Esthetic perceptions of facial silhouettes after treatment with a mandibular protraction appliance.

INTRODUCTION: In this retrospective study, we aimed to evaluate the effects on the facial silhouettes produced by a mandibular protraction appliance associated with corrective treatment in Class II patients. METHODS: The sample consisted of 54 (27 initial and 27 final) lateral radiographs from 27 patients. Of these patients, 14 were girls and 13 were boys, with a mean initial age of 12.27 years and a mean treatment period of 2.9 years. An album containing the silhouettes of the pretreatment and posttreatment profiles based on the lateral cephalograms of the patients was prepared. Then, 60 orthodontists and 60 laypeople chose the more esthetic facial silhouette (A or B) and the amount of alterations they perceived between the 2 silhouettes, according to a visual analog scale. A paired t test was used to compare the 2 groups of evaluators with a 5% significance level. RESULTS: Differences between the preferences regarding the pretreatment and posttreatment facial silhouettes were statistically significant for both groups. The posttreatment silhouettes were preferred by most evaluators. The visual analog scale scores showed that the lay evaluators identified greater differences between the pretreatment and posttreatment silhouettes than did the orthodontists (P <0.001). CONCLUSIONS: Based on the evaluators' judgments, treatment with the mandibular protraction appliance had a positive effect on the facial silhouette, and the laypeople better perceived this effect.

Agenesis of maxillary second premolar--diagnosis and clinical management.

Controlling the eruption and development of dentitions is fundamental for a good oral health. The early diagnosis and adequate treatment of occasional developmental disorders are essential to achieve occlusal, functional and esthetic harmony. Abnormality is the term used for classification of alterations and is the most common developmental anomaly in humans. Even though several factors causing tooth malformations have been identified, many are still partially understood, thus requiring a more thorough study. Anyway, the available knowledge provides bases to attempt the early diagnosis of tooth abnormalities, to allow the adoption of preventive and effective therapeutic approaches.

Six-year follow-up of maxillary anterior rehabilitation with forced orthodontic extrusion: achieving esthetic excellence with a multidisciplinary approach.

Orthodontic extrusion with multidisciplinary treatment can provide predictable outcomes in selected situations, reducing the costs and the adaptation times of gingival tissues after implant integration. Forced orthodontic extrusion is strongly related to interactions of teeth with their supportive periodontal tissues. This article reports a case of orthodontic extrusion of the maxillary incisors for later implant rehabilitation in a patient with periodontal disease. Slow forces were applied for 14 months. After this time, the teeth were extracted, and the implants were placed on the same day. Also in the same session, the provisional crown was fabricated for restoration of the anterior maxillary interdental papillae loss and for gingival contouring. Clinical and radiographic examinations at the 6-year follow-up showed successful tooth replacement and an improved esthetic appearance achieved by this multidisciplinary treatment. The decision to perform orthodontic extrusion for implant placement in adult patients should be multidisciplinary.

Using the HERBST appliance with atypical extractions in the lower dental arch.

This article reports the case of a patient with severe mandibular deficiency and crowding in the mandibular arch treated with atypical extractions of two premolars followed by mandibular advancement with the Herbst appliance. It became clear that this therapy corrected the malocclusion while improving facial.

Anterior open bite correction using bite block: a case report.

Several etiological factors that result in dental and/or skeletal alterations make the open bite a type of malocclusion with several treatment alternatives. Corrective fixed orthodontics in conjunction with mechanical or functional orthopedics is a routine approach in correcting this problem. However, orthosurgical treatment must never be discarded for cases with skeletal involvement. This article describes a clinical case which, despite involving skeletal aspects, was treated satisfactorily using a passive bite-block appliance in conjunction with corrective fixed orthodontics.

Correlation of different cephalometric measurements to define facial type.

