Mechanical Properties of Mini-Implants Used in Extra-Radicular Anchorage

ABSTRACT Objective: To evaluate the mechanical properties of mini-implants (MIs) manufactured from stainless steel and compare them with conventional titanium-aluminum-vanadium alloy MIs. Material and Methods: The following groups were formed: G1 (n=24), 8×1.5 mm steel MIs; G2 (n=24), 12×2.0 mm steel MIs; and G3 (n=24), 10×1.5 mm titanium MIs. The 72 MIs were inserted in the infra zygomatic crest region of the maxilla and retromolar trigone in the jaw of 10 pigs. Pull-out, insertion torque, fracture and percussion tests were performed in order to measure the tensile strength, primary stability and fracture strength of MIs. A digital torque gauge was used to measure insertion and fracture torque, a universal mechanical testing machine was used for pull-out testing and a periotest device was used to measure the micromovement of MIs. For morphological and MI component evaluation, scanning electron microscopy (SEM) was performed. D'Agostino & Pearson, Kruskal-Wallis, and Dunn post-hoc and normality tests were used. Results: G2 insertion and fracture torques were significantly higher than G1 and G3 insertion and fracture torques (p<0.05). The pull-out and percussion tests presented similar values among the groups. SEM revealed that the fracture point was predominantly on the fourth thread for steel MIs (G1 and G2) and on the seventh thread for titanium-aluminum-vanadium MIs (G3). Conclusion: The mechanical properties of stainless steel MIs are superior to those of titanium-aluminum-vanadium alloy MIs.

Craniofacial morphology of patients with unilateral cleft lip and palate at two stages of skeletal maturation

Abstract The aim of this retrospective cross-sectional investigation was to perform a 3D analysis of craniofacial morphology of patients with unilateral cleft lip and palate (UCLP) at two stages of skeletal maturation. Cone-beam computed tomography (CBCT) scans of 52 UCLP patients (34 prepubertal; 18 pubertal) were collected from an outpatient referral center for the treatment of craniofacial deformities. In total 15 multiplanar craniofacial landmarks were identified, 3D virtual surface models were created, and 13 variables were measured to assess the 3D Euclidean distances between landmarks and spatial position of the landmarks in the projected X, Y and Z components. Maxillary and mandibular pitch (clockwise, counterclockwise) rotation relative to the cranial base was also evaluated. The significance level was set at 5%. Maxillary retrusion value relative to the cranial base was higher and statistically significant greater (p = 0.028) in pubertal (SNA, 77.4° ± 6.2; N-ANS Y, 3.3 mm ± 3.1) than in prepubertal patients (SNA 81.0° ± 5.2; N-ANS Y, 5.8 mm ± 2.7). The posterior cranial base length (S-Ba Y) was significantly longer (p = 0.013) in pubertal (20.7 mm ± 3.4) than in prepubertal patients (18.4 mm ± 2.7). The upper facial height (N-ANS Z) was significantly greater (p = 0.01) in pubertal (46.9 mm ± 4.5) than in prepubertal patients (43.4 mm ± 3.0). Prepubertal and pubertal UCLP patients presented distinct patterns of craniofacial morphology, mainly in the sagittal component of the maxilla and in the posterior cranial base length. Pubertal patients had greater maxillary retrusion and posterior cranial base length.

Information and Communications Technology in Dentistry: an informative and educational approach for patients with fixed orthodontic appliances

ABSTRACT Objective: To develop and make available, at no cost to the user, Information and Communications Technology (ICT) tools for Dentistry, providing dental information and advice geared toward patients undergoing orthodontic treatment with fixed appliances. Material and Methods: A Dentistry-based content that contemplated information and advice concerning orthodontic treatment with fixed appliances was elaborated. The materials, which included instructions on oral hygiene and treatment strategies when faced with possible complications, were evaluated and validated by specialists, whose assessments reached a 85% approval. From the validated content, products using four distinct ICT tools were formulated. Results: The following technological products were developed: a program for community radios, three blog posts, four educational and informative videos, and a smartphone application - using texts, as well as images and videos. These ICT tools, geared toward patients wearing fixed orthodontic appliances, were made available by internet at no cost to the user, and the number of accesses is already expressive. Conclusion: These technological-scientific tools, developed and provided freely to the population, can aid patients during their treatment with fixed orthodontic appliances, contributing to the dissemination of reliable information, and clarifying doubts that may arise during orthodontic therapy. These free ICT tools serve to facilitate access to scientific knowledge, thereby favoring social inclusion, bearing in mind that this educational and informative material was offered in a simple and accessible manner to the general population.

RESUMO Objetivos: Desenvolver e disponibilizar, gratuitamente, ferramentas de tecnologia da informação e comunicação (TIC) para a Odontologia, abordando informações e orientações direcionadas a pacientes em tratamento ortodôntico com aparelho fixo. Material e Métodos: Foi elaborado um conteúdo que contemplou informações e orientações concernentes ao tratamento ortodôntico com aparelho fixo. O material, que abrangeu instruções sobre higiene bucal e sobre abordagens diante de possíveis intercorrências, foi avaliado e validado por especialistas. A partir do conteúdo validado, foram elaborados produtos utilizando quatro ferramentas distintas de TIC. Resultados: Foram desenvolvidos os seguintes produtos tecnológicos: um programa para rádios comunitárias, três postagens para blog, quatro vídeos educacionais e informativos, e um aplicativo para smartphones, utilizando não apenas textos, mas também imagens e vídeos. Essas ferramentas de TIC direcionadas a pacientes fazendo uso de aparelho ortodôntico fixo foram disponibilizadas gratuitamente via internet, e já contam com expressivo número de acessos. Conclusões: As ferramentas técnico-científicas, desenvolvidas e fornecidas livremente à população, podem auxiliar pacientes durante o tratamento com aparelho ortodôntico fixo, contribuir para disseminar informações confiáveis e esclarecer dúvidas que surgem durante a terapia ortodôntica. Essas ferramentas gratuitas de TIC facilitam o acesso ao conhecimento científico e, consequentemente, favorecem a inserção social, tendo em vista que esse material educacional e informativo foi ofertado de maneira simples e acessível à população.

