Bilateral tongue fibrous hyperplasia: A case report and literature review / Hiperplasia fibrosa bilateral de língua: relato de um caso e revisão daliteratura

Focal fibrous hyperplasia (FFH) is a pathology characterized by tissue enlargement as a result of increasing the number of inflammatory cells which receive chronic mechanical stimuli of low intensity that may affect gums, lip, palate, jugal mucosa and tongue.The aim of this article is to report a case of FFH on the lateral border on both sides of the tongue associated with the use of the Hyrax appliance in a hebiatric patient, whose chief complaint was chewing discomfort. This case was diagnosed clinically and by histopathology analysis and treated by surgical excision as well as the removal of Hyrax appliances. Follow-up care provided the recovery of the patient's quality of life.

La hiperplasia fibrosa focal (HFF) es una patología caracterizada por el aumento de tamaño de los tejidos como consecuencia del aumento del número de células inflamatorias que reciben estímulos mecánicos crónicos de baja intensidad que pueden afectar a encías, labio, paladar, mucosa yugal y lengua. El objetivo de este artículo es reportar un caso de FFH en el borde lateral a ambos lados de la lengua asociado al uso del aparato Hyrax en un paciente hebiátrico, cuyo principal motivo de consulta era la molestia masticatoria. Este caso fue diagnosticado clínicamente y por análisis histopatológico y tratado mediante escisión quirúrgica así como la retirada de los aparatos de Hyrax. La atención de seguimiento permitió la recuperación de la calidad de vida del paciente

Meta-analysis of condylar changes produced by a Twin-block appliance in Class Ⅱ malocclusion / 华西口腔医学杂志

OBJECTIVES@#To evaluate the effects of a Twin-block appliance on the condyles of patients with ClassⅡmalocclusion by conducting a systematic review and a Meta-analysis.@*METHODS@#Pubmed, Embase, Cochrane Library, Chinese BioMedical Literature Database, China National Knowledge Infrastructure, and VIP Database were electronically searched. Randomized controlled trials, controlled clinical trials, and single-arm trials on condylar changes produced by a Twin-block appliance in patients with ClassⅡmalocclusion were included. Two reviewers independently extracted and assessed the risk of bias. Meta-analyses were conducted with Review Manager 5.3.@*RESULTS@#Eight studies were included; among which, seven were of high quality. After treatment with a twin block appliance, condyles moved anteriorly. The anterior joint spaces decreased (P<0.000 01), whereas the posterior spaces increased (P<0.000 01). The superior spaces were not changed (P=0.11). Moreover, a significant difference was observed in the increase of the condylar space index (P<0.000 01). After treatment, the anteroposterior diameters of the condyles and condylar height increased (P=0.000 2 and P<0.000 01, respectively). By contrast, no significant changes were discovered in the medial external diameters of the condyles (P=0.42).@*CONCLUSIONS@#A Twin-block appliance can promote the growth of a condyle in the posterior and upper direction and move it forward in favor of the correction of Class Ⅱ malocclusion.

Development and characteristics of auricular fumigation moxibustion combined with heat-sensitive moxibustion device / 中国针灸

A moxibustion device with the functions of auricular fumigation moxibustion and heat-sensitive moxibustion is designed. The smoke of the ignited moxa stick is used for the fumigation moxibustion at the external auditory canal, while the heat generated works on Dazhui (GV 14) for heat-sensitive moxibustion. The device consists of five parts, i.e. combustion chamber, smoke pipe, smoke processing chamber, power module and connector. It solves the limitations such as unpleasant experience in treatment, unfavorable temperature control, easy scalding and excessive manual dependence induced by usual fumigation moxibustion and during heat-sensitive moxibustion. This moxibustion device may improve the safety and convenience when delivering the treatment with fumigation moxibustion and heat-sensitive moxibustion, as well as the work efficiency of medical staff.

Research progress on deep learning algorithms to assist 3D tooth segmentation of digital dental models / 口腔疾病防治

@#Three-dimensional tooth segmentation is the segmentation of single-tooth models from a digital dental model. It is an important foundation for diagnosis, planning, treatment and customized appliance manufacturing in digital orthodontics. With the deep integration of artificial intelligence technology and big data from stomatology, the use of deep learning algorithms to assist 3D tooth segmentation has gradually become mainstream. This review summarizes the current situation of deep learning algorithms that assist 3D tooth segmentation from the aspects of dataset establishment, algorithm architecture, algorithm performance, innovation and advantages, deficiencies of current research and prospects. The results of the literature review showed that deep learning tooth segmentation methods could obtain an accuracy of more than 95% and had good robustness. However, the segmentation of complex dental models, operation time and richness of the training database still need to be improved. Research and development of the "consumption reduction and strong core" algorithm, establishment of an authoritative data sample base with multiple centers, and expansion of data application depth and breadth will lead to further development in this field.

Orthodontic aligners: between passion and science

ABSTRACT Introduction: The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. Methods: Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. Conclusions: There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials.