The aim of this study was to analyze a possible correlation of different cephalometric measurements to define facial type and to evaluate the best measurement for diagnosis. The sample consisted of 95 lateral cephalograms of caucasian patients with normal occlusion, aged between 15 years and two months and 21 years and four months, of which 54 were male and 41 female. The facial types were divided into dolichofacial, mesofacial and brachyfacial, according to the standards stated by different authors, and a relationship among them was investigated using the Kappa and Total agreement methods. The highest agreement found was between FMA and SN.GoGn; the lowest was between SN. Gn and VERT index. According to literature review and the interpretation of the results, SN.GoGn appears to be the best measurement to define facial type.

Evaluation of distances between the mandibular teeth and the alveolar process in Brazilians with normal occlusion.

INTRODUCTION: The aims of this study were to evaluate the distances between the mandibular permanent teeth and the alveolar process in Brazilians with normal occlusion and to compare them with normal American values. METHODS: We used 59 mandibular casts from untreated subjects who had permanent dentition and the 6 keys to normal occlusion. A computer program was used to calculate the distances between the dental reference points and the alveolar process for each tooth. The mean values were then compared to the normal values by applying the Student t test at a significance level of 0.05. RESULTS: The results showed a progressive increase of these distances from the anterior region (incisors) to the posterior region (molars), from 0.00 to 2.49 mm. All measurements had statistically significant differences from the American sample, except for the values for canines and first premolars. CONCLUSIONS: Brazilians with normal occlusion have more lingual crown positions for the incisors, second premolars, and molars compared with Americans with normal occlusion. Although these findings were statistically significant, they are unlikely to be clinically significant.

A new concept of mandibular dental arch forms with normal occlusion.

INTRODUCTION: Because it is important to maintain dental arch dimensions during orthodontic therapy, all possible dental arch forms must be evaluated. METHODS: A mathematical method associated with a polynomial function was used to evaluate the dental arch forms of 63 mandibular models of Brazilian adolescents in the permanent dentition with normal occlusion. A bead was glued to each tooth to simulate an orthodontic accessory and help in the measurement of distances between the center of the bead to the x- and y-axes. The dental casts were digitized, and images were plotted on a computer program to obtain the sixth-degree polynomial and the graph of this function. These segments were organized into 8 groups according to the form of the anterior curve of the dental arch; these were named forms A through H. Each group was subdivided into 3 subgroups: small, medium, and large sizes. RESULTS: Form A was the most frequently observed at 22%, whereas form G was observed in only 2% of the total sample. Forms A, B, C, D, E, and F had more curve segments in medium size, and forms G and H had more curves in small size. A mean dental arch curve was calculated; however, this form coincided with form C, which had an incidence of 10%. CONCLUSIONS: The mandibular dental arch is represented by 23 forms; thus, a normal dental arch cannot be represented by only 1 simple arch form.

Miniplates as skeletal anchorage for treating mandibular second molar impactions.

Mandibular second molar impactions can be difficult to correct and might require surgery. A young man with an impacted mandibular right second molar was treated with a miniplate, which provided anchorage to upright the tooth. Although other devices are available, this technique appears to be predictable and quick, and has few side effects.

Dentoskeletal and soft-tissue changes with cervical headgear and mandibular protraction appliance therapy in the treatment of Class II malocclusions.

INTRODUCTION: In this study, we cephalometrically compared changes in the dentoskeletal and soft tissues after orthodontic treatment of Class II Division 1 malocclusions between the cervical headgear (CHG) and the mandibular protraction appliance (MPA) followed by fixed appliances. METHODS: The sample consisted of 50 patients divided into 2 groups of 25 patients each (13 male, 12 female). Group 1 patients were treated with CHG and fixed appliance, and group 2 patients were treated with the MPA and fixed appliances. The patients were matched according to sex, age, treatment time, and initial cephalometric variables. The groups were compared regarding pretreatment stage and treatment changes, with t tests, at P <.05. RESULTS: The CHG group showed statistically greater restriction of the anterior displacement of the maxilla, improvement of the skeletal Class II relationship, decreased facial convexity, extrusion and distalization of the maxillary first molar, and extrusion of the mandibular incisors. The MPA group had statistically greater increases in maxillary length, mandibular protrusion, maxillary incisor retrusion, mesial displacement of the mandibular first molars, and protrusion of the lower lip. CONCLUSIONS: The changes in Class II malocclusion correction between the CHG and the MPA were that the CHG corrected the Class II malocclusion primarily through greater action on the maxillary skeletal and dentoalveolar structures as compared with the MPA, which corrected the malocclusion through greater action on the mandibular dentoalveolar structures.

