displacement and a slight mandibular growth. Larger dentoalveolar changes occurred as extrusion, retrusion and lingualization of upper incisors; Intrusion, protrusion and vestibularization of the lower incisors; Mesialization and extrusion of lower molars. CONCLUSION: Considering the patients evaluated in this study, Forsus® presented similar results to other mandibular propulsion appliances, with dentoalveolar effects that favored Class II correction, however, with very slight skeletal modifications.

Otimização do procedimento de colagem de braquetes ortodônticos utilizando um recipiente fotoprotetor: passo a passo / Optimization of the bonding procedure of orthodontic brackets using a photoprotective vessel: step-by-step

A resina composta fotoativável é usualmente utilizada para o procedimento de colagem de braquetes ortodônticos. No entanto, seu uso requer cuidados antes da fotoativação, pois sua polimerização pode ocorrer precocemente por outras fontes de luz, que não a de um fotoativador dentário (e.g., luz ambiente). Foi idealizado um recipiente fotoprotetor que permite o armazenamento temporário do conjunto de pinças com os braquetes preparados com resina em sua base, evitando o processo de polimerização da resina antes do momento desejado. Objetivo: este estudo tem como objetivo apresentar uma descrição detalhada do procedimento de colagem de braquetes ortodônticos estéticos cerâmicos, quando se utiliza um recipiente fotoprotetor para otimizar o atendimento. Relato de caso: paciente do sexo feminino, 24 anos de idade, submeteu-se ao tratamento ortodôntico em clínica particular. Foram utilizados braquetes ortodônticos autoligados, cerâmicos de alumina policristalina. A colagem dos braquetes foi realizada na arcada inferior de maneira tradicional, porém se fez uso de um recipiente fotoprotetor (protótipo) para otimizar o procedimento. O recipiente teve como finalidade principal o armazenamento temporário de braquetes ortodônticos apreendidos em pinças ortodônticas, já com resina composta para colagem em suas bases. Concluiu-se a instalação do aparelho ortodôntico com a colocação de um arco ortodôntico redondo Ni-Ti 0,014". Considerações finais: a utilização do recipiente fotoprotetor mostrou-se clinicamente eficaz e apresentou um bom resultado final da satisfação tanto do profissional quanto do paciente. O seu uso foi capaz de reduzir o tempo de cadeira do paciente durante o procedimento e impediu a polimerização precoce da resina composta de colagem utilizada. (AU)

The photo-activated resin composite is usually used for the bonding procedure of orthodontic brackets. However, their use requires caution prior to photoactivation, as their polymerization may occur early by light sources other than a dental photoactivator (e.g. ambient light). A photoprotective vessel has been developed to allow temporary storage of the clamps assembly with the resin-prepared brackets, avoiding the polymerization process of the resin prior to the desired moment. Objective: this study purpose was to present a detailed description of the bonding procedure of ceramic orthodontic brackets when using a photoprotective vessel to optimize care. Case report: a 24-year-old female patient underwent orthodontic treatment in a private practice. Orthodontic brackets of polycrystalline alumina ceramics were used for treatment. Bracket bonding was performed in the lower arch in the traditional manner, however a photoprotective vessel (prototype) was used to optimize the procedure. The main purpose of the vessel was the temporary storage of orthodontic brackets- -clamps assembly, already with composite resin for bonding in their bases. The installation of the orthodontic appliance was finished with the placement of a 0.014" round Ni-Ti orthodontic arch. Final considerations: the use of the photoprotective vessel was clinically effective and with a good end result in both professional and patient satisfaction. Its use was able to reduce the patient's chair time during the procedure and prevented the early polymerization of the bonded composite resin used. (AU)

Agenesis of all permanent maxillary incisors: A rare clinical case with an interdisciplinary solution.

BACKGROUND: Clinical cases involving agenesis of all four maxillary incisors are rare, with no previous reports in the literature. CASE REPORT: The present case report describes an orthodontic treatment combined with esthetic dentistry in a 10-year-old girl with agenesis of all four permanent maxillary incisors, anterior crossbite, permanence of deciduous maxillary canines and transmigration of permanent maxillary canines into the region of the maxillary central incisors. For this case, it was decided on space closure using a fixed orthodontic apparatus and reshaping of the first premolars transforming them into canines. Porcelain veneers were used on the permanent and deciduous canines, substituting the maxillary central and lateral incisors, respectively. Regarding outcome, there was an improvement in facial profile, correction of the anterior crossbite, satisfactory intercuspidation of the teeth and significant esthetic improvement in smile. Maintaining the patient´s natural dentition also kept the bone plate intact for future placement of implants to substitute maxillary deciduous canines at the appropriate age. CONCLUSIONS: Interdisciplinary planning combining orthodontics and esthetic dentistry was key in resolving this case. Key words:Tooth agenesis, upper incisors, orthodontic treatment.

