Impact of fixed orthodontic retainers on oral health-related quality of life: a longitudinal prospective study

ABSTRACT Objective: The aim of the present study was to assess the impact of orthodontic retainers on oral health-related quality of life (OHRQoL) in the short and long terms after orthodontic treatment. Methods: Data from 45 patients up to three years after orthodontic treatment (T0) were analyzed. Patients were reassessed four years (T1) after T0. OHRQoL was measured using the OHIP-14 (Oral Health Impact Profile-14) questionnaire. The presence of a fixed retainer in the upper and/or lower arches, sex, and age were the predictive variables evaluated at T0 and T1. The occurrence of retainer fracture at T0 was clinically evaluated. Due to the COVID-19 pandemic, clinical examination on T1 was not possible, so the OHIP-14 and the self-perception of changes in teeth position and fracture of retainers were examined using an on-line questionnaire. Results: At the initial examination, the presence of upper retainers had a negative impact on quality of life (p=0.018). The OHIP-14 value increased significantly from T0 to T1 (p=0.014), regardless of the presence of retainers. The fracture or debonding of the retainer reported by the patient was the only variable that had a negative impact on OHRQoL (p=0.05). Conclusion: The use of fixed upper retainers suggests a negative impact on the quality of life of the orthodontic patient after the end of orthodontic treatment. This impact, however, is negligible in the long term, except when associated with fracture or debonding. This study emphasizes the need for continuous follow-up of orthodontic patients during the retention period.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o impacto das contenções ortodônticas na qualidade de vida relacionada à saúde bucal (QVRSB) em curto e longo prazos após o tratamento ortodôntico. Métodos: Foram analisados dados de 45 pacientes até três anos após o tratamento ortodôntico (T0). Os pacientes foram reavaliados quatro anos (T1) após T0. A QVRSB foi mensurada usando o questionário OHIP-14 (Oral Health Impact Profile-14). A presença da contenção fixa nas arcadas superior e/ou inferior, o sexo e a idade foram as variáveis preditoras em T0 e T1. A ocorrência de quebra da contenção em T0 foi avaliada clinicamente. Em razão da pandemia da COVID-19, não foi possível o exame clínico em T1; assim, a autopercepção das alterações na posição dos dentes e a quebra ou descolagem das contenções foram registradas por meio de um questionário online. Resultados: No exame inicial, a presença da contenção superior apresentou um impacto negativo na qualidade de vida (p=0,018). Em T1, o valor de OHIP-14 aumentou significativamente em comparação a T0 (p=0,014), independentemente da presença das contenções. A quebra ou descolagem da contenção relatada pelo paciente foi a única variável que apresentou um impacto negativo na QVRSB (p=0,05). Conclusão: O uso de contenção fixa superior sugere um impacto inicial negativo na qualidade de vida do paciente após o fim do tratamento ortodôntico. Esse impacto, entretanto, é insignificante em longo prazo, exceto quando associado à descolagem ou quebra das contenções ortodônticas. Esse estudo enfatiza a necessidade de acompanhamento contínuo das contenções fixas após a finalização do tratamento ortodôntico.

Impact of orthodontic treatment on OHRQoL of adolescents: a longitudinal study

ABSTRACT Objective: The aim of this study was to evaluate the extent to which orthodontic treatment need is perceived by the patients and by the orthodontist, as well as the possible impacts on the OHRQoL (Oral Health-Related Quality of Life) over the course of conventional orthodontic treatment in adolescent patients. Methods: The sample consisted of 55 adolescents. The perception of patients and orthodontists relative to the malocclusion was evaluated by the IOTN (Index of Orthodontic Treatment Need). The OHRQoL was evaluated by the Child-OIDP (Child-Oral Impacts on Daily Performances) questionnaire before the conventional orthodontic appliance was bonded (T0); and at the following time intervals: after one week (T1), one month (T2), three months (T3), six months (T4), and after the end of orthodontic treatment (T5). Results: Adolescents who had large orthodontic treatment needs had a poor OHRQoL, according to their self-perception (p=0.003) and according to the orthodontist's perception (p<0.001), when compared with patients with small and moderate needs. There was statistically significant difference in the OHRQoL between the time intervals T0 and T1 (p=0.021), T2 and T3 (p<0.001), T3 and T4 (p=0.033), and T0 and T5 (p<0.002). At the end of treatment, all evaluated participants reported an improvement in OHRQoL. Conclusions: It was concluded that adolescents and orthodontists agreed with regard to the perception of orthodontic treatment need. In the first week and in the first month of orthodontic treatment, there was a negative impact on the OHRQoL. After three months, an improvement of OHRQoL was detected, which has progressed over time.

RESUMO Objetivo: O objetivo deste estudo foi avaliar o quanto a necessidade de tratamento ortodôntico é percebida pelos pacientes e pelo ortodontista, bem como os possíveis impactos na Qualidade de Vida Relacionada à Saúde Bucal (QVRSB) ao longo do tratamento ortodôntico convencional em pacientes adolescentes. Métodos: A amostra foi composta por 55 adolescentes. A percepção dos pacientes e ortodontistas em relação à má oclusão foi avaliada pelo Índice de Necessidade de Tratamento Ortodôntico (IOTN). A QVRSB foi avaliada pelo questionário Child-OIDP (Child-Oral Impacts on Daily Performances) antes da colagem do aparelho ortodôntico convencional (T0); e nos seguintes intervalos de tempo: após uma semana (T1), um mês (T2), três meses (T3), seis meses (T4) e após o término do tratamento ortodôntico (T5). Resultados: Adolescentes que apresentavam grandes necessidades de tratamento ortodôntico apresentaram baixa QVRSB, segundo sua autopercepção (p=0,003) e segundo a percepção do ortodontista (p<0,001), quando comparados com pacientes com necessidades pequenas e moderadas . Houve diferença estatisticamente significativa na QVRSB entre os intervalos de tempo T0 e T1 (p=0,021), T2 e T3 (p<0,001), T3 e T4 (p=0,033) e T0 e T 5 (p<0,00 2 ). Ao final do tratamento, todos os participantes avaliados relataram melhora na QVRSB. Conclusões: Concluiu-se que adolescentes e ortodontistas concordaram quanto à percepção da necessidade de tratamento ortodôntico. Na primeira semana e no primeiro mês de tratamento ortodôntico, houve impacto negativo na QVRSB. Após três meses, foi detectada uma melhora na QVRSB, que progrediu ao longo do tempo.

