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.

Smile Arc Esthetics in Middle-Aged Man from the Layperson's Perspective Via Eye-Tracking

Abstract Objective: To evaluate the perceptions of smile esthetics associated with variations in the vertical plane of the maxillary incisors in the smile arc using eye-tracking software. Material and Methods: An image of a 59-year-old Caucasian male model was adapted and edited to make three changes in the vertical plane, simulating a convex, straight, and reverse smile arc. Four areas of interest were inserted at the right and left eyes, nose, and mouth. Forty laypeople raters between 18 and 45 years of age participated of the study. Eye-tribe hardware and Ogama software were used to perform eye-tracking. Attractiveness and age-perception questions were also incorporated into the study. ANOVA test and Pearson's correlation coefficient, at p < 0.05. Results: The most observed AOI in images with convex, straight, and reverse smiles, as assessed using heatmaps and point maps, was the mouth, followed by the right eye. A significant difference for the eye (p=0.02) was found when comparing convex and reverse smiles, whereas a significant difference for the mouth was observed between the straight and reverse smiles (p=0.03). Conclusion: Convex and straight smile arcs were associated with equal levels of attractiveness; the reverse smile was less attractive. No significant difference was noticed regarding age perception and the smile arcs. However, the reverse smile recorded a more complete fixation time.

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)

Modificação no aparelho ortopédico funcional de Klammt na interceptação da maloclusão Classe II, 1 / Klammt's functional orthopedic appliance modification in the interception of Class II / division 1 malocclusion

As má oclusões de Classe II, Divisão 1 são um desafio comum em Ortodontia, e há controvérsia entre a interceptação em idade precoce ou a realização de tratamento corretivo na adolescência. O objetivo deste estudo é apresentar o relato de caso com Classe I esquelética, má oclusão de Classe II, Divisão 1, sobressaliência 9,0 mm, sobremordida exagerada com incisivos superiores cobrindo totalmente os incisivos inferiores. Preconizou-se o ativador aberto elástico de Klammt com um alongamento vertical lingual na região posterior por 16 meses. Os resultados foram a redução da sobressaliência e da sobremordida devido a uma resposta mandibular verdadeira. A manutenção do posicionamento mandibular foi observada no exame de acompanhamento sem o uso de qualquer aparelho após 4 anos e 11 anos meses (AU)

The Class II, Division 1 malocclusions are a common challenge in orthodontics, and there is controversy between interception at an early age or performing single-stage treatment in adolescence. The aim of this study is to present a case report of a skeletal Class I, Class II, Division 1 malocclusion, overjet 9,0 mm, overbite with maxillary incisors totally covering the lower incisors. The interceptive orthodontics was performed with the aid of Klammt's elastic open activator for 16 months. The results were reduction of overjet and overbite due to a true mandibular response. The maintenance of a forward positioning of the mandible was observed after 4 years and 11 months in the follow-up examination without the use of any type of appliance. (AU)