Dentoskeletal changes due to rapid maxillary expansion in growing patients with tooth-borne and tooth-bone-borne expanders: A randomized clinical trial.

OBJECTIVES: To compare, using cone-beam computed tomography, the dentoskeletal changes in rapid maxillary expansion with tooth-bone-borne (Hybrid Hyrax) and tooth-borne (Hyrax) appliances. SETTING AND SAMPLE POPULATION: Forty-two patients who met the eligibility criteria (aged 11-14 years; transverse maxillary deficiency, posterior crossbite, and presence of upper first premolars and molars) were screened and allocated into two groups: HHG (treatment with Hybrid Hyrax) and HG (treatment with Hyrax). MAIN OUTCOME MEASURES: The primary outcomes included nasomaxillary dimensional changes. CBCT was performed before and 3 months after the activation phase. Measurements were performed using Dolphin® . Baseline data were compared using one-way ANOVA. For intergroup comparison, ANCOVA was used to analyze the initial age, appliance activations (mm), and mid-palatal suture maturation data as covariates. Statistical significance was set at 5%. RESULTS: The premolar region in HHG showed increased skeletal changes than in HG, with the difference being 1.5 mm (0.5; 2.6) in the nasal cavity (P = .004), 1.4 mm (0.3; 2.5) in the nasal floor (P = .019), and 1.1 mm (0.2; 2.1) in the maxilla (P = .022). The molar region in HHG showed increased skeletal changes with the difference being 0.9 mm (0.2; 1.5) in the nasal cavity (P = .005), and 0.9 mm (0; 1.8) in the maxilla (P = .042) than in HG. Premolar inclination was higher in HG. CONCLUSION: Hybrid Hyrax showed more skeletal changes and fewer dental side effects, especially in the first premolar region. The amount of activation influenced the higher nasal skeletal changes in the Hybrid hyrax group.

Safe sites for orthodontic miniscrew insertion in the infrazygomatic crest area in different facial types: A tomographic study.

INTRODUCTION: Temporary skeletal anchorage devices (TSADs) are used to obtain skeletal anchorage for orthodontic treatment. Their insertion in the infrazygomatic crest (IZC) allows efficient orthodontic mechanics. Different facial types have different bone configurations. We aimed to evaluate the differences in bone thicknesses in the IZC area among patients of each facial type to determine a safe zone for TSAD insertion. METHODS: For this retrospective study, 86 cone-beam computed tomography (CBCT) scans were divided into 3 groups according to the facial type: group I, 24 CBCT scans of hyperdivergent patients; group II, 30 scans of neutral patients; and group III, 32 scans of hypodivergent patients. The buccal alveolar bone thickness was measured in 6 zones between the second premolar and distal root of the second molar, 5, 7, 9, and 11 mm apical to the alveolar crest. RESULTS: The IZC areas with minimum thickness for TSAD insertion follows: group I, between first and second molars at 11 mm from the alveolar crest, mesial root of the second molar at 9 mm from the crest, and distal root of the second molar at 11 mm from the crest; groups II and III, between first and second molars at 11 mm from the crest and mesial root of the second molar at 11 mm from the crest. CONCLUSIONS: The safe zones for IZC miniscrew insertion are located 11 mm from the alveolar crest between the maxillary first and second molars and on the mesial root of the second molar for all the 3 facial types.

Three-dimensional evaluation of dental decompensation and mandibular symphysis remodeling on orthodontic-surgical treatment of Class III malocclusion.

INTRODUCTION: The purposes of this research were to identify the buccolingual inclinations of the mandibular teeth and the mandibular symphysis remodeling that result from the orthodontic decompensation movement. METHODS: The sample consisted of 30 adults with Class III dentofacial deformity, who had presurgical orthodontic treatment. Three-dimensional images were generated by cone-beam computed tomography scans at 2 different times (initial and before orthognathic surgery). Three-dimensional virtual models were obtained and superimposed using automated voxel-based registration at the mandible to evaluate B-point displacement, mandibular molar and incisor decompensation movement, and symphysis inclination and thickness. The 3-dimensional displacements of landmarks at the symphysis were quantified and visualized with color-coded maps using 3D Slicer (version 4.0; www.slicer.org) software. RESULTS: The measurements showed high reproducibility. The patients presented mandibular incisor proclination, which was consistent with the movement of tooth decompensation caused by the presurgical orthodontic treatment. Statistically significant correlations were found between the inclination of the mandibular incisors, symphysis inclination, and B-point displacement. Regarding the thickness of the symphysis and the inclination of the incisors, no statistically significant correlation was found. CONCLUSIONS: The buccolingual orthodontic movement of the mandibular incisors with presurgical leveling is correlated with the inclination of the mandibular symphysis and repositioning of the B-point but not correlated to the thickness of the symphysis.