Orthodontic treatment during pregnancy, lactation, and postmenopausal period: a questionnaire development

Abstract This study aimed to develop and validate a self-administered questionnaire in Brazilian Portuguese to verify the level of knowledge of orthodontists in the care of pregnant, lactating, and postmenopausal women, named "Considerations on Orthodontic Treatment during Pregnancy, Lactation, and Postmenopausal Periods." The development and validation of the questionnaire consisted of the following steps: a) item generation; b) item reduction; c) questionnaire design; and d) validity and reliability tests in a cross-sectional study with 258 orthodontists working in the field from different Brazilian states. A total of 60 orthodontists participated in test-retest over a mean period of 45 days. The preliminary questionnaire consisted of a total of 60 questions. After item reduction, 40 questions were selected for the final version of the questionnaire, with eight questions about pregnant women; six about lactating women; 18 about postmenopausal women, and eight about general knowledge in dentistry. Each item had three response options in the Likert scale format. Face and content validity analysis, reliability assessment through internal consistency (Cronbach's alpha and McDonald's omega), and test-retest reliability through the intraclass correlation coefficient (ICC) and Spearman's correlation coefficient were performed. Face and content validity indicated that the questionnaire was considered valid, objective, and easily understandable. The questionnaire had good internal consistency (Cronbach's alpha = 0.77; McDonald's omega = 0.78) and good test-retest reliability (ICC = 0.71; Spearman's correlation coefficient = 0.51). The questionnaire was considered valid and reliable to assess the level of knowledge of orthodontists in the care of pregnant, lactating, and postmenopausal women.

Orthodontics in the oral health care network of the Unified Health System (SUS)

Abstract This observational study aimed to describe and analyze data from two external evaluations of the National Program for Improving Access to and Quality of Dental Specialty Centers (PMAQ CEO), held in 2014 and 2018 in Brazil, which evaluated Dental Specialty Centers (CEO) using a national and census approach. We selected questions through a search in the microdata of the first and second evaluations. The groups were analyzed independently. To compare the groups, nonparametric tests were performed (Mann Whitney U). The formulated hypotheses were: there would be no differences between the data of these groups (h0) and there would be differences between the data of these groups (h1). For qualitative nominal variables, frequency distribution was verified and association tests were performed (chi-square test). The significance level for this study was set at 5%. We observed that orthodontic treatments were found in about 13% of the CEO. Regarding human resources, most professionals were specialists or had MSc or PhD degrees; were civil servants; had been hired by direct administration; or had been hired via public tender. Regarding the work process and inclusion of the CEO in the health care network, we observed a greater number of services that use single and electronic medical records, greater presence of services monitoring and analyzing goals, greater knowledge about monthly average of absenteeism (for 2018); and larger number of services with referrals from primary health care centers (for 2014). Expanding the view on orthodontics and including preventive, interceptive, and corrective treatments at different points in health care networks are essential strategies for achieving comprehensive care in universal health systems.

Effect of various educational methods on increasing parents' awareness of their children's preventive orthodontic treatments

Aim: Like other fields of health, the main focus in dentistry has shifted from treatment to prevention of diseases. Parents have a vital role in deciding about their children's oral health issues. This study aims to investigate the effectiveness of four educational methods (including printed pamphlets, digital pamphlets, faceto-face education, and educational films) in increasing the awareness of parents about preventive orthodontic treatments. Methods: The study samples were selected from patients who were referred to the Pediatric Dentistry Department. 150 parents of children between 4-12 years old participated in the study. They filled out a questionnaire including demographic data and knowledge about orthodontic problems and their early treatments. Then they were divided into five groups (control, printed pamphlet, digital pamphlet, face-to-face, educational films) and after one month they repeated the test. Results: A total of 102 fathers and 48 mothers were evaluated. There was no statistical difference between different ages, sex, or income in terms of their awareness, but the awareness score between educational groups was different. There has been observed a significant increase in the awareness level of all four groups (except the control group) (P < 0.05). The highest score was seen in the video group. The difference between printed pamphlets and digital pamphlets was not significant. Conclusions: The results indicate that educational films are the most effective way of increasing awareness about preventive orthodontic treatments

Evaluación del aparato funcional postratamiento de Waveney como alternativa en la contención del avance mandibular

Fundamento: Para la contención del avance mandibular es necesario utilizar un aparato que mantenga la mandíbula en la posición lograda por los aparatos activos y que su diseño no provoque movimientos dentarios indeseados. Objetivo: Describir los cambios clínicos y cefalométricos del aparato funcional postratamiento de Waveney como alternativa en la contención del avance mandibular. Metodología: Se realizó una investigación descriptiva observacional de corte transversal en el servicio Ortodoncia de la Clínica Estomatológica Docente Provincial Dr. Justo Ortelio Pestana Lorenzo de la provincia Sancti Spíritus, desde septiembre 2019 a febrero 2022. Se seleccionaron 20 pacientes que iniciaron su etapa de contención en este período y cumplieron los criterios de inclusión. Se utilizaron métodos del nivel empírico y estadístico. Se analizaron las variables: edad, sexo, variables morfológicas clínicas y cefalométricas, así como resultado de la contención. Resultados: Se constató una edad promedio de 15.6; el 65 % de los escolares pertenecían al sexo femenino. Al año de iniciada la contención se mantuvo el sobrepase incisivo en 2.95 mm, la relación molar de neutroclusión en el 65 %, ángulo SNB en 79°, el ángulo ANB en 2.80°, la posición del incisivo superior 2.45 mm, la posición del incisivo inferior en 1.90 mm y el perfil estético en 0.55 mm. Solo existió incremento en el valor promedio del resalte incisivo de 2.70 mm a 2.75 mm. Conclusiones: Al año de iniciada la contención con el aparato funcional postratamiento de Waveney no se observó modificación de las variables estudiadas, excepto el resalte incisivo con incremento de su valor promedio.