Effectiveness of Chewing Gum Containing CPP-ACP for Remineralisation of Demineralised Enamel around Orthodontic Brackets: An in Situ Study

Abstract Objective: To evaluate the effectiveness of chewing gums containing CPP-ACP in remineralisation of demineralised enamel around orthodontic brackets. Material and Methods: Enamel blocks from 120 bovine incisors were used. The blocks were flattened and polished, followed by the development of incipient subsurface caries. The blocks have been subjected to a baseline microhardness analysis. Orthodontic brackets were bonded to the exposed area of the blocks, reserving an area for hardness analysis. An in situ crossover (three-way crossover phases of 21 days with an interval of one week between them), controlled, randomised and blind experimental model was used, with the participation of 12 volunteers divided into groups: G1 - negative control group, without chewing gum; G2 - conventional sugar-free chewing gum, without CPP-ACP (placebo); and G3 - sugar-free chewing gum with CPP-ACP. The following parameters were analysed: superficial linear (Ra), volumetric roughness (Sa), and superficial structural loss, which was indicated by Gap measurement (difference between the healthy and treated area). Statistical tests used were the Friedman, Wilcoxon and Shapiro-Wilk, Kruskal Wallis' nonparametric tests and ANOVA. Results: There was a significant reduction in enamel microhardness after demineralisation in all the groups (p<0.05). This deleterious effect was attenuated in the three groups after the final evaluation, although there were no statistical differences (p<0.05); however, the final values did not return to the baseline values (p<0.05). Conclusion: Chewing gum containing CPP-ACP did not promote in situ remineralisation of demineralised enamel around orthodontic brackets.

Orthodontic retreatment: positive effects on the patient's self-esteem and quality of life

ABSTRACT Introduction: An increasing percentage of the world's population has had access to orthodontic treatment within the last few decades. Consequently, a larger number of patients seeking for correction of their malocclusions, nowadays, present with a history of previous orthodontic therapy. Orthodontists performing retreatments in their practice may have to face additional difficulties, and one of them is treating individuals that may be even more demanding for excellent results and efficient treatments. Objectives: This manuscript discusses the challenges faced when performing orthodontic retreatments. It illustrates a two-phase retreatment of a pre-adolescent and the ortho-surgical retreatment of a young adult with high demands for fast and exceptional results. Finally, this paper elaborates on the positive impacts that these retreatments had on the patients' self-esteem and quality of life.

RESUMO Introdução: Um percentual crescente da população mundial vem tendo acesso ao tratamento ortodôntico ao longo das últimas décadas. Consequentemente, hoje em dia, um maior número de pacientes em busca da correção de suas más oclusões apresenta um histórico de tratamento ortodôntico prévio. Ortodontistas que realizam retratamentos ortodônticos podem enfrentar dificuldades adicionais, e uma delas é ter que lidar com indivíduos que apresentam demandas e expectativas ainda maiores em relação à obtenção de resultados excelentes e de forma bastante eficiente. Objetivos: O presente artigo discute os desafios e os impactos positivos do retratamento ortodôntico causados na autoestima e na qualidade de vida dos pacientes, e ilustra o retratamento em duas fases de uma pré-adolescente, e o retratamento ortodôntico-cirúrgico de uma paciente adulta jovem que tinha demandas muito elevadas para a obtenção de resultados rápidos e excelentes.

Williams-Beuren Syndrome: What Orthodontists Need to Know / Síndrome de Williams-Beuren: Lo que los Ortodoncistas Deben Saber

ABSTRACT: Williams-Beuren syndrome is a rare disease with manifestations such as cardiovascular changes, distinct facial features, mental retardation, and learning disabilities. Oral manifestations are not commonly described and can often be misdiagnosed. This report describes the case of a male patient diagnosed with Williams-Beuren syndrome presenting classic clinical features that affect the face as a convex profile, with maxillary protrusion and mandibular retrusion, a discreetly acute nasolabial angle, passive labial sealing, and an open mandibular angle characteristic of Class II skeletal pattern. In addition, the patient has oral manifestations such as the absence of some dental elements, a Class II of Angle 1st division, dental cross bite, and atresic arches. The periodontal condition presents with generalized gingivitis. Knowledge about the possible manifestations of Williams-Beuren syndrome is important to improve the ability of orthodontists to better serve these patients.

RESUMEN: El síndrome de Williams-Beuren es una enfermedad rara con manifestaciones tales como cambios cardiovasculares, diversas características faciales, retraso mental y problemas de aprendizaje. Las manifestaciones orales no se describen comúnmente y con frecuencia se pueden diagnosticar erróneamente. Este informe describe el caso de un paciente masculino diagnosticado con síndrome de Williams-Beuren que presentaba características clínicas clásicas que afectaban la cara como un perfil convexo, con protrusión maxilar y retrusión mandibular, un ángulo nasolabial discretamente agudo, sellado labial pasivo y un ángulo mandibular abierto característico del patrón esquelético clase II. Además, el paciente presentaba manifestaciones orales tales como, ausencia de algunos elementos dentales, una clase II de Angle 1ª división, mordida dental cruzada y arcos acrílicos. La condición periodontal se presentaba con gingivitis generalizada. El conocimiento sobre las posibles manifestaciones del síndrome de Williams-Beuren es importante ya que mejora la capacidad de los ortodoncistas para atender mejor a estos pacientes.

