Evaluation of the perception of smile esthetics, in frontal view, with mandibular laterognatism, through the eye-tracking technique.

OBJECTIVES: To evaluate the perception of esthetics and the attractiveness of the smile, in frontal view, with mandibular asymmetry, through the eye-tracking. MATERIALS AND METHODS: OGAMA software and The Eye Tribe Tracker hardware were used to obtain eye tracking in certain areas of interest on the face. To simulate asymmetry, Photoshop® image editing software was used to create a vertical reference line to the midline of the face and make it symmetrical with control of the angulation relative to another horizontal reference line passing through the vertices. Then, the lower third of the face added asymmetries or deviations, starting from zero, with increments of 2 by 2 degrees up to 6 degrees. The study included 60 laypeople, 30 males and 30 females, without any knowledge about the study, showing good vision, and not having used drugs with the possibility of influencing cognitive or motor skills. RESULTS: From the heat map in cases of mandibular asymmetry, it is possible to visualize that for both sexes the evaluators evaluated with a certain degree of similarity mainly when the deviations presented with 6 degrees. The trajectory of the male and female gaze in cases with asymmetry shows that in cases with a magnitude of 6 degrees, the raters traced mainly in the region of the mouth with little transition in the eye region and mainly in the areas of interest considered as "other." In the images presented with a magnitude of up to 4 degrees, they were traced in the general image. CONCLUSIONS: The perception of laypeople from mandibular asymmetry to the right in females presented a higher perception when compared to males with mandible asymmetry to the left.

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.

Orthodontic treatment with passive eruption and mesialization of semi-impacted mandibular third molar in an adult with multiple dental losses

ABSTRACT Objective: This article describes the orthodontic treatment performed on an adult patient with multiple dental losses. Case report: A female patient, 20 years and 4 months old, presented with the following conditions: absence of teeth #26, #35, #36 and #46; semi-impacted tooth #48; inclined molars adjacent to an edentulous space; canines and premolars in a Class II relationship; a convex profile; biprotrusion; and forced lip sealing. Results: Space in the region of tooth #26 was closed, as well the space of tooth #46; tooth #48 erupted and followed mesial movement passively; space of the region of tooth #35 was maintained for the placement of a dental implant; uprighting of tooth #37 was obtained. Aesthetic and functional goals of the treatment were achieved. Results remained stable 10 years after the end of the treatment. Conclusion: The modified helical loop could be effectively used in orthodontic mechanics to close edentulous spaces. Passive semi-impacted mandibular third molar eruption and mesialization can occur in adults when proper space is provided.

RESUMO Objetivo: o presente artigo descreve o tratamento ortodôntico realizado em uma paciente adulta que apresentava múltiplas perdas dentárias. Relato do caso: paciente do sexo feminino com 20 anos e 4 meses de idade, apresentava as seguintes condições: ausência dos dentes #26, #35, #36 e #46; dente #48 semi-impactado; molares adjacentes ao espaço edentado inclinados; relação Classe II de caninos e pré-molares; perfil convexo; biprotrusão; selamento labial forçado. Resultados: foram obtidos o fechamento do espaço da região do dente #26, assim como do #46; o dente #48 irrompeu e acompanhou esse movimento mesial; manutenção do espaço da região do dente #35 para colocação de implante dentário; e verticalização do dente #37. Os objetivos estéticos e funcionais do tratamento foram alcançados. Os resultados alcançados permaneceram estáveis 10 anos após o fim do tratamento. Conclusão: a alça helicoidal modificada pode ser efetivamente usada na mecânica ortodôntica para fechar espaços edêntulos. A erupção passiva e a mesialização de terceiro molar mandibular semi-impactado podem ocorrer em adultos, quando espaço adequado é obtido.

Comparative study between different groups of esthetic component of the Index of Orthodontic Treatment Need and eye tracking.