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.

Correlation between buccolingual tooth inclination and alveolar bone thickness in subjects with Class III dentofacial deformities.

INTRODUCTION: The purposes of this study were to identify buccolingual inclinations and alveolar bone thickness in patients with Class III dentofacial deformities and to compare these measurements with those from subjects with normal occlusions to verify, based on the correlation between these 2 variables, whether the natural process of bone remodeling provides uniformity of bone thickness or whether it varies around the roots due to tooth inclination. METHODS: The sample consisted of 35 adults with normal occlusions and 35 adults with Class III dentofacial deformities with no previous orthodontic treatment. Buccolingual inclinations and alveolar bone thickness were measured at 3 heights from the cementoenamel junction from 3-dimensional images generated by cone-beam computed tomography. RESULTS: The region corresponding to the maxillary canines appeared to be thinner, and the palatal area of the maxillary central incisors and the distobuccal region of the mandibular second molars appeared to be thicker. Greater tooth inclinations were observed in the maxillary incisors and mandibular canines, and smaller tooth inclinations were observed on the buccal roots of the mandibular second molars. CONCLUSIONS: In subjects with Class III deformities, more statistically significant correlations were found between inclination and thickness in the mandibular teeth, whereas in subjects with normal occlusion, few statistically significant correlations were found between these 2 variables.

Periodontal evaluation after maxillary expansion with a tooth-bone-borne expander in growing patients : A randomized clinical trial.

PURPOSE: This two-arm parallel randomized controlled trial aimed to evaluate and compare periodontal changes due to rapid maxillary expansion (RME) using tooth-bone-borne and tooth-borne devices in growing patients via clinical examinations and cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Forty-two eligible patients (aged 11-14 years; transverse maxillary deficiency, posterior crossbite) were screened and divided into two groups based on the treatment received (randomization was performed using computer-generated numeric sequences): hybrid hyrax tooth-bone-borne group (TBB) and hyrax tooth-borne group (TB). The primary outcome was the change in cortical bone thickness (by CBCT). In addition, the clinical attachment level (CAL), gingival recession, and bleeding were assessed. Both examinations were performed before and 3 months after the activation phase. Intergroup comparisons were performed using analysis of covariance (ANCOVA; P < 0.05). RESULTS: Twenty-one patients (12 girls and 9 boys; mean initial age, 13.3 years) were included in the TBB group and 21 (5 girls and 16 boys; mean initial age, 13.2 years) were included in the TB group. The TB group exhibited a decrease in buccal bone thickness in the first premolars and first molars at all three evaluated levels. Specifically, tooth 14 at 3 mm from the enamel-cement junction showed a significant width reduction (0.7 mm; p < 0.001), accompanied by a notable increase in palatal cortical thickness at 6 mm of enamel-cement junction (1.13 mm; p < 0.001). CONCLUSIONS: RME resulted in buccal bone thickness reduction at the first premolar with hyrax treatment. In the molar region, both devices resulted in cortical bone alterations that were less pronounced in the TBB group.

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.

Short-term assessment of pain and discomfort during rapid maxillary expansion with tooth-bone-borne and tooth-borne appliances: randomized clinical trial.