Incidental findings in patients evaluated with cone beam computed tomography for orthodontic treatment / Achados incidentais em tomografia computadorizada de feixe cônico em pacientes avaliados para tratamento ortodôntico

ABSTRACT Objective: The aim of this retrospective study was to determine and quantify incidental findings in CBCT scans taken exclusively for orthodontic purposes. Methods: A total of 202 scans were evaluated by two examiners and classified into five different groups. Results: A total of 227 incidental findings were found in a sample of patients aged 5-58 years old. The highest number of findings was of dental origin (n = 157), followed by airway (N = 46), skull (N = 16) and ATM (n = 8). Scans with no incidental finding accounted for 20% of the examinations. Subjects having lower mean age were found in the group of airway findings. The prevalence of incidental findings in the current study was consistent with the literature, thus corroborating their high frequency. Orthodontists who make use of CBCT are responsible for assessment of all data. Conclusion: The precise evaluation of incidental findings may help in the early diagnosis, treatment and patient monitoring. Further studies should be conducted to assess the influence of these findings on the orthodontic treatment.

RESUMO Objetivo: Investigar e quantificar achados incidentais em exames de tomografia computadorizada de feixe cônico realizadas unicamente para fins ortodôntico. Métodos: Foram incluídos os exames de tomografia de feixe cônico com finalidade de diagnóstico ortodôntico no período de novembro de 2011 a abril de 2014 (n=202) avaliados por dois examinadores e os dados coletados classificados em cinco grupos diferentes. Foi realizada análise exploratória dos dados através do cálculo de média, desvio padrão, frequência e porcentagem. A associação entre o local do achado e o gênero foi verificada através do teste exato de Fisher. Resultados: Foi encontrado um total de 227 achados; o grupo com maior número de achados foi o de origem dental (n=157), seguido do grupo de vias aéreas (n=46), de crânio (n=16) e de ATM (n=8). Exames sem nenhum achado representaram 20% do total. Os sujeitos com menores médias de idade foram encontrados no grupo de vias aéreas. A prevalência de alterações tomográficas incidentais em pacientes ortodônticos é alta. Conclusão: Um cuidadoso diagnóstico das imagens de tomografia de feixe cônico além da região de interesse ortodôntica é indispensável para prevenir patologias ocultas. Estudos adicionais podem ser realizados para avaliar qual a influência desses achados no tratamento ortodôntico.

Prevalência de dentes supranumerários em pacientes de Ortodontia / Supernumerary teeth prevalence in Orthodontic patients

Existem várias alterações nos arcos dentários, entre estas se encontram as de número, forma e tamanho dos dentes. O dente supranumerário representa um fator etiológico importante e frequente da má oclusão. Este trabalho teve o objetivo de avaliar a prevalência de dentes supranumerários nos pacientes tratados nos cursos de pós-graduação em Ortodontia da Universidade Cidade de São Paulo. A amostra, composta por 1117 radiografias panorâmicas de pacientes que se submeteram a tratamento ortodôntico corretivo, foi estudada quanto à distribuição da prevalência de dentes supranumerários entre os gêneros, os arcos dentários e as regiões bucais. A média de idade da amostra foi de 13,7 anos, sendo que 56% dos pacientes eram do gênero feminino e 44% do masculino. Do total analisada, apenas 18 pacientes (1,61%) apresentaram dentes supranumerários. Em relação ao gênero, verificou-se uma prevalência de 1,9% no gênero feminino, enquanto o gênero masculino apresentou prevalência de 1,2%. Na comparação entre os gêneros não se verificou diferença com significância estatística. No total foram constatados 24 dentes supranumerários, uma vez que existiram radiografias de pessoas com a presença de mais de um dente supranumerário. Destes 24 dentes, 16 estavam no arco superior e 8 no arco inferior. A partir da metodologia aplicada e dos resultados obtidos, pôde-se concluir que: a prevalência de dentes supranumerários foi de 1,61% dos indivíduos da amostra; não se pôde verificar diferença significante na prevalência de supranumerários entre os gêneros masculino e feminino; e a prevalência de dentes supranumerários foi estatisticamente semelhante para os arcos dentários superior e inferior, apesar de 66,7% deles terem sido localizados no arco superior