Background: For mandibular advancement containment, it is necessary to use an appliance that holds the jaw in the achieved position by active appliances and that its design does not provoke undesired dental movements. Objective: To describe the clinical and cephalometric changes of the Orthodontic Appliances after the Waveney treatment as an alternative in the mandibular advancement containment. Methodology: A descriptive observational cross-sectional research was conducted at the Dr. Justo Ortelio Pestana Lorenzo Provincial Teaching Stomatology Clinic orthodontic service in Sancti Spíritus province, from September 2019 to February 2022. 20 patients who started their containment stage in this period and fulfilled the inclusion criteria were selected. Empirical and statistical methods were used. The following variables were analyzed: age, sex, clinical morphological and cephalometric variables, as well as the containment result. Results: An average age of 15.6 was found; 65% of the schoolchildren were female. One year after the containment was started, the incisive overpass was maintained at 2.95 mm, the neutroclusion molar rate at 65%, SNB angle at 79°, the ANB angle at 2.80°, the upper incisor position 2.45 mm, the lower incisor position by 1.90 mm and the esthetic profile by 0.55 mm. There was only an average increase in the incisor protrusion value from 2.70 mm to 2.75 mm. Conclusions: One year after containment with the Waveney post-treatment Orthodontic Appliances was initiated no changes were observed in the studied variables, except for incisor protrusion with an increase in its average value.

Effect of miniscrew placement height on the distribution of biological forces produced by clear aligner for mandibular molar distalization / 口腔疾病防治

Objective@#To explore the effect of different miniscrew placement heights on the distribution of biological forces produced by clear aligner combined with intramaxillary traction for mandibular molar distalization, to identify the miniscrew location that is conducive to the protection of lower anterior tooth anchorage and to provide a reference that can be used when designing clinical treatments.@*Methods@#Mimics, GeomagicStudio 2017, SolidWorks 2016, and Ansys workbench were used to establish finite element analysis models and perform mechanical analysis under the following six working conditions: working condition 1 was the control group without miniscrews; working conditions 2 to 5 had miniscrew in the buccal bone cortex between the first and second molars of the lower jaw 10 mm, 7 mm, 4 mm, and 1 mm from the top of the alveolar crest, respectively; working condition 6 had the miniscrew in the center of the buccal tongue at the anterior edge of the ascending branch of the lower jaw 5 mm above the occlusal plane.@*Results@#On the sagittal axis, miniscrew anchorage caused distal displacement of all teeth. Compared to the control group, in the miniscrew group, the displacement of the anterior molars exceeded that of the second molars. On the vertical axis, the result in the control group was similar to backward bending; the results in the miniscrew groups resembled the effect of a lever, lowering the lateral incisors and canines and raising the central incisors and first premolars. On the coronal axis, the second premolars and the first molars showed lingual displacement in the control group, and only the premolars and first molars showed lingual displacementin the miniscrew groups. The canines were the teeth that were most strongly affected by the change in miniscrew placement height.@*Conclusion@#The higher the miniscrew position is, the stronger the protective effect on the anterior anchorage. According to the miniscrew placement height, the mandibular arch should be properly narrowed, the central incisors and first premolars should be lowered, and the lateral incisors and canines should be raised when designing clinical treatments.

Study on the role of nano antibacterial materials in orthodontics (a review) / Estudo sobre o papel dos materiais nanoantibacterianos na ortodontia

Nanoparticles (NPs) are insoluble particles with a diameter of fewer than 100 nanometers. Two main methods have been utilized in orthodontic therapy to avoid microbial adherence or enamel demineralization. Certain NPs are included in orthodontic adhesives or acrylic resins (fluorohydroxyapatite, fluorapatite, hydroxyapatite, SiO2, TiO2, silver, nanofillers), and NPs (i.e., a thin layer of nitrogen-doped TiO2 on the bracket surfaces) are coated on the surfaces of orthodontic equipment. Although using NPs in orthodontics may open up modern facilities, prior research looked at antibacterial or physical characteristics for a limited period of time, ranging from one day to several weeks, and the limits of in vitro studies must be understood. The long-term effectiveness of nanotechnology-based orthodontic materials has not yet been conclusively confirmed and needs further study, as well as potential safety concerns (toxic effects) associated with NP size.

Nanopartículas (NPs) são partículas insolúveis com diâmetro inferior a 100 nanômetros. Dois métodos principais têm sido utilizados na terapia ortodôntica para evitar a aderência microbiana ou a desmineralização do esmalte: NPs são incluídas em adesivos ortodônticos ou resinas acrílicas (fluoro-hidroxiapatita, fluorapatita, hidroxiapatita, SiO2, TiO2, prata, nanopreenchimentos) e NPs são revestidas nas superfícies de equipamentos ortodônticos, ou seja, uma camada fina de TiO2 dopado com nitrogênio nas superfícies do braquete. Embora o uso de NPs em ortodontia possa tornar acessível modernos recursos, pesquisas anteriores analisaram as características antibacterianas ou físicas por um período limitado de tempo, variando de 24 horas a várias semanas, por isso devem ser compreendidos os limites dos estudos in vitro. A eficácia de longo prazo de materiais ortodônticos com base em nanotecnologia ainda não foi confirmada de forma conclusiva, o que exige mais estudos, bem como potenciais preocupações de segurança (efeitos tóxicos) associadas ao tamanho da NP.