RESUMO Introdução: As vantagens e desvantagens do uso de alinhadores ortodônticos têm sido reportadas com base mais na experiência clínica e opinião de experts do que em evidências científicas. Outro aspecto importante é que os alinhadores estão em processo de evolução constante. Assim, torna-se importante obter evidências recentes, que abranjam as novas atualizações na tecnologia de confecção, no desenvolvimento de novos protocolos de planejamento para as movimentações, a incorporação e desenho dos attachments e o auxílio da ancoragem esquelética. Métodos: As evidências encontradas em seis bases de dados eletrônicas (CINAHL, MEDLINE, EMBASE, Psych Info, Biblioteca Cochrane e Biblioteca Joanna Briggs) serão apresentadas por meio de perguntas e respostas. Conclusões: Há evidências de que os alinhadores apresentam diferentes níveis de dificuldade para realizar cada tipo de movimento, sendo os movimentos rotacionais e verticais os mais difíceis de serem executados. Quanto à percepção da dor causada pela movimentação dentária, parece haver menos impacto no início do tratamento, mas os alinhadores produzem mais alterações fonoarticulatórias e parecem exigir mais tempo de tratamento em casos mais complexos. Não há evidência de diferença na estabilidade pós-tratamento, e os alinhadores não impedem a ocorrência de reabsorção radicular, apesar da incidência e a gravidade da reabsorção poderem ser menores, facilitam a higiene bucal, reduzindo o risco de manchas brancas, cáries e doenças periodontais. Dada a evidência conflitante, a liberação de bisfenol-A pelo alinhador não pode ser negada. É preciso encontrar soluções que reduzam o impacto ambiental do descarte dos alinhadores. Há uma necessidade urgente de ensaios clínicos randomizados bem desenhados.

Edge level of aligners and periodontal health: a clinical perspective study in young patients

ABSTRACT Introduction: Although the superiority of clear aligners over multi-bracket appliances in keeping gingiva healthy has been suggested, the possible benefits of one aligner design over another have not yet been investigated, especially with regard to the vestibular edge. Objective: The aim of this study was to measure several periodontal indexes in adolescents undergoing orthodontic treatment with aligners, comparing two different types of rim. Methods: The study involved 43 patients aged between 14 and 18 years. The periodontal health was assessed using plaque index (PI), gingival index (GI), and gingival bleeding index (GBI), at the start of the treatment with aligners (T0), with a vestibular rim (VR) reaching up to 3 mm beyond the gingival margin. Three months later (T1), aligners were set to obtain a juxtagingival rim (JR) on the second quadrant and VR on the first quadrant. The periodontal indexes were measured again, both at T1 and then three months later (T2). Results: Intra-quadrant comparisons revealed a statistically significant worsening of the periodontal indexes only for the second quadrant (p<0.05), at T1 (GI), and especially at T2 (PI, GI, GBI), while no statistically significant changes were found for the first quadrant. Conclusions: More severe mechanical irritation, especially during insertion and removal of the aligner, can explain the worsening inflammatory indexes with the JR. In addition, the pressure exerted by the JR on the gingival sulcus seemed to facilitate plaque deposition, whereas the VR had a protective effect, reducing the risk of mechanical trauma.

RESUMO Introdução: Embora se alegue uma superioridade dos alinhadores transparentes sobre os aparelhos multibraquetes em manter a gengiva saudável, ainda não foram investigados os possíveis benefícios de um modelo de alinhador sobre outro, especialmente no que diz respeito à borda vestibular. Objetivo: O objetivo deste estudo foi medir vários índices periodontais em adolescentes submetidos a tratamento ortodôntico com alinhadores, comparando dois tipos diferentes de borda. Métodos: O estudo envolveu 43 pacientes com idade entre 14 e 18 anos. A saúde periodontal foi avaliada por meio do índice de placa (IP), índice gengival (IG) e índice de sangramento gengival (ISG), ao início do tratamento com alinhadores (T0), com borda vestibular (BV) estendendo-se até 3 mm além da margem gengival. Três meses depois (T1), os alinhadores foram ajustados para se obter uma borda justagengival (BJ) no segundo quadrante e BV no primeiro quadrante. Os índices periodontais foram medidos novamente tanto em T1 quanto três meses depois (T2). Resultados: As comparações intraquadrantes revelaram uma piora estatisticamente significativa nos índices periodontais apenas para o segundo quadrante (p<0,05), em T1 (IG) e especialmente em T2 (IP, IG, ISG), enquanto nenhuma mudança estatisticamente significativa foi encontrada para o primeiro quadrante. Conclusões: Irritações mecânicas mais intensas, principalmente durante a inserção e remoção do alinhador, podem explicar a piora dos índices inflamatórios com a BJ. Além disso, a pressão exercida pela BJ no sulco gengival pareceu facilitar a deposição de placa, enquanto a BV teve um efeito protetor, reduzindo o risco de trauma mecânico.

Treatment effects and lip profile changes following premolars extraction treatment vs fixed functional treatment in Class II division 1 malocclusion: A randomized controlled clinical trial

