Quality of life of families of adolescents undergoing fixed orthodontic appliance therapy: Evaluation of a cohort of parents/guardians of treated and untreated individuals.

BACKGROUND: Quality of life (QoL) measurements have been employed in medicine and dentistry to assess the effect of diseases and treatment on individuals' lives. AIM: To assess the effect of the initial 12 months of fixed orthodontic appliance therapy on the families of Brazilian adolescents. DESIGN: A cohort of 11- to 12-year-old adolescents and their parents/guardians participated. Treatment group (TG) consisted of 101 parents/guardians of adolescents who began fixed orthodontic appliance therapy. They completed four sets of the Family Impact Scale (FIS) at baseline, 1 month, 6 months and 12 months after the bonding of fixed appliances. Control group (CG) was composed of 175 parents/guardians of adolescents, who did not begin treatment, answering four sets of the FIS at the same intervals. The subscales of FIS were parental/family activity (PA), parental emotions (PE), family conflict (FC) and financial burden (FB). Statistical analysis was performed. RESULTS: The interaction of group (treatment) with time allowed one to observe significant changes in the PA (P < .001), PE (P < .001), FC (P < .001) and overall FIS score (P < .001), demonstrating an improvement in the subscale and overall QoL of families of adolescents. CONCLUSIONS: The effect of fixed orthodontic appliance therapy on the families of adolescents was highly beneficial.

Predisposing factors for external apical root resorption associated with orthodontic treatment.

OBJECTIVE: This study aimed to identify possible risk factors for external apical root resorption (EARR) in the maxillary incisors after orthodontic treatment. METHODS: The root length of 2,173 maxillary incisors was measured on periapical radiographs of 564 patients who received orthodontic treatment. The Kappa test was performed to evaluate intraexaminer and interexaminer reproducibility. Multiple binary logistic regression was used to determine the association between EARR and various factors. Odds ratios and 95% confidence intervals were reported. RESULTS: The risk of developing EARR was 70% higher in orthodontic treatment with maxillary premolar extraction (p = 0.004), 58% higher in patients with increased overjet (p = 0.012), 41% lower in two-phase orthodontic treatment (p = 0.037), and 33% lower in patients with deep bite (p = 0.039). The lateral incisors were 54% more likely to develop EARR (p < 0.001), dilacerated roots were 2.26 times more likely to develop EARR (p < 0.001), and for each additional millimeter of root length, the risk of EARR increased by 29% (p < 0.001). CONCLUSIONS: The potential risk factors for EARR after orthodontic treatment included treatment with maxillary premolar extraction, increased overjet at the beginning of treatment, and dilacerated roots.

Comparison of the accuracy of virtual and direct bonding of orthodontic accessories.

INTRODUCTION: Conventional direct and indirect bonding techniques fail to obtain the ideal bracket position. OBJECTIVE: To compare the accuracy of virtual and conventional direct bonding of orthodontic accessories. METHODS: A single virtual configuration (dental mannequin with Class I malocclusion) served as basis for generating the reference model (treated virtually) and the intervention models (10 digital models and 10 solid models, obtained by means of prototyping). A total of 560 teeth were then equally distributed between a group of orthodontists (Group I, direct bonding; and Group II, virtual bonding), working in two different time intervals. The individual positions of the accessories were measured after three-dimensional superimposition with customized software. The Student's-t test for paired samples, and Chi-square tests were used for statistical analysis, both at the level of significance of 5%. RESULTS: In comparison of the errors in raw values, there were significant differences only in the vertical (p< 0.001) and horizontal dimensions (p< 0.001). Considering the groups of ranges by clinical limits of the deviations, these differences were significant in the three dimensions, vertical (p< 0.001), horizontal (p= 0.044) and angular (p= 0.044). CONCLUSION: Virtual bonding made it possible to obtain more precise/accurate positioning of the orthodontic accessories. The potential accuracy of this method brings new perspectives to refining the indirect bonding protocols.

Periodontitis in individuals with liver cirrhosis: A case-control study.

