Evaluation of two stereophotogrametry software for 3D reconstruction of virtual facial models.

OBJECTIVE: The present study aimed to evaluate the accuracy of 3D facial soft tissue virtual models produced by two photogrammetry softwares (AgiSoft Photoscan and 3DF Zephyr Free), when compared to those created by cone beam computed tomography (CBCT). METHODS: Ten patients were submitted to two sequences of photographs performed with a DSLR camera (with and without the aid of a ring flash) and CBCT scans. Each photo series for each patient was processed with the softwares, and at the end, five models of each patient were generated: 1) CBCT, 2) AAL (Agisoft Ambient Light), 3) AFL (Agisoft Flash Light), 4) ZAL (Zephyr Ambient Light), and 5) ZFL (Zephyr Flash Light). Color coded maps and root-mean-square (RMS) distances were used to compare the photogrammetry models to the CBCT ones. RESULTS: One sample t-test showed significant differences between all methods versus CBCT. The worst results were seen in the ZAL group (discrepancies up to 5.17mm), while the best results were produced by AAL group (discrepancies up to 2.11mm). CONCLUSIONS: It can be concluded that this type of virtual facial models are reasonably accurate, although not perfect, and considering its lower biological and financial cost, they may play an important role in specific situations.

Tissue repair after selective alveolar corticotomy in orthodontic patients: A preliminary study.

OBJECTIVES: To analyze histologic findings of bone remodeling at the time of surgery and 90 days later at corticotomized and noncorticotomized sites. MATERIALS AND METHODS: Eight adult patients with bilaterally inclined mandibular molars were included in this split-mouth study. Corticotomy was performed on the test side, and bone was harvested on both mandibular hemi-arches. Bone blocks were shipped to Forsyth Institute lab (Boston, Mass). After surgery, cantilevers were activated to upright inclined mandibular molars on both sides. Approximately 90 days after surgery, new mandibular bone blocks were harvested from test and control sites. Histologic analyses were performed on both groups (test and control sides) at two time points: baseline (T0) and 90 days after surgery (T90). Bone blocks were stained with hematoxylin and eosin, and Masson's trichrome. The protocols enabled screening of new bone formation and collagen in mineralized and nonmineralized connective tissue. Outcomes were compared using a clustered generalized estimating equations model Results: The test group at T90 exhibited an increase of 16% of primary bone ( P < .05), an increase of 6.6 in osteocytes quantity ( P = .039), and an increase of 4.06 in reversal lines quantity ( P = .924). Both groups exhibited a decrease in the inorganic proportion. CONCLUSIONS: The intentional bone injury performed in adult patients undergoing orthodontic treatment can be considered temporary and reversible. Evidence indicates that baseline bone characteristics are unaltered.

Three-dimensional evaluation of mandibular anterior dental crowding in digital dental casts.

INTRODUCTION:: Digital dental models provide a more accurate and comprehensive assessment of orthodontic cases. Although this technique is quite promising, there are few three-dimensional measurements methods described in the literature. OBJECTIVE:: The aim of this study was to propose a method for assessing the degree of mandibular anterior dental crowding in the three planes of space, using digital dental models. METHODS:: Thirty dental casts were selected and scanned by Maestro 3D Dental Scanner and imported by Geomagic Qualify 2013 software. The degree of crowding was calculated by two examiners, based on the Little's Irregularity Index, by means of the definition of axial, coronal and sagittal planes for each model. Intraexaminer analysis was performed with Dahlberg's Formula (DF) and Intraclass Correlation Coefficients (ICC), and interexaminer analysis was performed with ICC and paired t-test. RESULTS:: The ICC showed an excellent agreement (p < 0.05) for all measurements, except for the intraexaminer and interexaminer in the Z-axis, in which it was found a moderate agreement. The DF showed a satisfactory accuracy with all measurements showing less than 1 mm difference. The paired t-test showed statistical difference between the examiners in two measurements, although it was clinical irrelevant. CONCLUSION:: When comparing the three planes of space, the Z-axis showed the greatest variation in landmarks placement; however, overall, the present method seems precise and reproducible.

