The Esthetics of the Nasolabial Fold and Age in the Elderly Via Eye-Tracking.

Background: Facial aging is associated with the loss of soft tissue fullness. Perioral signs of facial aging can add years to individuals' appearances and even affect their facial expressions in smiling and nonsmiling images. Aims: To evaluate the influence of the nasolabial fold on the visual perception of esthetics and age in the elderly, eye-tracking and a visual analog scale were used. Material and Methods: This study applied a cross-sectional study using 40 laypeople. Facial images of an elderly woman were modified to include facial expression lines such as nasolabial folds and marionette lines with no folds, intermediate, and accentuated depths folds. Eye tracking was implemented to measure the average number of fixations. Heat maps and dot maps were generated using eye-tracking software. A visual analog scale of attractiveness and age perception questionnaire were also incorporated into the study. Statistical analysis was performed using a significance of (P<0.05). Results: The majority of visual attention was paid to the eye and mouth areas. In the images with no folds, the right eye attracted a greater degree of fixation. In the images in which nasolabial folds were accentuated, the mouth area served as an area of high fixation. No statistical difference was observed between the groups in which smiling images were viewed. Nonsmiling images demonstrated significant differences between groups for variables including time until first fixation, complete fixation time, and number of fixations on the eyes and hemifaces. Old age and diminished attractiveness were associated with attenuated nasolabial folds, especially in nonsmiling images. Conclusion: The facial lines and expressions of elderly female individuals were assessed by laypeople using eye-tracking, showing that the deeper one's nasolabial folds, the more aged and less attractive one appears, especially in nonsmiling images. Smiling pictures were perceived to be more attractive and youthful; these perceptions should be considered in the search for improved esthetic results, whether in dental or facial esthetic treatments.

Predictors of perceived stress and quality of life amongst dental master and doctoral students.

OBJECTIVES: This study aimed to identify predictors of perceived stress and quality of life (QoL) amongst dental master and doctoral students. MATERIALS AND METHODS: This is a cross-sectional study with Brazilian students as participants (n = 707). The following instruments were administered: Perceived stress scale (PSS), the WHOQOL-BREF and a socio-demographic questionnaire. A linear regression model was estimated. RESULTS: The results showed that female was associated with higher scores of PSS and lower scores of QoL. A negative correlation was observed between PSS and all four domains of QoL. Multivariate analysis revealed that the set of selected variables partially explained the variability of PSS score (28%) and the four QoL domains: physical (52%), psychological (62%), social relationships (25%) and environment (37%). The variable number of children, hours of sleep, concurrent work and study, leisure time and physical activity practice were associated with positive changes on QoL, whilst PSS and medication intake with negative. Lower PSS score was associated with the variables age, hours of sleep, leisure time and physical activity. CONCLUSIONS: Our findings suggest that perceived stress and medication intake due to study are important predictors of lower QoL in dental master and doctoral students, especially in the psychological domain. More hours of sleep, leisure time and physical activity improved both QoL and perceived stress scores and might be feasible coping strategies for these outcomes in this population.

Distalization of maxillary molars with Invisalign aligners in nonextraction patients with Class II malocclusion.

INTRODUCTION: This retrospective study aimed to evaluate whether the treatment of Class II malocclusion with Invisalign aligners with sequential distalization of posterior teeth in adult patients would meet the criteria of American Board of Orthodontics (ABO) standards for the treatment and assess the predictive value of ClinCheck Pro software with the final results comparing the initial time, predictive planning using ClinCheck Pro software, and the final time without any require refinement. METHODS: The sample consisted of 32 adult patients with Class II malocclusion (n = 32 [7 men and 25 women]; mean age 35.47 ± 9.61 years). All of them used a set of Invisalign aligners; no refinement set was evaluated. The 7 measurements of the ABO Model Grading System, the millimeter measurements for the anteroposterior ratios of maxillary first molars and the overbite were used in the evaluations and were compared in phases initial time, predictive planning using ClinCheck Pro software, and the final time. For the intraexaminer reliability test, the intraclass correlation coefficient was calculated to analyze the reliability of the measures. The Shapiro-Wilk normality test was used to examine whether the variables were normally distributed. The Wilcoxon nonparametric test for paired samples was applied for variables that did not show normal distribution. The parametric Student t test for paired samples was used for variables that presented normal distribution. The significance level adopted for this study was 0.05. RESULTS: In comparison between final ClinCheck and posttreatment results, the ABO index showed a statistically significant difference between the predictions and results for alignment and rotation, buccolingual inclination, overjet, occlusal contact, occlusal relationship, molar relationship, and overbite. The final score of the ABO scores did not meet the standards for Class II correction, contrary to what the ClinCheck Pro software predicted. CONCLUSIONS: The null hypothesis that distalization of the posterior teeth occurs in adult patients using Invisalign aligners was rejected. The treatment of Class II malocclusion with Invisalign aligners did not occur as estimated by the virtual planning prepared by ClinCheck according to the standards for evaluating occlusal results established by the ABO at the end of the use of a set of aligners with sequential distalization.

