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1.
Medicine (Baltimore) ; 100(8): e24869, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663114

RESUMO

ABSTRACT: Techniques for enhancing the effective space of the mandibular arch are urgently needed. Therefore, this study aimed to perform mandibular expansion in combination with a fixed-appliance technique, with preliminary monitoring by finite element analysis and 3-dimensional cone-beam computed tomography (CBCT).Finite element models were structured according to CBCT images of a 14-year-old girl. The von Mises stress of the alveolar bone and tooth displacement were assessed in different models. The technique was also applied in an 11-year-old boy. CBCT was performed at post-expansion, post-retention, post-treatment and 2 years after treatment. Tooth movement and alveolar bone stress were assessed by the CAD software.Finite element analysis suggested that the teeth tended to stand upright in the buccal side in the expander model compared with the expander-remove model. However, minimum tooth change was observed in the normal model, indicating highest stability. The von Mises stress of the alveolar bone was decreased in the normal model compared with the expander model, suggesting that buccal-inclined teeth could more easily lead to alveolar bone stress than normal ones. Based on CBCT data and the 3D mandibular dentition model fitting, mandibular teeth tended to be upright in the buccal side after retention compared with the post-expansion condition, which somewhat differed from finite element analysis results. Furthermore, dehiscence and fenestration were not observed.This expansion technique is expected to increase the effective space after mandibular expansion and reduce buccal alveolar bone stress.


Assuntos
Mandíbula/diagnóstico por imagem , Aparelhos Ortodônticos Fixos , Técnica de Expansão Palatina/instrumentação , Técnicas de Movimentação Dentária/métodos , Adolescente , Criança , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Imageamento Tridimensional , Masculino , Projetos Piloto
4.
Am J Orthod Dentofacial Orthop ; 159(4): 435-442, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33573896

RESUMO

INTRODUCTION: The purpose of this reseach was to compare the effects of different periodic periodontal scaling protocols on the periodontal health of adolescents with fixed orthodontic appliances by assessing the aspartate aminotransferase (AST) and alkaline phosphatase (ALP) levels in gingival crevicular fluid and periodontal clinical indexes in a prospective cohort study. METHODS: Forty-eight adolescents were divided into 3 groups according to the interval of periodontal scaling (group A: once a month; group B: once every 3 months; group C: once every 6 months). The AST and ALP levels in the gingival crevicular fluid were measured before orthodontic treatment (T0) and at 1 (T1), 3 (T2), 6 (T3), and 9 (T4) months during orthodontic treatment. Periodontal clinical indexes (plaque index [PI], gingival index [GI], and probing depth) were also assessed. RESULTS: At T2, significantly lower AST and ALP levels were observed in group A than in groups B and C (P <0.05). At T3 and T4, lower AST and ALP levels were detected in groups A and B than in group C (P <0.05), and there was no significant difference between the A and B groups at T4 (P >0.05). At T2, the PI and GI were increased in groups B and C compared with group A, and at T3 and T4, significantly lower PI and GI values were observed in groups A and B than in group C (P <0.05). CONCLUSIONS: Periodontal scaling promotes the oral hygiene of adolescents undergoing fixed orthodontic treatment, and periodontal scaling protocols administered monthly and once every 3 months are better for controlling periodontal health than treatments administered once every 6 months.


Assuntos
Higiene Bucal , Aparelhos Ortodônticos Fixos , Adolescente , Índice de Placa Dentária , Líquido do Sulco Gengival , Humanos , Aparelhos Ortodônticos/efeitos adversos , Índice Periodontal , Estudos Prospectivos
7.
Oral Health Prev Dent ; 19(1): 67, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33491380

RESUMO

PURPOSE: Orthodontic treatment may introduce a risk to the integrity of enamel due to plaque accumulation and colonisation by oral microbes. This prospective cohort study observed the effect of fixed, self-ligating orthodontic appliances on saliva properties and oral microbial flora. Materials and Methods: Thirty adolescent patients were recruited (13 female, 17 male, mean age 13.97 ±â€¯2.07 years). Saliva samples were collected before placement of fixed orthodontic appliances (T0), and 4 (T1) and 12 (T2) weeks later. Salivary pH, flow rate and buffering capacity were recorded. All saliva samples were cultured on agar plates for 2 days. Salivary prevalence of Neisseria spp., streptococci, Staphylococcus aureus, coagulase-negative staphylococci and Candida albicans were assessed. Results: High buffering capacity was reported in 21 patients at T0, 22 patients at T1 and in 28 patients at T2. Saliva flow rate also increased over time (7.08 ml/5 min at T0, 7.93 ml/5 min at T1 and 8.35 ml/5min at T2). Mean pH was 7.63 at T0, 7.67 at T1 and 7.78 at T2. There was no evidence that either pH or the number of colonies of any of the microbial species changed over time. Conclusion: The increased buffering capacity of saliva as well as the salivary flow rate after initial bonding might be protective against the development of dental caries. Current microbial findings indicate that initiation of orthodontic treatment may not be associated with significant changes in oral microbial flora.