The Gingival Crevicular Fluid as a Source of Biomarkers to Enhance Efficiency of Orthodontic and Functional Treatment of Growing Patients.

Gingival crevicular fluid (GCF) is a biological exudate and quantification of its constituents is a current method to identify specific biomarkers with reasonable sensitivity for several biological events. Studies are being performed to evaluate whether the GCF biomarkers in growing subjects reflect both the stages of individual skeletal maturation and the local tissue remodeling triggered by orthodontic force. Present evidence is still little regarding whether and which GCF biomarkers are correlated with the growth phase (mainly pubertal growth spurt), while huge investigations have been reported on several GCF biomarkers (for inflammation, tissue damage, bone deposition and resorption, and other biological processes) in relation to the orthodontic tooth movement. In spite of these investigations, the clinical applicability of the method is still limited with further data needed to reach a full diagnostic utility of specific GCF biomarkers in orthodontics. Future studies are warranted to elucidate the role of main GCF biomarkers and how they can be used to enhance functional treatment, optimize orthodontic force intensity, or prevent major tissue damage consequent to orthodontic treatment.

Effect of orthodontic force on expression levels of ten cytokines in gingival crevicular fluid.

Various types of inflammatory mediators are involved in the cascade of biological events behind tissue remodeling allowing orthodontic tooth movement. This split-mouth longitudinal study aimed to evaluate the gingival crevicular fluid (GCF) levels of ten cytokines, IL-6, IL-8, IL-10, IL-13, IL-17, IFN-γ, GM-CSF, MCP-1, MIP-1ß and TNF-α, during initial orthodontic treatment. The sample comprised 15 healthy patients (9 males and 6 females, 13.9±2.5 years). The lower (test) incisors were moved using fixed appliance carrying a 0.014-inch nickel titanium wire, whereas the upper (control) incisors were bonded without any force. The GCF was collected from the test and control teeth before fixed appliance mounting (baseline) and after 1, 7 and 21days. In 6 sites per tooth, from canine to canine, periodontal conditions were defined as the percentage of sites with visible plaque and bleeding on probing. The total GCF cytokines levels were quantified using multianalysis Luminex technology. Throughout the experimental term, and for both test and control teeth, the mean percentage of sites with visible plaque and bleeding on probing were generally below 25% and 15%, respectively, although variability was also seen. In the test teeth, the GCF levels of all the cytokines remained constant throughout the experimental term. On the contrary, significant reductions were seen in the control teeth for each cytokine. Moreover, significantly greater levels of IL-6, GM-CSF, MCP-1 and TNFα were seen in the test teeth as compared to the control teeth at 7days. The reasons for the differential behavior in the levels of all the investigated cytokines between the test and control teeth may be related to the presence of orthodontic forces and/or subclinical tissue inflammation. Further investigation is needed to elucidate potential roles for these biomarkers in the tissue remodeling incident to orthodontic tooth movement.

Esthetic perception of orthodontic appliances by Brazilian children and adolescents.

OBJECTIVE:: The objective of this present study was to understand how children and adolescents perceive esthetic attractiveness of a variety of orthodontic appliances. It also analyzed preferences according to patients' age, sex and socioeconomic status. METHODS:: A photograph album consisting of eight photographs of different orthodontic appliances and clear tray aligners placed in a consenting adult with pleasing smile was used. A sample of children or adolescents aged between 8 and 17 years old (n = 276) was asked to rate each image for its attractiveness on a visual analog scale. Comparisons between the appliances attractiveness were performed by means of nonparametric statistics with Friedman's test followed by Dunn's multiple comparison post-hoc test. Correlation between appliances and individuals' socioeconomic status, age, sex, and esthetic perception was assessed by means of Spearman's correlation analysis. RESULTS:: Attractiveness ratings of orthodontic appliances varied nonsignificantly for children in the following hierarchy: traditional metallic brackets with green elastomeric ligatures > traditional metallic brackets with gray elastomeric ligatures > sapphire esthetic brackets; and for adolescents, as follows: sapphire esthetic brackets > clear aligner without attachments > traditional metallic brackets with green elastomeric ligatures. The correlation between individuals' socioeconomic status and esthetic perception of a given appliance was negative and statistically significant for appliances such as the golden orthodontic brackets and traditional metallic brackets with green elastomeric ligatures. CONCLUSION:: Metal appliances were considered very attractive, whereas aligners were classified as less attractive by children and adolescents. The correlation between esthetic perception and socioeconomic status revealed that individuals with a higher socioeconomic level judged esthetics as the most attractive attribute. For those with higher economic status, golden orthodontic brackets and traditional metallic brackets with green elastomeric ligatures were assessed as the worst esthetic option.

