Challenges of a two-phase orthodontic treatment of a mandibular lateral incisor-canine transposition and a maxillary palatally displaced canine: A case report.

INTRODUCTION: The management of eruption disturbances in orthodontics may be challenging and requires a careful diagnosis and treatment planning. This case report discusses the challenges of a two-phase orthodontic treatment of a patient presenting with a dental eruption pattern anomaly. PATIENT CONCERNS: A 10-year-old boy was presented with no complaints for a routine orthodontic evaluation during mixed dentition. PRIMARY DIAGNOSES: The patient was diagnosed with a skeletal Class I malocclusion with unilateral posterior crossbite, incomplete mandibular lateral incisor-canine transposition and a unilateral maxillary ectopic canine. INTERVENTIONS: Phase 1 started with rapid maxillary expansion to correct maxillary constriction and the ectopic eruption of the right maxillary canine. In the mandibular arch, phase 1 included the extraction of the left primary lateral incisor and canine, alignment of the left permanent lateral incisor and orthodontic traction of the left permanent canine. The duration of phase 1 was 14 months. Phase 2 involved a comprehensive course of orthodontic treatment and started when the patient was aged 13 years. This phase lasted 18 months. RESULTS: An adequate dental occlusion was obtained, and the treatment results were stable after an 18-month follow-up. CONCLUSION: In this case, the early diagnosis of the dental anomalies was valuable as it allowed an early intervention to be undertaken, which resulted in overall treatment simplification and potentially minimised the adverse effects. This case report reinforces the importance of a careful follow-up during mixed dentition.

Accuracy of artificial intelligence for tooth extraction decision-making in orthodontics: a systematic review and meta-analysis.

OBJECTIVE: This study aimed to analyze the accuracy of artificial intelligence (AI) for orthodontic tooth extraction decision-making. MATERIALS AND METHODS: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO, Computers & Applied Science, ACM Digital Library, Compendex, and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Three independent reviewers selected the studies and extracted and analyzed the data. Risk of bias, methodological quality, and certainty of evidence were assessed by QUADAS-2, checklist for AI research, and GRADE, respectively. RESULTS: The search identified 1810 studies. After 2 phases of selection, six studies were included, showing an unclear risk of bias of patient selection. Two studies showed a high risk of bias in the index test, while two others presented an unclear risk of bias in the diagnostic test. Data were pooled in a random model and yielded an accuracy value of 0.87 (95% CI = 0.75-0.96) for all studies, 0.89 (95% CI = 0.70-1.00) for multilayer perceptron, and 0.88 (95% CI = 0.73-0.98) for back propagation models. Sensitivity, specificity, and area under the curve of the multilayer perceptron model yielded 0.84 (95% CI = 0.58-1.00), 0.89 (95% CI = 0.74-0.98), and 0.92 (95% CI = 0.72-1.00) scores, respectively. Sagittal discrepancy, upper crowding, and protrusion showed the highest ranks weighted in the models. CONCLUSIONS: Orthodontic tooth extraction decision-making using AI presented promising accuracy but should be considered with caution due to the very low certainty of evidence. CLINICAL RELEVANCE: AI models for tooth extraction decision in orthodontics cannot yet be considered a substitute for a final human decision.

Orthodontists' criteria for prescribing cone-beam computed tomography-a multi-country survey.