Assuntos
Cárie Dentária , Saliva , Adolescente , Criança , Índice de Placa Dentária , Feminino , Humanos , Masculino , Aparelhos Ortodônticos , Aparelhos Ortodônticos Fixos/efeitos adversos , Estudos Prospectivos
8.
Clin Oral Investig ; 25(3): 1525-1534, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33409688

RESUMO

OBJECTIVES: Angle Class II malocclusions including a retrognathic mandible are the most frequent orthodontic problems. Both removable and fixed functional appliances can be used for mandibular advancement. Mandibular advancement after treatment with any fixed functional appliance has numerous therapeutic effects, such as stretching of masticatory muscles, ligaments, membranes and surrounding soft tissues, thus causing positional changes of the hyoid bone and epiglottis. This retrospective study investigates and compares treatment effects upon epiglottis- and hyoid bone position and posterior airway space in class II patients who received mandibular advancement through two different cast splint fixed functional appliances. MATERIAL AND METHODS: Two groups of 21 patients each ('Functional Mandibular Advancer' (FMA) and Herbst appliance) were investigated. The same experienced orthodontist performed the treatment in all patients, employing a single-step advancement protocol. The mandible always received initial protrusion into an edge-to-edge position. Conventional lateral cephalograms were available pre-treatment (T1) and immediately after appliance removal (T2) for all patients. The measurements comprised (I) hyoid bone, (II) epiglottis or (III) posterior airway space. Treatment-related changes were analysed with one-sample Student's t tests for intragroup comparisons and independent Student's t tests for intergroup comparisons. Statistical significance was set at p < 0.05. RESULTS: Measurements of the hyoid bone showed mostly increases for both appliances after treatment. Intergroup comparisons were not significant for FMA patients but significant for selected measurements in Herbst appliance patients. Intergroup comparisons showed insignificant changes. The posterior airway space was always insignificantly increased after treatment. The greatest increase was found caudally. Intergroup comparisons showed insignificant changes. CONCLUSIONS: Both fixed functional appliances cause an anterior and caudal displacement of epiglottis and hyoid bone and enlarge the posterior airway space. The therapeutic effects of the Herbst appliance are slightly larger, although not significantly. CLINICAL RELEVANCE: Treatment with either Herbst appliance of FMA alters the hyoid bone position and enlarges the posterior airway space. Still, long-term data are as yet unavailable; it remains unknown if the effects upon posterior airway space remain stable, and if a resulting posterior airway space enlargement may have clinical influence upon obstructive sleep apnoea syndrome.


Assuntos
Má Oclusão de Angle Classe II , Aparelhos Ortodônticos Funcionais , Cefalometria , Epiglote , Humanos , Osso Hioide , Má Oclusão de Angle Classe II/terapia , Mandíbula , Aparelhos Ortodônticos Fixos , Estudos Retrospectivos , Contenções
9.
Angle Orthod ; 91(2): 149-156, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33434285

RESUMO

OBJECTIVES: To determine dentoalveolar and skeletal effects produced in mature patients by the Carriere Motion Class III (CM3) appliance followed by fixed appliances. MATERIALS AND METHODS: This retrospective study evaluated 32 patients at three time points: T1 (initial), T2 (removal of CM3), and T3 (posttreatment). Serial cephalograms were traced and digitized, and best-fit regional superimpositions were constructed. Eleven linear and 7 angular variables were measured. The starting forms of the CM3 patients were compared with a sample of untreated subjects with normal occlusions and well-balanced faces. RESULTS: The CM3 phase lasted 6.3 months, followed by a phase of fixed appliances lasting 12.9 months; the total duration of treatment was 19.2 months. Minimal skeletal changes were measured sagittally, with only a slight increase in lower anterior facial height observed during treatment. Most treatment changes were dentoalveolar in nature. Wits appraisal increased 4.0 mm during treatment. The molar relationship improved by 6.0 mm during phase I, a value that rebounded slightly during phase II, resulting in an improvement toward Class I of 4.8 mm. Best-fit regional superimpositions revealed anterior movement of upper molars relative to the maxilla and posterior movement of lower molars relative to the mandible. CONCLUSIONS: The Carriere Motion Class III appliance is an effective and efficient method of resolving occlusal problems in minimally growing Class III patients. Primary treatment effects are dentoalveolar in nature with minimal skeletal alterations.