A produção tecnológica na odontologia: o registro de patentes / Technological production in Dentistry: the patent registration

A geração de conhecimento obtida por meio da pesquisa científica materializa-se no anúncio dos resultados à sociedade. Este se faz basicamente de 2 formas: com apresentações em congressos e publicação de artigos científicos, ou por meio da solicitação de patentes. Se há intenção em auferir ganhos financeiros e materiais com as descobertas, ideias e inventos resultantes da pesquisa, a solicitação de uma patente se faz necessária. O objetivo deste artigo foi contribuir com a divulgação das informações pertinentes às patentes para o profissional da Odontologia brasileira. Uma descrição sucinta das etapas necessárias para a sua solicitação foi realizada. Deve-se reconhecer o esforço do Instituto Nacional de Propriedade Industrial (INPI) em disponibilizar no seu sítio eletrônico todas as informações necessárias aos interessados em fazer um pedido de patente, de maneira inteligível e didática, possibilitando a estes realizar seus próprios pedidos de patente de maneira autônoma.

The generation of knowledge obtained through scientific research materializes in the announcement of results to society. This is basically done in two ways: with presentations at congresses and publication of scientific articles, or through the application for patents. If there is an intention to make financial and material gains with the discoveries, ideas and inventions resulting from the research, the application for a patent is necessary. The aim of this article was to contribute to the dissemination of information pertinent to patents for the Brazilian Dentistry professional. A brief description of the steps required for its request has been made. It must be recognized the effort of the Instituto Nacional da Propriedade Industrial (INPI) to make available on its website all the information necessary to those interested in making a patent application, in an intelligible and didactic way, enabling them to make their own patent applications.

Plaque index and gingival index during rapid maxillary expansion of patients with unilateral cleft lip and palate

ABSTRACT Objective: To assess, during rapid maxillary expansion, the plaque index (PI) and the gingival index (GI) of patients with unilateral cleft lip and palate(UCLP) using Hyrax (HX) or inverted mini-Hyrax (IMHX) rapid maxillary expanders (RME) considering patients' sex and age. Methods: PI (Quigley Index modified by Turesky et al) and GI (Löe and Silness) of 28 UCLP (11 females; 17 males: aged 8 to 15 years) submitted to daily RME activation were assessed before (T0) and 7 (T1), 28 (T2) and 90 (T3) days after activation. Log-linear models and Bonferroni correction were performed to analyze possible differences in PI and GI between RME, sexes or age groups over time. Results: Intra-group comparison revealed significant increases in PI of patients using HX (T0 < T2), IMHX (T0 < T3; T1< T3), males (T0 < T1; T0 < T2; T0 < T3) or aged 12-15 years (T0 < T1; T0 < T2; T0 < T3), and in GI of patients using IMHX (T0 < T3; T1 < T3), females (T1 < T3; T2 < T3) or aged 12-15 years (T0 < T3; T2 < T3). One inter-group difference in GI according to patients' age (8-11 < 12-15; T1) was observed. Conclusions: Since a single difference between groups was encountered, the results of this study indicated that PI and GI during maxillary expansion were similar between HX and IMHX, sexes and the analyzed age groups. Therefore, orthodontists can use these RME in UCLP patients according to the patient's necessity or their preferences.

RESUMO Objetivo: avaliar, durante a expansão rápida da maxila (ERM), o índice de placa dentária (IP) e o índice gengival (IG) de pacientes com fissura labiopalatina unilateral (FLPU), usando o aparelho disjuntor Hyrax (HX) ou o mini-Hyrax invertido (MHXI), considerando-se também o sexo e a idade. Métodos: o IP (Quigley-Hein modificado por Turesky et al.) e o IG (Silness e Löe) de 28 pacientes com FLPU (11 meninas; 8-15 anos de idade) tratados com ativação diária do aparelho de ERM foram avaliados antes (T0) e após 7 (T1), 28 (T2) e 90 (T3) dias da ativação inicial. Modelos de regressão log-linear e correção de Bonferroni foram usados para analisar as possíveis diferenças de IP e IG entre os grupos, de acordo com o tipo de aparelho de ERM, sexo e idade, ao longo do tempo. Resultados: as comparações intragrupos revelaram aumentos significativos do IP em pacientes usando HX (T0< T2) ou MHXI (T0< T3; T1< T3), com idades entre 12 e 15 anos (T0 < T1; T0 < T2; T0 < T3), e do IG de pacientes usando MHXI (T0< T3; T1< T3), que eram meninas (T1 < T3; T2 < T3), com idades entre 12 e 15 anos (T0 < T3; T2 < T3). Uma diferença no IG entre grupos foi observada em relação à idade dos pacientes (8-11 < 12-15; T1). Conclusões: uma única diferença entre grupos foi encontrada, o que sugere que os resultados de IP e IG, durante a expansão maxilar, foram semelhantes entre os grupos HX e MHXI, bem como entre os sexos e idades analisadas. Dessa forma, os ortodontistas podem usar esses aparelhos de ERM no tratamento de pacientes com FLPU de acordo com as necessidades do paciente ou suas preferências.