ABSTRACT Objective: The objective of this two-arm parallel randomized controlled trial was to evaluate the treatment effects and lip profile changes in skeletal Class II patients subjected to premolars extraction treatment versus fixed functional treatment. Methods: Forty six subjects fulfilling inclusion criteria were randomly distributed into Group PE (mean age 13.03±1.78 years) and Group FF (mean age 12.80±1.67 years) (n=23 each). Group PE was managed by therapeutic extraction of maxillary first premolars and mandibular second premolars, followed by mini-implant-supported space closure; and Group FF, by fixed functional appliance therapy. Skeletal, dental, and soft-tissue changes were analyzed using pre and post-treatment lateral cephalograms. Data obtained from this open label study was subjected to blind statistical analysis. Results: Extraction treatment resulted in greater increase of nasolabial angle (NLA: 3.1 [95% CI 2.08, 4.19], p<0.001), significant improvement of upper lip (UL-E line: -2.91 [95% CI -3.54, -2.28], p<0.001, UL-S line: -2.50 [95% CI -2.76, -2.24], p<0.001, UL-SnPog': -2.32 [95% CI -2.90, -1.74], p<0.01) and lower lip position (LL-E line: -0.68 [95% CI -1.36, 0.00], p<0.01, LL-S line: -0.55 [95% CI -1.11, 0.02], p<0.01, and LL-SnPog': -0.64 [95% CI -1.20, -0.07], p<0.01), lip thickness (UL thickness: 2.27 [95% CI 1.79, 2.75], p<0.001; LL thickness: 0.41 [95% CI -0.16, 0.97], p<0.01), upper lip strain (UL strain: -2.68 [95% CI -3.32, -2.04], p<0.001) and soft tissue profile (N'-Sn-Pog': 2.68 [95% CI 1.87, 3.50], p<0.01). No significant difference was observed between the groups regarding skeletal changes in the maxilla and mandible, growth pattern, overjet, overbite, interincisal angle and soft tissue chin position (p>0.05). Premolar extraction treatment demonstrated significant intrusion-retraction of maxillary incisors, better maintenance of maxillary incisor inclination, and significant mandibular molar protraction; whereas functional treatment resulted in retrusive and intrusive effect on maxillary molars, marked proclination of mandibular anterior teeth, and significant extrusion of mandibular molars. Both treatment modalities had similar treatment duration. Implant failure was seen in 7.9% of cases, whereas failure of fixed functional appliance was observed in 9.09% of cases. Conclusions: Premolar extraction therapy is a better treatment modality, compared to fixed functional appliance therapy for Class II patients with moderate skeletal discrepancy, increased overjet, protruded maxillary incisors and protruded lips, as it produces better dentoalveolar response and permits greater improvement of the soft tissue profile and lip relationship.

RESUMO Objetivo: O objetivo desse estudo randomizado controlado paralelo de dois braços foi avaliar os efeitos do tratamento e as mudanças no perfil labial em pacientes esqueléticos Classe II submetidos a tratamento com extração de pré-molares (EP) versus tratamento funcional fixo (FF). Métodos: Quarenta e seis indivíduos que preencheram os critérios de inclusão foram distribuídos aleatoriamente em Grupo EP (idade média 13,03±1,78 anos) e Grupo FF (idade média 12,80±1,67 anos) (n=23 cada). O grupo EP foi tratado com extração dos primeiros pré-molares superiores e segundos pré-molares inferiores, seguida de fechamento do espaço com ancoragem em mini-implantes; e o Grupo FF, com tratamento usando aparelhos funcionais fixos. As alterações esqueléticas, dentárias e de tecidos moles foram analisadas usando cefalogramas laterais pré e pós-tratamento. Os dados obtidos desse estudo aberto foram submetidos a análise estatística cega. Resultados: O tratamento com extrações resultou em maior aumento do ângulo nasolabial (ANL: 3,1 [IC 95% 2,08, 4,19], p<0,001), melhora significativa do lábio superior (Ls-Linha E: -2,91 [IC 95% -3,54, -2,28], p<0,001, Ls-Linha S: -2,50 [IC 95% -2,76, -2,24], p<0,001, Ls-SnPog': -2,32 [IC 95% -2,90, -1,74], p<0,01) e posição do lábio inferior (Li-Linha E: -0,68 [IC 95% -1,36, 0,00], p<0,01, Li-Linha S: -0,55 [IC 95% -1,11, 0,02], p<0,01, e Li-SnPog': -0,64 [IC 95% -1,20, -0,07], p<0,01), espessura dos lábios (espessura Ls: 2,27 [IC 95% 1,79, 2,75], p<0,001; espessura Li: 0,41 [IC 95% -0,16, 0,97], p<0,01), tensão do lábio superior (tensão Ls: -2,68 [IC 95% -3,32, -2,04], p<0,001) e perfil de tecidos moles (N'-Sn-Pog': 2,68 [IC 95% 1,87, 3,50], p<0,01). Nenhuma diferença significativa foi observada entre os grupos quanto às alterações esqueléticas na maxila e mandíbula, padrão de crescimento, sobressaliência, sobremordida, ângulo interincisal e posição dos tecidos moles do mento (p>0,05). O tratamento com extração de pré-molares demonstrou significativa intrusão-retração dos incisivos superiores, melhor manutenção da inclinação dos incisivos superiores e protração significativa dos molares inferiores; enquanto o tratamento funcional resultou em efeito retrusivo e intrusivo nos molares superiores, proclinação acentuada dos dentes anteriores inferiores e extrusão significativa dos molares inferiores. Ambas as modalidades de tratamento tiveram duração de tratamento semelhante. A falha do mini-implante foi observada em 7,9% dos casos, enquanto a falha do aparelho funcional fixo foi observada em 9,09% dos casos. Conclusões: O tratamento com extração de pré-molares é uma modalidade de tratamento melhor do que os aparelhos funcionais fixos para pacientes Classe II com discrepância esquelética moderada, sobressaliência aumentada, incisivos superiores protruídos e lábios protruídos, pois produz melhor resposta dentoalveolar e permite maior melhora do perfil dos tecidos moles e relacionamento labial.