OBJECTIVES: This study aimed to describe and compare CBCT imaging prescription in clinical practice among orthodontists from five countries in Europe and America. Additionally, it investigated factors associated with the prescribing and the use of guidelines for CBCT imaging. MATERIALS AND METHODS: A cross-sectional survey was carried out using an online questionnaire sent to all registered orthodontists in Belgium, Brazil, Canada, Romania, and the United States of America (USA). The data were analyzed by descriptive statistics, bivariate tests, and Poisson regression. RESULTS: The final sample consisted of 1284 participants. CBCT was prescribed by 84.4% of the participants for selected cases (84.9%), mainly for impacted teeth (92.4%), presurgical planning (54.1%), and root resorption (51.9%). High cost was most frequently the limiting factor for CBCT prescription (55.4%). Only 45.2% of those who were using CBCT imaging reported adhering to guidelines. CBCT imaging prescription was associated with the orthodontists' countries (p < .009, except for Belgium, p = .068), while the use of guidelines was associated with the respondents' country and additional training on CBCT imaging (p < .001). CONCLUSIONS: Orthodontists refer patients for CBCT for selected indications (impacted teeth, root resorption, presurgical planning, dentofacial deformities, as suggested by the international guidelines, and also for upper airway and temporomandibular joint evaluation). Many do not adhere to specific guidelines. There are substantial variations between the countries about the orthodontists' referral for CBCT and guideline usage, irrespective of gender. CBCT prescription may be limited by financial barriers, adhering to specific guidelines and prior CBCT training. CLINICAL RELEVANCE: CBCT prescription among orthodontists must be based on prescription criteria and current guidelines. It is advised to improve CBCT education and training to enhance CBCT selection, referral, analysis, and interpretation in orthodontic practice.

Three-dimensional assessment of craniofacial asymmetry in children with transverse maxillary deficiency after rapid maxillary expansion: A prospective study.

OBJECTIVE: The aim of this study was to evaluate craniofacial asymmetry in children with transverse maxillary deficiency, with or without functional unilateral posterior crossbite (UPC), before and after rapid maxillary expansion (RME). SETTING AND SAMPLE POPULATION: A sample of 51 children with cone beam computed tomography scans obtained before RME (T1) and a year after RME (T2). MATERIAL AND METHODS: This prospective study consisted of 2 groups: 25 children with functional UPC (6.77 ± 1.5 years) and 26 children without UPC (7.41 ± 1.31 years). Linear and angular measurements were obtained from zygomatic, maxilla, glenoid fossa and mandible, using original and mirrored 3D overlapped models. All right and left side comparisons in both groups and intergroups asymmetries were compared using MANOVA and t test for independent samples, respectively, statistically significant at P < .05. RESULTS: The UPC group showed no side differences, but mandibular horizontal rotation at T1, and this asymmetry was improved in T2. The non-UPC group showed at baseline significant lateral asymmetry in orbitale, position of palatine foramen, respectively, in average 2.95 mm and 1.16 mm, and 0.49 mm of average asymmetry in condylar height. The glenoid fossa was symmetric in both groups at T1 and T2. CONCLUSIONS: Children with transverse maxillary deficiency showed slight morphological asymmetry, located in the mandible position in cases of UPC, and in the orbital and maxillary regions in cases without UPC. One year after RME, patients improved their craniofacial asymmetry, with significant changes in the mandible and correction of the mandibular rotation in patients who presented UPC.

Three-dimensional comparison of the skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed appliances: A CBCT study.

OBJECTIVES: To compare three-dimensional (3D) skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed orthodontic treatment in growing patients. SETTING AND SAMPLE POPULATION: A sample of 35 adolescents with cone-beam computed tomography scans obtained prior to Herbst and Pendulum treatment (T1) and immediately after fixed appliance treatment (T2). MATERIALS AND METHODS: Patients with Class II malocclusion was assessed retrospectively and divided into two treatment groups: Herbst group (n = 17, age: 12.0 ± 1.6 years) and Pendulum group (n = 18, age: 12.1 ± 1.5 years), with a mean treatment duration of 2.8 ± 0.8 years and 2.5 ± 0.7 years, respectively. Reconstructions of the maxillomandibular and dentoalveolar regions and data in 3D were obtained relative to cranial base, maxillary and mandibular regional superimpositions. Treatment outcomes (T2-T1) were compared between both groups using t tests for independent samples (P<.05). RESULTS: Significant increase in mandibular length was observed in the Herbst group (7.3 ± 3.5 mm) relative to the Pendulum group (4.6 ± 4.5 mm). Inferior and anterior displacements of Pogonion were 2.2 mm and 1.6 mm greater in the Herbst group, respectively. The mesial displacement of the lower first molars was significantly greater in the Herbst group (1.9 mm). The upper first molars had contrasting results in sagittal displacement, with 0.6 ± 1.7 mm of distal displacement with the Pendulum and 1.4 ± 2.1 mm of mesial displacement with the Herbst. Lower incisor projection and proclination were similar between groups. CONCLUSIONS: The Herbst and Pendulum appliances followed by comprehensive orthodontic treatment effectively corrected Class II malocclusion in growing patients, but with differing skeletal and dentoalveolar effects.