There are several tooth abnormalities in the dental arches, which can be in the number, shape or size of the teeth. The supernumerary teeth represent an important etiologic factor of malocclusion, quietly frequent. This study aimed to evaluate the prevalence of supernumerary teeth in the patients who has been orthodontic treated in the Graduation course of University of São Paulo City (UNICID). The sample, which consisted of 1117 panoramic radiographs of patients who have undergone orthodontic treatment, was studied on the distribution of the prevalence of supernumerary teeth gender, dental arches and mouth regions. The average age of the sample was 13.7 years, and 56% of patients were female and 44% male. Of the total analyzed, only 18 patients (1.61%) had supernumerary teeth. Regarding to gender, there was a prevalence of 1.9% among females, while males showed prevalence of 1.2%. In comparing genders, there was no statistically significant difference. A total of 24 supernumerary teeth were observed, once existed radiographs from people with more than one supernumerary tooth. Considering these 24 supernumerary teeth, 16 were located in the upper arch, while just 8 were in the lower arch. From the applied methodology and the results obtained, it could be concluded that: the prevalence of supernumerary teeth was 1.61% of individuals in the sample; There was not found significant differences in the prevalence of supernumerary between males and females; and prevalence of supernumerary teeth was statistically similar to the upper and lower dental arches, although 66.7% of them being located on the upper arch

Posicionadores de braquetes ortodônticos ? revisão de literatura e desenvolvimento de um projeto de patente / Orthodontic brackets positioning ? literature review and development of a patent project

Em Ortodontia, a colagem de braquetes é um dos passos mais importantes durante o tratamento, principalmente na técnica Straight Wire, na qual os acessórios possuem uma forma específica para levar cada dente à posição prescrita, no que se refere à inclinação, angulação, ou mesmo adequando a posição vestíbulo-lingual das coroas, que variam devido às suas diferentes espessuras anatômicas. Outro ponto fundamental é a altura na qual os braquetes são posicionados, o que interfere diretamente na oclusão e na estética do sorriso. Se ocorre o posicionamento incorreto dos braquetes, além de contatos prematuros e outros possíveis danos, o profissional despenderá mais tempo realizando dobras compensatórias ou recolagens de acessórios. Assim sendo, o objetivo deste trabalho foi desenvolver e inscrever um projeto de patente, composto por um conjunto de posicionadores de braquetes ortodônticos, no intuito de promover um melhor e mais fácil posicionamento dos braquetes durante a colagem, diminuindo a chance de erros, otimizando o processo e tornando a rotina daclínica ortodôntica mais previsível e eficiente

In Orthodontics, brackets bonding is one of the most important steps during the treatment, especially in Straight Wire technique, in which accessories have an specific shape to led each tooth to its correct position, considering inclination, angulation, or even the buccal-lingual crowns position, that varies according to its thickness. Another important point is the height of the brackets, what interferes directly in the occlusion and in smile aesthetics. When an incorrect positioning of the brackets occurs, the clinician wastes time with rebonding or making wire bends. The aim of this study was to develop and submit a patent project, composed by a kit of brackets positioners, to promote a better and easier positioning during bonding, decreasing the chances of errors, optimizing the process and improving the orthodontic routine, with more predictability and efficiency

Pleasantness of facial profile and its correlation with soft tissue cephalometric parameters: Perception of orthodontists and lay people.

OBJECTIVE: This study was aimed to evaluate the perception of orthodontists and of lay people about the facial profile and its possible correlation with cephalometrics parameters. MATERIALS AND METHODS: A total of 20 evaluators were divided into two groups (10 orthodontists and 10 people with no relation to such area - lay people). They were asked to evaluate the photographs of 25 young males and of 25 young females, aged 17-24-year-old (mean age of 22.3 years, standard deviation 2.41 years). Photographs were randomly arranged in a photo album. The evaluators rated each photograph by means of a scale ranging from "good" to "deficient" based on the pleasantness of their facial profile. Nasolabial angle, Holdaway's H-line and the distance from H-line to nose tip were measured, in order to verify a possible relation between these soft tissue profile cephalometric measurements and the subjective ratings. RESULTS: The kappa statistics test showed a concordance of 0.23 among orthodontists and 0.24 among lay people. Regarding the perception of orthodontists and lay people on facial profile, no significant divergence could be detected. For the correlation between cephalometric parameters and subjective ratings, there was a statistically significant correlation between the measures H and H-nose and the rating ascribed to the profile. CONCLUSIONS: It was concluded that smaller the difference from the normal cephalometric pattern, the higher was the rating given to the profile, demonstrating an important relation between subjective and objective criteria.