Study on the role of nano antibacterial materials in orthodontics (a review)

Abstract Nanoparticles (NPs) are insoluble particles with a diameter of fewer than 100 nanometers. Two main methods have been utilized in orthodontic therapy to avoid microbial adherence or enamel demineralization. Certain NPs are included in orthodontic adhesives or acrylic resins (fluorohydroxyapatite, fluorapatite, hydroxyapatite, SiO2, TiO2, silver, nanofillers), and NPs (i.e., a thin layer of nitrogen-doped TiO2 on the bracket surfaces) are coated on the surfaces of orthodontic equipment. Although using NPs in orthodontics may open up modern facilities, prior research looked at antibacterial or physical characteristics for a limited period of time, ranging from one day to several weeks, and the limits of in vitro studies must be understood. The long-term effectiveness of nanotechnology-based orthodontic materials has not yet been conclusively confirmed and needs further study, as well as potential safety concerns (toxic effects) associated with NP size.

Resumo Nanopartículas (NPs) são partículas insolúveis com diâmetro inferior a 100 nanômetros. Dois métodos principais têm sido utilizados na terapia ortodôntica para evitar a aderência microbiana ou a desmineralização do esmalte: NPs são incluídas em adesivos ortodônticos ou resinas acrílicas (fluoro-hidroxiapatita, fluorapatita, hidroxiapatita, SiO2, TiO2, prata, nanopreenchimentos) e NPs são revestidas nas superfícies de equipamentos ortodônticos, ou seja, uma camada fina de TiO2 dopado com nitrogênio nas superfícies do braquete. Embora o uso de NPs em ortodontia possa tornar acessível modernos recursos, pesquisas anteriores analisaram as características antibacterianas ou físicas por um período limitado de tempo, variando de 24 horas a várias semanas, por isso devem ser compreendidos os limites dos estudos in vitro. A eficácia de longo prazo de materiais ortodônticos com base em nanotecnologia ainda não foi confirmada de forma conclusiva, o que exige mais estudos, bem como potenciais preocupações de segurança (efeitos tóxicos) associadas ao tamanho da NP.

Effect of peracetic acid on orthodontic elastics: an in vitro experiment / Efeito do ácido peracético nos elásticos ortodônticos: um estudo in vitro

Objetivo: Este estudo teve como objetivo avaliar a elasticidade de elásticos ortodônticos após desinfecção e esterilização com ácido peracético 0,2%. Materiais e métodos: Neste estudo piloto in vitro, elásticos ortodônticos Morelli® e American Orthodontics™ nas cores cinza e cristal foram divididas em três grupos experimentais: Grupo 1, imerso em água destilada por 72 horas, Grupo 2, imerso em peracético 0,2% por 10 min (para desinfecção) e Grupo 3, imerso em ácido peracético 0,2% por 30 min (para esterilização). Após a imersão, os valores de resistência à tração dos elásticos foram analisados em uma máquina de ensaios universal (EMIC DL-1000) para avaliar a resistência, em Newtons, necessária para a ruptura dos mesmos. A normalidade dos dados foi avaliada pelo teste de Shapiro-Wilk e os dados dos diferentes grupos experimentais foram comparados pelo teste ANOVA. Resultados: Para ambas as marcas, não houve diferença estatisticamente significativa entre os grupos experimentais quanto à resistência à tração. Discussão: O estudo apresentou um método alternativo para a desinfecção e esterilização de materiais termossensíveis. Conclusão: Assim, podemos concluir que a desinfecção e esterilização dos elásticos ortodônticos com ácido peracético 0,2% não alterou seu módulo de elasticidade.

Aim: This study aimed to evaluate the elasticity of orthodontic elastics after disinfection and sterilization with 0.2% peracetic acid. Materials and methods: In this in vitro pilot study, Morelli® and American Orthodontics™ elastic bands in gray and crystal colors were divided into three experimental groups: Group 1, immersed in distilled water for 72 hours, Group 2, immersed in 0.2% peracetic acid for 10 min (for disinfection) and Group 3, immersed in 0.2% peracetic acid for 30 min (for sterilization). After immersion, the tensile strength values of the elastics were analyzed in a universal test machine (EMIC DL-1000) to evaluate the strength, in Newtons, necessary for their rupture. Normality of the data was assessed using the Shapiro-Wilk test, and data from the different experimental groups were compared using the ANOVA test. Results: For both brands, there was no statistically significant difference between the experimental groups regarding tensile strength. Discussion: This study presented an alternative method for the disinfection and sterilization of thermo-sensitive materials. Conclusion: Thus, it can be concluded that the sterilization of orthodontic elastics with 0.2% peracetic acid did not change their modulus of elasticity.

Aesthetic perception of black spaces between lower incisors by laypeople of different ethnicities and age groups

Objective: To evaluate the degree of perception among lay people of different age groups about black spaces between lower incisors. Methodology: digital changes were performed in a frontal photograph of a smiling 30 year-old patient, simulating different dimensions of black spaces. The images were printed on photographic paper and applied with a questionnaire in order to evaluate the attractiveness using as tool a visual analogue scale (VAS). The participants were divided into 6 groups, considering race (Caucasian and Negroid) and age (15-19 years, 35-44 years and 65-74 years old). The differences between the examiners were checked by the Mann-Whitney test and the significance level was 5% (α = 0.05) for all analyzes. Results: The photographs that did not have black spaces were better graded and the ones that had larger black spaces scored worse. The older age group and the Negroid race group graded better the photograph with the largest black spaces, compared to the younger age groups and the group of Caucasians. Conclusion: black spaces between lower incisors are esthetically unattractive and their perception decreases with aging, besides being less relevant to older and Negroid people.

