Civil liability of orthodontists and aligner manufacturers in the treatment with orthodontic aligners.

INTRODUCTION: The use of clear aligners as an alternative to fixed orthodontic appliances has become popular due to the aesthetic demands of adult patients seeking orthodontic treatment. However, orthodontists' lack of knowledge about the legal consequences of their activities, and the lack of solid scientific evidence raise concerns regarding civil liability in this type of treatment. Marketing campaigns of manufacturing companies often exaggerate promises of results, and ignore the lack of scientific evidence. Patients, as consumers, are protected by the Consumer Protection Code, whereas orthodontists are considered treatment providers. Therefore, they can be held liable for damage caused to patients, whether by subjective or objective fault. OBJECTIVE: This article aims to identify the civil responsibilities of orthodontists and aligner manufacturing companies, by means of a literature review, providing basic legal guidance to help professionals protect themselves from possible lawsuits related to treatment with orthodontic aligners. CONCLUSIONS: The study highlights the importance of knowledge of legal notions in treatments with orthodontic aligners by orthodontists, who should legally safeguard themselves through individual written contracts, avoiding obligation of results. In addition, in cases of legal claims, it is possible that the manufacturing companies are jointly and severally liable for possible damages claimed by the patient.

Reconsidering the role of nasolabial angle in premolar extraction decision-making: A case-series study.

OBJECTIVES: To evaluate the impact of changes in upper incisor inclination and position on the alteration of the nasolabial angle (NLA) in a series of cases involving the extraction of four first premolars. MATERIALS AND METHODS: The study included 41 patients who underwent orthodontic treatment with premolar extractions. The patients were divided into two groups based on their pretreatment NLA values: Group 1 (NLA ≤ 100°) and Group 2 (NLA > 100°). Measurements of NLA, U1.NA and U1-NA were obtained before and after treatment and U1-Ls pretreatment measure was registered. Statistical analyses were performed to compare the differences in NLA, U1.NA and U1-NA between the two groups and to evaluate the influence of these variables added to U1-Ls (T1) on NLA changes. RESULTS: The results showed that Group 1 exhibited significant changes in NLA, while Group 2 did not. However, both groups showed significant changes in U1.NA and U1-NA. In Group 1, 80% of the individuals presented an increase in NLA and 20% no changes. In Group 2, 10% presented a decrease, 57% no changes and 33% an increase in NLA values. Multiple linear regression analysis indicated that the group factor had a statistically significant influence on NLA variation. Additionally, in Group 2, a negative correlation was observed between changes in U1.NA and NLA. CONCLUSIONS: The findings suggest that individuals with higher pretreatment NLA values tend to maintain their NLA values even after the correction of upper incisor inclination.

Evaluation of the impact of orthodontists' smile with malocclusions on social media and professional credibility.

OBJECTIVES: This study assessed laypeople's perceptions of orthodontist credibility based on malocclusions and whether these views affect their choice to seek treatment. Eye-tracking technology and questionnaires were utilized. MATERIALS AND METHODS: Ninety-five lay raters, through eye tracking and a questionnaire, assessed 12 images of orthodontists with malocclusions. Malocclusions were categorized by the Index Of Treatment Need (IOTN) as grade 1 (near ideal), 3 (anterior crowding), and 5 (with diastemas). Fixation points were recorded, and credibility was gauged via questionnaires. A Mentimeter word cloud was generated. RESULTS: IOTN 1 orthodontists were viewed as more credible than IOTN 3 (p < 0.001) and 5 (p < 0.001). Raters were more willing to receive treatment from IOTN 1 orthodontists. The focus for IOTN 1 was between eyes and mouth, while IOTN 3 and 5 were on the mouth. "Crooked teeth" and "spacing" were predominant in word clouds for IOTN 3 and 5. CONCLUSION: Orthodontists with an IOTN grade 1 rating were perceived as more competent, reliable, and professional, thus making it more likely for laypeople to choose them as their preferred providers. CLINICAL RELEVANCE: The smiles of professionals play a significant role in laypeople's decision to choose them as their orthodontist, and strategic utilization of social media can effectively deliver health information to a larger audience in a faster and more direct manner.

Civil liability of orthodontists and aligner manufacturers in the treatment with orthodontic aligners

ABSTRACT Introduction: The use of clear aligners as an alternative to fixed orthodontic appliances has become popular due to the aesthetic demands of adult patients seeking orthodontic treatment. However, orthodontists' lack of knowledge about the legal consequences of their activities, and the lack of solid scientific evidence raise concerns regarding civil liability in this type of treatment. Marketing campaigns of manufacturing companies often exaggerate promises of results, and ignore the lack of scientific evidence. Patients, as consumers, are protected by the Consumer Protection Code, whereas orthodontists are considered treatment providers. Therefore, they can be held liable for damage caused to patients, whether by subjective or objective fault. Objective: This article aims to identify the civil responsibilities of orthodontists and aligner manufacturing companies, by means of a literature review, providing basic legal guidance to help professionals protect themselves from possible lawsuits related to treatment with orthodontic aligners. Conclusions: The study highlights the importance of knowledge of legal notions in treatments with orthodontic aligners by orthodontists, who should legally safeguard themselves through individual written contracts, avoiding obligation of results. In addition, in cases of legal claims, it is possible that the manufacturing companies are jointly and severally liable for possible damages claimed by the patient.