AIM: The aim of this study was to evaluate the association between liver cirrhosis and periodontitis. METHODS: This case-control study included 294 individuals, 98 cases with liver cirrhosis and 196 controls. A full-mouth periodontal examination was performed and plaque index, probing depth, clinical attachment level and bleeding on probing were recorded. The association of risk variables with periodontitis was tested through univariate analysis and multivariate logistic regression, stratified by alcohol status. RESULTS: A high prevalence of periodontitis was observed among cases (62.2%) when compared to controls (41.8%). Individuals with cirrhosis presented a chance ~2 higher of having periodontitis than controls (OR = 2.28; 95% CI 1.39-3.78; p < .001). Significant variables associated with periodontitis in the final logistic models were as follows: (a) no/occasional alcohol use model-number of teeth up 14, age ≥45-55 years, male sex and smoking; (b) moderate and intensive alcohol use models-cirrhosis, number of teeth up 14, age ≥45-55 years, male sex and smoking. CONCLUSIONS: An important risk association between liver cirrhosis and periodontitis was observed. Additionally, the intensive alcohol use significantly increased the risk for periodontitis.

Tumor Necrosis Factor-alpha in Gingival Crevicular Fluid as a Diagnostic Marker for Periodontal Diseases: A Systematic Review.

OBJECTIVES: The aim of this systematic review was to evaluate human gingival crevicular fluid (GCF) tumor necrosis factor-alpha (TNF-α) as a potential biomarker for diagnosis of periodontal disease (International prospective register of systematic reviews [PROSPERO] number: CRD42015020199). METHODS: An electronic search for TNF-α in human GCF was conducted until May 17, 2018. Data from systemically healthy patients with healthy periodontium or periodontal disease were incorporated. Risk bias was assessed by Newcastle-Ottawa Scale for case-control studies and Jadad scale for clinical trials. RESULTS: Twenty-six studies were included (12 case-control studies, 7 clinical trials, and 7 randomized controlled trials). Most case-control studies showed increased TNF-α concentration in GCF of patients with periodontal disease. The clinical trials and randomized controlled trials demonstrated no consistent modification of TNF-α level after periodontal intervention. CONCLUSION: The present data support the use of TNF-α in GCF as a potential biomarker for diagnosis of periodontal disease but not to monitor the healing after therapy.

Cross-cultural adaptation and validation of the Impact of Fixed Appliances Measure questionnaire in Brazil.

The aim of this study was to translate and cross-culturally adapt the condition-specific instrument Impact of Fixed Appliances Measure (IFAM), assessing its validity and reliability for use among Brazilian children/adolescents. The IFAM was translated, back-translated, cross-culturally adapted, and pilot-tested. The Brazilian version of the IFAM (B-IFAM) was tested on 161 10-to-18-year-old children/adolescents. Internal consistency was assessed using Cronbach's alpha (α) and test-retest reliability by intraclass correlation coefficients (ICC). Construct validity was conducted using Pearson correlation among the overall and subscales of the B-IFAM. Discriminant validity was evaluated by comparisons of B-IFAM's means and SD with children's/adolescents' sex (Student t-test). Internal consistency was 0.89 for overall score and 0.55-0.86 for subscales. ICC for test-retest reliability was 0.81 for overall score and 0.55-0.78 for subscales. The overall score of the B-IFAM presented large correlation coefficients with most subscales (r = 0.52-0.74), supporting construct validity. Discriminant validity demonstrated statistically significant difference in the overall score, aesthetics, and physical impact subscales among female and male children's/adolescents' (p < 0.05). In the conclusion, the B-IFAM overall score and some subscales demonstrated adequate psychometric properties regarding reliability and validity. The study achieved a specific-condition instrument feasible for use on Brazilian children/adolescents who wear fixed orthodontic appliances.

Impact of orthodontic treatment on adolescents' quality of life: a longitudinal evaluation of treated and untreated individuals.