OBJECTIVE: The aim of this randomized clinical trial was to evaluate and compare, during the first week of rapid maxillary expansion (RME), the impact caused by two types of appliances: Hyrax and Hybrid Hyrax. METHODS: Forty-two patients who met the eligibility criteria (aged 11-14 years, with transverse maxillary deficiency, posterior crossbite, and presence of maxillary first premolars and first permanent molars) were selected and randomly divided into two groups: TBB GROUP (tooth-bone-borne expander), treated with Hybrid Hyrax (12 females and 9 males, mean age 13.3 ± 1.3 years), and TB GROUP (tooth-borne expander), treated with Hyrax (5 females and 16 males, mean age 13.3 ± 1.4 years). Pain and discomfort were assessed in two times: after the first day of activation (T1) and four days after, by means of the numerical rate scale and the instrument MFIQ (Mandibular Functional Impairment Questionnaire). Descriptive statistics and the Mann-Whitney test were used for comparison between groups and between sexes. A 5% significance level was adopted. RESULTS: Both appliances had a negative impact, generating pain and discomfort, and reducing functional capacity. However, the scores obtained were of low intensity and no significant differences were observed between the groups. Considering sexes, there were statistically significant differences, with the female sex presenting higher scores for pain and functional limitation. CONCLUSIONS: Despite causing impact in pain and increase in the functional limitation, these changes were of low intensity, with no statistical difference between the groups. Females were more sensitive to the impact caused by the RME.

Stress distribution analysis in anterior teeth caused by several retraction mechanics.

INTRODUCTION: Orthodontic retraction of the anterior teeth is indicated when the patient has a malocclusion with protrusion of the incisors. Several mechanics are indicated to perform this retraction. OBJECTIVE: The objective of this study was to compare the strains generated by four different types of retraction mechanics along the roots of the anterior teeth. METHODS: A photoelastic model simulating an arch with first premolars extraction was made. Sixty retraction archwires were prepared, including fifteen for each type of mechanics evaluated: sliding, teardrop loop spring, T-loop spring and double key loop archwire. The strains were observed in two perspectives: occlusal and oblique. In the occlusal perspective, strains were compared among the six anterior teeth. From the oblique perspective, strains were compared among the thirds of the left canine root. RESULTS: In the occlusal perspective, the teardrop loop spring mechanics presented greater strains, followed by T-loop spring, double key loop archwire and sliding mechanics. In all mechanics, strains were more concentrated in the canines than in the incisors. From the oblique perspective, the teardrop loop mechanics generated greater strains in the cervical regions of the canine, and in the apical regions, no differences were found in strains among the four types of mechanics. In the same mechanics, greater strains were present in the cervical zones. CONCLUSION: The teardrop loop spring retraction mechanic presented the greatest mean strain, and the sliding retraction mechanic presented the lowest mean strain on the root of anteroinferior teeth in the occlusal and oblique perspectives.

Maxillary protraction with rapid maxillary expansion and facemask versus skeletal anchorage with mini-implants in class III patients: a non-randomized clinical trial.

BACKGROUND: The use of skeletal anchorage devices for maxillary protraction in patients with class III malocclusion due to deficiency in the middle third of the face has been shown to be a promising approach to treatment of these patients. The aim of this study was to evaluate the treatment of class III patients with maxillary retrusion, using orthodontic mini-implants (MI) associated with intermaxillary elastics in comparison with the rapid maxillary expansion and facemask protocol (RME/FM). METHODS: In this prospective non-randomized clinical trial, the sample of 24 participants between 7 and 12 years of age (median age of 10.0 years and interquartile range = 3.0 years), at the stage prior to the pre-pubertal growth spurt, was divided in two groups. In group facemask (FM) (n = 12), the individuals received orthopedic treatment with RME/FM. In group MI (n = 12), two mini-implants were inserted in the region close to the maxillary first molar roots, and the other two in the region of the mandibular canines. Initial and final lateral teleradiographs were taken for cephalometric evaluation of all the cases. Statistical analysis included the Mann-Whitney, Wilcoxon, and Fisher's exact tests. The level of significance was 5% (α = 0.05). RESULTS: Improvement was verified in the facial profile and occlusion of the participants, showing advancement of the maxilla in the two groups, with significant differences (P ≤ 0.05) between T0 and T1 in the following measurements: SNA, ANB, Wits, Co-A, Co-Gn, NAP, A-Npog, overjet, and molar relationship. There was no statistically significant intergroup difference (P > 0.05) in the cephalometric measurements evaluated, but the time of treatment was significant, and was faster for group MI. CONCLUSIONS: The protocol with mini-implants may be an option for the correction of Class III due to maxillary deficiency.

Effect of orthodontic treatment on alveolar bone thickness in adults: a systematic review.