Selective alveolar corticotomy to intrude overerupted maxillary first molars: analysis of pulp vitality / Corticotomía alveolar selectiva para la intrusión de los primeros molares superiores extruidos: análisis de la vitalidad pulpar

The excessive and prolonged orthodontic treatment might result in loss of pulp vitality. Selective alveolar corticotomy is an alternative to accelerate the orthodontic treatment in adults. This study aimed to evaluate the impact of selective alveolar corticotomy associated with orthodontic intrusion on pulp vitality of overerupted maxillary first molars. Six individuals with extruded maxillary first molars were randomly selected to undergo corticotomy as coadjuvant therapy for intrusion. Pulp vitality was evaluated with thermal (Endo-Ice and Heated gutta-percha) and electric tests before the surgical procedure and after intrusion (90 days). The intrusion of all teeth was obtained (mean 2.26 ± 0.52 mm), and all teeth responded positively to pulp vitality tests before and after intrusion. This suggests that selective alveolar corticotomy did not promote pulp damage, and can be considered an effective and safe auxiliary method to intrusion of overerupted maxillary molars.

El tratamiento de ortodoncia prolongado puede provocar la pérdida de la vitalidad pulpar. La corticotomía alveolar selectiva es una alternativa para acelerar el tratamiento de ortodoncia en adultos. El objetivo del presente estudio fue evaluar el impacto de corticotomía alveolar selectiva asociada a la intrusión dental con ortodoncia en la vitalidad pulpar de los primeros molares superiores extruidos. Seis individuos con primeros molares superiores extruidos fueron seleccionados al azar para someterse a corticotomía como terapia adyuvante para la intrusión dental. La vitalidad pulpar se evaluó en ensayos térmicos (Endo-ice y gutapercha climatizada) y eléctrica antes del procedimiento quirúrgico y después de la intrusión (90 días). Se obtuvo la intrusión de todos los dientes (media 2,26 ± 0,52 mm) y todos los primeros molares respondieron positivamente a las pruebas de vitalidad pulpar, antes y después de la intrusión. Los resultados sugieren que la corticotomía alveolar selectiva no promueve daño pulpar y se puede considerar un método eficaz y seguro para ayudar a la intrusión de molares extruidos.

Do you know this syndrome? Leopard syndrome

ABSTRACT Hypertrophic cardiomyopathy is known as Leopard syndrome, which is a mnemonic rule for multiple lentigines (L), electrocardiographic conduction abnormalities (E), ocular hypertelorism (O), pulmonary stenosis (P), abnormalities of genitalia (A), retardation of growth (R), and deafness (D). We report the case of a 12-year-old patient with some of the abovementioned characteristics: hypertelorism, macroglossia, lentigines, hypospadias, cryptorchidism, subaortic stenosis, growth retardation, and hearing impairment. Due to this set of symptoms, we diagnosed Leopard syndrome.

Effects of rapid maxillary expansion in cleft patients resulting from the use of two different expanders

ABSTRACT Objective: The aim of this study was to evaluate the skeletal and dental effects of rapid maxillary expansion (RME) in cleft patients using two types of expanders. Methods: Twenty unilateral cleft lip and palate patients were randomly divided into two groups, according to the type of expander used: (I) modified Hyrax and (II) inverted Mini-Hyrax. A pretreatment cone-beam computed tomographic image (T0) was taken as part of the initial orthodontic records and three months after RME, for bone graft planning (T1). Results: In general, there was no significant difference among groups (p > 0.05). Both showed a significant transverse maxillary expansion (p < 0.05) and no significant forward and/or downward movement of the maxilla (p > 0.05). There was greater dental crown than apical expansion. Maxillary posterior expansion tended to be larger than anterior opening (p < 0.05). Cleft and non-cleft sides were symmetrically expanded and there was no difference in dental tipping between both sides (p > 0.05). Conclusions: The appliances tested are effective in the transverse expansion of the maxilla. However, these appliances should be better indicated to cleft cases also presenting posterior transverse discrepancy, since there was greater expansion in the posterior maxillary region than in the anterior one.

RESUMO Objetivo: o objetivo deste estudo foi avaliar os efeitos esqueléticos e dentários da expansão rápida da maxila (ERM) em pacientes fissurados, utilizando dois tipos de disjuntores. Métodos: vinte pacientes com fissura labiopalatal unilateral foram aleatoriamente divididos em dois grupos, de acordo com o tipo de aparelho utilizado: (1) Hyrax modificado e (2) Mini-Hyrax invertido. Tomografias computadorizadas de feixe cônico foram obtidas antes do tratamento (T0), como parte da documentação ortodôntica inicial, e três meses após a ERM, para o planejamento de enxertia óssea (T1). Resultados: não houve diferença significativa entre os grupos (p>0,05). Ambos apresentaram significativa expansão transversal da maxila (p<0,05), sem significativa movimentação anterior e/ou inferior da maxila (p>0,05). Houve uma maior expansão transversal das coroas em relação à expansão nos ápices. A tendência observada foi uma maior expansão na região posterior da maxila, em comparação à anterior (p<0,05). Avaliando o deslocamento dos lados fissurado e não fissurado, a expansão ocorreu de maneira simétrica e não houve diferença na inclinação dentária entre os lados (p>0,05). Conclusões: os aparelhos testados são eficazes na expansão transversal da maxila em pacientes fissurados. Porém, esses aparelhos seriam melhor indicados para casos de fissura labiopalatal com atresia transversal posterior, uma vez que a expansão foi maior na região posterior da maxila do que na região anterior.

Incisor proclination and gingival recessions: is there a relationship?