Three-dimensional assessment of mandibular asymmetry in skeletal Class I and unilateral crossbite malocclusion in 3 different age groups.

INTRODUCTION: This study aimed to evaluate the morphologic and positional features of the mandible in children, adolescents, and adults with skeletal Class I and unilateral posterior crossbite. METHODS: The sample included cone-beam computerized tomography images of 76 subjects, divided in 3 groups: (1) children (aged 6.77 ± 1.5 years; n = 25), (2) adolescents (aged 14.3 ± 1.7 years; n = 26), and (3) adults (aged 32.66 ± 13.4 years; n = 25) with unilateral posterior crossbite. Condylar and mandibular linear distances and angles were performed using a mirrored 3-dimensional overlapped model. Intragroup asymmetries were determined by a comparison between crossbite and no crossbite sides. The differences between both sides of all measurements were compared among groups and correlated to mandibular horizontal rotation (yaw) and age. RESULTS: The crossbite side showed shorter distances in the condyle and mandibular regions. Asymmetries were slightly but significantly greater in adults, as expressed by the lateromedial condylar distance, total ramus height, and mandibular length with an average 0.7 mm, 2.0 mm, and 1.5 mm, respectively. The mandibular yaw rotation was not correlated to age but moderately associated (r = 0.467) to asymmetry in mandibular length and total ramus height. CONCLUSIONS: Patients with skeletal Class I and unilateral crossbite showed small mandibular asymmetries and these conditions were slightly greater in adults, specifically in lateromedial condylar distances and mandibular body and length.

Comparison of Dimensions of the Nasopharynx and Oropharynx Using Different Anatomical References: Is There Equivalence?

PURPOSE: To evaluate the equivalence of the volumes obtained using different anatomic references to measure the nasopharynx and oropharynx on cone-beam computed tomography (CBCT) scans. We hypothesized that no variations would be found in the nasopharynx and oropharynx dimensions when measured using different measurement methods. MATERIALS AND METHODS: A total of 40 CBCT scans of patients with skeletal Class I (age range, 20 to 50 years) were measured independently by 2 of us. The nasopharynx and oropharynx subregions were volumetrically measured using the adopted limits of 5 different measurement methods (3 for the nasopharynx and 2 for the oropharynx) and InVivoDental software, version 5.4 (Anatomage, San Jose, CA). The minimum area and the minimum area of localization were also evaluated. The intra- and interexaminer concordance for the measurements from the different methods were verified using the interclass correlation coefficient (ICC). The analysis of variance for repeated measures was used to compare the measurements from the 3 nasopharynx methods. The paired t test was used to compare the measurements from the 2 oropharynx methods. The statistical tests were performed at the 5% significance level using SPSS software, version 22.0 (IBM Corp, Armonk, NY). RESULTS: The intra- and interexaminer ICC values were greater than 0.8. We found a statistically significant difference in the volume measurements among the 3 nasopharynx methods (P = .001). However, no differences were found in the minimum area or minimum area of localization comparisons. Statistically significant differences were also observed for the volume, minimum area, and minimum area of localization between the 2 oropharynx methods (P = .001). CONCLUSIONS: Studies that have used different methods of measurement should not be directly compared. The different measurement methods used for nasopharynx and oropharynx evaluations should not be compared.

An Oral Health-Related Quality of Life Comparison Between Adults With Unilateral Cleft Lip and Palate and Class III Malocclusion.