OBJECTIVES: This review aimed at evaluating changes in alveolar bone thickness after completion of orthodontic treatment. METHODS: Only prospective clinical studies that reported bone thickness in adult patients undergoing non-surgical orthodontic treatment were considered eligible. MEDLINE, EMBASE and LILACS databases were searched for articles published up to July 2018. RESULTS: A total of 12 studies met the selected criteria. Most of the studies showed that orthodontic treatment produces a reduction in bone thickness of incisors, mainly at the palatal side. CONCLUSION: On patients undergoing different orthodontic treatment techniques, there was a significant bone thickness reduction, mainly on the palatal side. CLINICAL RELEVANCE: These findings are relevant and have to be considered in diagnosis and planning of tooth movement, in order to prevent the occurrence of dehiscence and fenestration in alveolar bone.

Anterior crossbite treatment in the primary dentition: Three case reports.

Anterior crossbite is characterized by negative horizontal overjet between the jaws, and occurs due to skeletal, functional, and/or dental imbalances. It is often found in primary and mixed dentition stages and causes severe aesthetic, functional, and psychosocial impairment. We report the facial and occlusal effects of maxillary protraction associated with rapid maxillary expansion in three young patients with primary dentition. The proposed treatment plan consisted of protraction and rapid maxillary expansion. The mechanical device chosen was the facial mask combined with a McNamara rapid palatal expander. The anterior crossbite was corrected, and significant facial and cephalometric benefits were obtained. The treatment of maxillary protraction during the deciduous dentition stage, in cases where there is good acceptance and collaboration by patients, provides excellent clinical results and constitutes a viable treatment option.

Sex differences in pharyngeal airway morphology in adults with skeletal Class III malocclusion.

OBJECTIVES: To compare the pharyngeal airway dimensions in adults with skeletal Class III malocclusion and well-balanced faces, to ascertain whether sex can influence such measurements and to correlate skeletal pattern with pharyngeal dimensions. METHODOLOGY: Fifty adults were recruited and assigned to two groups: skeletal Class III (n = 25; 12 males and 13 females, mean age = 26.1 years), and skeletal Class I (n = 25; 11 males and 14 females, mean age = 26.0 years), with well-balanced faces. Pharyngeal measurements were made using cone beam computed tomography and analyzed with Dolphin Imaging software 11.5. RESULTS: Pharyngeal sagittal area, length, retroglossal area and width were statistically greater for males. Pharyngeal volume was greater for Class III patients (p = .0245), due to enlarged male dimensions. A significant but moderate correlation was observed between pharyngeal airway volume and ANB angle (r = -.4917) and effective mandibular length (Co-Gn, r = .5181). CONCLUSION: There is sexual differentiation in the pharyngeal airway morphology for Class III adults. As females present similar pharynx volume compared to a normal skeletal pattern, mandibular setback surgery should be carefully planned because of the risk of airway constriction.

Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion.

INTRODUCTION: The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults. OBJECTIVE: The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure. METHODS: The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests. RESULTS: There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth. CONCLUSION: Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

Short-term assessment of pain and discomfort during rapid maxillary expansion with tooth-bone-borne and tooth-borne appliances: randomized clinical trial

ABSTRACT Objective: The aim of this randomized clinical trial was to evaluate and compare, during the first week of rapid maxillary expansion (RME), the impact caused by two types of appliances: Hyrax and Hybrid Hyrax. Methods: Forty-two patients who met the eligibility criteria (aged 11-14 years, with transverse maxillary deficiency, posterior crossbite, and presence of maxillary first premolars and first permanent molars) were selected and randomly divided into two groups: TBB GROUP (tooth-bone-borne expander), treated with Hybrid Hyrax (12 females and 9 males, mean age 13.3 ± 1.3 years), and TB GROUP (tooth-borne expander), treated with Hyrax (5 females and 16 males, mean age 13.3 ± 1.4 years). Pain and discomfort were assessed in two times: after the first day of activation (T1) and four days after, by means of the numerical rate scale and the instrument MFIQ (Mandibular Functional Impairment Questionnaire). Descriptive statistics and the Mann-Whitney test were used for comparison between groups and between sexes. A 5% significance level was adopted. Results: Both appliances had a negative impact, generating pain and discomfort, and reducing functional capacity. However, the scores obtained were of low intensity and no significant differences were observed between the groups. Considering sexes, there were statistically significant differences, with the female sex presenting higher scores for pain and functional limitation. Conclusions: Despite causing impact in pain and increase in the functional limitation, these changes were of low intensity, with no statistical difference between the groups. Females were more sensitive to the impact caused by the RME.