The influence of fränkel-2 function regulator in the lower anterior teeth crown length / Influência da utilização do regulador de função frankel-2 no comprimento da coroa clínica dos dentes anteriores inferiores

Functional orthopedic appliances used for Class II malocclusion treatment, usually work by guiding jaws growth and modifying dental positions. Among these dentoalveolar effects, it is the lower incisors buccal tipping, that helps to improve the overjet, but may cause gingival recessions, especially when associated with other etiological factors. The objective of this study was to evaluate the clinical crown length of the lower anterior teeth in individuals with Angle's Class II malocclusion, after treatment with Fränkel-2 function regulator appliance (RF-2). Fifty Class II-malocclusion individuals were divided into 2 groups: G1 ­ 14 male, and 11 female, treated with the Fränkel-2 function regulator appliance for 18 months, with average pre-treatment age (T1) of 11 years (sd=7 months) and average post-treatment age (T2) of 12 years and 7 months (sd=7 months); and G2 ­ a control group with 25 individuals (12 male and 13 female) with average age at T1 of 10 years and 3 months (sd=11 months) and at T2 of 12 years and 1 month (sd=11 months), which was part of a normal occlusion sample. The 100 dental cast models were analyzed at T1 and T2, with a digital caliper, measuring the distance from the incisal edge to the most concave portion of the gingival margin of lower incisors and canines. Data were checked by a Student's t-test and a paired t-test. Considering T2, the group 1 presented a significant increase in the crown length of all lower anterior teeth. On the other hand, in the group 2, this was observed only for the teeth 33, 42 and 43, suggesting that patients treated with RF-2 had more gingival recession than the control group.

Os aparelhos ortopédicos funcionais utilizados para o tratamento da má oclusão de Classe II normalmente atuam guiando o crescimento dos maxilares e modificando as posições dentais. Dentre esses efeitos dento alveolares está a inclinação dos incisivos inferiores para vestibular, o que auxilia na melhora do overjet, mas pode causar recessões gengivais, especialmente se associado a outros fatores etiológicos. O objetivo deste estudo foi avaliar o comprimento da coroa clínica dos dentes anteriores inferiores em indivíduos com má oclusão de Classe II, após o tratamento com o aparelho regulador de função Fränkel-2 (RF-2). Cinquenta indivíduos com Classe II foram divididos em dois grupos: G1 ­ 14 meninos e 11 meninas, tratados com o aparelho regulador de função Frankel-2, por 18 meses, com média de idade pré-tratamento (T1) de 11 anos (DP=7 meses) e média de idade pós-tratamento (T2) de 12 anos e 7 meses (DP=7 meses); e G2 ­ um grupo controle com 25 indivíduos (12 meninos e 13 meninas) com média de idade em T1 de 10 anos e 3 meses (DP=11 meses) e em T2 de 12 anos e 1 mês (DP=11 meses), que fazia parte de uma amostra de oclusão normal. Os 100 modelos de gesso foram avaliados em T1 e T2, com um paquímetro digital, medindo a distância da borda incisal à parte mais côncava da margem gengival dos incisivos e caninos inferiores. Os dados foram checados pelo teste t de Student e pelo teste t pareado. Considerando T2, o grupo 1 apresentou um aumento significante no comprimento das coroas de todos os dentes anteriores inferiores. Por outro lado, no grupo 2, isto foi observado somente para os dentes 33, 42 e 43, sugerindo que os pacientes tratados com o RF-2 apresentaram mais recessões gengivais do que o grupo controle.

Avaliação da deformação de cadeias elásticas de diversas marcas em diferentes tempos / Evaluation of various elastomeric chains deformation brands in different times

O objetivo deste trabalho foi avaliar a deformação elástica de 14 marcas comerciais nos períodos de sete, 14, 21 e 28 dias. Três elos de cada elástico foram cortados e mensurados para a individualização do estiramento de 50% do tamanho original. Cinco amostras de cada fabricante foram colocadas em um template, onde permaneceram estiradas, presas por amarrilhos metálicos, imersas em saliva artificial (Saliform, Fórmula & Ação, São Paulo, Brasil), em estufa a 37°C. Para cada tempo, os elásticos foram removidos, aferidos por paquímetro digital e descartados. Os dados foram submetidos à estatística descritiva, Anova a dois critérios e teste de Tukey (5%). A Anova indicou diferença estatisticamente significativa entre as marcas comerciais e entre os tempos avaliados, assim como entre as possíveis interações entre os grupos. O teste de Tukey demonstrou a formação de grupos homogêneos entre as marcas, demonstrando que os grupos que melhor se comportaram foram: TP Orthodontics, GAC e Rock Mountain. Verificou-se ainda que, quanto maior o tempo que os elásticos permaneceram estirados, mais eles se deformaram. Concluiu-se que existe deformação plástica em todas as marcas, variando em função da marca, aumentada em função do tempo.

The aim of this work was to evaluate elastic deformation of 14 different brands after 7, 14, 21 and 28 days stretched. Three loops were cut and measured with a digital caliper to stretch individualization of 50% of the original size. Five samples of each brand were placed directly in the template where it remained stretched by metal ligadures in artificial saliva at 37°C. For each period, elastics were measured and discarded. Data was submitted to descriptive statistical analysis, 2-way Anova and Tukey test (5%). 2-way Anova showed statistically significant difference among trademarks, intervals measured; as well as possible interactions among groups. Tukey test showed best behavior for TP Orthodontics, GAC and Rock Mountain. It was also verified that elastics deformation was proportional to the stretching time. It was concluded that there was plastic deformation in all brands, varying among brands, increasing in function of time.