RESUMO Introdução: O uso de alinhadores transparentes como alternativa aos aparelhos ortodônticos fixos tem se tornado popular, devido às demandas estéticas dos pacientes adultos em busca de tratamento ortodôntico. No entanto, a falta de conhecimento dos ortodontistas sobre as consequências jurídicas de suas atividades, e a falta de evidências científicas sólidas levantam preocupações em relação à responsabilidade civil nesse tipo de tratamento. Muitas vezes, as campanhas de marketing das empresas fabricantes exageram nas promessas de resultados e desconsideram a falta de evidências científicas. O paciente, como consumidor, é protegido pelo Código de Defesa do Consumidor, e o ortodontista é considerado um fornecedor de tratamento. Portanto, ele pode ser responsabilizado por danos causados ao paciente, seja por culpa subjetiva ou objetiva. Objetivo: Identificar, por meio de uma revisão bibliográfica, as responsabilidades civis dos ortodontistas e das empresas fabricantes de alinhadores, fornecendo orientações jurídicas básicas para ajudar os profissionais a se protegerem de possíveis demandas judiciais relacionadas ao tratamento com alinhadores ortodônticos. Conclusões: O estudo destaca a importância do conhecimento de noções jurídicas em tratamentos com alinhadores ortodônticos, devendo o profissional resguardar-se juridicamente por meio de contratos individuais por escrito, prevenindo-se de assumir uma obrigação de resultado com o paciente. Além disso, em casos de demandas judiciais, é possível que as empresas fabricantes respondam solidariamente a possíveis danos reclamados pelo paciente.

Orthodontics social media, perceptions of science- and non-science-based posts among orthodontists, dentists, students and laypeople.

Worldwide, social media is gaining popularity year after year. In Brazil, by 2027, there will be more than 188 million users of social media sites, against 165 million in 2022, therefore, the usage of general population and health care professionals, including orthodontists, is increasing. Differently from scientific journals that undergo a rigorous peer review process prior to publication, the same level of demand is not found on social media. Hence, this study aimed to assess whether orthodontists can recognize scientifically based and non-science-based posts and if their perceptions are different from general opinion (laypeople), dentistry students, and dentists (non-orthodontists). The posts were created using the search tool on Instagram with the hashtags #clearaligners #acceledent #selfligatingbraces and #propelorthodontics, four scientific based posts and four without or with low scientific evidence were selected and evaluated through a virtual questionnaire in the QUALTRICS platform by 385 people, (175 laypeople, 102 dentists, 58 dentistry students, and 50 orthodontists) using a visual analogue scale (VAS). In addition, four questions were asked. ANOVA (Adjusted Bonferroni correction) and Pearson's chi-squared, and Student T tests were applied to identify statistical differences. Significant difference was found only for posts with no scientific evidence between orthodontist's group when comparing with laypeople (p < 0.001) for the #selfligatingbraces, and the #propelorthodontics for the group orthodontists when compared with laypeople (p = 0.031) and dentists (p = 0.033). Instagram was the favorite social media where most of the participants spend more than 3 h. Of the participants, 97% used social media to keep informed and read the news. Almost half of the respondents search for orthodontics services on social media. Orthodontists were able to perceive differences in only two posts from the general perception (laypeople) regarding non- or low-scientific-evidence posts.

Pharyngeal airway subdivisions in 3-dimensional analysis: Differences between anterior and posterior anatomic boundaries.

INTRODUCTION: This study aimed to evaluate if there were differences between anterior and posterior anatomic boundaries used for the 3-dimensional determination of pharyngeal airway. METHODS: The sample included 150 cone-beam computed tomography scans from healthy patients divided according to (1) age: 6-11, 12-16, and ≥16 years; (2) sex: female and male; (3) anteroposterior skeletal pattern: Class I, II, and III; (4) vertical pattern: brachyfacial, mesofacial, and dolichofacial; and (5) craniocervical inclination (CCI): natural head posture, head flexion, and head extension. Anatomic regions were created to determine the correspondences between structures anteriorly and posteriorly to the pharyngeal airway. RESULTS: The location of the epiglottis, vallecula, hyoid, C2, and C3 were statistically different according to the CCI, and the location of vallecula, C3, and C4 were different according to sex. However, no statistically significant differences were observed between the frequencies of anterior and posterior anatomic region locations among age and different anteroposterior and vertical skeletal patterns. Posterior landmarks tend to be located below the anterior ones; consequently, the anatomic subregion they define will also be located below. CONCLUSIONS: Anterior and posterior structures and vertical and anteroposterior skeletal patterns may determine upper airway limits regardless of age. However, the studies must be paired according to sex, and CCI must be standardized.