INTRODUCTION: The objective of this study was to determine how different people perceive distinct malocclusions with the use of eye tracking and to compare the results with scores from the subjective visual attractiveness scale (VAS) following 3 grades obtained from the Aesthetic Component of the Index of Orthodontic Treatment Need (AC-IOTN) scale. METHODS: Ninety participants were equally distributed into 3 groups-dentists, orthodontists, and laypeople-and underwent 1 eye-tracking session. After being positioned and calibrated, they were shown 3 dental images. The images reflected the AC-IOTN grades of 1 (close to ideal), 5 (borderline need for treatment), and 8 (definite need for treatment). During the viewing, eye-tracker data were collected for fixation points, duration, and attractiveness (according to the VAS) for each image. The variables were statistically tested with the use of 2-way analysis of variance and complete factorial model (between groups, grades, and for the interactions between them). RESULTS: Grade 1 received the highest subjective score independently from the participant group. This was in contrast to grades 5 and 8, which received similar scores, although the means of fixation points and duration were not significantly different among the grades (P > 0.05). The scores obtained from the dentist group were significantly higher than those from the other groups when the comparison was independent from the grade. In terms of fixation points, there were differences between dentists and orthodontists and between orthodontists and laypeople. The fixation point mean was higher for orthodontists than for dentists and was similar to that for laypeople. CONCLUSIONS: Orthodontists were able to closely analyze the occlusal problems presenting with more severe malocclusions, and the specialists noticed more fixation points. Duration times, however, were not significantly different, because the orthodontists had greater interest, even in situations of unfavorable esthetics.

Orthodontic treatment with passive eruption and mesialization of semi-impacted mandibular third molar in an adult with multiple dental losses.

OBJECTIVE: This article describes the orthodontic treatment performed on an adult patient with multiple dental losses. CASE REPORT: A female patient, 20 years and 4 months old, presented with the following conditions: absence of teeth #26, #35, #36 and #46; semi-impacted tooth #48; inclined molars adjacent to an edentulous space; canines and premolars in a Class II relationship; a convex profile; biprotrusion; and forced lip sealing. RESULTS: Space in the region of tooth #26 was closed, as well the space of tooth #46; tooth #48 erupted and followed mesial movement passively; space of the region of tooth #35 was maintained for the placement of a dental implant; uprighting of tooth #37 was obtained. Aesthetic and functional goals of the treatment were achieved. Results remained stable 10 years after the end of the treatment. CONCLUSION: The modified helical loop could be effectively used in orthodontic mechanics to close edentulous spaces. Passive semi-impacted mandibular third molar eruption and mesialization can occur in adults when proper space is provided.

Class II Division 2 Subdivision Malocclusion in an Adult Patient treated with the Forsus Fatigue-resistant Device placed Unilaterally.

Treatment of Class II subdivision malocclusion is challenging, and orthodontists frequently struggle to determine the choice of treatment. Several treatment modalities have been proposed for correcting these types of malocclusion. Thus, the aim of this case report is to present dentoalveolar and facial outcomes achieved using an unilateral Forsus fatigue-resistant device combined with fixed appliances in an adult female patient presenting with Class II subdivision malocclusion. Treatment outcome was effective producing dental esthetics and functional positive stable results after 3-year, 2-month follow-up.

Miniscrew Composition, Transmucosal Profile, and Cortical Bone Thickness: A Three-dimensional Finite-element Analysis of Stress Fields.