Assuntos
Má Oclusão de Angle Classe II , Aparelhos Ortodônticos Funcionais , Adolescente , Adulto , Cefalometria , Humanos , Má Oclusão de Angle Classe II/diagnóstico por imagem , Má Oclusão de Angle Classe II/terapia , Mandíbula , Maxila , Desenho de Aparelho Ortodôntico , Aparelhos Ortodônticos Fixos , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 99(50): e23165, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327234

RESUMO

BACKGROUND: Although several researchers have analyzed the dental identity of patients experience with corrective methods using fixed and removable appliances, the consequences stay debatable. This meta-analysis intended to verify whether the periodontal status of removable appliances is similar to that of the conventional fixed appliances. METHODS: Relevant literature was retrieved from the database of Cochrane library, PubMed, EMBASE, and CNKI until December 2019, without time or language restrictions. Comparative clinical studies assessing periodontal conditions between removable appliances and fixed appliances were included for analysis. The data was analyzed using the Stata 12.0 software. RESULTS: A total of 13 articles involving 598 subjects were selected for this meta-analysis. We found that the plaque index (PLI) identity of the removable appliances group was significantly lower compared to the fixed appliances group at 3 months (OR = -0.57, 95% CI: -0.98 to -0.16, P = .006) and 6 months (OR = -1.10, 95% CI: -1.60 to -0.61, P = .000). The gingival index (GI) of the removable appliances group was lower at 6 months (OR = -1.14, 95% CI: -1.95 to -0.34, P = .005), but the difference was not statistically significant at 3 months (OR = -0.20, 95% CI: -0.50 to 0.10, P = .185) when compared with that of the fixed appliances group. The sulcus probing depth (SPD) of the removable appliances group was lower compared to the fixed appliances group at 3 months (OR = -0.26, 95% CI: -0.52 to -0.01, P = .047) and 6 months (OR = -0.42, 95% CI: -0.83 to -0.01, P = .045). The shape of the funnel plot was symmetrical, indicating no obvious publication bias in the Begg test (P = .174); the Egger test also indicated no obvious publication bias (P = .1). CONCLUSION: Our meta-analysis demonstrated that malocclusion patients treated with the removable appliances demonstrated a better periodontal status as compared with those treated with fixed orthodontic appliances. However, the analyses of more numbers of clinical trials are warranted to confirm this conclusion.


Assuntos
Má Oclusão/terapia , Aparelhos Ortodônticos Fixos/efeitos adversos , Aparelhos Ortodônticos Removíveis/efeitos adversos , Doenças Periodontais/etiologia , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Má Oclusão/classificação , Má Oclusão/diagnóstico , Pessoa de Meia-Idade , Desenho de Aparelho Ortodôntico/tendências , Aparelhos Ortodônticos/provisão & distribução , Avaliação de Resultados em Cuidados de Saúde , Doenças Periodontais/epidemiologia , Índice Periodontal , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Ned Tijdschr Tandheelkd ; 127(12): 699-704, 2020 Dec.
Artigo em Holandês | MEDLINE | ID: mdl-33367297

RESUMO

One of the main disadvantages of orthodontic treatment with fixed appliances is the formation of demineralisations around the brackets. These demineralisations develop because the brackets produce an increased number of plaque retention sites and a change in the oral environment, resulting in a different plaque composition. To prevent the formation of these demineralisations several methods are used during orthodontic treatment. Using additional fluoride is the best solution, for example, rinsing daily with a fluoride mouthwash, applying a fluoride varnish during every scheduled check-up, or using toothpaste with a high concentration of fluoride. The last 2 methods are less effectively incorporated in daily practice in the Netherlands due to financial or time factors. Additional measures, like using fluoride-releasing adhesives, CPP-ACP(F) or a chlorhexidine rinse appear to be less effective in reducing demineralisations. It is also important to provide specific oral hygiene and dietary instructions, based on an individual risk assessment.