Orthodontic compensation in skeletal Class III malocclusion: a case report.

AIM: To describe the dentoskeletal changes occurring during treatment of a patient with a skeletal Class III malocclusion treated for orthodontic compensation at 10 years 4 months of age. METHODS: Rapid maxillary expansion was performed with a Hyrax appliance, Petit orthopedic face mask, high-pull chin cap, and bioprogressive fixed mechanics. RESULTS: The mechanics employed yielded downward and backward mandibular rotation (3 degrees of opening of the facial axis), advancement of the maxillary incisors, and retraction of the mandibular incisors. The result was satisfactory from both esthetic and functional standpoints, providing adequate overjet and overbite, and with stability at 5 years posttreatment. CONCLUSION: The option for compensatory treatment of the skeletal Class III malocclusion without extractions and without orthognathic surgery might be a good option for young patients with good compliance, convergent facial pattern (brachyfacial), and with deep bite, since such occlusal characteristics allow the downward and backward mandibular rotation that is necessary for correction of this problem.

Early tooth extraction in the treatment of anterior open bite in hyperdivergent patients.

AIM: To describe the treatment of a 7-year-old patient with a hyperdivergent (dolichofacial) pattern, Class II Division 1 malocclusion, and anterior open bite. METHODS: Treatment was performed in 2 stages following the principles of the Ricketts bioprogressive technique and comprised early extraction of the maxillary permanent first molars and primary second molars. RESULTS: The treatment plan established for correction of the initial malocclusion reached the orthodontic goals, providing optimal esthetics and normal function. CONCLUSION: Posterior dentoalveolar height, which is fundamental in diagnosis and treatment planning, should be investigated in cases with excessive vertical dimension. In addition, extraction of permanent or primary maxillary posterior teeth at an early age may be a good option for hyperdivergent patients with excessive posterior dentoalveolar height.

Cephalometric variables used to predict the success of interceptive treatment with rapid maxillary expansion and face mask. A longitudinal study.

INTRODUCTION: Prognosis is the main limitation of interceptive treatment of Class III malocclusions. The interceptive procedures of rapid maxillary expansion (RME) and face mask therapy performed in early mixed dentition are capable of achieving immediate overcorrection and maintenance of facial and occlusal morphology for a few years. Individuals presenting minimal acceptable faces at growth completion are potential candidates for compensatory orthodontic treatment, while those with facial involvement should be submitted to orthodontic decompensation for orthognathic surgery. OBJECTIVES: To investigate cephalometric variables that might predict the outcomes of orthopedic treatment with RME and face mask therapy (FM). METHODS: Cephalometric analysis of 26 Class III patients (mean age of 8 years and 4 months) was performed at treatment onset and after a mean period of 6 years and 10 months at pubertal growth completion, including a subjective facial analysis. Patients was divided into two groups: success group (21 individuals) and failure group (5 individuals). Discriminant analysis was applied to the cephalometric values at treatment onset. Two predictor variables were found by stepwise procedure. RESULTS: Orthopedic treatment of Class III malocclusion may have unfavorable prognosis at growth completion whenever initial cephalometric analysis reveals increased lower anterior facial height (LAFH) combined with reduced angle between the condylar axis and the mandibular plane (CondAx.MP). CONCLUSION: The results of treatment with RME and face mask therapy at growth completion in Class III patients could be predicted with a probability of 88.5%.

Periodontal and dental effects of surgically assisted rapid maxillary expansion, assessed by using digital study models.