Asociación entre utilización de Guía de Referencia Clínica a Ortodoncia y derivación pertinente

Objetivo Los Servicios de Salud en Chile tienen una demanda insatisfecha en ortodoncia y muchas de las interconsultas no son pertinentes. Buscando una solución, el Servicio de Salud Metropolitano Norte (SSMN) implementó la "Guía de Referencia Clínica Ortodoncia (GRCO) para Servicios Públicos de Salud". El objetivo de este estudio fue evaluar si existe asociación entre utilizar GRCO y pertinencia en derivaciones a Ortodoncia realizadas por odontólogos de Atención Primaria. Materiales y Métodos Se realizó un estudio observacional analítico en 167 pacientes derivados por odontólogos que utilizaron la GRCO y 167 pacientes derivados por odontólogos que no la utilizaron. Una especialista en ortodoncia evaluó pertinencia en la derivación. Los datos se analizaron mediante la prueba de chi-cuadrado, y la prueba t-test. Resultados De los odontólogos que usaron la guía solo un 3% de sus derivaciones fueron no pertinentes, mientras que aquellos que no la usaron, tuvieron un 54% de derivaciones no pertinentes (p <0,001). Odontólogos que no usan la GRCO presentan 38 veces más probabilidad de realizar una derivación no pertinente. (OR 38,8; IC 14,9 - 125,9). Conclusión El uso de Guía de Referencia Clínica a Ortodoncia se asocia fuertemente con la pertinencia en la derivación de pacientes a la especialidad ortodoncia.

Objective. Health Services in Chile have an unsatisfied demand in orthodontics and the largest waiting list for dental specialties, with many of the referrals being irrelevant. Seeking a solution, the North Metropolitan Health Service (SSMN) implemented the "Orthodontic Clinical Referral Guideline (GRCO) for Public Health Services", to define the appropriateness of referrals. The objective of this study was to assess whether there is an association between the GRCO and the appropriateness of orthodontic referrals made by Primary Health Care dentists of the SSMN. Materials and methods. An analytical observational study was carried out in 167 patients referred by dentists who used the GRCO and 167 patients referred by dentists who did not use it. A calibrated orthodontic specialist assessed the relevance of the referral. The data was analyzed using the chi-square test, and the t-test. Results. Only 3% of the referrals made by dentists who used the GRCO were inappropriate, compared to 54% of those who did not use it. Dentists who do not use the GRCO are 38 times more likely to make an inappropriate referral than those who adhere to the GRCO (OR 38.8; CI 14.9 - 125.9) Conclusion. The use of the Orthodontic Clinical Referral Guideline is strongly associated with appropriateness in referring patients to the orthodontic specialty.

Validación y Comparación de un Nuevo Método para Predecir el Ancho Mesiodistal de Caninos y Premolares no Erupcionados en una Población Chilena de la Región de Valparaíso, Chile

Uno de los principales problemas durante la dentición mixta es la determinación de la futura discrepancia entre tamaño dentario y el espacio disponible. Para predecir el ancho mesiodistal de los dientes permanentes no erupcionados se han introducido diferentes métodos de análisis. Objetivo: El propósito de este estudio fue comparar el método Tanaka-Johnston con una nueva ecuación de regresión para predecir el ancho mesiodistal de caninos y premolares permanentes no erupcionados en una población de la región de Valparaíso, Chile. Material y método: Este estudio fue realizado en la Facultad de Odontología de la Universidad de Valparaíso, desde octubre de 2022 a junio de 2023 (8 meses), la muestra estuvo compuesta por 202 modelos de estudio del departamento de ortodoncia (91 hombres y 111 mujeres) en el rango de edad de 11 -20 años. Resultados: Se demostró que el método elaborado por Lara-Sandoval presenta mayor fiabilidad respecto a las medidas mesiodistales reales de los pacientes (ICC 0,773 para maxilar y 0,762 para mandíbula), en comparación con el método de Tanaka-Johnston (ICC 0,665 para maxilar y 0,623 para mandíbula). No existen diferencias significativas entre los valores reales y el método de Lara-Sandoval. Conclusión: El método de Lara-Sandoval es mejor que el propuesto por Tanaka-Johnston para determinar el ancho mesiodistal de caninos y premolares para esta muestra. Es necesario validar este método en otras regiones del país para ser utilizado con mayor seguridad que el ya existente como método estándar nacional.

One of the main orthodontic problems in mixed dentition is the determination of future tooth and size arch discrepancy. In order to predict the mesiodistal widths of unerupted permanent teeth different methods of analyses have been introduced. The aim of this study is to compare the Tanaka-Johnston analysis with a new regressive equation to predict the mesiodistal width of unerupted permanent canines and premolars in a Chilean population sample, from Valparaíso region. This study was conducted at the Universidad de Valparaíso Dental Faculty, from october 2022 to june 2023 (8 months), and the sample comprised historical dental casts from 202 patients (91 boys and 111 girls) in the age range of 11-20 from the orthodontics department. All the patients are from the Valparaíso region, Chile. The results show that the predictions of the new regressive equation method are closer to the actual mesiodistal measurements of the patients (ICC 0,773 for maxilla and 0,762 for mandible), compared to the Tanaka- Johnston method (ICC 0,665 for maxilla and 0,623 for mandible). There are no significant differences between the real values and the Lara-Sandoval method. Lara-Sandoval method is better than the one proposed by Tanaka-Johnston to determine the mesiodistal width of canines and premolars in this sample population. It is necessary to validate this method in other regions of the country to be used with greater security than the ones that already exists as a national standard method.