PURPOSE: To assess the impact of fixed appliance therapy on the quality of life of a cohort of Brazilian adolescents. METHODS: The treatment group was composed of individuals who started orthodontic treatment. The control group was composed of individuals not selected for immediate treatment. Adolescents answered the Brazilian short form of the Child Perceptions Questionnaire (CPQ11-14). Higher scores indicate a greater negative impact on quality of life. Adolescents in the treatment group completed four sets of interviews: prior to appliances' bonding (T1), 1 month (T2), 6 months (T3) and 12 months (T4) after appliances' placement. Adolescents in the control group were assigned to a comparable schedule. Statistics included inter-group comparisons, Friedman and Wilcoxon tests, and mixed-effects models. RESULTS: In the treatment group, the functional limitation score was higher at T1 (p = 0.004) and T2 (p = 0.007) compared to T4. The emotional well-being score was higher at T1 compared to T2 (p < 0.001), T3 (p < 0.001) and T4 (p < 0.001). The overall CPQ11-14 score was higher at T1 compared to T2 (p = 0.005), T3 (p < 0.001) and T4 (p < 0.001). The overall CPQ11-14 score was also higher at T2 compared to T3 (p = 0.001). No significant change was found in the control group. In the mixed-effects models, the interaction between group (treatment) and time was significant for functional limitations (p < 0.001), emotional well-being (p < 0.001), social well-being (p = 0.004) and the overall CPQ11-14 score (p < 0.001). CONCLUSION: Quality of life improved among adolescents undergoing orthodontic treatment. Orthodontists should inform patients what they might expect regarding the physical and the psychosocial repercussions of appliance therapy.

Cross-cultural adaptation and validation of the Impact of Fixed Appliances Measure questionnaire in Brazil

Abstract: The aim of this study was to translate and cross-culturally adapt the condition-specific instrument Impact of Fixed Appliances Measure (IFAM), assessing its validity and reliability for use among Brazilian children/adolescents. The IFAM was translated, back-translated, cross-culturally adapted, and pilot-tested. The Brazilian version of the IFAM (B-IFAM) was tested on 161 10-to-18-year-old children/adolescents. Internal consistency was assessed using Cronbach's alpha (α) and test-retest reliability by intraclass correlation coefficients (ICC). Construct validity was conducted using Pearson correlation among the overall and subscales of the B-IFAM. Discriminant validity was evaluated by comparisons of B-IFAM's means and SD with children's/adolescents' sex (Student t-test). Internal consistency was 0.89 for overall score and 0.55-0.86 for subscales. ICC for test-retest reliability was 0.81 for overall score and 0.55-0.78 for subscales. The overall score of the B-IFAM presented large correlation coefficients with most subscales (r = 0.52-0.74), supporting construct validity. Discriminant validity demonstrated statistically significant difference in the overall score, aesthetics, and physical impact subscales among female and male children's/adolescents' (p < 0.05). In the conclusion, the B-IFAM overall score and some subscales demonstrated adequate psychometric properties regarding reliability and validity. The study achieved a specific-condition instrument feasible for use on Brazilian children/adolescents who wear fixed orthodontic appliances.

Perception of parents and caregivers regarding the impact of malocclusion on adolescents' quality of life: a cross-sectional study

ABSTRACT Objective: The objective of this article was to assess the perception of parents and caregivers regarding the impact of malocclusion on adolescents’ oral health -related quality of life (OHRQoL). Methods: This cross-sectional study consisted of a sample of 280 parents/caregivers of 11 and 12-year-old adolescents who answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Parent-assessed quality of life of adolescents was the dependent variable. The main independent variable was adolescents’ malocclusion which was diagnosed by means of the Dental Aesthetic Index (DAI). Based on DAI cut-off points, adolescents were classified into four grades of malocclusion, with different orthodontic treatment recommendations assigned to each grade: no need/slight treatment need, elective treatment, highly desirable treatment and mandatory treatment. Adolescents’ age and sex, as well as family monthly income, were considered as confounding variables. Statistical analysis involved descriptive statistics, bivariate analyses, and Poisson regression with robust variance. Results: Of the 280 parents/caregivers initially accepted in this study, 18 refused to answer the P-CPQ. Therefore, 262 individuals participated in this assessment, providing a response rate of 93.5%. The severity of adolescents’ malocclusion was significantly associated with a higher negative impact on parents’/caregivers’ perception on the oral symptoms (p< 0.05), functional limitations (p < 0.001), emotional well-being (p < 0.001), and social well-being (p < 0.001) subscale scores as well as on the overall P-CPQ score (p < 0.001), even after having been adjusted for the controlling variables. Conclusions: Parents/caregivers reported a negative impact of malocclusion on adolescents’ OHRQoL. Increased severity of malocclusion is associated with higher adverse impact on OHRQoL.