Aim: To test the hypothesis that there is no relationship between the amount of vestibular inclination of mandibular incisors and the appearance of gingival recession in this region. Methods: This study included 20 patients selected in accordance with the following inclusion criteria: 1. adult patients without gingival recession in the mandibular incisors before treatment (T0), 2. no previous orthodontic treatment, 3. treated without tooth extraction in the mandibular arch, 4. bonded mandibular splinting from one canine to another after the active stage of orthodontic treatment (T1), 5. no visible wear of the incisal edge of the mandibular incisors, 6. Pre- and post-treatment teleradiography and plaster casts, and plaster casts 3 years post-treatment (T2). Depending on the amount of inclination of the mandibular incisors after treatment, the sample was divided into two groups: Group 1- 10 individuals (IMPA T1-T0 ≤ 5˚) and Group 2- 10 individuals (IMPA T1-T0 > 5˚). The measurement of length of the clinical crown (LCC) of the four mandibular incisors, distance between the incisal edge and vestibular marginal gingiva were made in plaster casts at T0, T1 and T2. Results: In spite of Group 1 presenting a reduction in LCC at T2, there was no statistically significant difference in LCC in the 3 time intervals evaluated in the two groups. Conclusions: The null hypothesis was accepted. The variation in the amount of vestibular inclination of the mandibular incisors during orthodontic treatment and 3 years after conclusion of treatment did not promote the appearance of gingival recessions in this group of patients (Au)

Enamel loss and superficial aspect during bonding and debonding of metallic brackets / Perda de esmalte e aspecto superficial durante colagem e descolagem de bráquetes metálicos

To evaluate the cumulative enamel loss during bonding and debonding procedures of orthodontic metallic brackets and to analyze the enamel superficial roughness. Forty-seven maxillary first premolars were obtained for quantitative and qualitative analysis. For quantitative analysis, forty premolars were weighed at each stage of treatment and the equivalent thickness of enamel loss was measured. The amount of tooth mass loss in each stage was divided by the density value to obtain the corresponding enamel volume lost. Subsequently, these volumes were divided by a circular area with a diameter of 7 mm, thus obtaining the equivalent thickness of enamel loss. They were assessed under the following conditions: as sound enamel, after acid conditioning, following the removal of residual resin composite, after final polishing with high or low-speed, and with or without water refrigeration. A rugosimeter was used to obtain a graphic registration of the enamel superficial roughness before and after acid conditioning. The data were analyzed with the Quantikov software and the Shapiro Wilk's and Wilcoxon statistical tests were used to evaluate enamel superficial roughness. The one-way ANOVA followed by Bonferroni Post-Hoc tests were used to analyze the amount of enamel loss. For qualitative analysis, scanning electron microscopy (SEM) of the enamel surfaces was performed on seven premolars, one in each step. Acid conditioning significantly increased enamel surface roughness (p<0.01). Based on the dental mass weighed after each stage of evaluation, enamel loss was statistically significant in all stages (p<0.01). However, when the 4 different final polishing methods were compared, no statistically significant differences were registered regarding loss of mineralized structure (p=0.72). The SEM analysis revealed that the tungsten-carbide bur with water refrigeration and lowspeed rubber points caused less damage to the enamel. The greatest amount of enamel loss was due to acid conditioning. The losses relative to abrasion with composite removal or after the 4 polishing protocols were similar. Finally, none of the enamel surfaces was restored to their original aspects after bonding and debonding metallic brackets.

Determinar a perda de esmalte durante os procedimentos de colagem e descolagem de bráquetes ortodônticos e analisar a rugosidade superficial do esmalte. Quarenta e sete primeiros pré-molares superiores foram obtidos para análise quantitativa e qualitativa. Para a análise quantitativa, quarenta pré-molares foram pesados em cada uma das etapas do tratamento e a espessura equivalente do esmalte foi medida. A perda de massa em cada fase foi dividida pelo valor de densidade do esmalte para obter o volume correspondente. Em seguida, o volume foi dividido pela área circular de 7 mm de diâmetro, obtendo-se assim a espessura equivalente da perda de esmalte. Os dentes foram avaliados nas seguintes condições: esmalte íntegro, após condicionamento ácido, depois da remoção da resina remanescente e após o polimento final em alta e baixa rotação, com e sem refrigeração. Ainda foi utilizado um rugosímetro para obtenção dos registros gráficos de perfis da rugosidade superficial do esmalte antes e após o condicionamento ácido. Os dados foram analisados utilizando-se o software Quantikov, para determinação e comparação dos comprimentos dos registros obtidos antes e após o condicionamento ácido, o teste Shapiro Wilk e o Wilcoxon para rugosidade superificial do esmalte e, por fim, o ANOVA um fator seguido pelo Bonferroni Post-Hoc para perda de esmalte. Para a análise qualitativa, foi empregada a microscopia eletrônica de varredura nas superfícies de esmalte de sete pré-molares, um dente para cada etapa. O condicionamento ácido promoveu o aumento do comprimento do perfil de superfície do esmalte, ou seja, o aumento da rugosidade (p<0,01). Na avaliação da massa dos elementos dentários, percebeu-se que a perda de esmalte foi estatisticamente significante em todas as etapas do experimento (p<0,01). Entretanto, ao comparar os diferentes métodos de polimentos, verificou-se que não há diferença estatisticamente significante na perda de estrutura mineralizada (p=0,72). Na análise da microscopia eletrônica de varredura, a remoção da resina com broca carbide de tungstênio multilaminada com refrigeração e o polimento em baixa rotação sob refrigeração apresentaram menos dano ao esmalte. A maior perda de esmalte foi devida ao condicionamento ácido. As perdas referentes ao desgaste com a broca e o polimento são semelhantes e os 4 protocolos de polimento testados resultaram em diminuições similares na espessura do esmalte. Nenhuma das superfícies de esmalte foi restaurada ao seu aspecto original após a colagem e descolagem de bráquetes metálicos.