OBJECTIVE: The present study assessed the maxillary dental arch changes produced by surgically assisted rapid maxillary expansion (SARME). METHODS: Dental casts from 18 patients (mean age of 23.3 years) were obtained at treatment onset (T1), three months after SARME (T2) and 6 months after expansion (T3). The casts were scanned in a 3D scanner (D-250, 3Shape, Copenhagen, Denmark). Maxillary dental arch width, dental crown tipping and height were measured and assessed by ANOVA and Tukey's test. RESULTS: Increased transversal widths from T1 and T2 and the maintenance of these values from T2 and T3 were observed. Buccal teeth tipping also showed statistically significant differences, with an increase in all teeth from T1 to T2 and a decrease from T2 to T3. No statistically significant difference was found for dental crown height, except for left first and second molars, although clinically irrelevant. CONCLUSION: SARME proved to be an effective and stable procedure, with minimum periodontal hazards.

Skeletal maturation in individuals with Down's syndrome: comparison between PGS curve, cervical vertebrae and bones of the hand and wrist.

INTRODUCTION: This study was conducted with the aim of adapting the methods developed by Martins and Sakima to assess skeletal maturation by cervical vertebrae in the pubertal growth spurt (PGS) curve. It also aimed to test the reliability and agreement between those methods and the method of hand and wrist radiograph when compared two by two and all together.  METHODS: The sample comprised 72 radiographs, with 36 lateral radiographs of the head and 36 hand-wrist radiographs of 36 subjects with Down's syndrome (DS), 13 female and 23 male, aged between 8 years and 6 months and 18 years and 7 months, with an average age of 13 years and 10 months.  RESULTS AND CONCLUSIONS: Results revealed that adapting the methods developed by Martins and Sakima to assess skeletal maturation by cervical vertebrae in the PGS curve is practical and useful in determining the stage of growth and development of individuals. The stages of maturation evaluated by cervical vertebrae and ossification centers observed in radiographs of the hand and wrist were considered reliable, with excellent level of agreement between the methods by Hassel and Farman as well as Baccetti, Franchi and McNamara Jr and Martins and Sakima. Additionally, results revealed an agreement that ranged between reasonable to good for the three methods used to assess the skeletal maturation, showing statistical significance.

From conventional to self-ligating bracket systems: is it possible to aggregate the experience with the former to the use of the latter?

INTRODUCTION: Orthodontics, just as any other science, has undergone advances in technology that aim at improving treatment efficacy with a view to reducing treatment time, providing patients with comfort, and achieving the expected, yet hardly attained long-term stability. The current advances in orthodontic technology seem to represent a period of transition between conventional brackets (with elastic modules) and self-ligating brackets systems. Scientific evidence does not always confirm the clear clinical advantages of the self-ligating system, particularly with regard to reduced time required for alignment and leveling (a relatively simple protocol), greater comfort for patients, and higher chances of performing treatment without extractions - even though the number of extractions is more closely related to patient's facial morphological pattern, regardless of the technique of choice. Orthodontics has recently and brilliantly used bracket individualization in compensatory treatment with a view to improving treatment efficacy with lower biological costs and reduced treatment time. OBJECTIVE: This paper aims at presenting a well-defined protocol employed to produce a better treatment performance during this period of technological transition. It explores the advantages of each system, particularly with regards to reduced treatment time and increased compensatory tooth movement in adult patients. It particularly addresses compensable Class III malocclusions, comparing the self-ligating brackets system, in which greater expansive and protrusive tooth movement (maxillary arch) is expected, with Capelozza Prescription III conventional brackets, in which maintaining the original form of the arch (mandibular arch) with as little changes as possible is key to yield the desired results.

Effects of mandibular protraction appliance associated to fixed appliance in adults.