RESUMO Objetivo: o objetivo deste artigo foi avaliar a percepção de pais/cuidadores com relação ao impacto da má oclusão na qualidade de vida relacionada à saúde bucal (QVRSB) de adolescentes. Métodos: este estudo transversal consistiu de uma amostra de 280 pais/cuidadores de adolescentes com 11 a 12 anos que responderam o Parental-Caregiver Perceptions Questionnaire (P-CPQ). A percepção de pais/cuidadores com relação à qualidade de vida dos adolescentes foi considerada a variável dependente. A variável independente principal foi a má oclusão dos adolescentes, que foi diagnosticada por meio do Índice Estético Dental (IED). Com base nos pontos de corte do IED, os adolescentes foram classificados em quatro categorias de má oclusão, com diferentes recomendações de tratamento ortodôntico atribuídas a cada uma dessas categorias: sem necessidade ou com leve necessidade de tratamento; tratamento eletivo; tratamento altamente desejável; e tratamento obrigatório. A idade e o sexo dos adolescentes e a renda familiar mensal foram consideradas variáveis de confusão. A análise estatística envolveu estatística descritiva, análise bivariada e regressão de Poisson com variância robusta. Resultados: dos 280 pais/cuidadores inicialmente aceitos nesse estudo, 18 se recusaram a responder ao P-CPQ. Portanto, 262 indivíduos participaram dessa avaliação, resultando em uma taxa de resposta de 93,5%. A gravidade da má oclusão dos adolescentes foi significativamente associada com um impacto mais negativo na percepção de pais / cuidadores nas subescalas sintomas bucais (p < 0,05), limitações funcionais (p < 0,001), bem-estar emocional (p < 0,001) e bem-estar social (p< 0,001), mesmo após o ajuste para as variáveis de confusão. Conclusões: os pais/cuidadores relataram um impacto negativo da má oclusão na QVRSB dos adolescentes. Quanto mais grave a má oclusão, mais adverso é o impacto dessa condição na QVRSB.

Perception of parents and caregivers regarding the impact of malocclusion on adolescents' quality of life: a cross-sectional study.

OBJECTIVE:: The objective of this article was to assess the perception of parents and caregivers regarding the impact of malocclusion on adolescents' oral health -related quality of life (OHRQoL). METHODS:: This cross-sectional study consisted of a sample of 280 parents/caregivers of 11 and 12-year-old adolescents who answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ). Parent-assessed quality of life of adolescents was the dependent variable. The main independent variable was adolescents' malocclusion which was diagnosed by means of the Dental Aesthetic Index (DAI). Based on DAI cut-off points, adolescents were classified into four grades of malocclusion, with different orthodontic treatment recommendations assigned to each grade: no need/slight treatment need, elective treatment, highly desirable treatment and mandatory treatment. Adolescents' age and sex, as well as family monthly income, were considered as confounding variables. Statistical analysis involved descriptive statistics, bivariate analyses, and Poisson regression with robust variance. RESULTS:: Of the 280 parents/caregivers initially accepted in this study, 18 refused to answer the P-CPQ. Therefore, 262 individuals participated in this assessment, providing a response rate of 93.5%. The severity of adolescents' malocclusion was significantly associated with a higher negative impact on parents'/caregivers' perception on the oral symptoms (p< 0.05), functional limitations (p < 0.001), emotional well-being (p < 0.001), and social well-being (p < 0.001) subscale scores as well as on the overall P-CPQ score (p < 0.001), even after having been adjusted for the controlling variables. CONCLUSIONS:: Parents/caregivers reported a negative impact of malocclusion on adolescents' OHRQoL. Increased severity of malocclusion is associated with higher adverse impact on OHRQoL.