Effectiveness of fluoride sealant in the prevention of carious lesions around orthodontic brackets: an OCT evaluation

Abstract Objective: This article aimed to evaluate in vitro the efficiency of Pro Seal fluoride sealant application in the prevention of white spot lesions around orthodontic brackets. Material and Methods: Brackets were bonded to the buccal surface of bovine incisors, and five groups were formed (n = 15) according to the exposure of teeth to oral hygiene substances and the application of enamel sealant: G1 (control), only brushing was performed with 1.450 ppm fluoride; G2 (control) brushing associated with the use of mouthwash with 225 ppm fluoride; G3, only Pro Seal sealant application was performed with 1.000 ppm fluoride; G4 Pro Seal associated with brushing; G5 Pro Seal associated with brushing and mouthwash. Experimental groups alternated between pH cycling and the procedures described. All specimens were kept at a temperature of 37 °C throughout the entire experiment. Both brushing and immersion in solutions were performed within a time interval of one minute, followed by washing in deionized water three times a day for 28 days. Afterwards, an evaluation by Optical Coherence Tomography (OCT) of the spectral type was performed. In each group, a scanning exam of the white spot lesion area (around the sites where brackets were bonded) and depth measurement of carious lesions were performed. Analysis of variance (ANOVA) was applied to determine whether there were significant differences among groups. For post hoc analysis, Tukey test was used. Results: There was statistically significant difference between groups 1 and 2 (p = 0.003), 1 and 3 (p = 0.008), 1 and 4 (p = 0.000) and 1 and 5 (p = 0.000). The group in which only brushing was performed (Group 1) showed deeper enamel lesion. Conclusion: Pro Seal sealant alone or combined with brushing and/or brushing and the use of a mouthwash with fluoride was more effective in protecting enamel, in comparison to brushing alone.

Resumo Objetivo: avaliar in vitro a eficiência da aplicação de selante fluoretado Pro Seal na prevenção de lesões de mancha branca ao redor de braquetes ortodônticos. Métodos: braquetes foram fixados na face vestibular de incisivos bovinos, formando os seguintes cinco grupos (n = 15) de acordo com a exposição a substâncias de higiene bucal e a aplicação do selante de esmalte: 1) controle - realizada apenas escovação; 2) controle - escovação + utilização de enxaguante bucal com flúor; 3) apenas aplicação de selante Pro Seal (Reliance Orthodontic Products, Itasca, Ill); 4) Pro Seal + escovação; 5) Pro Seal + escovação + bochecho. Os grupos experimentais alternaram entre ciclagem de pH e os procedimentos descritos. Todos os espécimes foram mantidos, durante todo o experimento, à temperatura de 37°C. Tanto a escovação quanto a imersão nas soluções foram realizadas em um intervalo de tempo de 1 minuto, seguidas por lavagem em água deionizada, três vezes por dia, durante 28 dias. Após isso, realizou-se avaliação utilizando Tomografia por Coerência Óptica (OCT) do tipo espectral (Ganymede OCT/Thorlabs, Newton, EUA). Em cada grupo, foi realizado um exame em varredura da área de mancha branca (em torno da região onde foram colados os braquetes), assim como a aferição da profundidade das lesões de cárie. A análise de variância (ANOVA) foi aplicada para determinar se houve diferenças significativas entre os grupos. Para o testepost hoc, foi utilizado o teste de Tukey. Resultados: houve diferença estatisticamente significativa entre os grupos 1 e 2 (p = 0,003), 1 e 3 (p = 0,008), 1 e 4 (p = 0,000) e 1 e 5 (p = 0,000). O grupo onde apenas escovação foi feita (Grupo 1) mostrou lesão do esmalte mais profunda. Conclusão: o selante ProSeal sozinho ou combinado com escovação e/ou escovação e uso de bochechos com flúor foi eficaz em proteger mais do que apenas escovar esmalte.

Color stability of ceramic brackets immersed in potentially staining solutions

OBJECTIVE: To assess the color stability of five types of ceramic brackets after immersion in potentially staining solutions.METHODS: Ninety brackets were divided into 5 groups (n = 18) according to brackets commercial brands and the solutions in which they were immersed (coffee, red wine, coke and artificial saliva). The brackets assessed were Transcend (3M/Unitek, Monrovia, CA, USA), Radiance (American Orthodontics, Sheboygan, WI, USA), Mystique (GAC International Inc., Bohemia, NY, USA) and Luxi II (Rocky Mountain Orthodontics, Denver, CO, USA). Chromatic changes were analyzed with the aid of a reflectance spectrophotometer and by visual inspection at five specific time intervals. Assessment periods were as received from the manufacturer (T0), 24 hours (T1), 72 hours (T2), as well as 7 days (T3) and 14 days (T4) of immersion in the aforementioned solutions. Results were submitted to statistical analysis with ANOVA and Bonferroni correction, as well as to a multivariate profile analysis for independent and paired samples with significance level set at 5%.RESULTS: The duration of the immersion period influenced color alteration of all tested brackets, even though these changes could not always be visually observed. Different behaviors were observed for each immersion solution; however, brackets immersed in one solution progressed similarly despite minor variations.CONCLUSIONS: Staining became more intense over time and all brackets underwent color alterations when immersed in the aforementioned solutions.