Tratamento orto-cirúrgico de mordida aberta anterior: um relato de caso / Ortho-surgical treatment of anterior open bite: a case report / Tratamiento ortoquirúrgico de la mordida abierta anterior: reporte de un caso

Objetivo: discorrer sobre um caso clínico de mordida aberta anterior com uma abordagem de tratamento orto-cirúrgica. Relato de caso: Paciente, leucoderma, sexo feminino, 21 anos, ASA 1, buscou tratamento cirúrgico, após a recomendação do ortodontista. Esta já havia realizado tratamento ortodôntico no período de dois anos, mas sem alcançar resultados satisfatórios. Ao exame clínico, se concluiu uma ausência de assimetria facial significativa e uma paciente face longa. Além de um padrão esquelético classe II, com uma bi-protusão dos incisivos caracterizando uma mordida aberta anterior, no qual, posteriormente foi solicitada a cirurgia para a correção da deformidade dentofacial e maloclusão. Conclusão: Em síntese, após todo o tratamento orto-cirúrgico houve uma melhora significativa da oclusão da paciente, com o posterior ganho da sua autoconfiança e estética facial e, consequentemente, o reestabelecimento da sua função mastigatória, respiratória e fonação.

Objective: discuss a clinical case of anterior open bite with an ortho surgical treatment approach. Case report: Patient, Caucasian, female, 21 years old, ASA 1, sought surgical treatment after orthodontist recommendation. The patient already went through orthodontic treatment for two years, not achieving satisfactory results. On clinical examination, there was an absence of significant facial asymmetry and a long-face. In addition to a class II skeletal pattern, with a bi-protrusion of the incisors characterizing an anterior open bite, in which surgery was later requested to correct the dentofacial deformity and malocclusion. Conclusion: In summary, after ortho-surgical treatment, there was a significant improvement in the patient's occlusion, with substantial increase of her self-confidence and facial aesthetics and consequently, the reestablishment of patient's masticatory, respiratory and phonation function.

Objetivo: discutir un caso clínico de mordida abierta anterior con abordaje de tratamiento ortoquirúrgico. Reporte de caso: Paciente, caucásica, sexo femenino, 21 años, ASA 1, buscó tratamiento quirúrgico, por recomendación del ortodoncista. Ya se había sometido a un tratamiento de ortodoncia durante dos años, pero sin lograr resultados satisfactorios. En el examen clínico, había ausencia de asimetría facial significativa y una cara alargada. Además de un patrón esquelético clase II, con biprotrusión de los incisivos caracterizando una mordida abierta anterior, en la que, posteriormente, se solicitó cirugía para corregir la deformidad dentofacial y maloclusión. Conclusión: En resumen, después de todo el tratamiento ortoquirúrgico, hubo una mejoría signifi cativa en la oclusión de la paciente, con la consiguiente ganancia en su confi anza en sí misma, en su estética facial y en consecuencia, el restablecimiento de su función masticatoria, respiratoria y fonatoria.

Contribution of Digital Technology to the Surgical Technique of Miniscrew Insertion: a Literature Review

Orthodontic miniscrews are used to achieve absolute anchorage. Their insertion technique is simple but must be precise to avoid intra- and postoperative complications. This study aimed to review the literature on the role of digital technology in the precise placement of miniscrews and to describe the different stages of the insertion guide manufacturing chain. The databases used were PubMed, Science Direct, and Google Scholar, including the following English descriptors: "Orthodontic Anchorage Procedures," "Cone Beam Computed Tomography." Digital technology improves the accuracy of miniscrew placement by using 3D imaging to assess the quantity and quality of bone and the proximity of anatomical structures in the area to be implanted. By combining 3D imaging with the new techniques of 3D printing and virtual planning, the orthodontist can obtain a personalized placement guide for the patient using computer-aided design and manufacturing techniques. A digitally-assisted miniscrew insertion system is a promising technique for precise and safe miniscrew insertion but cannot be used routinely. Therefore, large-scale studies are needed to map miniscrew insertion in different areas, considering ethnicity, gender, and different anatomical characteristics.

Alteración en la integridad de la membrana basal en agrandamiento gingival inducido por tratamiento ortodóncico

Introducción: El agrandamiento gingival inducido por tratamiento de ortodoncia es un aumento progresivo, localizado o generalizado del tejido gingival. Objetivo: Determinar aspectos morfológicos en la membrana basal del tejido gingival de pacientes con agrandamiento gingival inducido por tratamiento de ortodoncia. Métodos: Estudio descriptivo de corte transversal, donde se analizaron tejidos gingivales de pacientes con agrandamiento gingival inducido por tratamiento de ortodoncia (grupo test: n=5) e individuos sanos (grupo control: n=5) mediante análisis histológicos e inmunohistoquímico con anticuerpo policlonal anti-citoqueratina 14. Las interrupciones de la membrana basal grado 1 y grado 2 fueron identificadas. Fue utilizado el programa estadístico R versión 4.0.2 para Windows. Se declaró significancia si p <0,05. Resultados: Se constató la presencia de rupturas de la membrana basal en todos los pacientes del grupo test. Estos individuos presentaron una mayor cantidad de cambios morfológicos en el tejido gingival. Exponiendo así, valores estadísticamente significativos de rupturas de la membrana basal (Grado I) y rupturas rodeadas de células epiteliales y/o fibroblastos gingivales (Grado II) en comparación con el grupo control (p <0,001). Conclusión: El tejido epitelial de pacientes con agrandamiento gingival inducido por tratamiento de ortodoncia presenta una evidente pérdida en la integridad de la membrana basal. Estas discontinuidades sugieren un aumento considerable de la plasticidad del epitelio en pacientes con agrandamiento gingival inducido por tratamiento de ortodoncia.