OBJECTIVE: This retrospective study aimed to conduct a cephalometric evaluation of the skeletal, dental and soft tissue effects resulting from treatment of adult patients presenting Class II malocclusion, performed with a Mandibular Protraction Appliance (MPA) combined with a fixed orthodontic appliance. METHODS: The sample consisted of teleradiographs obtained before and after treatment of 9 adult patients (initial mean age of 22.48 years) with bilateral Class II, division 1, malocclusion. Paired t test (p < 0.05) was applied to compare initial and final values. RESULTS: t test revealed an increase in anteroinferior facial height and posterior facial height. The dental changes include: extrusion of upper incisors, buccal inclination, protrusion of lower incisors, mesialization and extrusion of mandibular molars. Regarding the soft tissue component, there was an increase in nasolabial angle in addition to upper lip retrusion. CONCLUSIONS: The effects of treating Class II malocclusion adult patients, by means of using Mandibular Protraction Appliance (MPA) combined with a fixed appliance were mostly observed in the mandibular arch, and consisted of buccal inclination, protrusion and intrusion of incisors, and mesialization and extrusion of the molars.

Evaluation of the cervical vertebrae maturation index in lateral cephalograms taken in different head positions.

The aim of this study was to evaluate if upward or downward head inclination might interfere with determination of the growth stage, using cervical vertebrae maturation index (CVMI), in order to verify the accuracy of such diagnosis when radiographs are taken with errors. Forty-nine patients, 26 females and 23 males, aged 9 to 15 years, were submitted to 3 lateral cephalograms: normal (NHP), with 15° upward head inclination (NHP-Up), and with 15° downward head inclination (NHP-Down). Three examiners evaluated the CVMI on the 147 cephalograms. The agreement among examiners was higher in the evaluation of cephalograms taken in NHP. The weighted Kappa test revealed moderate to substantial agreement between NHP and NHP-Up and between NHP and NHP-Down. There was greater agreement between NHP-Up and NHP-Down. It may be concluded that the evaluation of the CVMI on cephalograms in NHP is different as compared with radiographs taken with inclinations. Both NHP-Up and NHP-Down exhibited greater disagreement in the interpretation among examiners, since the evaluation method was not designed for cephalograms with positioning errors.

New perspective on Herbst therapy for skeletal Class II malocclusions: a proposal for maxillary protrusion management.

Angle Class II malocclusions may present morphologic deviations originated from the maxilla, mandible, or both. Since its reintroduction by Pancherz, the Herbst appliance has demonstrated effectiveness in the management of patients with mandibular deficiency. Because of the intermaxillary anchorage, the action of mandibular advancement provokes simultaneous reaction of maxillary restriction, similar to high-pull headgear. This aimed of this report is to compare two cases treated in two phases. In the first interceptive phase, the transverse problem was corrected by rapid maxillary expansion, which was followed by a Herbst appliance for mandibular advancement; in the second corrective phase, the cases were finished with fixed appliances. Although Herbst appliances were used in both patients, one patient with maxillary protrusion and another with mandibular deficiency, their use targeted different types of skeletal discrepancies. This difference allowed for the comparison of treatment effects, and although both patients had their malocclusion corrected, it seems reasonable to conclude that the final outcome was more favorable for the patient with maxillary protrusion.

Comparative in vitro study of the shear bond strength of brackets bonded with restorative and orthodontic resins.

The aim of this study was to evaluate the shear bond strength of brackets bonded with different restorative systems and compare it with that afforded by an established orthodontic bonding system. Seventy human bicuspids were used, divided into five different groups with 14 teeth each. Whereas a specific orthodontic bonding resin (Transbond™ XT) was used in the control group, the restorative systems Charisma, Tetric Ceram, TPH Spectrum and Z100 were used in the other four groups. Seven days after bonding the brackets to the samples, shear forces were applied under pressure in a universal testing machine. The data collected was evaluated using the ANOVA test and, when a difference was identified, the Tukey test was applied. A 5% level of significance was adopted. The mean results of the shear bond strength tests were as follows: Group 1 (Charisma), 14.98 MPa; Group 2 (Tetric Ceram), 15.16 MPa; Group 3 (TPH), 17.70 MPa; Group 4 (Z100), 13.91 MPa; and Group 5 or control group (Transbond™ XT), 17.15 MPa. No statistically significant difference was found among the groups. It was concluded that all tested resins have sufficient bond strength to be recommended for bonding orthodontic brackets.