OBJETIVO: avaliar a estabilidade da cor de cinco tipos de braquetes cerâmicos após imersão em soluções potencialmente corantes.MÉTODOS: noventa braquetes foram divididos em 5 grupos (n = 18) de acordo com a marca comercial dos braquetes e as soluções em que foram imersos (café, vinho tinto, Coca-Cola e saliva artificial). Os baquetes avaliados foram Transcend (3M / Unitek, Monrovia, CA, EUA), Radiance (American Ortodontia, Sheboygan, WI, EUA), Mystique (GAC International Inc., Bohemia, NY, EUA) e Luxi II (Rocky Mountain Orthodontics, Denver, CO, EUA). Alterações cromáticas foram analisadas com o uso de um espectrofotômetro de reflectância e por inspecção visual, em cinco intervalos de tempo específicos. Os momentos de avaliação foram: 24 horas (T1), 72 horas (T2), 7 dias (T3) e 14 dias (T4) de imersão nas soluções. Os resultados foram submetidos à avaliação estatística com análise de variância e correção de Bonferroni, bem como a uma análise do perfil multivariada para amostras independentes e pareadas, com nível de significância de 5%.RESULTADOS: a duração do período de imersão influenciou na alteração de cor de todos os braquetes testados, mesmo admitindo-se que essas alterações nem sempre puderam ser observadas visualmente. Diferentes comportamentos foram observados em cada solução de imersão; no entanto, braquetes imersos em um mesmo tipo de solução progrediram de forma semelhante, apesar das pequenas variações.CONCLUSÕES: a coloração se tornou mais intensa com o tempo, e todos os braquetes sofreram alteração de cor nas soluções imersas.

In vitro Evaluation of Color Changes of Aesthetic Orthodontic Elastic Ligatures / Evaluación in vitro de los Cambios de Color en Ligaduras Elásticas Ortodónticas Estéticas

The objective of this study was to evaluate the possible changes in color of aesthetic elastic ligatures soaked in different solutions. Five different brands of aesthetic elastic ligatures were evaluated in the present study. Measurement of the discs´ color was performed using a reflectance spectrophotometer (UV-visible spectrophotometer, UV-2450, Shimadzu®, Kyoto, Japan). Subsequently, the discs were immersed in artificial saliva (AS) or three different solutions: red wine (RW) (Miolo Terranova® 2010, Casa Nova, Brazil), coffee (CF) (Café Três Corações®, RioGrande do Norte, Brazil) or Coca-Cola® (CC) (Coca-Cola®, Belo Horizonte, Brazil). It was determined that the tested solutions were able to cause color changes in the aesthetic elastic ligatures. The coffee solution caused the greatest color change in all of the brands of ligatures evaluated, followed by the red wine solution. In conclusion, OSE and GAC brands of aesthetic elastic ligatures displayed the best performance.

El objetivo de este estudio fue evaluar los posibles cambios en el color de ligaduras elásticas estéticas embebidas en diferentes soluciones. Cinco diferentes marcas de ligaduras elásticas estéticas fueron evaluados en el presente estudio. La medición de discos de color se realizó con un espectrofotómetro de reflectancia (espectrofotómetro UV-visible, UV-2450, Shimadzu®, Kyoto, Japón). A continuación, los discos se sumergieron en saliva artificial o tres soluciones diferentes: vino tinto (Miolo Terranova® 2010, Casa Nova, Brasil), café (Café Três Corações®, RioGrande do Norte, Brasil) o Coca-Cola® (Coca-Cola®, Belo Horizonte, Brasil). Se determinó que las soluciones testeadas fueron capaces de causar cambios de color en las ligaduras elásticas estéticas. La solución de café causó el mayor cambio de color en todas las marcas de ligaduras evaluados, seguido por la solución de vino tinto. En conclusión, las marcas de ligaduras elásticas estéticas OSE y GAC muestran el mejor desempeño.

Effect of different enamel conditionings on the bond strength of glass ionomer cement and ceramic brackets

Aim: To evaluate the effect of different enamel conditionings on the shear bond strength (SBS) and bond failure patterns of a resin modified glass ionomer cement (RMGIC) used to bond ceramic brackets. Methods: 105 human premolars extracted for orthodontic reasons were divided into 7 groups according to the enamel surface treatments: conditioners (35% phosphoric acid and 10% polyacrylic acid), type of adhesive (Transbond(r) and Fuji Ortho LC Capsule(r)), washing time and drying of the surface. Results: A significant p<0.05 was observed among the shear bond strength values obtained with seven different types of enamel preparation prior to bonding. The group that had the tooth surface conditioned with polyacrylic acid and enamel surface slightly dried before bracket placement showed no significant difference (p>0.05) to the group that had brackets bonded with composite resin. The two groups that had enamel prepared with polyacrylic acid and brackets bonded with GIC on a wet surface showed significantly lower shear bond strength than the control group (p<0.05). Conclusions: Moisture contamination decreased SBS, but not enough to preclude the use of RMGIC as an alternative to composite resin (CR) for direct bonding of ceramic brackets.