OBJECTIVE: To compare oral health-related quality of life (OHRQoL) before treatment of adults with unilateral cleft lip and palate (UCLP) and surgical Class III malocclusion, and to consider if clefts needing different orthodontic treatment protocols could influence people's self-perception. DESIGN: Cross sectional. SETTING: Cleft Lip and Palate Center and Clinic of Orthognathic Surgery from a School of Dentistry. PARTICIPANTS: A sample of adults with repaired nonsyndromic UCLP (n = 52) which was age- and sex-matched with a noncleft Class III malocclusion sample seeking orthognathic surgery (n = 51). In turn, the cleft group was subdivided according to treatment planning into nonsurgical orthodontic and surgical orthodontic approaches. MAIN OUTCOME MEASURE: The whole sample was assessed using the short-form oral health impact profile (OHIP-14), with higher scores indicating a poorer OHRQoL. Statistical comparisons were performed with Mann-Whitney U and Kruskal-Wallis tests, and effect size. Bonferroni adjustment was used for post hoc tests (P < .017). RESULTS: The OHIP-14 scores of the UCLP and Class III groups were significantly different (P = .001, η2 = 0.108), and higher in Class III. The largest commitment was in the physical disability, physical pain, and psychological disability domains. In addition, no differences were found when the UCLP treatment planning was considered. CONCLUSION: Surgical Class III malocclusion have a poorer OHRQoL when compared to patients with UCLP, irrespective of whether they are treated surgically or orthodontically. Therefore, the greater commitment of OHRQoL appears to be influenced by the etiology of Class III, and not by treatment plan.

Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery.

PURPOSE: To evaluate the effect of genioplasty on the size of the pharyngeal airway space (PAS) in a sample of patients without obstructive sleep apnea syndrome (OSAS) undergoing maxillomandibular advancement (MMA) surgery. MATERIALS AND METHODS: Lateral cephalometric radiographs of 52 patients who underwent orthognathic surgery for MMA were obtained before (T1) and after (T2) surgery. The radiographs were digitized and the anteroposterior dimensions of the PAS were measured at the nasopharynx, oropharynx, and hypopharynx levels. The sample was divided into 2 groups: MMA with genioplasty (n = 27; average age, 30.81 yr) and without genioplasty (n = 25; average age, 37.64 yr). Comparisons were made between T1 and T2 in patients with and without genioplasty. Horizontal and vertical changes of the maxilla, mandible, and chin were correlated to changes in the PAS. RESULTS: MMA resulted in an increased anteroposterior PAS at the 3 levels analyzed (P < .05), except in the hypopharynx, in cases without genioplasty (P = .141). When the groups with and without genioplasty were compared, there were no significant differences (P > .05) in the PAS. There was a statistically relevant correlation between horizontal mandibular change and the oropharynx (r = 0.484 and r = 0.509, respectively) and between vertical chin change and the hypopharynx (r = 0.434 and r = 0.455, respectively) for groups with and without genioplasty. There was a statistically relevant correlation between horizontal chin change and the hypopharynx (r = 0.586) for surgeries without genioplasty. CONCLUSION: Considering the limitations inherent to retrospective study designs, the results suggested that MMA surgery, with and without advancement genioplasty, can promote immediate gains to the PAS. A larger gain was possible in the hypopharynx for MMA with genioplasty. MMA without genioplasty could represent a greater gain in the nasopharynx and oropharynx. Further studies should evaluate functional parameters in patients with OSAS to measure the possible benefits of this increase in the PAS.

A 22-year follow-up of the nonsurgical expansion of maxillary and mandibular arches in a young adult: Are the outcomes stable, relapsed, or unstable with aging?

Adult maxillary and mandible arch expansion without a surgical approach can be uncertain when long-term stability is considered. This case report describes the treatment of a 19-year-old woman with an Angle Class I malocclusion with constricted maxillary and mandibular arches. The patient's main complaint was mandibular anterior crowding. The treatment plan included expansion of the mandibular arch concurrent with semirapid maxillary expansion. An edgewise appliance was used to adjust the final occlusion. Smile esthetics and dental alignment were improved without straightening the profile. This outcome was followed up with serial dental casts for 22 years after treatment. At the end of that period, the occlusion and tooth alignment were clinically satisfactory, further supported by mandibular fixed retention. However, the transverse widths were continuously and gradually reduced over time, superposing orthodontic transverse relapse and natural arch constriction caused by aging.

