Atypical Extraction of Maxillary Central Incisor for the Correction of Angle Class II Malocclusion / Extracción Atípica de Incisivo Central Maxilar en la Corrección de la Maloclusión de Angle Clase II

ABSTRACT: This case describes the treatment of Class II malocclusion in a patient missing one of the maxillary central incisors due to traumatic impaction. The treatment approach consisted in the extraction of the remaining maxillary central incisor, followed by diastema closure and re-anatomization of lateral incisors into central incisors. The results obtained were considered satisfactory concerning occlusal, aesthetic and functional aspects. This therapeutic approach may be used as an alternative for similar cases.

RESUMEN: Este caso clínico describe el tratamiento de la mala oclusión de Clase II en un paciente con ausencia de uno de los incisivos centrales superiores debido a impactación. El abordaje del tratamiento consistió en la extracción de este elemento dental y del otro incisivo central, seguido del cierre de los diastemas y reanatomización de los incisivos laterales en incisivos centrales. Los resultados obtenidos fueron considerados satisfactorios con relación a los aspectos oclusales, estéticos y funcionales. Así, esta planificación se puede utilizar como una nueva alternativa de abordaje terapéutico para estos casos.

Influence of facial pattern in smile attractiveness regarding gingival exposure assessed by dentists and laypersons.

INTRODUCTION: The present study aimed to assess the influence of facial pattern in smile attractiveness on different levels of gingival exposure evaluated by dental specialists and laypersons. METHODS: Frontal photographs of 2 white Brazilian women, one with a long face and the other with a balanced face, were acquired and subsequently modified to simulate gingival exposure from 0 to 6 mm. Four groups of evaluators of both sexes (mean age 34 y), including laypersons (n = 24) and dental specialists (n = 72; 24 orthodontists, 24 periodontists, and 24 maxillofacial surgeons), used a Likert-type scale to evaluate the attractiveness of the smiles of these subjects with different levels of gingival exposure. Kruskal-Wallis and Friedman tests were used to compare the perceptions of the dental specialists and laypersons. Spearman rank correlation coefficient was used to associate the age of the examiners with their rating outcomes. Statistical significance was set at P < 0.05. RESULTS: Statistically significant differences were observed for the following levels of exposure for the long-faced subject: 0 mm, 4 mm, 5 mm, and 6 mm. Laypersons were less critical than dental specialists. In the balanced-face subject, statistically significant differences were observed between laypersons and dental specialists for gingival exposure levels of 4 mm, 5 mm, and 6 mm. Laypersons perceived gingival exposure to a lesser extent for the balanced-face subject than for the long-face subject. The balanced face was better rated than the long face by dental specialists and laypersons for all levels of gingival exposure. CONCLUSIONS: Facial patterns influenced the smile attractiveness evaluation. The facial characteristics of a balanced facial pattern attenuated the perception of gingival exposure.

Segmented mechanics for traction of impacted maxillary canine: case report with a 3-year follow-up / Mecânica segmentada para tracionamento de canino su perior impactado: relato de caso com acompanhamento de 3 a nos

Young patients are increasingly concerned with smile aesthetics, resulting in the early visit to the dental office. It is of great importance that professionals such as orthodontists, pediatric dentists, and general practitioners are aware of the potential changes in positioning and development that may compromise aesthetics, considering they may prevent future complex orthodontic treatments. This case report describes the treatment of a patient aged 9 years and 4 months, who complained at assessment about the size and position of maxillary incisors. Clinically, the patient presented atresic maxilla and eruption of teeth 12 and 22. The poor positioning of tooth 22 alerted for the potential retention of tooth 23. A two-phase treatment was proposed, including an intercepting phase and a corrective phase. In the intercepting phase, rapid maxillary expansion (RME) was performed, which increased the room for eruption of tooth 23 and prevented the collapse of tooth 22. After the activation period, the Haas expander was locked and removed six months later. Twenty-five months after the removal, the second phase started with fixed corrective orthodontics and traction of tooth 23, for which the enamel was drilled and traction was performed using the segmented technique with a 0.019" x 0.025" Titanium Molybdenum Alloy (TMA) cantilever and anchorage in passive transpalatal arch (PTA). The use of this technique minimizes the side effects on the teeth adjacent to tooth 23 and enamel drilling prevents potential losses of the traction device by detachment. After 4 months of segmented mechanics, the devices were removed and the PTA was maintained. Twenty-six months later, the patient was 14 years and 4 months old, presenting direct subdivision Class III molar relationship, upper and lower crowding, and unsatisfactory relationship between bone bases due to the excessive mandibular growth. A new RME was performed, and after 3 months a Capelozza Pattern III fixed appliance was installed in the lower arch. Additionally, an upper fixed appliance was installed after the RME retention period. One year and 4 months later, the appliances were removed and a maxillary Hawley plate was installed with a 0.6-mm fixed mandibular intercanine arch. The follow-up lasted 3 years and 4 months and the results were maintained, preserving the occlusal and facial characteristics.