Introduction: Orthodontic treatment-induced gingival enlargement is a progressive, localized or generalized increase in gingival tissue. Objective: To determine morphologic aspects in the basal membrane of the gingival tissue in patients with orthodontic treatment-induced gingival enlargement. Methods: A descriptive and cross-sectional study was carried out, in which gingival tissues of patients with orthodontic treatment-induced gingival enlargement (test group: n=5) and healthy individuals (control group: n=5) were analyzed by histological and immunohistochemical analysis with the polyclonal antibody anticytokeratin 14. Grade 1 and grade 2 disrupted basal membrane were identified. The statistical program R (version 4.0.2) for Windows was used. Significance was declared if p was greater than 0.05. Results: The presence of disrupted basal membranes was observed in all the patients from the test group. These individuals presented a greater number of morphological changes in the gingival tissue. Compared to the control group (p < 0.001), statistically significant values were observed for cases of disrupted basal membrane (grade I) and disruptions surrounded by epithelial cells or gingival fibroblasts (grade II). Conclusion: The epithelial tissue of patients with orthodontic treatment-induced gingival enlargement shows an evident loss of the basal membrane integrity. These discontinuities are suggestive of a considerable increase in epithelial plasticity in patients with orthodontic treatment-induced gingival enlargement.

Tratamento da classe III com disjunção maxilar e tração reversa da maxila: relato de caso clínico / Class III treatment weth maxillary disjunction and reverse maxillary traction: clinical case report

Objetivo: A má oclusão classe III de Angle se caracteriza por protrusão mandibular, retrusão maxilar ou pela combinação de ambas. Além de prejudicar a estética facial do paciente, essa má oclusão pode causar alterações funcionais e respiratórias. Uma das alternativas de tratamento para esses casos é o uso da máscara de Petit e do aparelho disjuntor de Hyrax. Este estudo tem como objetivo avaliar por meio da cefalometria ortodôntica se o tratamento com expansão maxilar em conjunto com a tração reversa da maxila diminuem os agravos estéticos e funcionais do paciente Classe III. Relato de caso: o relato de caso descrito no presente trabalho é sobre uma paciente que foi submetida a esse tratamento, sendo descrito por meio de análises cefalométricas, exames radiográficos, fotos intrabucais e achados clínicos. Considerações finais: A verificação dos resultados obtidos após o término do tratamento mostrou que a paciente teve uma boa adesão ao uso desses aparelhos e obteve resultados satisfatórios na sua função mastigatória, na sua oclusão e na sua estética facial e dentária.(AU)

Objective: Angle class III malocclusion is characterized by mandibular protrusion, maxillary retrusion or a combination of both. In addition to impairing the patient's facial aesthetics, this malocclusion can cause functional and respiratory changes. One of the treatment alternatives for these cases is the use of the Petit mask and the Hyrax breaker device. This study aims to evaluate, through orthodontic cephalometry, whether the treatment with maxillary expansion in conjunction with the reverse traction of the maxilla reduces the aesthetic and functional problems of Class III patients. Case report: the case report described in the present work is about a patient who underwent this treatment, being described through cephalometric analysis, radiographic examinations, intraoral photos and clinical findings. Final considerations: The verification of the results obtained after the end of the treatment showed that the patient had a good adherence to the use of these devices and obtained satisfactory results in her masticatory function, in her occlusion and in her facial and dental aesthetics.(AU)

Orthodontic treatment in traumatized permanent teeth: a systematic review / Tratamento ortodôntico em dentes permanentes traumatizados: uma revisão sistemática

Objective: to analyze, through literature review, the available literature on orthodontic treatment in traumatized permanent teeth. Methods: A literature search was performed in electronic databases (PubMed and SciELO) using the descriptors [tooth injuries] OR [injuries, teeth] OR [injury, teeth] OR [teeth injury] OR [injuries, tooth] OR [injury, tooth] OR [tooth injury] OR [teeth injuries] AND [orthodontics]. Observational studies and clinical trials were included, narrative reviews, laboratory and in vitro studies, case reports and series as well as articles that presented abstracts written in languages other than Portuguese, English and Spanish were excluded from the study. Two reviewers considered the eligibility, the risk of bias of the analyzed data and the qualitative synthesis of the studies included. A total of 1,322 references were found and 4 articles met all inclusion criteria and were included in the qualitative analysis. Some consequences like pulp necrosis and root resorption have been highlighted and trauma severity should be considered when orthodontically intervening in previously traumatized teeth. Final considerations: The traumatized teeth can be orthodontically treated as long as the time of tissue reorganization is respected, and the pull and periodontal conditions are followed up.(AU)

Objetivos: analisar, por meio de revisão de literatura, a respeito do tratamento ortodôntico em dentes permanentes traumatizados. Metodologia: Uma pesquisa bibliográfica foi realizada em bancos de dados eletrônicos (PubMed e SciELO) usando os descritores [tooth injuries] ou [injuries, teeth] ou [injury, teeth] ou [teeth injury] ou [injuries, tooth] ou [injury, tooth] ou [tooth injury] ou [teeth injuries] e [orthodontics]. Foram incluídos estudos observacionais e ensaios clínicos, revisões narrativas, estudos laboratoriais e in vitro, relatos de casos e séries, bem como artigos que apresentassem resumos redigidos em idiomas diferentes do português, inglês e espanhol foram excluídos do estudo. Dois revisores consideraram a elegibilidade, o risco de viés dos dados analisados e a síntese qualitativa dos estudos incluídos. Foram encontradas 1.322 referências e 4 artigos atenderam a todos os critérios de inclusão e foram incluídos na análise qualitativa. Algumas consequências como necrose pulpar e reabsorção radicular têm sido destacadas e a gravidade do trauma deve ser considerada na intervenção ortodôntica em dentes previamente traumatizados. Considerações finais: Os estudos incluídos nesta revisão sugerem que dentes traumatizados podem ser tratados ortodônticamente desde que respeitado o tempo de reorganização tecidual e acompanhadas as condições pulpares e periodontais.(AU)