MARPE as an adjunct to orthodontic treatment.

INTRODUCTION: Miniscrew or microimplant-assisted rapid palatal expansion (MARPE) devices are used to achieve a skeletal expansion of the palate and to increase the arch perimeter. OBJECTIVE: To describe the treatment of a 23-year-old woman with an Angle Class II, division 1 malocclusion with constricted maxillary and mandibular arches. CASE REPORT: The patient's main complaint was mandibular anterior crowding. The treatment plan included expansion of the mandibular arch concurrent with maxillary expansion, using a MARPE appliance in combination with a full-fixed appliance to align and level the crowded mandibular teeth, along with miniscrews as anchorage for the maxillary teeth and for distalization of the molars and premolars. A successful non-extraction orthodontic treatment was accomplished after 28 months, and the occlusion and teeth alignment, as well as facial goals, were resolved in a clinically satisfactory manner. CONCLUSION: The treatment objectives were met, and the outcome of the expansion of the maxillary arch with a MARPE appliance as an adjunct to a fixed appliance was considered a success. An esthetic, functional, and stable result after a 1-year follow-up was achieved and was satisfactory to the patient.

Eyes wide open to avoid misleading diagnosis and treatment planning.

INTRODUCTION: The treatment of impacted and transposed teeth is a challenge for clinical practice. A precise assessment of the relative position of the transposed tooth could lessen the risks of adverse effects, such as root resorption and periodontal problems. DESCRIPTION OF THE CASE: An 18-year-old patient went to the Orthodontic Department of the Federal University of Juiz de Fora, Brazil for a re-evaluation of the orthodontic treatment to which she had been receiving since the age of 12. Attempted traction of an impacted maxillary canine resulted in root resorption, marked mobility and alteration in the position of adjacent teeth as well as loss of alveolar bone in the anterior region of the maxilla. This tooth was not only partially transposed, but it also had ankylosis, external and internal tooth resorption, which indicated the need for tooth extraction. A change was made to the treatment plan, with the extraction of the canine, bone graft and mesial movement of the posterior teeth. RESULTS: All the spaces were closed at the end of treatment, with normal overbite and overjet. At the follow-up, the teeth position, the shape of dental arches, disocclusion guides and dental occlusion were preserved. The bone graft in the maxilla showed height and mineral density stability. CONCLUSION: The presence of the maxillary permanent canines in the dental arch is important for both aesthetics and a functional occlusion. However, despite the importance of their maintenance in the arch, it is well advised that each case be analysed individually.

Uma alternativa simples e eficiente para correção de recidivas após 15 anos de tratamento ortodôntico ­ relato de caso / A simple and efficient alternative for the correction of relapses after 15 years of orthodontic treatment ­ case report

Recidivas são frequentemente observadas após o tratamento ortodôntico e, com o objetivo de evitá-las e manter a estabilidade das posições dentárias após o tratamento, o uso de contenções superiores e inferiores é indicado. Entretanto, alguns pacientes não as usam de maneira correta, causando uma perda na estabilidade da posição dentária alcançada com o tratamento ortodôntico. Devido ao fato de os pacientes estarem mais preocupados com conforto e estética e o uso de alinhadores ortodônticos ser uma ferramenta viável para pequenas correções, o objetivo deste estudo foi descrever um caso clínico de correção de recidivas 15 anos após o fim do tratamento ortodôntico. As fotografias intraorais mostraram uma relação de má oclusão de Classe I com overjet e overbite satisfatórios, rotação do dente 23, extrusão do dente 11, desgaste incisal do dente 41 e apinhamento anteroinferior. Clinicamente, a paciente apresentava contato prematuro nos dentes 11 e 41 durante o movimento de protusão mandibular. O tratamento foi realizado com 4 alinhadores superiores e 10 alinhadores inferiores. Após este set de alinhadores, foram necessários mais 6 alinhadores inferiores, 2 por refinamento. Após 5 meses, a paciente apresentava boa oclusão, com guias laterais, protrusão sem interferência, além de alinhamento e nivelamento dentários. Esse caso clínico provou que o uso de alinhadores ortodônticos é eficiente em corrigir pequenas recidivas de tratamento ortodôntico.(AU)