Evaluation In Vitro of Frictional Resistance of Self-Ligating Esthetic and Conventional Brackets / Evaluación In Vitro de la Resistencia Friccional en Brackets de Autoligado Estéticos y Convencionales

The objective of this study was to evaluate the frictional resistance created in self-ligating esthetic and conventional brackets during simulated orthodontic sliding mechanics. Four different types of brackets were used: 3 self-ligating type of different brands (Clarity SL, 3M Unitek; Damon 3®, Ormco Corporation; In-Ovation C®, GAC International), in addition to conventional esthetic brackets (Radiance®, American Orthodontics) associated with conventional elastic ligatures (Sani-tie®, GAC International) and low friction ligatures (Slide®, Leone). To simulate sliding mechanics, stainless steel wires with thicknesses of 0.018" and 0.017"x0.025" (GAC International) were used. Five groups (n=10) were submitted to five consecutive mechanical tests in a universal test machine model Emic® DL 500. The results showed low frictional levels in all tested self-ligating brackets and with use of 0.018" wire (p<0.05). However, with 0.017x0.025" wire, Groups Damon 3, Clarity SL and Slide showed lower frictional forces when compared with In-Ovation C (p>0.05). Moreover, conventional esthetic brackets associated with conventional ligatures resulted in greater frictional resistance with both wires tested (p>0.05). All the self-ligating brackets presented lower frictional levels than the conventional accessories. Active self-ligating bracket In-Ovation C, demonstrated higher degree of frictional force when associated with rectangular wire. The Slide® ligature may be an alternative to the use of self-ligating brackets.

El objetivo fue evaluar la resistencia a la fricción producida en de brackets de autoligado estéticos y convencionales durante la simulación mecánica de deslizamiento ortodóncico. Se utilizaron cuatro tipos diferentes de soportes: 3 de tipo autoligado de diferentes marcas (Clarity SL, 3M Unitek; Damon 3®, Ormco Corporation; In-Ovation C®, GAC International), además de brackets estéticos convencionales (Radiance®, American Orthodontics) asociado con ligaduras elásticas convencionales (Sani-tie®, GAC International) y ligaduras de baja fricción (Slide®, Leone). Para simular la mecánica de deslizamiento, se utilizaron alambres de acero inoxidable con un espesor de 0,018" y 0,017"x0.025" (GAC Internacional). Cinco grupos (n = 10) fueron sometidos a cinco pruebas mecánicas consecutivas en una máquina de prueba universal modelo Emic DL ® 500. Los resultados mostraron niveles bajos de fricción en todos brackets de autoligado probados y con el uso de alambre de 0.018" (p<0,05). Sin embargo, con alambe de 0,017x0,025", los grupos Damon 3, Clarity SL y Slide® mostraron menores fuerzas de fricción en comparación con In-Ovation C (p>0,05). Por otra parte, los brackets estéticos convencionales asociados con ligaduras convencionales resultaron tener una mayor resistencia a la fricción con ambos alambres probados (p>0,05). Todos los brackets de autoligado presentan niveles de fricción más bajo que los accesorios convencionales. El brackets activo de autoligado In-Ovation C, demostró un mayor grado de fuerza friccional cuando se asocia con alambre rectangular. La ligadura Slide® puede ser una alternativa al uso de brackets de autoligado.

Physical and chemical properties of orthodontic brackets after 12 and 24 months: in situ study

Objective: The aim of this article was to assess how intraoral biodegradation influenced the surface characteristics and friction levels of metallic brackets used during 12 and 24 months of orthodontic treatment and also to compare the static friction generated in these brackets with four different methods of the ligation of orthodontic wires. Material and Methods: Seventy premolar brackets as received from the manufacturer and 224 brackets that were used in previous orthodontic treatments were evaluated in this experiment. The surface morphology and the composition of the deposits found in the brackets were evaluated with rugosimetry, scanning electron microscopy, and energy dispersive X-ray spectroscopy. Friction was analyzed by applying tensile tests simulating sliding mechanics with a 0.019x0.025" steel wire. The static friction levels produced by the following ligation methods were evaluated: loosely attached steel ligature around all four bracket wings, steel ligature attached to only two wings, conventional elastomeric ligation around all 4 bracket wings, and non-conventional Slide® elastomeric ligature. Results: The results demonstrated the presence of biodegradation effects such as corrosion pits, plastic deformation, cracks, and material deposits. The main chemical elements found on these deposits were Carbon and Oxygen. The maximum friction produced by each ligation method changed according to the time of intraoral use. The steel ligature loosely attached to all four bracket wings produced the lowest friction levels in the new brackets. The conventional elastic ligatures generated the highest friction levels. The metallic brackets underwent significant degradation during orthodontic treatment, showing an increase in surface roughness and the deposit of chemical elements on the surface. Conclusion: The levels of static friction decreased with use. The non-conventional elastic ligatures were the best alternative to ...

Disjuntor com cobertura oclusal: confecção laboratorial e aplicação clínica / Bonded expander: fabrication and clinical application

A expansão rápida da maxila é um procedimento rotineiramente utilizado para aumentar a dimensão transversa do arco superior. Diversos disjuntores já foram descritos para esta finalidade. Com o intuito de amenizar ou eliminar efeitos colaterais verticais de disjuntores bandados, foi desenvolvido o disjuntor com cobertura oclusal. Este artigo tem o objetivo de descrever uma técnica laboratorial que aperfeiçoa a confecção do disjuntor com cobertura oclusal, bem como ilustrar sua aplicação clínica na correção de severa deficiência transversa associada à dimensão vertical aumentada.

Rapid maxillary expansion is routinely used in Orthodontics to increase the transverse dimension of the maxillary arch. Different types of expanders have been described in the literature. The bonded expander was introduced as an attempt to minimize or eliminate the vertical side effects often registered with the traditional banded expanders. The purpose of this article is to describe a laboratory technique that facilitates the bonded expander fabrication and to illustrate its clinical application to correct a severe transverse maxillary deficiency associated with an increased vertical dimension.