The influence of malocclusion on social aspects in adults: study via eye tracking technology and questionnaire.

BACKGROUND: Smile esthetics has a strong influence on perception, attractiveness, and personal characteristics. It is unknown how malocclusions may influence the appearance of the individual's smile. This study aimed to investigate whether malocclusion affects the visual perception of esthetics, age, employability, honesty, intelligence and to meet its obligation in time in middle-aged adults. Facial frontal smiling photographs of a male and a female middle-aged adult with 3 different malocclusions were shown to and evaluated by 90 laypeople (non-dentists), divided into groups: young adults (14-44 years), middle-aged adults (45-59 years), and elders (over 60 years). The index of treatment need (IOTN) was used, and IOTN 1, 5, and 8 images were created in Photoshop using the male and female photographs. In total, 6 photographs were evaluated, 3 areas of interest (AOI)-eyes, nose, and mouth-were created for statistical comparison. The Ogama and Eye Tribe tracker were used in conjunction to measure eye tracking. A visual analog scale (VAS) was employed with a questionnaire surveying individuals' perception of age, employability, honesty, intelligence, and ability to meet obligations. Kruskal-Wallis, one-way analysis of variance, Pearson's-chi-squared, and Pearson correlation test were applied. RESULTS: No statistical difference was found in complete fixation time and time until the first fixation for each AOI for eye-tracking. VAS showed statistical differences in the male and female IOTN 1 images when compared with the IOTN 5 and 8 for both models, and there was no difference between genders in the IOTN 1. As the perceived age of the model increased, the chances of getting hired decreased. Employability, honesty, intelligence, and ability to meet obligations showed higher values for IOTN 1. There were significant differences between age ranges; perception of intelligence in the female IOTN 1 model (p = 0.002) and IOTN 8 model (p < 0.001) and honesty between young adults and middle-aged adults in the male IOTN 1 and 8 images (p < 0.001). CONCLUSIONS: There was a difference between age groups in the perception of honesty and intelligence. A well-balanced and attractive was perceived as more youthful and attractive in both genders and may increase the chance of being selected for a job interview or being hired.

The visual perception of aligned and crowded maxillary lateral incisors when smiling via eye tracking.

Background: This study aimed to investigate whether the alignment of the teeth while smiling alters the visual perception by laypeople using eye tracking. Methods: Facial images (two males and two females) were digitally edited to show a smile pattern with aligned teeth and one with crowded teeth. Sixty laypeople were selected to observe the images. The number of fixations, fixation duration, and time until the first fixation were recorded using an eye-tracking system. The results were qualitatively calculated with dot maps. Numerical data were analyzed using an independent Student's t test. Results: There were no significant differences in fixation duration and the number of fixations in the crowded smile, mainly that of the male. The fixation times for the teeth were significantly different when the participants viewed the male subjects with a crowded smile (P<0.05). Dot maps showed greater attention to the smile with crowded teeth in both genders. Conclusion: The crowded maxillary incisor smile attracted more visual attention to males from laypeople.

The effects of images posted to social media by orthodontists on public perception of professional credibility and willingness to become a client.

BACKGROUND: Many patients choose health professionals using the Internet, whether through websites or social media. In orthodontics, an orthodontist's relationship with active and potential patients can be affected by social media interactions, both as a marketing tool and as a tool for providing educational information. The purpose of the present study was to analyze the public perception of professional credibility and willingness to become a client, based on images posted by orthodontists on Instagram. METHOD: This was a cross-sectional study performed using a digital self-administered questionnaire based on images from public Instagram profiles of orthodontists found using certain hashtags. The themes of the posts were analyzed through a qualitative analysis, and the results were expressed as categories. After analyzing 2445 images, 12 thematic categories emerged. A total of 446 individuals (225 laypeople, 66 dental students, and 155 dentists) evaluated the images in regard to the perception of professional credibility and willingness to become a client. One-way ANOVA and chi-square tests were applied, considering a 5% significance level. RESULTS: It was found that more than 95% of the participants used social media, primarily Instagram, WhatsApp, and Facebook, and the social network most used to research health services was Instagram. Statistically significant differences were found in the mean value of perceived professional credibility between the groups (p < 0.05) for the following categories: "dental traction," "mini-implant mechanics," "before and after treatment," "aesthetic brackets," "metallic brackets," and "clear aligners." The categories "being a teacher" and "before and after treatment" had a higher impact on the participants' perception of credibility and willingness to become a client, unlike the "social relationship" and "family relationship" categories. CONCLUSIONS: Some of the themes found in the orthodontists' social media posts were found to influence the perceptions around professional credibility and willingness to become a client, although there were differences among the participants in the present study.