Agreement between adolescents and parents or caregivers in rating adolescents' quality of life during orthodontic treatment.

INTRODUCTION: The purpose of this study was to assess the agreement between Brazilian adolescents and their parents or caregivers regarding the adolescents' oral health-related quality of life during orthodontic treatment. METHODS: The sample consisted of 102 adolescent-parent/caregiver pairs. Adolescents answered the short form of the child perceptions questionnaire, and the parents or caregivers answered the parental-caregiver perceptions questionnaire. These questionnaires have 14 items in common organized across 4 subscales: oral symptoms, functional limitations, emotional well-being, and social well-being. Agreement on the overall score and the subscales was determined using comparison and correlation analysis. The former was performed through comparison of the mean directional and absolute differences. The latter was analyzed using the intraclass correlation coefficient. RESULTS: The mean directional difference was significant for the oral symptoms subscale, with parents' reports lower than adolescents' reports (P = 0.012). However, it was not significant for the other 3 subscales and the overall score (P >0.05). The mean absolute difference for the overall score was 5.15, representing 9.2% of the maximum possible score. The intraclass correlation coefficient was 0.66, indicating substantial agreement. CONCLUSIONS: There was agreement between adolescents and their parents or caregivers in rating adolescents' oral health-related quality of life during orthodontic treatment.

Effect of chlorhexidine varnish on gingival growth in orthodontic patients: a randomized prospective split-mouth study.

INTRODUCTION: Fixed orthodontic appliances patients suffer limitations on the effective control of biofilm by mechanical methods, bringing the need of a coadjutant in the control of inflammation and oral health improvement. OBJECTIVE: The aim of this prospective split-mouth blind study was to analyze the effect of a 40% chlorhexidine (CHX) varnish on gingival growth of patients with orthodontic fixed appliances. METHODS: Healthy teenage patients with fixed orthodontic appliances and increased gingival volume were recruited (n = 30). Each individual was his own control, having in the maxilla one control side and one treatment side. An application of varnishes occurred on the vestibular area of the upper premolars and first molar crowns, on the control side (placebo varnish) and on the experimental side (EC40(r) Biodentic CHX varnish). The varnishes and sides were randomly chosen and its identification and group was kept by a third party observer and it was not revealed to the researchers and participants until the end of study. In order to establish a baseline registration, digital photographs were taken by a trained photographer before varnish application at baseline (T0), as well as 14 days (T14) and 56 days (T56) after the application. The gingival volume was calculated indirectly using the vestibular areas (mm2) of the upper second premolars' clinical crowns by RapidSketch(r) software, at all study times. The data were analyzed using ANOVA and the Turkey-Krammer test. RESULTS: It was observed, in the final sample of 30 individuals, that at T0, the control and treatment groups were similar. At T14 and T56, a progressive reduction of the clinical crown area was seen in the control group, and an increase in the average area was detected in the experimental group (p < 0,05). CONCLUSIONS: The use of 40% CHX varnish decreases the gingival overgrowth in patients undergoing orthodontic treatment. Further studies are necessary to set the action time and frequency of application.

Parent-assessed quality of life among adolescents undergoing orthodontic treatment: a 12-month follow-up.