A preocupação dos pacientes jovens com a estética do sorriso está cada vez maior, ocasionando na visita precoce ao consultório odontológico. É de grande importância que os profissionais, tanto ortodontistas quanto odontopediatras e clínicos gerais, estejam atentos à possíveis alterações de posicionamento e desenvolvimento que comprometam a estética, visto que isso pode evitar tratamentos ortodônticos complexos no futuro. Este relato de caso descreve o tratamento de uma paciente de 9 anos e 4 meses que na avaliação se queixou do tamanho e posição dos incisivos superiores. Clinicamente apresentou maxila atrésica e dentes 12 e 22 em erupção. O mal posicionamento do dente 22 alertou para possível retenção do dente 23. Um tratamento em duas fases foi proposto: uma fase interceptadora e uma segunda fase corretiva. Na interceptadora foi realizada expansão rápida da maxila (ERM), aumentando o espaço para erupção do dente 23 e evitando colapso com o dente 22. Após o período de ativação, o expansor de Haas foi travado e sua remoção feita seis meses após o travamento. Passados 25 meses da remoção, iniciou-se a segunda fase, com ortodontia fixa corretiva e tracionamento do dente 23. Para o tracionamento, foi feita perfuração no esmalte e tracionamento por meio da técnica segmentada, utilizando cantilever de Titanium Molybdenum Alloy (TMA) 0,019" x 0,025" e ancoragem em barra transpalatina passiva (BTP). A utilização desta técnica minimiza efeitos colaterais aos dentes adjacentes ao 23 e a perfuração de esmalte evita possíveis perdas do dispositivo de tracionamento por descolagem. Após 4 meses de mecânica segmentada, removeu-se os dispositivos mantendo a BTP. Passados mais 26 meses, a paciente se encontrava com 14 anos 4 meses, relação molar de Classe III subdivisão direita, apinhamento superior e inferior e relação insatisfatória das bases ósseas, devido ao crescimento excessivo da mandíbula. Foi realizada nova ERM, após 3 meses instalou-se aparelho fixo Padrão III de Capelozza no arco inferior e, após o período de contenção da ERM, instalou-se o aparelho fixo superior. Após 1 ano e 4 meses, removeu-se os dispositivos e se instalou uma placa de Hawley superior, com barra fixa intercaninos de 0.6mm no arco inferior. Com acompanhamento de 3 anos e 4 meses, os resultados foram mantidos, preservando ascaracterísticas oclusais e faciais.

Influence of reminder therapy for controlling bacterial plaque in patients undergoing orthodontic treatment: A systematic review and meta-analysis.

OBJECTIVE: To assess the scientific evidence regarding the influence of reminder therapy on plaque index, gingival index, and white spots in patients subjected to orthodontic treatment. MATERIALS AND METHODS: Randomized clinical trials were searched in the electronic databases LILACS, PubMed, SciELO, Scopus, Web of Science, Embase, LIVIVO, and Cochrane Library. The databases OpenThesis and OpenGrey were used to capture the "gray literature," preventing selection and publication biases. The risk of bias was assessed by the Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials tool. The software Review Manager was used for the meta-analysis. The heterogeneity among studies was assessed through the I 2 statistic. A summary of the overall strength of evidence available was assessed using the Grades of Recommendations Assessment, Development, and Evaluation tool. RESULTS: A total of 332 records were found, from which only 7 articles met the inclusion criteria and were subjected to analysis. Reminder therapy showed improved scores for the plaque index (standardized mean difference = -1.22; 95% confidence interval = -2.03 to -0.42; P = .003) and the gingival index (standardized mean difference = 1.49; 95% confidence interval = -2.61 to 0.37; P = .009). Moreover, there was lower occurrence of white spots (relative risk = 0.53; 95% confidence interval = 0.38 to 0.74; P < .001) when reminder therapy was implemented. CONCLUSIONS: According to the existing high-quality evidence, reminder therapy is a valuable strategy and may contribute to the reduction of plaque and gingival indices as well as to the lower occurrence of white spots in patients subjected to orthodontic treatment.