An eye-tracking and visual analogue scale attractiveness evaluation of black space between the maxillary central incisors.

OBJECTIVE: To study the influence of black space between the maxillary central incisors on the aesthetic visual perception of the face, via eye-tracking and visual analogue scale (VAS). METHODS: Black space between the central incisors was created, for both sexes, as follows: control, 1-mm black space, 2-mm black space and 3-mm black space. Ninety raters participated in this study, divided into three groups: 30 laypeople, 30 nonorthodontists, and 30 orthodontists. After the visual calibration of each observer, eight photographs were presented in the Ogama® software concomitant with the use of the hardware The Eye Tribe®. Ogama generated information depending on the eye-tracking of each rater, regarding the time until the first fixation, time of fixation, heatmap, scanpath, and total time of fixation, to evaluate the areas deemed to be of interest according to the raters. Later on, the VAS was used, where each rater evaluated the images in an album on a scale of zero to 10 points. RESULTS: The eyes and mouth were the areas more often noticed by the raters according to the heatmaps, while no significant difference was observed in time until the first fixation between the three groups of raters (p> 0.05). However, regarding the time of fixation on the mouth, a significant difference was observed (p< 0.05) when comparing the three groups. CONCLUSION: Black space has a negative effect on the aesthetic perception of the face. The amount of attention on the mouth is correspondent to the size of the black space.

An eye-tracking and visual analogue scale attractiveness evaluation of black space between the maxillary central incisors

ABSTRACT Objective: To study the influence of black space between the maxillary central incisors on the aesthetic visual perception of the face, via eye-tracking and visual analogue scale (VAS). Methods: Black space between the central incisors was created, for both sexes, as follows: control, 1-mm black space, 2-mm black space and 3-mm black space. Ninety raters participated in this study, divided into three groups: 30 laypeople, 30 nonorthodontists, and 30 orthodontists. After the visual calibration of each observer, eight photographs were presented in the Ogama® software concomitant with the use of the hardware The Eye Tribe®. Ogama generated information depending on the eye-tracking of each rater, regarding the time until the first fixation, time of fixation, heatmap, scanpath, and total time of fixation, to evaluate the areas deemed to be of interest according to the raters. Later on, the VAS was used, where each rater evaluated the images in an album on a scale of zero to 10 points. Results: The eyes and mouth were the areas more often noticed by the raters according to the heatmaps, while no significant difference was observed in time until the first fixation between the three groups of raters (p> 0.05). However, regarding the time of fixation on the mouth, a significant difference was observed (p< 0.05) when comparing the three groups. Conclusion: Black space has a negative effect on the aesthetic perception of the face. The amount of attention on the mouth is correspondent to the size of the black space.

RESUMO Objetivo: Avaliar a percepção visual e estética do espaço negro entre os incisivos centrais superiores, via rastreamento do olhar e escala visual analógica (EVA). Métodos: Manipulou-se o espaço negro entre os incisivos centrais superiores, para ambos os sexos, da seguinte forma: imagem controle, espaço negro de 1 mm, espaço negro de 2 mm e espaço negro de 3 mm. Participaram desse estudo noventa avaliadores, divididos em três grupos: 30 leigos, 30 cirurgiões-dentistas e 30 ortodontistas. Após a calibração visual de cada observador, foram projetadas oito fotografias no software OGAMA® em conjunto com o hardware The Eye Tribe®. O OGAMA gerou informações do rastreamento do olhar de cada avaliador com relação ao tempo até a primeira fixação, mapa de calor, trajetória do olhar e tempo total de fixação para avaliar as áreas consideradas de interesse, de acordo com os avaliadores. Posteriormente, utilizou-se a EVA para avaliar as imagens a partir de um álbum, em uma escala de 0 a 10 pontos. Resultados: Os olhos e a boca foram as áreas com maior fixação pelos avaliadores, de acordo com os mapas de calor. Os resultados estatísticos não apresentaram diferença estatisticamente significativa entre os três grupos de avaliadores (p> 0,05), quanto ao tempo até a primeira fixação. Porém, em relação ao tempo de fixação na boca, observou-se diferença estatisticamente significativa (p< 0,05) na comparação dos três grupos. Conclusão: O espaço negro apresentou um efeito negativo na percepção estética da face. O aumento de fixação na boca correspondeu ao aumento do tamanho do espaço negro.