Recurrences are frequently observed after orthodontics treatment, and in order to avoid them and keep the stability of dental positions after treatment, the use of maxillary and mandibular retainers are indicated. However, some patients do not use them properly causing the break of stability position obtained with the orthodontic treatment. As patients are more concerned with confort and esthetic and the use of clear aligners is a viable tool for small corrections, the aim of this study was to describe a case of relapse correction wich occurred after 15 years of orthodontic treatment with the use of clear aligners. The intraoral photographs showed a Class I maloclusion with satisfactory overjet and overbite, rotation of 23, extrusion of 11, incisal waste of 41, and mandibular anterior crowding, Clinically, the patient had premature contact with teeth 11 and 41 during protrusion movement. The entire treatment was done with 4 maxillary aligners and 10 mandibular aligners. After this set of aligners, it was necessary other 6 mandibular aligners, 2 per refinements. After 5 months, the patient presented good oclusion, with lateral guides, protrusion with no interferences, the teeth were aligned and leveled. This case report proved that clear aligners are efficient in correcting relapses.(AU)

Visual perception of repaired cleft lip scarring face associated with different malocclusions via eye-tracking.

Background. This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent patient, as assessed via eye-tracking. Methods. Index of orthodontic treatment need (IOTN) malocclusions, grades 1, 5, and 8 were added to the frontal view facial image of an adolescent male model showing asymmetries of the nose and upper lip after CL surgery using the software Photoshop CS5® software. The eye movements of 91 laypeople observers were tracked by an Eye Tribe infrared sensor connected to OGAMA© software. A Kruskal-Wallis test was used to identify differences in total fixation time and time until the first fixation for the areas of interest. A visual analog scale (VAS) of attractiveness was also used in the study. Statistical analysis was performed adopting a significance level of P<0.05. Results. The area of interest (AOI) were found to be the mouth and teeth, which were more focused on gazed at than any other area, regardless of the grade of IOTN. For observers of different ages, there were significant differences in the time until the first fixation on the scar of the repaired CL region for IOTN grade 1 (P=0.007). Images showing IOTN grade 1 repaired CL regions received the highest VAS scores. The older the age, the greater the tendency to give a higher VAS score for the same malocclusion. Conclusion. The presence of a CL scar on the upper lip did not attract the eye of laypeople observers of different ages, regardless of the degree of malocclusion in the non-smile image. The age of the observers did influence the perception of attractiveness, with older observers giving higher scores than younger ones. As the severity of the malocclusion increased, they were found to be less attractive.

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.

MARPE as an adjunct to orthodontic treatment

ABSTRACT Introduction: Miniscrew or microimplant-assisted rapid palatal expansion (MARPE) devices are used to achieve a skeletal expansion of the palate and to increase the arch perimeter. Objective: To describe the treatment of a 23-year-old woman with an Angle Class II, division 1 malocclusion with constricted maxillary and mandibular arches. Case report: The patient's main complaint was mandibular anterior crowding. The treatment plan included expansion of the mandibular arch concurrent with maxillary expansion, using a MARPE appliance in combination with a full-fixed appliance to align and level the crowded mandibular teeth, along with miniscrews as anchorage for the maxillary teeth and for distalization of the molars and premolars. A successful non-extraction orthodontic treatment was accomplished after 28 months, and the occlusion and teeth alignment, as well as facial goals, were resolved in a clinically satisfactory manner. Conclusion: The treatment objectives were met, and the outcome of the expansion of the maxillary arch with a MARPE appliance as an adjunct to a fixed appliance was considered a success. An esthetic, functional, and stable result after a 1-year follow-up was achieved and was satisfactory to the patient.

RESUMO Introdução: Os aparelhos para expansão rápida da maxila (ERM) apoiada em mini-imlantes (MI) (MARPE) são usados para obter uma expansão esquelética do palato e aumentar o perímetro da arcada dentária superior. Objetivo: Este relato de caso descreve o tratamento de uma paciente do sexo feminino de 23 anos de idade, com má oclusão Classe II de Angle, divisão 1, com constrição das arcadas superior e inferior. Relato de caso: A queixa principal da paciente era o apinhamento anteroinferior. O plano de tratamento incluiu a expansão maxilar usando o aparelho MARPE, em combinação com aparelho fixo para a expansão da arcada inferior, concomitante ao alinhamento e nivelamento. Utilizou-se MI como ancoragem para a distalização dos molares e pré-molares superiores. O tratamento ortodôntico sem extrações foi realizado em 28 meses, e a oclusão e o alinhamento dos dentes, assim como os resultados faciais obtidos, foram clinicamente satisfatórios. Conclusão: Os objetivos do tratamento foram alcançados, e o resultado da ERM com aparelho MARPE junto ao aparelho fixo foi considerado um sucesso. Observou-se resultados estéticos e funcionais estáveis após um ano de acompanhamento, satisfatórios para a paciente.