Accuracy of dental development for estimating the pubertal growth spurt in comparison to skeletal development: a systematic review and meta-analysis.

OBJECTIVES: This study aimed to search for scientific evidence concerning the accuracy of dental development for estimating the pubertal growth spurt. METHODS: It was conducted according to the statements of PRISMA. An electronic search was performed in six databases, including the grey literature. The PICOS strategy was used to define the eligibility criteria and only observational studies were selected. RESULTS: Out of 1,416 identified citations, 10 articles fulfilled the criteria and were included in this systematic review. The association between dental development and skeletal maturity was considered strong in seven studies, and moderate in two, although the association with the pubertal growth spurt had been verified in only four articles. According to half of the studies, the tooth that provided the greater association with the ossification centres was the lower canine. The meta-analysis performed also indicated a positive association, being stronger in females [0.725 (0.649-0.808)]. However, when the method used for dental evaluation was considered, it was possible to verify greater correlation coefficients for Nolla [0.736 (0.666-0.814)] than for Demirjian [0.631 (0.450-0.884)], at the boys sample. The heterogeneity test reached high values (Q = 51.00), suggesting a potential bias within the studies. CONCLUSIONS: Most of individual studies suggested a strong correlation between dental development and skeletal maturation, although the association with the peakof pubertal growth spurtwas clearly cited only in some of them. However, due to the high heterogeneity found among the studies included in this meta-analysis, a pragmatic recommendation about the use of dental stages is not possible.

Influence of orthodontic treatment on root resorption: a systematic review

Objective: To perform a systematic review relating the existence of root resorption during orthodontic treatment. Methods: The research was performed in two electronic databases (PubMed and OpenGrey). The OpenGrey database was used exclusively for searching the "grey literature", avoiding selection and publication bias. Eligibility criteria included full texts available online, but with no language restriction. Aiming to work with more current articles on the subject, a filter for thelast ten years was applied. Articles that had no direct relation with the main outcome of this study were excluded, as well as clinical case reports and opinions, literature review articles, editorials, and letters to the editor. All eligible studies were assessed for risk of bias and individual quality, and all research steps were performed independently by two eligibility reviewers. Results: Initially, 77 articles were selected, but after the application of exclusion criteria, only 71 were included. Six articles were eligible for qualitative assessment. Overall, incisors are the teeth most affected by root resorption and there is a higher rate of root resorption in retraction mechanics. Conclusion: There is a relationship between root resorption and orthodontic treatment.

A atratividade facial percebida por leigos e cirurgiões-dentistas: uma revisão sistemática

Objetivo: avaliar sistematicamente, com base na literatura, se a opinião de leigos é mais flexível na avalia- ção da estética facial quando comparada à opinião de cirurgiões-dentistas. Materiais e método: foram utilizadas para a pesquisa as bases de dados eletrônicas LILACS, PubMed, SciELO e OpenGrey. Especificamente, a base OpenGrey foi utilizada para captação da "literatura cinza". Foram selecionados artigos publicados nos últimos dez anos, com textos completos disponíveis on-line em inglês, espanhol e português. Os artigos indexados em mais de uma base de dados foram contabilizados somente uma vez. Foram excluídos os artigos de revisão da literatura, relatos de caso e editoriais/cartas ao editor. Toda a pesquisa foi feita por dois revisores de elegibilidade. Resultados: foram identificados 118 registros, tendo sido três estudos elegíveis para a pesquisa. Todos os trabalhos selecionados envolviam ortodontistas e leigos como avaliadores. A Escala Analógica Visual e um Escore de Avaliação de Perfil foram utilizados como mensuração, analisados pelas fotografias. Dois artigos analisaram alterações anteroposteriores e um artigo analisou alterações na assimetria facial (frontal). Conclusão: mediante os estudos avaliados, nota-se que não há evidências claras de que leigos são mais flexíveis nas avaliações da estética facial.