Reanatomização de incisivos inferiores para a correção da discrepância de Bolton / Mandibular incisors reshaping to correct Bolton discrepancy

Resumo A agenesia de um incisivo inferior, além de causar um problema estético, pode gerar inclinações indesejáveis dos dentes, desvio da linha média inferior e aumento do overjet e overbite, além de uma discrepância de Bolton. O objetivo deste trabalho é apresentar uma abordagem de tratamento interdisciplinar realizado em um paciente jovem do sexo masculino com agenesia do incisivo central inferior esquerdo. Foi realizada abertura de pequenos espaços entre os incisivos inferiores com molas abertas. A distribuição dos espaços para reanatomização dos incisivos inferiores com resina composta corrigiu a discrepância de Bolton e proporcionou resultados estéticos e funcionais com overjet e overbite adequados.(AU)

Abstract Agenesis of a mandibular incisor, besides causing an esthetic problem, can generate undesirable teeth inclinations, lower midline deviation and increased overjet and overbite, in addition to a Bolton discrepancy. The objective of this paper is to present an interdisciplinary treatment approach performed in a young male patient with a mandibular left central incisor agenesis. The opening of small spaces between mandibular incisors was performed with coil springs. Space distribution for reshaping mandibular incisors with composite upturned the Bolton discrepancy and provided aesthetic and functional results with adequate overjet and overbite (AU)

Classe II, divisão 1 ­ da dentição mista à permanente com aparelho ortopédico funcional e fixo / Class II, division 1 ­ from mixed to permanent dentition with functional and fixed orthopedic appliance

Resumo O tratamento ortodôntico da maloclusão Classe II, divisão 1 em uma ou duas fases ainda é controverso na Ortodontia contemporânea. O presente relato de caso clínico ilustra o tratamento ortodôntico de um paciente de 6 anos de idade com queixa estética e bullying em relação ao sorriso, apresentando Classe II esquelética, maloclusão Classe II, divisão 1 de Angle, overjet com labioversão exagerada dos incisivos superiores, overbite exagerado com os incisivos inferiores tocando a mucosa do palato, ausência de selamento labial e perfil inferior da face côncavo. Na Fase I, realizou-se a expansão rápida da maxila com aparelho expansor tipo Hyrax associado ao aparelho ortopédico funcional fixo tipo Herbst, durante 11 meses. Na Fase II, utilizou-se o aparelho ortodôntico fixo associado a elásticos intermaxilares por 13 meses. O tratamento em duas fases da maloclusão Classe II, divisão 1, após 24 meses, mostrou-se eficaz em estabelecer resultados oclusais e funcionais adequados e melhora na estética do terço inferior da face (AU)

Abstract Orthodontic treatment of Class II, division 1 malocclusion in one or two phases is still controversial in contemporary Orthodontics. The present clinical case presents the orthodontic treatment of a 6-year-old patient with aesthetic complaint regarding the smile and bullying, presenting skeletal Class II, Class II malocclusion, Angle division 1, overjet with exaggerated protrusion of the maxillary incisors, exaggerated overbite with the lower incisors touching the palatal mucosa, absence of lip sealing and concave inferior face profile. In Phase I, rapid maxillary expansion was performed with Hyrax-type expander together with the Herbst fixed functional orthopedic device for 11 months. In Phase II, the fixed orthodontic appliance associated with intermaxillary elastics was used for 13 months. The two-phase treatment of Class II malocclusion, division 1 showed to be effective after 24 months, establishing adequate occlusal and functional results and improving the aesthetics of the lower third of the face.(AU)

Laypeople's and dental students' perceptions of a diastema between central and lateral incisors: Evaluation using scanpaths and colour-coded maps.