Longitudinal assessment of the impact of orthodontic treatment on adolescents' quality of life: a comparison between boys and girls using a condition specific questionnaire / Avaliação longitudinal do impacto do tratamento ortodôntico na qualidade de vida de adolescentes: comparação entre meninos e meninas utilizando um questionário condição especifica

ABSTRACT The aim of this study was to compare the impact of the first year of wearing of a fixed orthodontic appliance on the Oral Health-Related Quality of Life (OHRQoL) between boys and girls, by means of a condition-specific instrument. The study included 69 adolescents aged 10 to 18 years, who were undergoing orthodontic treatment with a fixed appliance. Of the 69 adolescents, 38 were girls (55.1%) and 31 were boys (44.9%). They answered the Brazilian version of the Impact of Fixed Appliance Measure (B-IFAM) questionnaire three months (T1) and one year (T2) after the fixed appliance was installed. This questionnaire contains 43 questions, distributed across nine domains. The higher the scores, the more negative the perception of the adolescent concerning the impact of the fixed appliance on his/her OHRQoL. Sociodemographic and clinical variables were also analyzed, and statistical analysis was performed. For the domains, the effect size (the magnitude of the difference between girls and boys) and the minimal clinically important difference were also calculated. The adjusted regression showed that there was a significantly greater increase in the overall B-IFAM score in girls than in boys, indicating a more negative perception of the OHRQoL over the study time [Coefficient=11.77 (3.47- 20.60), p=0.006]. From T1 to T2, there was a significantly greater increase in the scores (more negative perception of OHRQoL over time) in girls than in boys for the domains aesthetics (p=0.034) and physical impact (p=0.011). These differences were clinically significant. The effect size (the magnitude of the difference) was moderate. The impact of wearing a fixed appliance on the OHRQoL was more negative in girls than in boys during the first year of orthodontic treatment.

RESUMO O objetivo deste estudo foi comparar o impacto do primeiro ano de uso do aparelho fixo na qualidade de vida relacionada a saúde bucal (QVRSB) entre meninas e meninos, através de um instrumento condição específica. Sessenta e nove adolescentes entre 10 e 18 anos, em tratamento ortodôntico com aparelho fixo foram incluídos. Adolescentes responderam ao questionário Impact of fixed appliance measure (B-IFAM) no terceiro mês de uso do aparelho fixo (T1) e um ano após a colagem do aparelho fixo (T2). Este questionário possui 43 perguntas, distribuídas em nove domínios. Quanto maior os escores, mais negativa a percepção do adolescente com relação ao impacto do aparelho fixo na QVRSB. Variáveis sociodemográficas e clínicas também foram avaliadas. Análise estatística foi realizada. Para os domínios, tamanho de efeito (a magnitude da diferença entre meninas e meninos) e diferença mínima clinicamente importante também foram calculadas. Dos 69 adolescentes, 38 eram meninas (55,1%) e 31 eram meninos (44,9%). Na regressão ajustada, meninas apresentaram um aumento significativamente maior do escore total do B-IFAM do que meninos, indicando uma percepção mais negativa da QVRSB ao longo do tempo de acompanhamento [Coeficiente=11,77 (3,47-20,60), p=0.006]. Meninas apresentavam um aumento significativamente maior dos escores de T1 para T2 (percepção mais negativa da QVRSB ao longo do tempo) em relação aos meninos para os domínios estética (p=0,034) e impacto físico (p=0,011). Estas diferenças também foram clinicamente significativas. O tamanho do efeito (a magnitude da diferença) foi moderado. Meninas demonstraram um impacto mais negativo do uso do aparelho fixo na QVRSB do que meninos nos 12 primeiros meses de tratamento ortodôntico.

Drug-induced Sleep Endoscopy: Are there Predictors for Failure of Oral Appliance Treatment?

Abstract Introduction In the literature, evidence is lacking on the predictive value of druginduced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] >10 events/hour or < 50% reduction) and a group with OAT benefit (AHI <10 events/hour or >50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI <30events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI <30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver (p< 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.

Aparelhos de registro tipo "George Gauge" para posição mandibular terapêutica em aparelhos intra-orais para ronco primeiro e síndrome obstrutiva da apneia e hiponeia / Obstrutiva do sono (SHAOS) type recording devices "George Gauge" recording devices for therapeutic mandibular position in intraoralappliances for snoring first and obstructive sleepapnea hyponea syndrome (SHAOS)

As multifatoriedades do aumento da SHAOS têm diversas causas, desdês de obesidades até sedendarismo de grande proporção. No entanto a ciência tem feito grandes esforços para isso se altere. Mesmo assim muito tem que se pesquisar para um tratamento efetivo que seja capaz de ajudar o paciente a ter um sono reparador e uma qualidade de vida mais satisfatória. A sofisticação dos CPAP, melhores alternativas para o tratamento se sofisticaram de tal em volume, barulho e tamanho que estão aumentanto em muito sua utilização. Os mini-cpaps são uma prova disso. No entanto ainda nos confrontamos com a baixa adesão do tratamento frente ao desconforto causado. Ao aparelhos intra-orais são uma alternativa viáveis para os casos de IAH (índice de apneia e hipopneia) leve, moderada e ronco primário. Importante frisar que sem um exame de polissografia e teleradiografias laterais o Cirurgião Dentista não pode fazer nada(AU)