AIM: The aim of this study was to use the finite-element method (FEM) to analyze the stress fields generated in miniscrews (MSs) and surrounding bone on applying a force perpendicular to the MS according to variations in the cortical bone thickness and changes in the transmucosal profile length and MS composition. MATERIALS AND METHODS: Miniscrews with stainless steel (SS) and titanium alloy mechanical properties with a 1 to 2 mm transmucosal profile inserted in bone blocks with cortical bone of varying thickness (1 and 2 mm) were three-dimensionally modeled using computer-aided design (CAD) and examined using FEM. A 3.5 N force perpendicular to the long axis of the MS was applied in the four mechanical tests: EM1: SS MS and a 1 mm transmucosal profile; EM2: titanium MS and a 1 mm transmucosal profile; EM3: SS MS and a 2 mm transmucosal profile; and EM4: titanium MS and a 2 mm transmucosal profile. RESULTS: The stress distributions in all mechanical tests were highest at the MS, especially at the MS-cortical bone interface. A greater stress concentration occurred in cortical bone measuring 1 mm thick than in the cortical bone measuring 2 mm thick. The MSs with a 2 mm transmucosal profile showed higher stress than those with a 1 mm transmucosal profile. CONCLUSION: The titanium alloy MSs showed higher stress fields and deflection voltages than the SS MSs at the same cortical bone thickness and with the same transmucosal profile. CLINICAL SIGNIFICANCE: From a mechanical perspective, this study showed the stress field generated in MSs with SS and titanium alloy (Ti) mechanical properties and surrounding bone. The stress distribution was concentrated at the MS, mainly at the interface with the cortical bone, and the difference between the stress values for the Ti and SS MSs was very small. Under this condition, the two types of MSs are suitable for orthodontic applications because their yield limits are much higher.

Clinical Outcome of an Impacted Maxillary Canine: From Exposition to Occlusion.

AIM: The aim is to report a case of impacted maxillary right canine successfully positioned into the occlusion line. BACKGROUND: Although the treatment of choice for an impacted canine is a combined surgical-orthodontic approach, there are differences in technique. The preorthodontic uncovering and autonomous eruption technique is a safe and predictable option for the treatment of palatally impacted maxillary canines in adolescents and adults as is the orthodontic creation of a space before minimal surgical exposure, the bonding of a small attachment (an eyelet), full-flap closure, and immediate traction. Although the mechanical management of impacted teeth is a routine task for most orthodontists, certain types of impaction can be frustrating. CASE DESCRIPTION: An 18-year-old adult patient presented for clinical examination with a mobile maxillary right deciduous canine, the absence of a maxillary right permanent canine, Angle Class I malocclusion, an overjet of 2.0 mm, an overbite of 3.0 mm, and rotated canine and left maxillary central and lateral incisors. Cephalometric measurements revealed a skeletal Class I relationship as well as upright maxillary incisors (1. NA = 18°) and mandibular incisors (1. NB = 16°, IMPA = 80°). The facial profile was concave. Clinically, a constricted maxillary arch was observed, and the patient had a nail-biting habit. CONCLUSION: The canine was aligned, leveled and positioned in the occlusion line. The esthetic, functional and periodontal results remained stable in the retention phase. CLINICAL SIGNIFICANCE: Various treatment strategies are available to treat impacted maxillary canines. The surgical, periodontal, and orthodontic considerations in the management of impacted canines must be clearly explained to the patient.

A versatilidade do bracket pré-ajustado para o incisivo lateral superior em caso de mordida cruzada / The versatility of the pre-adjusted bracket for the maxillary lateral incisor in caso of crossbite

A versatilidade é um recurso técnico que permite sobrecorrigir a maloclusão e personaliza o tratamento ortodôntico, reduzindo a necessidade de introduzir dobras de primeira, segunda e terceira ordem nos fios ortodônticos nas quatro fases do tratamento e pode ser utilizada a partir do estágio inicial até a finalização. O objetivo deste trabalho é descrever o uso da versatilidade do bracket pré-ajustado, do sistema MBT, em um caso clínico de incisivo lateral superior direito em mordida cruzada e com falta de espaço severo para o posicionamento na linha de oclusão. A consideração final é que a colagem do bracket no incisivo lateral superior, sistema MBT com um giro de 180°, no incisivo lateral em palatogressão, apresentou uma biomecânica eficiente na movimentação da raiz para vestibular, proporcionando volume na região alveolar sem a inserção de dobras no arco ortodôntico e com boa intercuspidação e estética dentária e facial (AU)

Versatility is a technical feature that allows malocclusion overcorrection, and personalizes the orthodontic treatment, reducing the need to introduce first, second, and third order bends in the orthodontic wires in the four treatment phases, and it can be used from the initial stage until the end. The purpose of this article is to describe the versatility use of the pre-adjusted bracket of the MBT system in a clinical case of cross-bite of the right maxillary lateral incisor and severe lack of space for positioning in the occlusion line. The final consideration is that the bracket bonding to the maxillary lateral incisor, MBT system with a 180° rotation, in palatally displaced maxillary lateral incisor, presented an efficient biomechanics to move the root to the vestibular, providing volume in the alveolar region without the insertion of additional bends in the orthodontic arch wire, and with good intercuspidation and dental and facial aesthetics.(AU)

Tridimensional finite element analysis of teeth movement induced by different headgear forces.