Avaliação da inclinação vestibulolingual dos tubos de primeiros molares inferiores da prescrição MBT / Evaluation of the inclination buccolingual of the first molar tubes in MBT prescription

O presente estudo avaliou a precisão do torque de tubos metálicos de primeiros molares inferiores na prescrição MBT, em seis marcas comerciais: Unitek 3M, Abzil, American Orthodontics, Morelli, Aditek e TP Orthodontics. Empregaram-se 20 tubos de cada marca, totalizando 120 tubos. As imagens ampliadas do perfil dos tubos foram obtidas por um único operador, com a utilização de um microscópio eletrônico de varredura, e os ângulos foram mensurados empregando-se o software AutoCAD 2008 (32 Bit). O ângulo vestibulolingual foi determinado pelos ângulos APO (ângulo da parede oclusal) e APC (ângulo da parede cervical), e foram comparados aos valores de referência de -20º. Para a análise estatística, utilizou-se o teste paramétrico de análise de variância (Anova) e o teste de Tukey HSD, com intervalo de confiança de 95% e nível de significância de p < 0,05. Considerando-se os ângulos APO e APC, a marca Aditek foi a que mais se distanciou do valor de prescrição. As marcas Unitek 3M e TP Orthodontics foram as que mais se aproximaram dos valores de prescrição, respectivamente, para os ângulos APC e APO. Concluiu-se que existem variações na inclinação vestibulolingual dos tubos avaliados, podendo comprometer o posicionamento final dos dentes.

The aim of this current study was to evaluate the torque precision of the first lower molar metallic tubes according to the MBT prescription in six different commercial brands: Unitek 3M, Abzil, American Orthodontics, Morelli, Aditek e TP Orthodontics. Twenty tubes of each brand were used, adding up to 120 tubes. The enlarged images of the tube profiles were obtained by only one operator using an electronic scanning microscope, and the angles were measured by using the AutoCAD 2008 (32 bits) software. The buccolingual angle was determined by the angles APO (occlusal wall angle) and APC (cervical wall angle) and they were compared to the reference values of -20°. For statistical analysis, the parametric test of analysis of variance (Anova) and Tukey HSD test were used, with a confidence interval of 95% and significance level of p < 0.05. Considering the APO and APC angles, the Aditek brand was the one which got the farthest from the prescription value. Unitek 3M and TP Orthodontics were the nearest ones to the prescription values, respectively, for the APC and APO angles. It was concluded that there are variations in the buccolingual inclination of the tubes which were evaluated, compromising the final positioning of the teeth.

The inadequacy of the Y-axis of growth (SNGn) for the vertical pattern assessment in patients with sagittal discrepancies.

AIM: The aim of this cephalometric study was to evaluate the influence of the sagittal skeletal pattern on the 'Y-axis of growth' measurement in patients with different malocclusions. MATERIALS AND METHODS: Lateral head films from 59 patients (mean age 16y 7m, ranging from 11 to 25 years) were selected after a subjective analysis of 1630 cases. Sample was grouped as follows: Group 1 - class I facial pattern; group 2 - class II facial pattern; and Group 3 - class III facial pattern. Two angular measurements, SNGoGn and SNGn, were taken in order to determine skeletal vertical facial pattern. A logistic regression with errors distributed according to a binomial distribution was used to test the influence of the sagittal relationship (Class I, II, III facial patterns) on vertical diagnostic measurement congruence (SNGoGn and SNGn). RESULTS: RESULTS show that the probability of congruence between the patterns SNGn and SNGoGn was relatively high (70%) for group 1, but for groups II (46%) and III (37%) this congruence was relatively low. CONCLUSION: The use of SNGn appears to be inappropriate to determine the vertical facial skeletal pattern of patients, due to Gn point shifting throughout sagittal discrepancies. Clinical Significance: Facial pattern determined by SNGn must be considered carefully, especially when severe sagittal discrepancies are present.

Association between the facial type and morphology of the upper central incisor in normal occlusion subjects.