OBJECTIVE: To assess parents' and caregivers' view of the first twelve months of adolescents' orthodontic treatment with fixed appliances and to assess the evaluative properties of the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) in the orthodontic setting. METHODS: Data from a sample of 96 parents and caregivers of adolescents undergoing orthodontic treatment with fixed appliances were collected by means of P-CPQ. Assessments were performed before banding and bracket bonding (T1) and 12 months after placement of fixed appliances (T2). Statistical analysis included Wilcoxon signed-rank test for the overall P-CPQ score and Bonferroni correction for P-CPQ subscales. The evaluative properties of the P-CPQ were assessed through responsiveness calculation and the minimally clinical important difference (MCID). RESULTS: Among the 96 participants, 76 were mothers of patients, 16 were fathers, and four were other family members. Adolescents' mean age was 11.49 ± 0.50 years. Most families earned equal to or less than three times the Brazilian monthly minimum wage. There was significant improvement in the emotional and social well-being subscales (p< 0.001), which contributed to improve patient's overall quality of life (p< 0.001). Reductions in scores were associated with clinically meaningful moderate changes in the overall score as well as in the emotional and social well-being subscales. The MCID was 6.16 for the P-CPQ overall score. CONCLUSION: Parents and caregivers reported significant improvement in the quality of life of adolescents undergoing orthodontic treatment with fixed appliances.

Comparative Study of the Effect of Acid Etching on Enamel Surface Roughness between Pumiced and Non-pumiced Teeth.

BACKGROUND: The objective was to perform a comparative analysis of the effect of acid etching on enamel roughness between pumiced and non-pumiced teeth. MATERIALS AND METHODS: The sample was composed of 32 dental surfaces divided into two groups: Group 1-16 surfaces having received pumice prophylaxis; and Group 2-16 surfaces not having received pumice prophylaxis. The teeth were kept in saline until the first record of surface roughness prior to etching. For each surface, a roughness graph was obtained through trials using a surface roughness tester. This procedure was repeated two more times at different locations for a total of three readings which, later, were converted in a mean value. The teeth were then acid etched with a 37% phosphoric acid for 60 s, rinsed with water, air dried, and tested with the roughness tester again using the same protocol described for baseline. The Quantikov image analysis program was used to measure the length of the graphs. The average value of the lengths was recorded for each surface before and after etching. The increase in roughness caused by acid etching was calculated and compared between groups. RESULTS: The mean increase in roughness caused by the etching was 301 µm (11.37%) in Group 1 and 214 µm (8.33%) in Group 2. No statistically significant difference was found between samples with and without pumice prophylaxis (P = 0.283). CONCLUSION: The present study showed that the effect of acid etching on enamel roughness was not significantly affected by prior pumice prophylaxis.

Parent-assessed quality of life among adolescents undergoing orthodontic treatment: a 12-month follow-up

Objective: To assess parents' and caregivers' view of the first twelve months of adolescents' orthodontic treatment with fixed appliances and to assess the evaluative properties of the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) in the orthodontic setting.Methods:Data from a sample of 96 parents and caregivers of adolescents undergoing orthodontic treatment with fixed appliances were collected by means of P-CPQ. Assessments were performed before banding and bracket bonding (T1) and 12 months after placement of fixed appliances (T2). Statistical analysis included Wilcoxon signed-rank test for the overall P-CPQ score and Bonferroni correction for P-CPQ subscales. The evaluative properties of the P-CPQ were assessed through responsiveness calculation and the minimally clinical important difference (MCID).Results: Among the 96 participants, 76 were mothers of patients, 16 were fathers, and four were other family members. Adolescents' mean age was 11.49 ± 0.50 years. Most families earned equal to or less than three times the Brazilian monthly minimum wage. There was significant improvement in the emotional and social well-being subscales (p< 0.001), which contributed to improve patient's overall quality of life (p< 0.001). Reductions in scores were associated with clinically meaningful moderate changes in the overall score as well as in the emotional and social well-being subscales. The MCID was 6.16 for the P-CPQ overall score.Conclusion:Parents and caregivers reported significant improvement in the quality of life of adolescents undergoing orthodontic treatment with fixed appliances.