BACKGROUND: This study aimed to simulate the actions of low-pull (LP), high-pull (HP), and combined pull (CP) headgears (HGs) and to analyze tooth movement tendencies through finite element analysis. METHODS: Tomographic slices of a human maxilla with complete permanent dentition were processed by reconstruction software, and the triangular surface mesh was converted into non-uniform rational B-spline (NURBS) curves. An HG facial bow was also modulated in 3D. The teeth and bone were considered to have isotropic and linear behavior, whereas the periodontal ligament was considered to have non-linear and hyperelastic behavior. Data regarding the application points, directions and magnitudes of forces were obtained from the literature and from a dolichofacial patient with class II, division 1 malocclusion, who was treated with a CP HG. RESULTS: The CP HG promoted 37.1 to 41.1 %, and the HP HG promoted 19.1 to 31.9 % of LP distalization. The HP HG presented the highest intrusion, and the LP HG presented the highest extrusion of the first molar. The LP HG contracted the distal side, and the HP and CP HGs contracted the lingual and distobuccal roots of the second molar to a lesser degree. CONCLUSIONS: The LP HG promotes the greatest distalization, followed by the CP and HP HGs; the LP HG causes greater extrusion of the first molar, and the HP HG causes greater intrusion of the first molar. The LP HG causes greater contraction of the second molar than the HP HG.

Stress Distribution Evaluation of the Periodontal Ligament in the Maxillary Canine for Retraction by Different Alveolar Corticotomy Techniques: A Three-dimensional Finite Element Analysis.

AIM: By using the finite element method (FEM), this study aimed to evaluate the effect of different corticotomy formats on the distribution and magnitude of stress on the periodontal ligament (PDL) during retraction of the maxillary canine. MATERIALS AND METHODS: A geometric model of the left hemi-jaw was created from computed tomography scan images of a dry human skull and loads were administered during distalization movement of the canine. Three trials were performed: (1) without corticotomy, (2) box-shaped corticotomy and perforations in the cortical bone of the canine (CVC) and (3) CVC and circular-shaped corticotomy in the cortical bone of the edentulous space of the first premolar. RESULTS: There was no difference in stress distribution among the different corticotomy formats. CONCLUSION: Different corticotomy formats used to accelerate orthodontic tooth movement did not affect stress distribution in the PDL during canine retraction. CLINICAL SIGNIFICANCE: From a mechanical perspective, the present study showed that the stress distribution on the PDL during canine retraction was similar in all the corticotomy formats. When using the Andrews T2 bracket, the PDL presented the highest levels of stress in the middle third of the PDL, suggesting that the force was near the center of resistance. Also, as bone weakening by corticotomies did not influence stress distribution, the surgical procedure could be simplified to a less aggressive one, focusing more on inflammatory cellular stimulation than on bone resistance. A simpler surgical act could also be performed by most orthodontists in their practices, enhancing postoperative response and reducing patient costs.

Orthodontic intrusion of maxillary incisors: a 3D finite element method study.