Incisor display during speech and smile: Age and gender correlations.

OBJECTIVES: To evaluate age- and gender-related changes in the soft tissues, incisors, and gingival display during rest, speech, and posed smile. MATERIALS AND METHODS: A total of 265 participants (122 men, 143 women) ranging in age from 19 years to 60 years were recruited for this study. Participants were divided into one of the following four age groups: 19 to 24 years, 25 to 34 years, 35 to 44 years, and 45 to 60 years. Image capture was performed using standardized videographic methods. Each video produced pictures where measurements were performed: rest, speech, and smile positions. RESULTS: A statistically significant gender dimorphism was apparent in most of the variables. There was a significant increase in the upper lip length and lip commissures height with aging and more markedly in men. A greater exposure of mandibular incisor with increasing age was a feature in both genders. With increasing age there was a significant decrease in maxillary incisor display, especially for men. CONCLUSIONS: After 25 years of age there is significant difference in the aging process between men and women. Gingival and maxillary incisor display during speech and smile is a youthful and feminine characteristic.

Levels of gingival crevicular fluid matrix metalloproteinases in periodontally compromised teeth under orthodontic forces.

OBJECTIVE: To examine levels of matrix metalloproteinases (MMPs)-1, -2, -3, -7, -8, -12, and -13 in the gingival crevicular fluid (GCF) of periodontally compromised teeth at different time points during orthodontic movement. MATERIALS AND METHODS: Ten controlled periodontitis subjects were submitted to orthodontic treatment. One dental arch was subjected to orthodontic movement, and teeth in the opposite arch were used as controls. GCF samples were collected from the lingual sites of two movement and two control incisors 1 week before orthodontic activation (-7 d), immediately after orthodontic activation, and after 1 hour, 24 hours, and 7, 14, and 21 days. Multiplexed bead immunoassay was used to measure MMPs in GCF. Data were analyzed using Friedman and Wilcoxon statistical tests. RESULTS: The only significant change found over time was in the levels of MMP-1 in the movement group (P < .05). When the two groups were compared after activation, the only statistically significant difference found was in levels of MMP-12 24 hours after activation (P < .05). CONCLUSIONS: Our findings suggested that the orthodontic movement of periodontally compromised teeth without active pockets did not result in significant changes in the GCF levels of MMPs.

Tratamento ortodôntico de Classe III em pacientes com periodonto reduzido / Class III orthodontic treatment in reduced periodontium patients

Introdução: o tratamento ortodôntico de pacientes adultos apresenta várias limitações. Dentre as mais frequentes e preocupantes, podemos citar a perda exagerada do suporte ósseo e a dificuldade de se obter uma ancoragem satisfatória devida às perdas de vários elementos dentários. Para exemplificar tais problemas, relata-se nesse artigo um caso clínico tratado de maneira eficiente com abordagem multidisciplinar e adequação da mecânica ortodôntica à necessidade desse paciente, em particular. Resultados: os objetivos do tratamento foram alcançados e os resultados considerados satisfatórios diante das limitações inerentes do caso. Foram estabelecidos correta chave de oclusão de caninos, bom transpasse vertical e horizontal e boa intercuspidação funcional. Conclusão: com base na literatura consultada, pode-se concluir que o tratamento de pacientes com periodonto reduzido requer adequação mais simplificada dos objetivos do tratamento, com modificações específicas na mecânica ortodôntica, já que o centro de resistência ao movimento encontra-se deslocado apicalmente.