AIM: The purpose of this study was to verify the association between the facial type and the morphology of the upper central incisor, to potentially provide a guide for artificial tooth selection in esthetic and prosthetic rehabilitation. MATERIALS AND METHODS: The sample consisted of 51 lateral teleradiographs (lateral cephalometric radiographs) and cast models of subjects with a naturally optimal occlusion and at least four of the six keys of Andrews, for optimal occlusion. The facial type was defined by two cephalometric measurements (SN.Gn and SN.GoGn) and classified into dolichofacial, meso- facial and brachyfacial after digitizing the radiographs. The incisor morphology was classified into quadrangular, oval and triangular after 3D digitizing the models and evaluation of the images by 12 dentists. The evaluation between the examiners was performed by Kappa test. In order to test the differences between the variables, it was used a chi-square test (5%). RESULTS: No significant difference (p < 0.05) was found between the studied variables. CONCLUSION: Facial type was not associated with the morphology of the upper central incisor, considering the methodology and population included in the present study. CLINICAL SIGNIFICANCE: Using the facial type as a way to select the morphology of the upper central incisor proved to be inadequate in this study.

Evaluation of the Cervical Vertebrae Maturation Index in Lateral Cephalograms Taken in Different Head Positions

The aim of this study was to evaluate if upward or downward head inclination might interfere with determination of the growth stage, using cervical vertebrae maturation index (CVMI), in order to verify the accuracy of such diagnosis when radiographs are taken with errors. Forty-nine patients, 26 females and 23 males, aged 9 to 15 years, were submitted to 3 lateral cephalograms: normal (NHP), with 15° upward head inclination (NHP-Up), and with 15° downward head inclination (NHP-Down). Three examiners evaluated the CVMI on the 147 cephalograms. The agreement among examiners was higher in the evaluation of cephalograms taken in NHP. The weighted Kappa test revealed moderate to substantial agreement between NHP and NHP-Up and between NHP and NHP-Down. There was greater agreement between NHP-Up and NHP-Down. It may be concluded that the evaluation of the CVMI on cephalograms in NHP is different as compared with radiographs taken with inclinations. Both NHP-Up and NHP-Down exhibited greater disagreement in the interpretation among examiners, since the evaluation method was not designed for cephalograms with positioning errors.

O objetivo deste estudo foi avaliar se a inclinação da cabeça para cima ou para baixo interfere na determinação do estágio de crescimento por meio do Índice de maturação das vértebras cervicais (IMVC), verificando a acurácia deste método de diagnóstico, quando as radiografias são tomadas com erros. Quarenta e nove pacientes, 26 do gênero feminino e 23 do masculino, entre 9 e 15 anos de idade, foram submetidos a 3 telerradiografias em norma lateral: posição natural de cabeça (PNC), cabeça inclinada 15° para cima (PNC-alta), e 15° para baixo (PNC-baixa). Três examinadores avaliaram o IMVC nas 147 telerradiografias. A concordância entre os examinadores foi alta na avaliação das telerradiografias obtidas em PNC. O teste Kappa revelou concordância moderada a substancial entre PNC e PNC-alta e entre PNC e PNC-baixa. Houve concordância significante entre PNC-alta e PNC-baixa. Pode-se concluir que a avaliação do IMVC em telerradiografias obtidas em PNC difere em comparação com as radiografias tomadas com inclinações. Tanto PNC-alta quanto PNC-baixa demonstraram maior discordância na interpretação entre os examinadores, uma vez que o método de avaliação não foi preconizado para telerradiografias com erros de posicionamento.

Evaluation of the cervical vertebrae maturation index in lateral cephalograms taken in different head positions.

The aim of this study was to evaluate if upward or downward head inclination might interfere with determination of the growth stage, using cervical vertebrae maturation index (CVMI), in order to verify the accuracy of such diagnosis when radiographs are taken with errors. Forty-nine patients, 26 females and 23 males, aged 9 to 15 years, were submitted to 3 lateral cephalograms: normal (NHP), with 15° upward head inclination (NHP-Up), and with 15° downward head inclination (NHP-Down). Three examiners evaluated the CVMI on the 147 cephalograms. The agreement among examiners was higher in the evaluation of cephalograms taken in NHP. The weighted Kappa test revealed moderate to substantial agreement between NHP and NHP-Up and between NHP and NHP-Down. There was greater agreement between NHP-Up and NHP-Down. It may be concluded that the evaluation of the CVMI on cephalograms in NHP is different as compared with radiographs taken with inclinations. Both NHP-Up and NHP-Down exhibited greater disagreement in the interpretation among examiners, since the evaluation method was not designed for cephalograms with positioning errors.