The multifactorial causes of the increase in SHAOS have several causes, from obesity to a large sedentary lifestyle. However science has made great efforts to change this. Even so, much remains to be researched for an effective treatment that is capable of helping the patient to have a restful sleep and a more satisfactory quality of life. The sophistication of CPAP, the best alternatives for treatment, has become so sophisticated in volume, noise and size that its use is greatly increasing. The mini-cpaps are proof of that. However, we are still faced with the low adherence to the treatment due to the discomfort caused. Intraoral appliances are a viable alternative for cases of mild, moderate AHI (apnea and hypopnea index) and primary snoring. It is important to emphasize that without a polysomnography exam and lateral teleradiographies, the Dental Surgeon cannot do anything(AU)

Effectiveness of functional orthodontic appliances in obstructive sleep apnea treatment in children: literature review / Eficácia dos aparelhos ortodônticos funcionais no tratamento da apneia obstrutiva do sono em crianças: revisão da literatura

Abstract Introduction: Obstructive sleep apnea syndrome is a common condition in childhood and if left untreated can result in many health problems. An accurate diagnosis of the etiology is crucial for obstructive sleep apnea treatment success. Functional orthodontic appliances that stimulate mandibular growth by forward mandibular positioning are an alternative therapeutic option in growing patients. Objective: To perform a literature review about the effects of functional orthodontic appliances used to correct the mandibular deficiency in obstructive sleep apnea treatment. Methods: The literature search was conducted in June 2020 using Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS Ovid; SciELO Web of Science; EMBASE Bireme and BBO Bireme electronic databases. The search included papers published in English, until June 2020, whose methodology referred to the types and effects of functional orthopedic appliances on obstructive sleep apnea treatment in children. Results: The search strategy identified thirteen articles; only four articles were randomized clinical studies. All studies using the oral appliances or functional orthopedic appliances for obstructive sleep apnea in children resulted in improvements in the apnea-hypopnea index score. The cephalometric (2D) and tomographic (3D) evaluations revealed enlargement of the upper airway and increase in the upper airspace, improving the respiratory function in the short term. Conclusion: Functional appliances may bean alternative treatment for obstructive sleep apnea, but it cannot be concluded that they are effective in treating pediatric obstructive sleep apnea. There are significant deficiencies in the existing evidence, mainly due to absence of control groups, small sample sizes, lack of randomization and no long-term results.

Resumo Introdução: A síndrome da apneia obstrutiva do sono é uma condição comum na infância e, se não tratada, pode resultar em muitos problemas de saúde. Um diagnóstico preciso da etiologia é crucial para o sucesso do tratamento dessa condição clínica. Aparelhos ortodônticos funcionais que estimulam o crescimento mandibular através do anteroposicionamento mandibular são uma opção terapêutica para pacientes em crescimento. Objetivo: Fazer uma revisão da literatura sobre os efeitos do aparelho ortodôntico funcional usado para corrigir a deficiência mandibular no tratamento da apneia obstrutiva do sono. Método: A pesquisa bibliográfica foi feita em junho de 2020 nos os bancos de dados eletrônicos da Cochrane Library; PubMed, EBSCO (Dentistry & Oral Sciences Source), Lilacs Ovid; SciELO Web of Science; Embase Bireme e BBO Bireme. A busca incluiu artigos publicados em inglês, até junho de 2020, cuja metodologia referia-se aos tipos e efeitos dos aparelhos ortopédicos funcionais no tratamento da apneia obstrutiva do sono em crianças. Resultados: A estratégia de busca identificou 19 artigos; apenas quatro eram estudos clínicos randomizados. Todos os estudos que usaram aparelhos orais ou aparelhos ortopédicos funcionais para apneia obstrutiva do sono em crianças resultaram em melhorias no índice de apneia-hipopneia. As avaliações cefalométrica (2D) e tomográfica (3D) mostraram alargamento das vias aéreas superiores e aumento do espaço das vias aéreas superiores, que melhoraram a função respiratória em curto prazo. Conclusão: Os aparelhos funcionais podem ser um tratamento opcional para apneia obstrutiva do sono, mas não é possível concluir que sejam eficazes na população pediátrica. Existem deficiências significativas nas evidências existentes, principalmente devido à ausência de grupos de controle, tamanho pequeno das amostras, falta de randomização e ausência de resultados em longo prazo.

Post-Expansion and End of Treatment Outcomes of Semi-Rapid Maxillary Expansion with a Modified Removable Appliance

Context: Maxillary expansion is the mainstay therapy for maxillary transverse deficiency. There has been a constant search for the most effective yet biologically friendly method of maxillary expansion, alternatives being, slow, rapid and semi rapid. Aims: The purpose of this study was to explore the outcome of palatal expansion achieved using a removable plate and low continuous forces brought about by a semi rapid screw activation protocol. Settings and Design: Retrospective study. Methods and Material: Plaster models of 56 consecutive patients treated for maxillary expansion were obtained pre?treatment (T0), post?expansion (T1), and post fixed appliance treatment (T2). The radiographic images of the models were traced using Image J software. Linear and angular measurements were evaluated to measure transverse change. Statistical Analysis Used: Interclass Correlation Coefficient [ICC] and Dahlberg’s formula were used for reliability test. The differences in the mean values between the three duration groups [T0, T1 and T2] were analysed using Analysis of Variance (ANOVA). For multiple comparisons, a post hoc Tukey honestly significant difference (HSD) test was performed. Results: Significant increase in inter?molar, alveolar and palatal linear widths were observed from T0 to T1 with significant relapses from T1 to T2, with an overall net gain remaining at T2. Similarly, significant increases in all angular measurements were observed from T0 to T1 with significant relapses from T1 to T2 and an overall insignificant change at T2 as compared to T0. Conclusion: The appliance and protocol were effective in producing transverse expansion with minimal molar and alveolar tipping.