OBJECTIVE: In orthodontic treatment, intrusion movement of maxillary incisors is often necessary. Therefore, the objective of this investigation is to evaluate the initial distribution patterns and magnitude of compressive stress in the periodontal ligament (PDL) in a simulation of orthodontic intrusion of maxillary incisors, considering the points of force application. METHODS: Anatomic 3D models reconstructed from cone-beam computed tomography scans were used to simulate maxillary incisors intrusion loading. The points of force application selected were: centered between central incisors brackets (LOAD 1); bilaterally between the brackets of central and lateral incisors (LOAD 2); bilaterally distal to the brackets of lateral incisors (LOAD 3); bilaterally 7 mm distal to the center of brackets of lateral incisors (LOAD 4). RESULTS AND CONCLUSIONS: Stress concentrated at the PDL apex region, irrespective of the point of orthodontic force application. The four load models showed distinct contour plots and compressive stress values over the midsagittal reference line. The contour plots of central and lateral incisors were not similar in the same load model. LOAD 3 resulted in more balanced compressive stress distribution.

Orthodontic intrusion of maxillary incisors: a 3D finite element method study

Objective: In orthodontic treatment, intrusion movement of maxillary incisors is often necessary. Therefore, the objective of this investigation is to evaluate the initial distribution patterns and magnitude of compressive stress in the periodontal ligament (PDL) in a simulation of orthodontic intrusion of maxillary incisors, considering the points of force application. Methods: Anatomic 3D models reconstructed from cone-beam computed tomography scans were used to simulate maxillary incisors intrusion loading. The points of force application selected were: centered between central incisors brackets (LOAD 1); bilaterally between the brackets of central and lateral incisors (LOAD 2); bilaterally distal to the brackets of lateral incisors (LOAD 3); bilaterally 7 mm distal to the center of brackets of lateral incisors (LOAD 4). Results and Conclusions: Stress concentrated at the PDL apex region, irrespective of the point of orthodontic force application. The four load models showed distinct contour plots and compressive stress values over the midsagittal reference line. The contour plots of central and lateral incisors were not similar in the same load model. LOAD 3 resulted in more balanced compressive stress distribution.

Objetivo: frequentemente, no tratamento ortodôntico, é necessário o movimento de intrusão dos incisivos superiores. Assim, o objetivo deste estudo é avaliar o padrão de distribuição inicial e magnitude das tensões compressivas no ligamento periodontal (LPD) na simulação da intrusão ortodôntica dos incisivos superiores, considerando os pontos de aplicação da força. Métodos: modelos anatômicos 3D reconstruídos a partir de tomografias computadorizadas de feixe cônico foram utilizados para simular os carregamentos da intrusão dos incisivos superiores. Os pontos eleitos para a aplicação das forças foram: centralizado entre os braquetes dos incisivos centrais (LOAD 1); bilateralmente, entre os braquetes dos incisivos centrais e laterais (LOAD 2); bilateralmente, distal aos braquetes dos incisivos laterais (LOAD 3); bilateralmente, 7mm distal ao centro dos braquetes dos incisivos laterais (LOAD 4). Resultados e Conclusões: as tensões concentraram-se na região apical do LPD, independentemente do ponto de aplicação da força ortodôntica; os quatro modelos de carregamento mostraram distribuição e valores de tensão compressiva distintos na linha mediana sagital de referência; os gráficos de distribuição das tensões não foram similares para os incisivos central e lateral no mesmo modelo de carregamento; o LOAD 3 resultou em uma distribuição mais equilibrada das tensões compressivas.

Therapeutic approach to Class II, Division 1 malocclusion with maxillary functional orthopedics.

INTRODUCTION: Interceptive treatment of Class II, Division 1 malocclusion is a challenge orthodontists commonly face due to the different growth patterns they come across and the different treatment strategies they have available. OBJECTIVE: To report five cases of interceptive orthodontics performed with the aid of Klammt's elastic open activator (KEOA) to treat Class II, Division 1 malocclusion. METHODS: Treatment comprehends one or two phases; and the use of functional orthopedic appliances, whenever properly recommended, is able to minimize dentoskeletal discrepancies with consequent improvement in facial esthetics during the first stage of mixed dentition. The triad of diagnosis, correct appliance manufacture and patient's compliance is imperative to allow KEOA to contribute to Class II malocclusion treatment. RESULTS: Cases reported herein showed significant improvement in skeletal, dental and profile aspects, as evinced by cephalometric analysis and clinical photographs taken before, during and after interceptive orthodontics.