OBJECTIVE: This study aimed to use eye tracking to analyse people's visual perceptions of smiles with a diastema between the maxillary central and lateral incisors, based on different categories of observers. SETTING AND SAMPLE POPULATIONS: An image of a diastema between the maxillary central and lateral incisors was shown to dental students and laypeople. MATERIALS AND METHODS: Our null hypothesis was that there would be no difference in the visual perception of the different graduations of diastemas between the two groups. The diastemas were edited in Photoshop® to gradually increase the distance between the maxillary central and lateral incisors from no diastema to 1.5 mm and 3.5 mm diastemas. These diastemas were evaluated by using a TheEyeTribe© tracker in conjunction with OGAMA© 5.0 software. A total of 37 dental students and 33 laypeople looked at eight randomly arranged images of smiles. The data were analyzed using color coded maps, scanpaths, and the Kruskal-Wallis test with a level of significance of 5%. RESULTS: Laypeople tended to observe the eyes, focusing more on the right than the left, and spent less time focusing on the diastema region than did the dental students. There were differences for the same magnitude of diastema within participant groups. As the width of the diastema increased, both students and laypeople focused more on the diastema region. CONCLUSIONS: The two groups of evaluators presented different perceptions of smiles in cases of diastema between the maxillary central and lateral incisors when evaluated using eye-tracking.

Perceived stress and quality of life among graduate dental faculty.

OBJECTIVE: This study aimed to identify the predictors of perceived stress and quality of life (QoL) among graduate dental faculty. METHODS: This cross-sectional study was conducted using a representative sample of 348 dental faculty members from master's and doctoral programs in Brazil. Data were collected using self-administered questionnaires between August and December 2018. QoL was assessed using the multidimensional World Health Organization Quality of Life assessment (WHOQOL-BREF). Perceived stress was assessed using the Perceived Stress Scale (PSS). Participant sociodemographic characteristics served as the independent variables. The data were subjected to linear regression analysis. RESULTS: Women obtained higher PSS scores and lower QoL scores (P < 0.05). There was a negative correlation between perceived stress and all 4 QoL domains. Multivariate analysis revealed that a combination of the independent variables (i.e., sex, age, sleep duration, dual employment, medication intake due to work, and leisure time) explained 32% of the variance in perceived stress. Regarding QoL, perceived stress, sleep duration, and medication intake due to work explained 50%, 58%, 27%, and 40% of the variance in the physical health, psychological, social relationships, and environment domain scores, respectively. Sex (i.e., female) and medication intake due to work predicted higher levels of perceived stress. In contrast, age, sleep duration, dual employment, and leisure time were associated with lower levels of perceived stress. CONCLUSION: Perceived stress and medication intake due to work had a negative effect on QoL, whereas sleep duration had a positive impact on QoL.

Long-term stability of a Class III malocclusion with severe anterior open bite and bilateral posterior crossbite in a hyperdivergent patient.

Anterior open bite malocclusion is generally associated with several causes. This case report describes the 2-phase treatment of a 13-year-old boy with a Class III malocclusion, severe anterior open bite, and bilateral posterior crossbite treated without surgical intervention. An orthopedic approach was performed in phase 1 with a hyrax-type palatal expander, followed by maxillary protraction with a facemask for a 10-month period to promote the correction of transverse and sagittal deviations. In phase 2, a comprehensive orthodontic approach using fixed preadjusted appliances associated with intermaxillary elastics was performed. These approaches, combined with good patient compliance, established a functional and esthetic occlusal relationship, normal overjet and overbite, and a well-balanced facial appearance. The 4.5-year follow-up indicated that treatment results were stable.

The Eye-Tracking Study of the Impact of the Gingival Margin Height of Maxillary Lateral Incisors.

The objective of this study was to verify differences in eye-tracking metrics and subjective smile esthetic ratings between general practitioners, orthodontists, and laypersons in cases of maxillary lateral incisor gingival margin deviations. Unilateral apical and incisal gingival margin deviations of 1, 2, and 3 mm were digitally produced in pictures of a man and a woman smiling. Specific areas of interest (AOIs) were created in each picture. Eye-tracking metric data included the time to first fixation (TFF) and number of fixations (NF). A specific sensor and software were used to acquire information on the eye movements. Data on the smile esthetic ratings were obtained using a visual analog scale (VAS). Analysis of variance and Pearson correlation were applied. The TFF on the AOIs in the mouth was shorter for general practitioners and orthodontists, signifying that general practitioners and orthodontists rapidly perceived the features in these areas, while for laypersons, the TFF was shorter for the AOIs of the eyes (P < .05). The NF was greater on the AOIs in the mouth for general practitioners and orthodontists, whereas to the laypersons, the NF tended to be greater on the AOIs in the eyes. Mean VAS scores differed between observer groups (P < .05). For the male picture, the 1-mm and 2-mm apical gingival margin deviations received the highest scores from the laypersons, while for both female and male pictures, the 1-mm apical deviation received the highest scores from the general practitioners and orthodontists. Higher VAS scores resulted in longer times that general practitioners and orthodontists spent looking at the gingival margin changes. General practitioners and orthodontists differ from laypersons in their perceptions of smile esthetics. Eye-tracking metrics revealed that the AOIs in the mouth aroused greater interest from the general practitioners and orthodontists, and this interest became greater as the gingival margin deviations increased to 3 mm. Laypersons fixated more on the AOIs of the eyes. The VAS scores indicated that general practitioners and orthodontists were more critical than laypersons, accepting smaller deviations in the gingival margins of the maxillary lateral incisors.