Objetivo: avaliar as percepções de pais e cuidadores com relação à qualidade de vida de adolescentes durante os primeiros 12 meses de tratamento ortodôntico com aparelhos fixos, e examinar as propriedades técnicas da versão brasileira do questionário Parental-Caregiver Perceptions Questionnaire(P-CPQ) no cenário ortodôntico.Métodos:dados de uma amostra de 96 pais e cuidadores de adolescentes em tratamento ortodôntico com aparelhos fixos foram coletados através do questionário P-CPQ. As avaliações foram realizadas antes da bandagem e colagem de braquetes (T1) e 12 meses após a colocação do aparelho fixo (T2). A análise estatística incluiu o teste Wilcoxon signed rankpara o escore total do P-CPQ e a correção de Bonferroni para as subescalas do questionário. As propriedades técnicas do P-CPQ foram examinadas por meio do cálculo da responsividade e da mínima diferença clinicamente importante (MDCI).Resultados:dos 96 participantes, 76 eram mães de pacientes, 16 eram pais e 4 possuíam outra relação familiar. A idade média dos adolescentes foi de 11,49 ± 0,50 anos. A maioria das famílias tinha uma renda mensal igual ou menor a três salários mínimos brasileiros. Houve uma melhora significativa nas subescalas de bem-estar emocional e bem-estar social, que contribuíram para uma melhora do escore total de qualidade de vida (p< 0,001). As reduções dos escores do P-CPQ foram associadas com alterações clinicamente moderadas para o escore total e para as subescalas de bem-estar emocional e bem-estar social. A MDCI para o escore total do P-CPQ foi de 6,16.Conclusões: pais e cuidadores relataram uma melhora significativa na qualidade de vida de adolescentes em tratamento ortodôntico com aparelhos fixos.

Effect of chlorhexidine varnish on gingival growth in orthodontic patients: a randomized prospective split-mouth study

Introduction: Fixed orthodontic appliances patients suffer limitations on the effective control of biofilm by mechanical methods, bringing the need of a coadjutant in the control of inflammation and oral health improvement.Objective: The aim of this prospective split-mouth blind study was to analyze the effect of a 40% chlorhexidine (CHX) varnish on gingival growth of patients with orthodontic fixed appliances. Methods: Healthy teenage patients with fixed orthodontic appliances and increased gingival volume were recruited (n = 30). Each individual was his own control, having in the maxilla one control side and one treatment side. An application of varnishes occurred on the vestibular area of the upper premolars and first molar crowns, on the control side (placebo varnish) and on the experimental side (EC40(r) Biodentic CHX varnish). The varnishes and sides were randomly chosen and its identification and group was kept by a third party observer and it was not revealed to the researchers and participants until the end of study. In order to establish a baseline registration, digital photographs were taken by a trained photographer before varnish application at baseline (T0), as well as 14 days (T14) and 56 days (T56) after the application. The gingival volume was calculated indirectly using the vestibular areas (mm2) of the upper second premolars' clinical crowns by RapidSketch(r) software, at all study times. The data were analyzed using ANOVA and the Turkey-Krammer test.Results:It was observed, in the final sample of 30 individuals, that at T0, the control and treatment groups were similar. At T14 and T56, a progressive reduction of the clinical crown area was seen in the control group, and an increase in the average area was detected in the experimental group (p < 0,05).Conclusions: The use of 40% CHX varnish decreases the gingival overgrowth in patients undergoing orthodontic treatment. Further studies are necessary to set the action time and frequency of application.

Introdução: pacientes com aparelhos ortodônticos fixos sofrem limitações no controle efetivo de biofilme por métodos mecânicos, trazendo a necessidade de um coadjuvante no controle na inflamação e melhora na saúde bucal.Objetivo:esse estudo cruzado prospectivo randomizado teve como objetivo analisar o efeito do verniz de clorexidina (CHX) a 40% no crescimento gengival de pacientes com aparelhos ortodônticos fixos.Métodos:indivíduos adolescentes com aparelhos ortodônticos fixos e aumento de volume gengival foram recrutados para a pesquisa (n = 30). Cada participante atuou como seu próprio controle, tendo, na maxila, um lado controle e um tratamento. No lado controle, aplicou-se verniz placebo e no lado experimental, o verniz EC40(r) Biodentic CHX, ambos na face vestibular das coroas dos pré-molares e primeiro molar superiores. Os vernizes e lados foram escolhidos de forma aleatória e a identificação deles e a que grupo pertenciam foi mantida por um terceiro observador, não sendo revelada aos pesquisadores nem aos participantes até o final do estudo. Fotografias digitais foram tiradas por um fotógrafo treinado, antes da aplicação do verniz no tempo inicial (T0), bem como 14 dias (T14) e 56 dias (T56) após a aplicação. O volume gengival foi calculado indiretamente, por meio das áreas vestibulares (mm2) das coroas dos segundos pré-molares superiores, com o softwareRapidSketch(r), em todos os tempos de estudo. Os dados foram analisados usando ANOVA e teste de Turkey-Krammer.Resultados:na amostra final de 30 indivíduos, observou-se que, em T0, os grupos controle e tratamento foram semelhantes. Já em T14 e T56, foi observada uma progressiva redução na área da coroa clínica no grupo controle, e um aumento na área média do grupo experimental (p< 0,05).Conclusão:o uso do verniz de CHX a 40% diminui o excessivo crescimento gengival em pacientes sob tratamento ortodôntico. Estudos futuros são necessários para se determinar o tempo de ação e a frequência de aplicação.