Assuntos
Cariostáticos , Cárie Dentária , Cárie Dentária/etiologia , Cárie Dentária/prevenção & controle , Fluoretos , Humanos , Países Baixos , Aparelhos Ortodônticos/efeitos adversos , Aparelhos Ortodônticos Fixos
16.
Sci Rep ; 10(1): 21989, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33319834

RESUMO

Fixed orthodontic appliances are common and effective tools to treat malocclusion. Adverse effects of these appliances, such as dental caries and periodontitis, may be associated with alteration of the microbiome. This study investigated the impact of these appliances on the dynamics of the oral microbiome. Seventy-one patients were selected. Supragingival plaque samples were collected before placement (T0) and six months after placement (T1). Saliva samples were collected at T0 and T1, and then when appliance removal (T2). Microbial DNA was analyzed by 16S rRNA meta-sequencing. The diversity analysis indicated dynamic changes in the structure of the oral microbiome. Taxonomic analysis at phylum level showed a significant increase in Bacteroidetes and Saccharibacteria (formally TM7) and decrease in Proteobacteria and Actinobacteria over time, in both plaque and saliva. Genus level analysis of relative abundance indicated a significant increase in anaerobic and facultative anaerobes in both plaque and saliva. Fixed orthodontic appliances induced measurable changes in the oral microbiome. This was characterized by an increase in relative abundance of obligate anaerobes, including periodontal pathogens. It can be concluded that this dysbiosis induced by fixed orthodontic appliances is likely to represent a transitional stage in the shift in microbiome from healthy to periodontitis.


Assuntos
Grupo com Ancestrais do Continente Asiático , Microbiota , Boca/microbiologia , Aparelhos Ortodônticos Fixos/microbiologia , Bactérias/classificação , Biodiversidade , Gengiva/microbiologia , Humanos , Japão , Periodontite/microbiologia , Filogenia
17.
Angle Orthod ; 90(4): 485-490, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378505

RESUMO

OBJECTIVE: To assess the efficacy and efficiency of treatment in adolescents presenting with mild malocclusions, comparing outcomes using clear aligners to fixed appliances. MATERIALS AND METHODS: Patients identified retrospectively and consecutively from one private practice had been treated with either clear aligners (Invisalign, Align Technology, Santa Clara, Calif) or fixed appliances (0.022 Damon, Ormco, Orange, Calif; n = 26/group). Assessments of occlusion were made using the American Board of Orthodontics Discrepancy Index (DI) for initial records and Cast-Radiograph Evaluation (CRE) for final records. Number of appointments, number of emergency visits, and overall treatment time were determined from chart reviews. Data were analyzed using Pearson's correlation, Wilcoxon rank tests, unpaired t-tests, and Chi-square tests, with significance set to P ≤ .05. RESULTS: Pretreatment, the aligner and fixed groups showed no significant difference in overall severity (DI: 11.9 ± 5.3 vs 11.6 ± 4.8) or in any individual DI category. Posttreatment scores showed finishes for the aligner group had fewer discrepancies from ideal relative to the fixed appliance group (CRE: 30.1 ± 8.3 vs 37.0 ± 9.3; P < .01). Patients treated with aligners had fewer appointments (13.7 ± 4.4 vs 19.3 ± 3.6; P < .0001), fewer emergency visits (0.8 ± 1.0 vs 3.6 ± 2.5; P < .0001), and shorter overall treatment time (16.9 ± 5.7 vs 23.4 ± 4.4 months; P < .0001). CONCLUSIONS: Outcomes for treatment of mild malocclusions in adolescents showed equivalent effectiveness of clear aligners compared to fixed appliances, with significantly improved results for clear aligner treatment in terms of tooth alignment, occlusal relations, and overjet. Assessment of the number of appointments, number of emergency visits, and overall treatment time showed better outcomes for treatment with clear aligners.


Assuntos
Má Oclusão , Aparelhos Ortodônticos Removíveis , Adolescente , Humanos , Má Oclusão/terapia , Desenho de Aparelho Ortodôntico , Aparelhos Ortodônticos Fixos , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Resultado do Tratamento
18.
Angle Orthod ; 90(6): 844-850, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378520

RESUMO

OBJECTIVE: To determine if an adjunct proteolytic pre-rinse along with contemporary methods of dental cleaning may more effectively remove visual plaque in subjects with fixed orthodontic appliances. MATERIALS AND METHODS: Forty-three orthodontic subjects, ages 10 to 25, completed this single site, double-blind, crossover clinical trial. Subjects randomly received bromelain enzyme or a powdered-sugar placebo pre-rinse, followed by manual tooth brushing and use of a Waterpik. Subjects received the alternate pre-rinse during the subsequent visit. Baseline and residual plaque accumulation were recorded via disclosing tablet and digital photography. A single, blinded examiner scored visual plaque scores from randomized photographs. Treatment effects on composite plaque score were evaluated using repeated-measures analysis of variance. A 5% significance level was used for all tests. RESULTS: No significant differences in plaque scores were noted at baseline or post-rinse between the enzyme and placebo. The changes from baseline to post-rinse (P = .190), post-brushing (P = .764), and post-Waterpik (P = .882) were not significantly different between interventions. Significant reduction in plaque scores were observed in both arms of the study after brushing (P < .01) and waterjet use (P < .01). Neither age (P = .220) nor gender (P = .449) impacted plaque scores. CONCLUSIONS: Use of a bromelain enzyme pre-rinse alone did not significantly enhance plaque removal. A significant reduction in retained plaque was observed with the application of brushing and or Waterpik.