Research progress on the relationship between orthodontic treatment and the oral microbiome / 口腔疾病防治

@#With the deepening of research in oral microbiomics, an important relationship between changes in the oral microbiome and orthodontic treatment has been found. Orthodontic treatment will have an impact on the oral and systemic microbiome. The presence of oral appliances can change the quantity and quality of the oral microbiometo and increase the risk of oral and even systemic diseases in patients undergoing orthodontic treatment. Compared with fixed orthodontic treatment, clear aligners will not have a harmful impact on the structure of the oral microbiome, which is more conducive to maintain oral health during the orthodontic treatment process. In addition, different bracket types and materials can lead to different changes in the oral microbiome, and the occurrence and development of orthodontic-related diseases, such as white spot lesions, dental caries, gingivitis and periodontitis, are also related to changes in the oral microbiome. At present, the role of the oral microbiome in the process of orthodontic treatment needs to be further studied. Whether a change in the oral microbiome caused by orthodontic treatment can be restored after orthodontic treatment is still uncertain and needs more research. This paper reviews the research progress on the application of microbiomics in orthodontics, including the impact of fixed appliances and clear aligners on the microbiome and the relationship between orthodontic-related diseases and the oral microbiome.

Application of nanoparticles in preventing enamel demineralization during orthodontics / 口腔疾病防治

@#Enamel demineralization is one of the most common adverse reactions to orthodontic treatment. The existence of orthodontic appliances affects oral hygiene maintenance, which easily leads to plaque accumulation and oral flora dysbiosis, and cariogenic bacteria produce acid to cause enamel demineralization. It not only affects aesthetics but may develop into caries and endanger oral health. Therefore, enamel demineralization has become an urgent problem. Nanoparticles generally refer to solid particles with diameters of 1 to 100 nm and have unique physicochemical properties that provide a new strategy for preventing enamel demineralization during orthodontics. Reviewing the relevant literature, nanoparticles used for the prevention of enamel demineralization in orthodontics may be classified into antibacterial, remineralization and carrier-type nanoparticles according to their functions. Most research was performed on the application of nanoparticles to modify orthodontic adhesives for enhancement of antibacterial or remineralization properties, but some studies also focused on the modification of orthodontic appliances with nanoparticles for surface coating or overall doping to provide antimicrobial properties. The advantage of these two approaches is that they are not dependent on patient compliance. Nanoparticle-modified fluoride varnishes and nanocarriers loaded with antimicrobial or remineralization agents may be used to promote oral health care in orthodontic patients, which have a sustained preventive effect but depend on the cooperation of the patient. It was indicated that the small size effect of nanoparticles provides better performance, but there may be certain safety issues, and there is still some influence on the physicochemical properties of the modified materials themselves. These issues must be further explored. Although there are some limitations in the current studies, nanoparticles are expected to play an important role in the prevention of enamel demineralization during orthodontics in the future.

Alinhadores Ortodônticos Removíveis Versus Aparelhos Ortodônticos Fixos: uma Revisão da Literatura / Removable Orthodontic Aligners Versus Fixed Orthodontic Appliances: a Literarture Review

Com intuito de pontuar os paralelos entre as técnicas ortodônticas com aparelhagem fixa e alinhadores transparentes, este estudo propôs revisar a literatura científica sobre alinhadores ortodônticos removíveis versus aparelhos ortodônticos fixos. Foram selecionados artigos de 2005 a 2021, utilizando as bases de dados PubMed, Scopus, Web of Science, Cochrane Library, Clinical Trials e Opengrey. Os artigos abordavam temáticas como sensação dolorosa, saúde periodontal, higiene, microbiota, reabsorção radicular, qualidade de vida e efetividade do tratamento. Os alinhadores apresentaram maior aceitabilidade pelos pacientes e vantagens claras em relação à dor, higiene, qualidade de vida, reabsorção radicular e saúde periodontal, sendo inferior aos aparelhos ortodônticos fixos na efetividade do tratamento e na interferência na fala.

In order to point out the parallels between orthodontic techniques with fixed appliances and transparent aligners, this study proposed to review the scientific literature on removable orthodontic aligners versus fixed orthodontic appliances. Articles from 2005 to 2021 were selected, using the PubMed, Scopus, Web of Science, Cochrane Library, Clinical Trials and OpenGrey databases. The articles addressed issues such as pain, periodontal health, hygiene, microbiota, root resorption, quality of life and treatment effectiveness. Aligners showed greater acceptability by patients and clear advantages in relation to pain, hygiene, quality of life, root resorption and periodontal health, being inferior to fixed orthodontic appliances in terms of effectiveness and speech capacity.