Therapeutic approach to Class II, Division 1 malocclusion with maxillary functional orthopedics

INTRODUCTION: Interceptive treatment of Class II, Division 1 malocclusion is a challenge orthodontists commonly face due to the different growth patterns they come across and the different treatment strategies they have available.OBJECTIVE: To report five cases of interceptive orthodontics performed with the aid of Klammt's elastic open activator (KEOA) to treat Class II, Division 1 malocclusion.METHODS: Treatment comprehends one or two phases; and the use of functional orthopedic appliances, whenever properly recommended, is able to minimize dentoskeletal discrepancies with consequent improvement in facial esthetics during the first stage of mixed dentition. The triad of diagnosis, correct appliance manufacture and patient's compliance is imperative to allow KEOA to contribute to Class II malocclusion treatment.RESULTS: Cases reported herein showed significant improvement in skeletal, dental and profile aspects, as evinced by cephalometric analysis and clinical photographs taken before, during and after interceptive orthodontics.

INTRODUÇÃO: o tratamento interceptor da má oclusão de Classe II primeira divisão é um desafio comum para os ortodontistas, em função dos diferentes padrões de crescimento que podem ser encontrados e das estratégias de tratamento disponíveis.OBJETIVO:apresentar cinco casos de interceptação da má oclusão de Classe II primeira divisão usando o ativador aberto elástico de Klammt (AAEK).MÉTODOS: o tratamento dessa má oclusão pode ser realizado em uma ou duas fases; e a utilização dos aparelhos ortopédicos funcionais, de acordo com suas indicações, pode minimizar as discrepâncias dentoesqueléticas, melhorando, consequentemente, a estética facial na primeira fase da dentição mista. O diagnóstico, a correta confecção do aparelho e a cooperação do paciente são a tríade indispensável para que o AAEK seja um coadjuvante no tratamento dessa má oclusão.RESULTADOS: os casos clínicos apresentaram melhora significativa nos aspectos esquelético, dentário e de perfil, evidenciada pelas análises cefalométricas e, no aspecto clínico, pelas fotografias pré- e trans-tratamento e após a interceptação.

General dentist orthodontic practice in foreign legal systems

OBJECTIVE: General dentist orthodontic practice is a controversial issue and this paper aims to analyze it comparing foreign laws to Brazilian Legal System. METHODS: Regulations and scientific texts concerning orthodontic practice by general dentists, in Portuguese or English language, were sought. RESULTS AND CONCLUSION: Portugal clearly forbids general dentist orthodontic practice; United States of America do not clearly forbid general dentist orthodontic practice, but do regulate and promote campaigns to encourage public to seek specialist service; in Australia and England, corrective orthodontics are offered both by orthodontists and general dentists; it was not possible to evaluate how orthodontic services are provided in Eastern Europe; and the fact that general dentists are forbidden to practice corrective orthodontics in Brazilian Legal System is compatible to other countries policy.

Treatment of an adult with several missing teeth and atrophic old mandibular first molar extraction sites.

This report describes the orthodontic treatment of a woman, aged 34 years 2 months, with several missing teeth and atrophic mandibular first molar extraction sites. We had planned to close the spaces from the missing maxillary canines with mesial movement of the premolars and molars. In the mandibular arch, protraction of the second molars into first molar extraction sites and reduction of the mandibular incisor protrusion were performed. No miniscrews or bone plates were used. A modified helical loop was used, and it can be considered a simple and an efficient orthodontic method of closing the spaces without mesial or lingual tipping and rotation. Pleasing esthetic and functional results were achieved.

Orthodontic-prosthetic treatment of an adult with a severe Class III malocclusion.

This case report describes the treatment of a 37-year-old woman with multiple restored and missing teeth, a Class III subdivision malocclusion, and complete dental crossbite. Treatment options included orthognathic surgery and an orthodontic-prosthetic approach. The patient opted for nonsurgical treatment with space opening for prosthetic replacement of the first maxillary molars.