Evaluation of the stability of open bite treatment using a removable appliance with palatal crib combined with high-pull chincup

OBJECTIVE: The aim of this prospective study was to cephalometrically analyze the stability of dentoalveolar and skeletal changes produced by a removable appliance with palatal crib associated to high-pull chincup in individuals with anterior open bite treated for 12 months, and compare them to individuals with similar malocclusion and age, not submitted to orthodontic treatment, also followed for the same period. METHODS: Nineteen children with a mean age of 9.78 years old treated for 12 months with a removable appliance with palatal crib associated with chincup therapy were evaluated after 15 months (post-treatment period) and compared with a control group of 19 subjects with mean age of 9.10 years with the same malocclusion that was followed-up for the same period. Seventy-six lateral cephalograms were evaluated at T1 (after correction) and T2 (follow-up) and cephalometric variables were analyzed by statistical tests. RESULTS: The results did not show significant skeletal, soft tissue or maxillary dentoalveolar changes. Overall, treatment effects on the experimental group were maintained at T2 evaluation with an increase of 0.56 mm in overbite. Overjet and maxillary incisors/molars position (vertical and sagittal) remained essentially unchanged during the study period. Only mandibular incisors showed significant changes (labial inclination and protrusion) compared to control group. CONCLUSIONS: Thus, it can be concluded that the early open bite treatment with a removable appliance and palatal crib associated with high-pull chincup therapy provided stability of 95%.

OBJETIVO: avaliar cefalometricamente a estabilidade das alterações dentoesqueléticas e tegumentares, no protocolo de tratamento com o aparelho removível com grade palatina associado à mentoneira, em jovens portadores de mordida aberta anterior tratados por 12 meses, comparando-os com um grupo de jovens portadores de má oclusão semelhante que não foram submetidos ao tratamento ortodôntico. MÉTODOS: avaliou-se um total de 76 telerradiografias em norma lateral de 38 jovens. Dois grupos compuseram a amostra: o Grupo 1 (Controle), composto por 19 jovens (idade média de 9,10 anos) que não receberam qualquer tratamento para a correção de sua má oclusão; e o Grupo 2 (Tratado), composto por 19 jovens (idade média de 9,78 anos) que receberam o protocolo de tratamento durante 12 meses. Verificou-se a estabilidade do tratamento da má oclusão durante aproximadamente 15 meses após a remoção dos aparelhos. Os dados obtidos nas medidas cefalométricas (diferenças das médias das alterações) para os dois grupos foram computados pelo teste t de Student não pareado. RESULTADOS: os resultados mostraram que os componentes esquelético e tegumentar não apresentaram alterações significativas. O overbite, overjet e o posicionamento dos dentes superiores mantiveram-se estáveis. Os incisivos inferiores vestibularizaram e protruíram no Grupo Tratado, enquanto o Grupo Controle apresentou maior extrusão desses dentes. Os molares inferiores também extruíram mais significativamente no Grupo controle. CONCLUSÃO: pode-se concluir que o protocolo de tratamento da mordida aberta anterior utilizando aparelho removível com grade palatina associado à mentoneira mostrou estabilidade de aproximadamente 95%, ressaltando a grande importância desse tratamento na dentição mista.

Ethical and legal considerations on professional liability of the orthodontist

INTRODUCTION: After the enactment of Law 8078, of September 11, 1990, the Consumers Defense Code implied important alterations in Brazil's legal scenario, providing a greater balance in the relationship between consumers and service providers. From this law, dental surgeons came to establish a consumer relationship with their clients. OBJECTIVE: Due to the ethical and legal issues against the dental professionals, this work makes general considerations about the nature of the dentist´s obligation in services, specifically in Orthodontics. CONCLUSION: The responsibility of the professional shall be restricted to predictable risks and undertaken obligations. When the professional warns the client in a correct, clear and express manner, it will lower the chances of being later charged.

INTRODUÇÃO: após a promulgação da Lei nº. 8.078, de 11 de setembro de 1990, o Código de Defesa do Consumidor provocou importantes alterações no cenário jurídico brasileiro, proporcionando um maior equilíbrio nas relações estabelecidas entre os consumidores e os fornecedores de produtos e serviços. A partir dessa lei, os cirurgiões-dentistas passaram a estabelecer com seus pacientes uma relação de consumo. OBJETIVO: tecer considerações sobre a natureza obrigacional do cirurgião-dentista especialista em Ortodontia. CONCLUSÃO: a responsabilidade do contratado será compreendida entre os riscos previsíveis e as obrigações assumidas. Quando o profissional alerta de forma correta, clara e expressa, diminuem-se as chances de serem posteriormente cobrados.

Dentoalveolar comparative study between removable and fixed cribs, associated to chincup, in anterior open bite treatment.