Myofunctional therapy using twin block appliance in a class II Malocclusion patient with ADHD

@#A 9-year-old male ADHD patient with class II dentoskeletal malocclusion came to the Pediatric Department of Universitas Airlangga, Surabaya, with a chief complaint of a protrusive look. The patient had a behavior disorder of ADHD (Attention Deficit Hyperactivity Disorder), in which its symptoms may be challenging in dental treatment since it heavily depends on the patient’s obedience and case selection. References and similar studies of myofunctional therapy in Class II Malocclusion Patients with ADHD are still scarce. Most patients with class II malocclusion present with hyperactive perioral muscle and altered tongue position. Hence, myofunctional appliance is a reliable treatment choice. A special rule where the patient was asked to focus on the operator’s instruction for 10 minutes and then a 5-minute break, was applied to this patient to overcome ADHD symptoms as a behavior management strategy. This is in line with a theory stating that children with ADHD are prone to distraction, causing them to have a shorter duration of focus, limited sustained attention span, poor impulse control, and motor overactivity compared to normal children. This strategy gave a positive result in maintaining the cooperation of the patient using the twin block for 6 months which is lead to positive progress in malocclusion correction.

Skeletal Class II Malocclusion Treatment with Combined Twin Block and Lip Bumper Appliances: A Case Report

ABSTRACT@#Functional appliances have been used over a century in clinical orthodontic treatments for skeletal Class II malocclusion patients. Its popularity is attributed to its high patient adaptability and ability to produce rapid treatment changes. The twin block and lip bumper can be combined depending on the patient’s cases. The purpose of therapy with twin block is effective in mandibular growth deficiencies to induce supplementary lengthening of mandibular by stimulating increased growth at the condylar cartilage. The patient was a ten-year-old male patient with skeletal Class II malocclusion. He had a convex facial profile, SNA (sella, nasion, A point) angle of 77.5°, SNB (sella, nasion, B point) angle of 73.0°, ANB (A point, nasion, B point) angle of 4.5°, overjet of 6.5 mm, overbite of 11/41 = 5.0 mm, 21/31 = 4.5 mm, abnormal upper labial frenulum, crossbite in the second left premolar of maxilla, crowded anterior teeth of mandibular, deficiency of mandibular growth, lower lip sucking habit, anterior teeth of maxilla with diastema and proclination. Orthodontic treatment for patient is a combination of twin block and lip bumper appliances. After seven months, frenectomy is used to eliminate and correct the spacing in the frenulum. After 10 months, the patient’s skeletal and profile had improved to skeletal Class I malocclusion, SNA angle of 78.0°, SNB angle of 75.0°, ANB angle of 3.0°, overbite and overjet of 4.0 mm, and the lower lip sucking habit had stopped. Twin block and lip bumper appliances are particularly good alternative treatment in managing selected cases of skeletal Class II malocclusion.

Pulpal blood flow changes and pain scores related to using Superelastic 0. 018-inch Nickel Titanium as the first orthodontic alignment archwire: a prospective clinical trial

Abstract Background Optimal orthodontic force results in maximum rate of tooth movement without tissue damage. Even though starting orthodontic treatment with a thicker archwire may shorten treatment duration, the evidence on the effect of using 0.018-inch NiTi as the first alignment archwire on pulpal blood flow (PBF) status is still scarce. Objectives to record PBF changes and pain scores associated with using 0.018-inch NiTi as the first alignment archwire during fixed orthodontic treatment. Methodology Patients were selected from subjects attending postgraduate orthodontic teaching clinics at Jordan University of Science and Technology. In total, forty healthy patients who exhibited mild lower arch crowding were included. A split-mouth trial design was used. Each patient received two archwire sizes at one time joined in the midline by crimpable hook and applied in the lower arch. Patients were assigned into one of two groups based on archwire sizes used. Group 1: 0.014-inch and 0.018-inch NiTi (Six males, 14 females aged 19.4±1.33 years) and Group 2: 0.016-inch and 0.018-inch NiTi (Seven males, 13 females aged 19.6±1.45 years). The archwire size group was randomly allocated with a 1:1 allocation ratio. A Laser Doppler Flowmeter was used to measure PBF at different time intervals (T0-T5). Pain scores were recorded using a visual analogue scale (VAS). A repeated measures ANOVA and a post-hoc Bonferroni comparison tests were conducted to examine differences at the different time points before and during orthodontic alignment. Results For all studied archwire sizes, PBF decreased 20 minutes after their placement. Most PBF changes occurred within 24hours and continued to decrease until 72 hours after archwire placement where the maximum reduction was reached. Eventually, normal values were reverted within 1 month. PBF changes were similar between all alignment - groups. Conclusions Initial orthodontic alignment with 0.018-inch NiTi does not cause irreversible changes to pulpal vasculature or produces higher pain scores.

Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation

ABSTRACT The Herbst appliance can be very effective in treatment of Class II patients with mandibular retrognathism. Because of the continuous action in a full-time basis, treatment time using it normally takes from six to ten months, and is usually followed by a second phase of full fixed appliances, in order to obtain both occlusal refinement and long term stability. Despite Herbst appliance's effectiveness in the occlusal and dentoalveolar perspectives, its facial results may differ among patients with different growth patterns, as well as in distinct stages of skeletal maturation. In the current paper, two patients with different facial patterns are presented, who were treated under the same protocol, using Herbst and full fixed appliances in different skeletal maturation stages, and both dentoalveolar and facial results are compared and discussed.