Nonsurgical treatment of skeletal maxillary protrusion with gummy smile using headgear for growth control, mini-implants as anchorage for maxillary incisor intrusion, and premolar extractions for incisor retraction.

INTRODUCTION: An adolescent girl, aged 12 years 11 months, was evaluated for orthodontic treatment. Her chief complaints included a difficulty with keeping her lips passively closed and excessive gingival exposure upon smiling. Her treatment plan included (1) restriction of maxillary growth with cervical headgear, (2) extraction of the maxillary first premolars to reduce the maxillary protrusion and the mandibular second premolars to facilitate Class II dental correction, and (3) management of maxillary incisor intrusion via anchoring with mini-implants. When indicated, even in the absence of large space discrepancies, extractions can be beneficial to the patient. The final results showed an attractive smile, passive lip seal, and a more esthetic and balanced facial profile. Retention records confirmed the stability of the treatment. The 5-year follow-up visit revealed that the treatment results were quite stable.

Esporões linguais para a interceptação da mordida aberta anterior dentária. Em uma consulta? / Linguistic spurs for the interception of anterior open dental bite. In a consultation?

Introdução A mordida aberta anterior (MAA) deve ser prevenida e interceptada em idade precoce, preferencialmente na dentição mista, para se estabelecer um ambiente adequado para a estabilidade dos resultados em longo prazo¹. O posicionamento anterior da língua em repouso, deglutição atípica com interposição lingual e hábitos deletérios como a sucção digital são descritos como fatores etiológicos comuns da MAA²,³. Existem outras condições possivelmente ensejadoras da MAA, incluindo crescimento vertical severo, respiração predominantemente bucal e sucção dos lábios². A prevalência da MAA na dentição mista é de 17,7% e a sua etiologia é multifatorial4. Quando ela resulta principalmente da posição anormal da língua, recomenda-se o tratamento ortodôntico2,3,5,6. Os esporões linguais corrigem o comportamento e a postura da língua, proporcionando a interceptação com o fechamento progressivo da MAA por reflexo proprioceptivo, promovendo uma posição superior da língua em repouso e estabilidade dos resultados 2,3,6. Neste "point of view" será descrita uma técnica simples de confecção e adesão direta de esporões linguais para a interceptação da MMA, que pode ser executada numa única consulta.(AU)

Introduction The anterior open bite (MAA) must be prevented and intercepted at an early age, preferably in mixed dentition, to establish an appropriate environment for long-term stability of results¹. The anterior positioning of the tongue at rest, atypical swallowing with lingual interposition and deleterious habits such as digital sucking are described as common etiological factors of MAA²,³. There are other possible conditions for MAA, including severe vertical growth, predominantly mouth breathing and lip sucking². (AU)

Biomechanics for Orthodontic Intrusion of Severely Extruded Maxillary Molars for Functional Prosthetic Rehabilitation.

The objective of this clinical case is thus to present a Class II, division 1, subdivision malocclusion with a severely extruded maxillary left hemiarch, which, due to the loss of mandibular teeth, makes prosthetic rehabilitation of the edentulous spaces impossible. A significant intrusion was performed with mini-implants followed by miniplates associated with fixed appliance and elastomeric chains. The results of this process showed that the biological responses of the teeth and the surrounding bony structure to the intrusion were demonstrated to be normal and acceptable. A clinically significant intrusion of the left maxillary molars, along with the recovery of the interocclusal space and the prosthetic rehabilitation, was obtained with a fixed orthodontic appliance that was associated to the biomechanics with TADs. It also allowed the obtaining of Class I canine relationship, demonstrated periodontal health and favored the prosthetic rehabilitation with good occlusion, aesthetics, and satisfactory function.