Cytokine measurements in gingival crevicular fluid and periodontal ligament: Are they correlated?

INTRODUCTION: Mechanical stress can induce molecular changes in gingival crevicular fluid (GCF) and the periodontal ligament (PDL). It is still not clear whether changes in the PDL and GCF are linked. In this study, we aimed to analyze the expression of cytokines in GCF and PDL after mechanical stress. METHODS: Twenty-three healthy patients were included. The experimental group consisted of premolars subjected to a force of 0.980 N for 1, 3, 7, 14, 21, or 28 days. The contralateral teeth were the controls. GCF and PDL samples were collected at the same time points for analysis of cytokines using the cytometric bead array. RESULTS: Interleukin (IL)-6 (IL-6) production was significantly elevated in the PDL on day 1 after force application. Significantly strong positive correlations between GCF and PDL in experimental group were seen on days 3 (interferon-gamma), 7 (IL-10), 14 (IL-17A), and 28 (IL-17A, tumor necrosis factor-alpha), and significantly strong negative correlation were seen on days 14 (interferon-gamma) and 21 (IL-2, IL-10). CONCLUSIONS: Different patterns of IL-6 expression were seen in the PDL and GCF after mechanical stress. Despite occasional correlations between GCF and PDL, the molecular contributions of the PDL to the GCF changes could not be clearly defined by our model.

Kinetics of interleukin-6 and chemokine ligands 2 and 3 expression of periodontal tissues during orthodontic tooth movement.

INTRODUCTION: Mechanical loading induces remodeling of the periodontal ligament and the alveolar bone and is mediated by cytokines and chemokines. In this study, we investigated the kinetics of interleukin-6 and chemokine ligands 2 and 3 levels in periodontal ligaments subjected to orthodontic forces. METHODS: We used 64 premolars in this split-mouth design study. The experimental group consisted of premolars subjected to a force of 0.980 N in the apical direction for 3 hours, 15 hours, 3 days, 12 days, or 21 days with a 0.017 × 0.025-in beta-titanium alloy cantilever. The contralateral teeth, without orthodontic appliances, were used as controls. The premolars were extracted for orthodontic reasons, and the periodontal ligaments were scraped for analysis of cytokine levels by ELISA. RESULTS: Compared with the control group, an increase in chemokine ligand 2 was observed on days 3 and 12, and increases in interleukin-6 and chemokine ligand 3 were observed on day 12 in the experimental group. CONCLUSIONS: Our data demonstrated differential expressions of interleukin-6 and chemokine ligands 2 and 3 in periodontal ligaments after mechanical loading; this might reflect the distinct roles of these molecules in the bone remodeling process.

Gingival volume measurement through the analysis of tooth crown area: a digital and computed method.

This paper presents a method for measuring gingival volume through the analysis of the tooth crown area of anterior teeth using digital photographs and computer analysis. Three photographs were taken and manipulated to simulate gingival overgrowth to perform a numeric correlation of change in gingival volume. The proposed method is easy, noninvasive, and provides rich data for statistical analysis or clinical classification of the gingival condition.