RESUMO Um número significativo de pacientes que procuram o tratamento ortodôntico apresenta má oclusão de Classe II acompanhada pelo retrognatismo mandibular. Abordagens ortopédicas para avanço mandibular são comumente utilizadas enquanto houver crescimento facial remanescente e, nesses casos, o estágio de maturação esquelética deve ser avaliado para definir a melhor época de intervenção terapêutica. Após concluída a fase ortopédica, normalmente é realizada uma segunda fase ortodôntica para refinamento oclusal, com o intuito de oferecer maior estabilidade das correções em longo prazo. No presente artigo, serão discutidos os resultados do avanço mandibular ortopédico considerando-se diferentes estágios de crescimento.

Cephalometric evaluation of changes in vertical dimension and molar position in adult non-extraction treatment with clear aligners and traditional fixed appliances

ABSTRACT Introduction: Orthodontists have been using clear aligners to treat malocclusions, and one potential effect of treatment with orthodontic aligners is the intrusion and/or resists extrusion of the posterior teeth. This "bite-block effect" is primarily anecdotal due to the frequent occurrence of posterior open bites in patients after clear aligner therapy. Objective: The purpose of this study was to compare changes promoted by clear aligners and traditional fixed appliances in cephalometric measurements of the vertical dimension and molar position in adult patients with Class I malocclusion treated with non-extraction. Methods: Pre- and post-treatment lateral cephalometric radiographs of adult patients treated with either clear aligners (n=44) or traditional fixed appliances (n=22) were selected for retrospective analysis. Eight interval measurements and one nominal measurement were evaluated: anterior overbite (OB), mandibular plane angle related to cranial base (SN_MP) and related to Frankfort (FMA), lower molar height (L6H) and upper molar height (U6H), palatal plane to mandibular plane angle (PP_MP), lower facial height (LFH), total facial height (TFH), and posterior open bite (Posterior_OB). A single evaluator traced all cephalographs, and changes in select measures of the vertical dimension were compared within and between groups. Results: OB decreased (1.15 mm) and L6H increased (0.63 mm) in the traditional fixed appliance group. Mandibular plane angles (related to cranial base and to Frankfort) increased (0.43° and 0.53°, respectively) in the clear aligner group, but just FMA showed significant difference between groups (difference of 0.53°). LFH and TFH increased (ranging from 0.52 mm to 0.80 mm) in both groups, with no differences between treatment modality. Presence of visible posterior open bite significantly increased over the course of treatment. OB, FMA and L6H exhibited an interaction between treatment stage (pre- and post-treatment) and modality (clear aligner therapy and traditional fixed appliances), but no interaction among these three variables was found. Conclusions: The evidence does not support the theory that clear aligner therapy produces better vertical dimension control than traditional fixed appliances. Traditional fixed appliance therapy slightly extruded the lower molar, and clear aligner therapy produced a slightly mandibular backward rotation.

RESUMO Introdução: Ortodontistas têm usado os alinhadores transparentes para tratar más oclusões, e um potencial efeito desse tratamento é a intrusão e/ou resistência à extrusão dos dentes posteriores. Esse efeito de "bloco de mordida" é principalmente empírico, devido à ocorrência frequente de mordidas abertas posteriores em pacientes após a terapia com alinhadores transparentes. Objetivo: O objetivo do presente estudo foi comparar as mudanças promovidas pelos alinhadores transparentes e aparelho fixo convencional nas medidas cefalométricas de dimensão vertical e posição do molar em pacientes adultos com má oclusão de Classe I tratados sem exodontias. Métodos: Radiografias cefalométricas laterais pré- e pós-tratamento de pacientes adultos tratados com alinhadores transparentes (n=44) ou com aparelho fixo tradicional (n=22) foram selecionadas para uma análise retrospectiva. Oito medidas de intervalo e uma medida nominal foram avaliadas: trespasse vertical anterior (OB), ângulo do plano mandibular em relação à base do crânio (SN_MP) e em relação ao Plano de Frankfurt (FMA), altura do molar inferior (L6H) e altura do molar superior (U6H), ângulo do plano palatal ao plano mandibular (PP_MP), altura facial inferior (LFH), altura facial total (TFH) e mordida aberta posterior (Posterior_OB). Um único avaliador fez todos os traçados cefalométricos, e as mudanças nas medidas da dimensão vertical foram comparadas intra e intergrupos. Resultados: OB reduziu (1,15 mm) e L6H aumentou (0,63 mm) no grupo de aparelho fixo tradicional. Os ângulos do plano mandibular (em relação à base do crânio e ao plano de Frankfurt) aumentaram (0,43° e 0,53°, respectivamente). No grupo dos alinhadores invisíveis, apenas o FMA apresentou diferença significativa entre os grupos (diferença de 0,53º). LFH e TFH aumentaram (variando de 0,52 mm a 0,80 mm) em ambos os grupos, sem diferenças entre as modalidades de tratamento. A presença de uma mordida aberta posterior visível aumentou significativamente durante o curso do tratamento. OB, FMA e L6H exibiram interação entre o estágio do tratamento (pré- e pós-tratamento) e a modalidade (terapia com alinhadores invisíveis ou aparelho fixo tradicional), porém não foi encontrada interação entre essas três variáveis. Conclusões: A evidência não suporta a teoria de que a terapia com alinhadores invisíveis produz melhor controle da dimensão vertical do que o aparelho fixo. O tratamento com aparelhagem fixa extruiu ligeiramente o molar inferior, e o tratamento com alinhadores invisíveis produziu uma ligeira rotação posterior da mandíbula.