Diagnostic capability of artificial intelligence tools for detecting and classifying odontogenic cysts and tumors: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the diagnostic capability of artificial intelligence (AI) for detecting and classifying odontogenic cysts and tumors, with special emphasis on odontogenic keratocyst (OKC) and ameloblastoma. STUDY DESIGN: Nine electronic databases and the gray literature were examined. Human-based studies using AI algorithms to detect or classify odontogenic cysts and tumors by using panoramic radiographs or CBCT were included. Diagnostic tests were evaluated, and a meta-analysis was performed for classifying OKCs and ameloblastomas. Heterogeneity, risk of bias, and certainty of evidence were evaluated. RESULTS: Twelve studies concluded that AI is a promising tool for the detection and/or classification of lesions, producing high diagnostic test values. Three articles assessed the sensitivity of convolutional neural networks in classifying similar lesions using panoramic radiographs, specifically OKC and ameloblastoma. The accuracy was 0.893 (95% CI 0.832-0.954). AI applied to cone beam computed tomography produced superior accuracy based on only 4 studies. The results revealed heterogeneity in the models used, variations in imaging examinations, and discrepancies in the presentation of metrics. CONCLUSION: AI tools exhibited a relatively high level of accuracy in detecting and classifying OKC and ameloblastoma. Panoramic radiography appears to be an accurate method for AI-based classification of these lesions, albeit with a low level of certainty. The accuracy of CBCT model data appears to be high and promising, although with limited available data.

Orthodontic finishing errors detected in board-approved cases: common types and prediction.

OBJECTIVE: To report and rank orthodontic finishing errors recorded in the clinical phase of the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) examination and correlate pretreatment case complexity with orthodontic treatment outcomes. MATERIALS AND METHODS: This single-center cross-sectional survey collected retrospective data from the clinical phase of BBO examinations between 2016 and 2023. The quality of orthodontic clinical outcomes of each case was assessed by means of the Cast-Radiograph Evaluation (CRE), while case complexity was evaluated using the Discrepancy Index (DI), both tools provided by the American Board of Orthodontics. Survey items were analyzed using descriptive statistics, and a correlation analysis between total CRE and DI scores (p<0.05) was also performed. RESULTS: A total of 447 orthodontic records was included. Orthodontic finishing errors were often observed, and no case was completely perfect. In the total CRE score, an average of 15 points was discounted for each case. Most frequently found issues involved problems with alignment, buccolingual inclination, marginal ridge, and occlusal relationship. The median DI score for initial case complexity was 22.0 (range 10.0 - 67.0). There was no significant correlation between the DI and CRE scores (p=0.106). CONCLUSION: Orthodontic finishing errors are inevitable, even in well-finished board-approved cases. Rotation, excessive buccolingual inclination, and discrepancies in marginal ridges are the most frequently observed areas of concern, in that order. Moreover, while case complexity, determined by DI, can impact orthodontic planning and pose challenges for clinicians, the study did not consider it a determining factor in predicting treatment outcomes.

Iatrogenic absence of maxillary canines: Bolton discrepancy treated with mandibular incisor extraction.

This case report describes the orthodontic treatment of an adult patient with iatrogenic absence of the maxillary canines, moderate maxillary and severe mandibular dental crowding, a Bolton discrepancy with a large mandibular anterior excess, a maxillary right lateral incisor crossbite, and Angle Class II molar relationships. The treatment consisted of fixed appliance therapy, mandibular incisor extraction, tooth bleaching, and dental recontouring. This method of treatment maintained the patient's good facial appearance, improved the dental esthetics, and provided a good functional occlusion, eliminating the arch length and Bolton discrepancies and providing a good outcome with minimal undesirable effects.

Craniofacial morphological differences between Down syndrome and maxillary deficiency children.