OBJECTIVE: The aim of this prospective study was to compare the dentoalveolar effects produced by two types of palatal crib, removable (Rpc+C) and fixed (Fpc+C), combined with chincup in growing patients with anterior open bite. MATERIAL AND METHODS: each group comprised 30 patients, in the mixed dentition phase, with similar cephalometric characteristics and skeletal ages. Group 1 (Rpc+C) presented initial mean age of 8.3 years and mean anterior open bite of 4.0 mm. Group 2 (Fpc+C) presented initial mean age of 8.54 years and mean anterior open bite of 4.3 mm. The evaluation period comprised 12 months between initial (T1) and second lateral radiograph (T2). The T2-T1 changes were compared cephalometrically in the 2 groups using the non-paired t-test. RESULTS: Vertical changes in the posterior dentoalveolar region were similar between the groups (about 1 mm) and no significant differences were found in molar mesialization. The Fpc+C group had in average 1.6 mm more improvement of the overbite as a result of greater maxillary incisor extrusion (1.3 mm). Patients in this group also presented less lingual tipping of maxillary incisors and more mandibular incisors uprighting. CONCLUSIONS: The Fpc+C combination was more efficient in the correction of the negative overbite mainly due to greater extrusion of the maxillary incisors. However, the Rpc+C appliance promoted better upper and lower incisor inclination, resulting in a more adequate overjet.

A comparative study between lip bumper and headgear as maxillary molar retainers following distalization.

Abstract: There are many appliances that can be used to correct molar relationship, achieving upper molar distalization, in Class II malocclusion. This research aimed to study the dental effects promoted by lip bumper to retain maxillary molars that had previously been distalized using a Cetlin appliance in conjunction with headgear.

Avaliação da inclinação vestibulolingual dos tubos de segundos molares inferiores na prescrição MBT / Evaluation of the inclination bucco lingual of the second molar tubes on MBT prescription

O objetivo deste estudo foi avaliar a precisão do torque detubos metálicos na prescrição MBT, utilizando os segundos molaresinferiores como amostra representativa de quatro marcas comerciais.Quatro marcas que produzem tubos na prescrição foram selecionadas:Abzil, Aditek, American Orthodontics e 3M Unitek. Foram usados 20tubos de cada marca, constituindo 80 tubos. As imagens ampliadasdo perfil dos tubos foram obtidas por um único operador com autilização de um microscópio eletrônico de varredura, e os ângulosforam mensurados empregando-se o software AutoCAD 2008 (32Bit).Oângulo vestibulolingual foi estabelecido pela mensuração dos ângulosAPO (ângulo da parede oclusall e APC (ângulo da parede cervicall, eforam comparados aos valores de referência de -10°. Na avaliação dainclinação vestibulolingual por meio do ângulo APC, as marcas Abzil,American Orthodontics e 3M Unitek encontravam-se em conformidadecom a prescrição e eram semelhantes entre si. Para o ângulo APO,apenas a marca 3M Unitek ficou em conformidade com a prescrição,sem diferença estatística (p > 0,05).

The aim of the present study was to verify the torqueprecision of metallic tubes with MBT prescription using the lower secondmolars as the representa tive sample of four commercial brands. Fourtrademarks that provide MBT prescription tubes were selected: Abzil,Aditek, American Orthodontics, 3M Unitek. Twenty tubes each trademarkwere used, comprising 80 tubes. The enlarged images of the profile ofthe tubes were obtained by a single operator using a scanning electronmicroscope and the angles were measured using AutoCAD 2008 (32Bit).The bucco lingual angle was established by measuring the APO angles(angle of the oclusal wall) and were (angle of the cervical wall) and werecompared to reference values of -10°. In assessing the bucco lingualinclination angle by APC, the marks Abzil, American Orthodontics and3M Unitek were in accordance with the prescription and were similar. Forthe angle APO, only 3M Unitek was in accordance with the prescription,without statistical difference (p > 0.05).

Dentoalveolar comparative study between removable and fixed cribs, associated to chincup, in anterior open bite treatment

OBJECTIVE: The aim of this prospective study was to compare the dentoalveolar effects produced by two types of palatal crib, removable (Rpc+C) and fixed (Fpc+C), combined with chincup in growing patients with anterior open bite. MATERIAL AND METHODS: each group comprised 30 patients, in the mixed dentition phase, with similar cephalometric characteristics and skeletal ages. Group 1 (Rpc+C) presented initial mean age of 8.3 years and mean anterior open bite of 4.0 mm. Group 2 (Fpc+C) presented initial mean age of 8.54 years and mean anterior open bite of 4.3 mm. The evaluation period comprised 12 months between initial (T1) and second lateral radiograph (T2). The T2-T1 changes were compared cephalometrically in the 2 groups using the non-paired t-test. RESULTS: Vertical changes in the posterior dentoalveolar region were similar between the groups (about 1 mm) and no significant differences were found in molar mesialization. The Fpc+C group had in average 1.6 mm more improvement of the overbite as a result of greater maxillary incisor extrusion (1.3 mm). Patients in this group also presented less lingual tipping of maxillary incisors and more mandibular incisors uprighting. CONCLUSIONS: The Fpc+C combination was more efficient in the correction of the negative overbite mainly due to greater extrusion of the maxillary incisors. However, the Rpc+C appliance promoted better upper and lower incisor inclination, resulting in a more adequate overjet.