Orthodontic and surgical treatment of a patient with hemifacial microsomia.

This article describes the surgical and orthodontic treatment of a 12-year-old boy with a significant deformity and functional involvement caused by hemifacial microsomia. The left mandibular ramus and condyle were hypoplastic and abnormal in form and location. The lower third of the face was increased, with mandibular retrusion and significant facial asymmetry. He had difficulties in speaking and chewing and problems related to his facial appearance, which caused severe psychosocial disturbances. The patient received orthodontic treatment and temporomandibular joint reconstruction with a costochondral graft on the left side while he was still growing. Three-year follow-up records are presented.

Matrix metalloproteinases and chemokines in the gingival crevicular fluid during orthodontic tooth movement.

Matrix metalloproteinases (MMPs) and monocyte chemoattractants are key modulators of the biological mechanisms triggered in the periodontium by mechanical forces. The gingival crevicular fluid (GCF) provides a non-invasive method to assess longitudinally the release of inflammatory mediators during orthodontic tooth movement. The goal of this study was to examine the GCF levels of MMP-3, MMP-9, and MMP-13 and of the chemokines macrophage inflammatory protein (MIP)-1ß, monocyte chemoattractant protein (MCP)-1, and regulated on activation normal T cells expressed and secreted (RANTES) at different time points during orthodontic tooth movement. Fourteen subjects (three males and 11 females, 18.8 ± 4.8 years of age; range from 12 to 28 years) had their maxillary canines retracted. Thirty-second GCF samples were collected from the tension and pressure sides 7 days prior to the activation of the orthodontic appliance, on the day of activation, and after 1 and 24 hours, and 14, 21, and 80 days of constant force application. The volume of GCF was measured and samples analysed using a multiplexed bead immunoassay for the content of the six target molecules. Differences in the mean GFC volumes and mean level for each analyte over time were assessed using the Friedman test, and differences between the tension and pressure sides at each time point with the Mann-Whitney test. The mean levels of the three MMPs changed significantly over time but only at the compression side (P < 0.05, Friedman test). The GCF levels of the three chemokines were not affected by the application of mechanical stress. The levels of MMPs in GCF at the pressure side are modulated by the application of orthodontic force.

Controlled tooth movement to correct an iatrogenic problem.

This case report describes the treatment of a 9-year old boy, who had his maxillary central incisors extruded by noncontrolled elastic mechanics to close a diastema. The article describes the consequences of this movement and how the problem was solved with controlled intrusion.

Treatment of an anterior open bite with the multiloop archwire technique.

This is a treatment report of a patient with an anterior open bite and predominance of vertical growth. Multiloop edgewise archwire (MEAW) mechanics were used and resulted in an efficient bite closure and good occlusion. For retention, a bonded 3-3 retainer was used in the mandible whereas a wraparound retainer was employed in the maxilla.

Orthodontic management of a patient with impacted and transposed mandibular canines.

This patient report describes the treatment of a 10-year-old female with complete transposition of her impacted mandibular canines and lateral incisors. The patient had a Class I occlusion, and her mandibular lateral incisors were in crossbite with the maxillary central incisors. The treatment objectives were to create space for the impacted canines and align them with the incisors, one of which was extracted. After treatment, the appearance of the patient's teeth was improved, the occlusion was preserved, and overjet and overbite were corrected.

Orthodontic and surgical treatment of a patient with an ankylosed temporomandibular joint.

This article describes the surgical and orthodontic treatment of a girl with facial deformities and functional involvement. The left temporomandibular joint was ankylosed, and the lower third of the face was markedly deficient, with mandibular retrusion and severe laterognathism to the left side. Mouth-opening was limited, and the patient had problems speaking and chewing. Two surgical procedures had been performed previously at another institution. We treated the patient with condylar surgery while she was still growing, followed by orthodontic treatment and orthognathic surgery after growth was complete. Twelve-year follow-up records are presented.