Maxillary deficiency is one of the facial features of Down syndrome (DS). Differences in craniofacial morphology between DS and nonsyndromic skeletal Class III malocclusion with maxillary deficiency remain unclear. This study compared the craniofacial differences of white male children from Central-Western Brazil with DS (n = 30, mean age: 8 years 3 months), skeletal Class III profile with maxillary deficiency (n = 30, mean age: 7 years 9 months), and skeletal Class I profile (n = 30, mean age: 8 years 2 months), using lateral cephalometric radiographs. The differences among the three groups were compared with analysis of variance and Tukey's tests. The DS group showed reduced anterior cranial base (S-N, P < 0.001] and facial dimensions (Co-Gn, N-Me, N-ANS, and ANS-Me, P < 0.001), except in posterior dimensions (S-Go, P < 0.005; Ar-Go, P > 0.005). Maxillary length (Co-A, P < 0.001) and facial convexity (NAP, P < 0.005) were reduced when compared with the control group, although maxillary position to cranial base (SNA, P < 0.005) was within the normal range. A flattened cranial base (BaSN, P < 0.001) also contributed to differentiating DS from nonsyndromic groups. The group with maxillary deficiency showed a more unfavourable maxillomandibular relationship (MMD, P < 0.001) and a mandibular protrusion (SNB, P < 0.001). Subjects with DS differed from Class III with maxillary deficiency with respect to the flatter cranial base and reduced maxillary length. Maxillary deficiency was not so expressive in the face of DS subjects because of the overall reduction in craniofacial dimensions.

Prevalence of mandibular asymmetry in different skeletal sagittal patterns.

OBJECTIVES: To analyze the prevalence of mandibular asymmetry in skeletal sagittal malocclusions. MATERIALS AND METHODS: PubMed/MEDLINE, EMBASE, LILACS, Web of Science, Scopus, LIVIVO and gray literature (OpenGrey, ProQuest, and Google Scholar) were electronically searched. Two independent investigators selected the eligible studies, and assessed risk of bias and certainty of evidence (GRADE). One reviewer independently extracted the data and the second reviewer checked this information. Any disagreement between the reviewers in each phase was resolved by discussion between them and/or involved a third reviewer for final decision. RESULTS: Electronic search identified 5,132 studies, and 5 observational studies were included. Risk of bias was low in two studies, moderate in one, and high in two. The studies showed high heterogeneity. Mandibular asymmetry ranged from 17.43% to 72.95% in overall samples. Horizontal chin deviation showed a prevalence of 17.66% to 55.6% asymmetry in Class I malocclusions, and 68.98% in vertical asymmetry index. In Class II patients, prevalence of mandibular asymmetry varied from 10% to 25.5% in horizontal chin deviation, and 71.7% in vertical asymmetry index. The Class III sample showed a prevalence of mandibular asymmetry ranging from 22.93% to 78% in horizontal chin deviation and 80.4% in vertical asymmetry index. Patients seeking orthodontic or orthognathic surgery treatment showed greater prevalence of mandibular asymmetry. CONCLUSIONS: Skeletal Class III malocclusion showed the greatest prevalence of mandibular asymmetry. Mandibular vertical asymmetry showed a marked prevalence in all malocclusions. However, conclusions should be interpreted with caution due to use of convenience samples and low-quality study outcomes.

Efficacy of two low-level laser therapy protocols following lower third molar surgery - a randomized, double-blind, controlled clinical trial.

The aim of this study was to test two low-level laser therapy protocols by evaluating pain control, swelling and trismus in the postoperative period of lower third molar surgeries. This was a randomized, double-blind, placebo-controlled, crossover trial. Patients presenting two symmetrically impacted mandibular third molars were included. One side was randomly assigned for LLLT applied immediately after surgery (T1) and then after 24 (T2) and 48 hours (T3) (Protocol A). The other side received LLLT applied immediately after surgery and placebo after 24 and 48 hours (Protocol B). LLLT was given by intraoral application (660nm, 5 J/cm2, 10 s, 20 mW, 4 points) followed by extraoral application (789 nm, 30 J/cm2, 20 s, 60 mW, 8 points). The placebo application was similar to that of the experimental side but with laser simulation. The primary outcomes were pain control, swelling and trismus intensity at T1, T2, T3 and 7 days after surgery (T4). Data were analyzedbyANOVArepeated measures and Wilcoxon test (p<.05). The final sample consisted of 21 patients (42 teeth). There were no statistical differences for pain level between protocols A and B over time (p= .909), although the amount of analgesic medication was lower with protocol A at T2 (p=.022). There were no differences in swelling (p=.958) or trismus (p=.837) between the protocols used over time. Both protocols performed similarly for pain control, swelling and trismus. Therefore, for practical reasons, a single laser application in the immediate postoperative period could be indicated for the management of postoperative discomfort in lower third molar surgery.