Tempo de tratamento ortodôntico com aparelhos autoligados: revisão de literatura

Introdução: Atualmente, braquetes autoligados têm sido sugeridos para reduzir o tempo de tratamento na Ortodontia. Objetivo: Dessa maneira, o presente estudo objetivou revisar a literatura acerca do tempo de tratamento com esses braquetes, em comparação com outros braquetes e tratamentos sugeridos. Revisão de literatura: Foi realizada pesquisa bibliográfica de caráter descritivo, que compreendeu o levantamento de referencial teórico na base de dados eletrônica Medline ­ PubMed. A seleção de artigos foi feita a partir dos títulos e resumos e a revisão compreendeu 4 artigos publicados na língua inglesa no período de 2019 a 2023. Conclusão: Há uma escassez de estudos clínicos envolvendo essa temática e o tratamento ortodôntico com aparelhos autoligados parece apresentar menor tempo de tratamento em comparação com aparelhos fixos tradicionais. No entanto, os estudos não mostraram diferenças estatisticamente significativas na redução desse tempo. Pode-se sugerir que mais estudos clínicos sejam conduzidos no intuito de elucidar essa questão.

Introduction: Currently, self-ligating brackets have been suggested to reduce treatment time in Orthodontics. Objective: Therefore, the present study aimed to review the literature about the treatment time with these brackets, in comparison with other brackets and suggested treatments. Literature review: Descriptive bibliographical research was carried out, which included the survey of theoretical references in the electronic database Medline ­ PubMed. The selection of articles was made based on titles and abstracts and the review comprised 4 articles published in the English language from 2019 to 2023. Conclusion: there is a shortage of clinical studies involving this topic and orthodontic treatment with self-ligating appliances seems to present shorter treatment time compared to traditional fixed appliances. However, the studies did not show statistically significant differences in reducing this time. It can be suggested that more clinical studies be conducted to elucidate this issue.

Inmunolocalización de citoqueratina 14, 19 y Ki-67 en el epitelio de pacientes con agrandamiento gingival

R E S U M E N En pacientes con ortodoncia aparecen eventos patológicos no deseados como agrandamiento gingival inducido por tratamiento de ortodoncia (AGTO) o hipertrofia gingival. El objetivo del estudio es identificar la distribución inmunohistoquímica de citoqueratina CK-14, CK-19 y Ki-67 en epitelio gingival de pacientes con AGTO. Se seleccionaron I3 pacientes divididos en: grupo control (n=6), conformado por individuos periodontalmente sanos no portadores de aparatología ortodóntica y grupo test (n=7), integrado por pacientes con AGTO. Los marcadores CK-14, CK-19 y Ki-67 fueron identificados mediante inmunohistoquímica con anticuerpos monoclonales y observados en un microscopio óptico Leica DM 500. En los pacientes del grupo test el tejido epitelial se mostró hipertrófico con pérdida en la continuidad de la membrana basal. La CK-14 y CK-19 fue positiva en el epitelio de todos los sujetos evaluados, con una expresión positiva de alta intensidad en células de la lámina basal del grupo test. El promedio de células positivas para Ki-67 en el grupo test fue de 56%. En conclusión, la CK-14, CK-19 y Ki-67 son marcadores con elevada inmunoreactividad en tejido gingival de pacientes con AGTO portadores de ortodoncia.

During orthodontic treatment, unwanted pathological events such as gingival overgrowth induced by orthodontic treatment or gingival hypertrophy may appear The objective of this study is to identify immunohistochemical distribution of cytokeratin CK-14, CK-19 and Ki-67 in the gingival epithelium of patients with gingival overgrowth induced by orthodontic treatment. Thirteen patients were selected divided into: control group (n = 6), conformed of periodontally healthy individuals without orthodontic appliances and the test group (n = 7), conformed of patients with gingival overgrowth induced by orthodontic treatment. The biomarkers CK-14, CK-19 and Ki-67 were identified by immunohistochemistry with monoclonal antibodies and observed in a Leica DM 500 optical microscope. Hypertrophic epithelial tissue with loss of continuity of the basement membrane was found in the test group patients. CK-14 and CK-19 were positive in the epithelial tissue of all the subjects evaluated, with a high intensity positive expression in the cells of the basal lamina of the test group. The average number of cells positive for Ki-67 in test group was 56%. In conclusion, CK-14, CK-19 and Ki-67 are biomarkers with high immunoreactivity in the gingival tissue of patients with gingival overgrowth induced by orthodontic treatment.

Durante o tratamento ortodôntico, eventos patológicos indesejados como o crescimento gengival induzido pelo tratamento ortodôntico (CGTO) ou hipertrofia gengival podem aparecer: O objetivo deste estudo é identificar a distribuição imuno-histoquímica das citoqueratinas CK -14, CK-19 e Ki-67 no epitélio gengival de pacientes com CGTO. Foram selecionados 13 pacientes divididos em: grupo controle (n=6), conformado por indivíduos periodontalmente saudáveis sem aparelhos ortodônticos e o grupo teste (n=7), conformado por pacientes com CGTO. Os biomarcadores CK-14, CK-19 e Ki-67 foram identificados por imuno-histoquímica com anticorpos monoclonais e observados em microscópio óptico Leica DM 500. Tecido epitelial hipertrófico com perda de continuidade da membrana basal foi encontrado nos pacientes do grupo teste. CK-14 e CK-19 foram positivos no tecido epitelial de todos os sujeitos avaliados, com expressão positiva de alta intensidade nas células da lâmina basal do grupo teste. O número médio de células positivas para Ki-67 no grupo teste foi de 56%. Em conclusão, CK-14, CK-19 e Ki-67 são biomarcadores com alta imunorreatividade no tecido gengival de pacientes com CGTO.