Assuntos
Placa Dentária , Escovação Dentária , Adolescente , Adulto , Criança , Placa Dentária/terapia , Índice de Placa Dentária , Método Duplo-Cego , Humanos , Aparelhos Ortodônticos Fixos , Método Simples-Cego , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-33317118

RESUMO

BACKGROUND: To evaluate the effectiveness of conservative treatment with functional appliances for condylar fractures in pediatric age. METHODS: Four electronic databases (PubMed, EBSCO, Scopus, and Web of Science) were consulted with no restriction of publication status or year, up to 31 August 2020. SELECTION CRITERIA: based on the PICOS criteria, the selection criteria were set for observational human studies, with at least 10 patients and six months of follow-up. The study population included pediatric patients (aged 5-16 years), with unilateral or bilateral condylar fracture, treated with functional appliances. Condylar remodeling and mandibular growth were analyzed through sequential radiographic examinations. DATA COLLECTION AND ANALYSIS: Two independent reviewers carried out title-abstract screening, and a senior investigator was involved to solve any disagreement. The quality of the evidence was assessed through the Canada Institute of Health Economics (IHE) quality appraisal checklist, and the National Institutes of Health (NIH) quality assessment tool. RESULTS: A total of 971 articles were retrieved from the electronic search; among them, three studies met the eligibility criteria. A moderate risk of bias was detected in all the studies, due to common limitations (absence of multicenter studies, prospective design, blindness of the investigators, patients' drop-out). At follow-up examinations (between 6 months and 4.9 years), the difference of condylar neck length between the "injured" and "healthy" side was approximately 2 mm, while the anteroposterior condylar width discrepancy was recorded up to 1 mm. CONCLUSIONS: Short- and long-term data revealed that conservative treatment with functional appliances led to partial or full radiological recovery of the joint morphology, along with good to excellent functional results. Patients' age has a crucial role on the treatment choice, and the type of fracture (presence of condylar displacement, or dislocation) is also a major prognostic indicator of the radiologic outcome. LIMITATION: To confirm the effectiveness of functional appliances, more prospective clinical long-term follow-up studies with homogeneous samples of condylar fractures are deemed necessary. Registration: The study protocol was registered on PROSPERO (CRD42020205650).


Assuntos
Tratamento Conservador , Fraturas Mandibulares , Adolescente , Canadá , Criança , Pré-Escolar , Tratamento Conservador/estatística & dados numéricos , Humanos , Fraturas Mandibulares/diagnóstico por imagem , Fraturas Mandibulares/terapia , Aparelhos Ortodônticos Fixos/estatística & dados numéricos , Estudos Prospectivos , Radiografia Panorâmica , Estudos Retrospectivos , Resultado do Tratamento
20.
Angle Orthod ; 90(5): 634-639, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33378478

RESUMO

OBJECTIVES: To examine the effect of micro-osteoperforation (MOP) on the space closure rate using passive self-ligating or conventional brackets. MATERIALS AND METHODS: This was a two-arm parallel randomized controlled trial undertaken at the outpatient department of a dental college. There were 60 participants (30 women and 30 men) who fulfilled the inclusion criteria. Both the study and control groups were subjected to MOPs throughout the period of space closure. MOPs were repeated every 28 days. The experimental group (mean age 19.5 ± 1.66 years) was bonded with passive self-ligating brackets while the control group (mean age 19.9 ± 1.13 years) was bonded with conventional brackets. Both groups were examined and compared for rate of space closure. An evaluation was conducted for both groups until the entire extraction space was closed and confirmed by evaluation of a tight contact between the canine and the second premolar using a piece of dental floss. RESULTS: Before the initiation of retraction, all initial criteria were similar between the two groups (P > .05). No difference was observed between the two groups in the rate of space closure (P > .05). CONCLUSIONS: MOP in conjunction with passive self-ligation does not increase the rate of orthodontic space closure when compared with MOP used with conventional brackets.


Assuntos
Braquetes Ortodônticos , Fechamento de Espaço Ortodôntico , Adolescente , Adulto , Dente Pré-Molar/cirurgia , Feminino , Humanos , Masculino , Desenho de Aparelho Ortodôntico , Aparelhos Ortodônticos Fixos , Fios Ortodônticos , Técnicas de Movimentação Dentária , Adulto Jovem
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