O objetivo deste estudo foi testar dois protocolos de terapia com laser de baixa intensidade (LBI) para controle da dor, edema e trismo no período pós-operatório de cirurgias de terceiro molar inferior. Neste estudo randomizado, duplo-cego, controlado, de boca dividida foram incluídos pacientes que apresentavam os terceiros molares inferiores simetricamente. Um lado foi aleatoriamente designado para receber LBI aplicada imediatamente após a cirurgia (T1) e após 24 (T2) e 48 (T3) horas (Protocolo A). O lado oposto recebeu LBI imediatamente após a cirurgia e placebo após 24 e 48 horas (Protocolo B). A aplicação de LBI foi realizada intraoralmente (660nm, 5 J/cm2, 10 s, 20 mW, 4 pontos), seguida pela aplicação extraoral (789 nm, 30 J/cm2, 20 s, 60 mW, 8 pontos). O efeito do placebo foi similar ao experimental. Os desfechos primários eram dor, edema e intensidade do trismo nos tempos T1, T2, T3 e 7 após a cirurgia (T4). Os dados foram analisadosporANOVA e teste deWilcoxon (p<.05). A amostra final consistiu de 21 pacientes (43 dentes). Não houve diferença estatística para o nível de dor entre os protocolos A e B ao longo do tempo (p=.909), embora a quantidade de medicação analgésica tenha sido menor com o protocolo A em T2 (p= .022). Não houve diferença para edema (p=.958) ou trismo (p=.837) entre os protocolos ao longo do tempo. Em conclusão, a aplicação de LBI imediatamente após a cirurgia e após 24 e 48 horas (Protocolo A) apresenta melhor resultado para controle da dor. Ambos os protocolos foram similares para dor, edema e trismo. Portanto, por razões de praticidade, uma aplicação única de laser imediatamente após a cirurgia pode estar indicada para o manejo do desconforto pós-operatório em cirurgias de terceiros molares inferiores.

Prevalence of Bruxism in Brazilian Children: A Systematic Review and Meta-Analysis.

Purpose: The prevalence of bruxism in children varies considerably. The purpose of this study was to synthesize evidence of the prevalence of bruxism in Brazilian children and consider how proportions differ between genders, assessment approaches, and geographical regions. Methods: A search was conducted using five databases and in gray literature. Two independent investigators selected the studies and extracted data. The risk of bias was assessed via the Joanna Briggs Institute tool for studies on prevalence. The certainty of the evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results: Twenty-two cross-sectional studies were included after a two-step selection. Overall, 13,076 children from all regions of the country were assessed. The risk of bias ranged from high to low. Data were pooled in a random-effect model and resulted in an overall prevalence of sleep and awake bruxism of 25.8 percent (95 percent confidence interval [95% CI] equals 22.2 to 29.4; I2 equals 96 percent; prediction interval equals 0.07 to 0.44) and 20.1 percent (95% CI equals 18.0 to 22.3; I2 equals 30 percent; prediction interval equals 0.18 to 0.22), respectively. Subgroup and sensibility analysis showed distribution similarity between genders (P=0.96), assessment approaches (P=0.88), and geographical regions (P=0.44). Conclusions: "Possible" and "probable" sleep bruxism affects one in four Brazilian children, and there is evidence with a low level of certainty that its prevalence does not vary between genders, assessment approaches, or geographical regions. The distribution of bruxism is still an unknown subject and presumably occurs because of individual rather than regional or collective factors.