RESUMO Objetivo: O objetivo deste ensaio clínico randomizado foi avaliar e comparar, durante a primeira semana de expansão rápida da maxila (ERM), o impacto causado por dois tipos de aparelhos: Hyrax e Hyrax Híbrido. Métodos: Quarenta e dois pacientes que atendiam aos critérios de seleção (idade de 11 a 14 anos, com deficiência transversal da maxila, mordida cruzada posterior e presença de primeiros pré-molares e primeiros molares permanentes superiores) foram selecionados e divididos aleatoriamente em dois grupos: Grupo DOS (expansor dento-osseossuportado), tratado com Hyrax Híbrido (12 mulheres e 9 homens, idade média 13,3 ± 1,3 anos), e Grupo DS (expansor dentossuportado), tratado com Hyrax (5 mulheres e 16 homens, idade média de 13,3 ± 1,4 anos). A dor e o desconforto foram avaliados em dois momentos: após o primeiro dia de ativação (T1) e após quatro dias, por meio da escala de frequência numérica e do instrumento MFIQ (Questionário de Limitação Funcional Mandibular). A estatística descritiva e o teste de Mann-Whitney foram utilizados para comparação entre os grupos e entre os sexos. Adotou-se nível de significância de 5%. Resultados: Ambos os aparelhos tiveram impacto negativo, gerando dor e desconforto e reduzindo a capacidade funcional. No entanto, os escores obtidos foram de baixa intensidade e não foram observadas diferenças significativas entre os grupos. Considerando os sexos, houve diferenças estatisticamente significativas, com o sexo feminino apresentando maiores escores para dor e limitação funcional. Conclusões: Apesar de causar impacto na dor e aumento na limitação funcional, essas alterações foram de baixa intensidade, sem diferença estatística entre os grupos. As mulheres foram mais sensíveis ao impacto causado pela ERM.

Stress distribution analysis in anterior teeth caused by several retraction mechanics

ABSTRACT Introduction: Orthodontic retraction of the anterior teeth is indicated when the patient has a malocclusion with protrusion of the incisors. Several mechanics are indicated to perform this retraction. Objective: The objective of this study was to compare the strains generated by four different types of retraction mechanics along the roots of the anterior teeth. Methods: A photoelastic model simulating an arch with first premolars extraction was made. Sixty retraction archwires were prepared, including fifteen for each type of mechanics evaluated: sliding, teardrop loop spring, T-loop spring and double key loop archwire. The strains were observed in two perspectives: occlusal and oblique. In the occlusal perspective, strains were compared among the six anterior teeth. From the oblique perspective, strains were compared among the thirds of the left canine root. Results: In the occlusal perspective, the teardrop loop spring mechanics presented greater strains, followed by T-loop spring, double key loop archwire and sliding mechanics. In all mechanics, strains were more concentrated in the canines than in the incisors. From the oblique perspective, the teardrop loop mechanics generated greater strains in the cervical regions of the canine, and in the apical regions, no differences were found in strains among the four types of mechanics. In the same mechanics, greater strains were present in the cervical zones. Conclusion: The teardrop loop spring retraction mechanic presented the greatest mean strain, and the sliding retraction mechanic presented the lowest mean strain on the root of anteroinferior teeth in the occlusal and oblique perspectives.

RESUMO Introdução: A retração ortodôntica dos dentes anteriores é indicada quando o paciente apresenta má oclusão com vestibularização dos incisivos. Diferentes mecânicas são indicadas para realizar essa retração. Objetivo: O objetivo do presente estudo foi comparar as tensões geradas por quatro diferentes tipos de mecânicas de retração nas raízes dos dentes anteriores. Métodos: Um modelo fotoelástico foi confeccionado simulando uma arcada com os primeiros pré-molares extraídos. Foram preparados 60 arcos de retração, sendo quinze para cada tipo de mecânica avaliada: deslizamento, alça de Bull, alça em T e arco de dupla chave. As tensões foram observadas em duas perspectivas: oclusal e oblíqua. Na vista oclusal, as tensões foram comparadas entre os seis dentes anteriores. Na vista oblíqua, as tensões foram comparadas entre os terços radiculares do canino esquerdo. Resultados: Na vista oclusal, a mecânica com alça de Bull apresentou maiores tensões, seguida da alça em T, arco de dupla chave e mecânica de deslizamento. Em todas as mecânicas, as tensões se concentraram mais nos caninos do que nos incisivos. Na vista oblíqua, a mecânica com alça de Bull gerou maiores tensões nas regiões cervicais dos caninos; nas regiões apicais, não houve diferenças nas tensões entre os quatro tipos de mecânicas. Dentro de uma mesma mecânica, as maiores tensões estiveram presentes nas regiões cervicais. Conclusão: A mecânica de retração com alça de Bull apresentou a maior média de tensões, e a mecânica de retração por deslizamento apresentou a menor média de tensões na raiz dos dentes anteroinferiores, nas vistas oclusal e oblíqua.

Low-level laser therapy effects on pain perception related to the use of orthodontic elastomeric separators.

INTRODUCTION: Some patients refer to pre-banding orthodontic separation as a painful orthodontic procedure. Low-level laser therapy (LLLT) has been reported to have local analgesic effect. OBJECTIVE: The aim of this single-blind study was to investigate the perception of pain caused by orthodontic elastomeric separators with and without a single LLLT application (6J). METHODS: The sample comprised 79 individuals aged between 13 and 34 years old at orthodontic treatment onset. Elastomeric separators were placed in first maxillary molars at mesial and distal surfaces and kept in place for three days. The volunteers scored pain intensity on a visual analogue scale (VAS) after 6 and 12 hours, and after the first, second and third days. One third of patients received laser applications, whereas another third received placebo applications and the remaining ones were controls. Applications were performed in a split-mouth design. Thus, three groups (laser, placebo and control) were assessed. RESULTS: No differences were found among groups considering pain perception in all periods observed. CONCLUSION: The use of a single-dose of LLLT did not cause significant reduction in orthodontic pain perception. Overall pain perception due to orthodontic separator placement varied widely and was usually mild.

Oral health-related quality of life in patients with dentofacial deformity: a new concept in decision-making treatment?

BACKGROUND: The parameters for the indication of surgical-orthodontic treatment by professionals do not always coincide with the factors which motivate patients to seek treatment. PURPOSE: The purpose of this review is to check the main applications of oral health-related quality of life (OHRQoL) assessment in the treatment of dentofacial deformities and discuss how this approach enriches the traditional diagnostic evaluation and the treatment plan. RESULTS: The indicators of OHRQoL are psychometric tools which can help orthodontists and maxillofacial surgeons in making individual treatment decisions, which include the following: (1) public health triage, (2) decision to treat or not to treat, (3) stipulating the ideal time for treatment, (4) decision making in borderline cases, (5) estimating if the patient will follow the treatment, and (6) they also act as tools to evaluate health services and patient satisfaction or dissatisfaction with the treatment performed. CONCLUSION: It was concluded that the psychometric and morphological information tended to complement each other and helped to achieve better results, thereby leading to successful professional-patient relationships.

TMJ response to mandibular advancement surgery: an overview of risk factors.

OBJECTIVE: In order to understand the conflicting information on temporomandibular joint (TMJ) pathophysiologic responses after mandibular advancement surgery, an overview of the literature was proposed with a focus on certain risk factors. METHODS: A literature search was carried out in the Cochrane, PubMed, Scopus and Web of Science databases in the period from January 1980 through March 2013. Various combinations of keywords related to TMJ changes [disc displacement, arthralgia, condylar resorption (CR)] and aspects of surgical intervention (fixation technique, amount of advancement) were used. A hand search of these papers was also carried out to identify additional articles. RESULTS: A total of 148 articles were considered for this overview and, although methodological troubles were common, this review identified relevant findings which the practitioner can take into consideration during treatment planning: 1- Surgery was unable to influence TMJ with preexisting displaced disc and crepitus; 2- Clicking and arthralgia were not predictable after surgery, although there was greater likelihood of improvement rather than deterioration; 3- The amount of mandibular advancement and counterclockwise rotation, and the rigidity of the fixation technique seemed to influence TMJ position and health; 4- The risk of CR increased, especially in identified high-risk cases. CONCLUSIONS: Young adult females with mandibular retrognathism and increased mandibular plane angle are susceptible to painful TMJ, and are subject to less improvement after surgery and prone to CR. Furthermore, thorough evidenced-based studies are required to understand the response of the TMJ after mandibular advancement surgery.