Harmonização do sorriso: aliando ortodontia e estética / Smile harmonization: combining orthodontics and aesthetics

Atualmente é evidente a demanda contínua por padrões de beleza, cada vez mais impecáveis, um sorriso alinhado e harmônico com dentes brancos para se sorrir com confiança. O tratamento odontológico interdisciplinar tem como intuito proporcionar uma boa saúde periodontal, restabelecer a estética e a função do sistema estomatognático. Objetivo: apresentar um relato de caso clínico envolvendo harmonização do sorriso como cirurgia plástica periodontal para alinhamento da margem gengival na região anterior e restaurações diretas em resina composta após a finalização do tratamento ortodôntico, evidenciando a importância da abordagem conservadora e multidisciplinar no âmbito do tratamento estético. Relato de caso: Realizamos o tratamento ortodôntico com aparelho autoligado cerâmico para alinhamento do arco dental e intrusão do elemento 13, em sequência executamos um recorte gengival nos elementos 12 e 22, clareamento dental associado após 15 dias, subsequentemente, reanatomização dentária no elemento 44 para que o elemento 13 não voltasse a extruir pela falta de contato oclusal, e por fim, remodelação dental fazendo uso de resina composta nos elementos 12, 21 e 22 devido a manchas de hipocalcificação dental. Conclusão: Contudo, a estética bucal tem a capacidade de possibilitar a melhoria na autoestima, devolvendo à função, proporcionando satisfação e bem-estar ao indivíduo, enaltecendo o sorriso.

Currently, the continuous demand for increasingly impeccable beauty standards is evident, an aligned and harmonic smile with white teeth to smile with confidence. Interdisciplinary dental treatment aims to provide good periodontal health, restore the aesthetics and function of the stomatognathic system. Objective: to present a clinical case report involving smile harmonization as periodontal plastic surgery for aligning the gingival margin in the anterior region and direct composite resin restorations after completion of orthodontic treatment, highlighting the importance of a conservative and multidisciplinary approach in the field of aesthetic treatment . Case report: We performed orthodontic treatment with a self-ligating ceramic appliance for aligning the dental arch and intruding element 13, then performed a gingival cutout on elements 12 and 22, associated tooth whitening after 15 days, subsequently, dental reanatomization on element 44 to that element 13 would not extrude again due to the lack of occlusal contact, and finally, dental remodeling using composite resin in elements 12, 21 and 22 due to dental hypocalcification stains. Conclusion: However, oral aesthetics has the ability to improve self-esteem, returning to function, providing satisfaction and well-being to the individual, enhancing the smile.

Analysis of biofilm formation by Candida albicans in different types of orthodontic fixed appliances and devices / Análise da formação de biofilme por Candida albicans em diferentes tipos de aparelhos e dispositivos ortodônticos fixos

Objective: in this study, biofilm formation by Candida albicans in fixed orthodontic appliances was evaluated. Material and Methods: a total of 300 conventional metal brackets (MC), ceramic (CB), self-ligation (SLB), nickel-titanium (NiTi), and nickel-chromium (NiCr) wires, and ligatures types were organized into thirty groups (n=10). To induce biofilm formation, brackets, wires, and ligatures were joined, sterilized, placed in 24-well plates, contaminated with standardized suspensions of C. albicans (107 cells/mL), and incubated at 37 °C for 48 h with shaking. The biofilms formed were detached using an ultrasonic homogenizer, and suspensions were serially diluted and plated on Sabouraud dextrose agar to determine colony-forming units per mL. Scanning electron microscopy was performed before and after the biofilm formation. Results: lower amount of biofilm formation was observed in the MC group than in the CB and SLB groups (p<0.0001). SLB and CB showed similar biofilm formation rates (p=0.855). In general, the cross-sectional wires .018"x.025" showed higher biofilm formation when associated with the three types of brackets. When brackets, wires, and ligatures were associated, the sets with NiCr wires and SSL ligatures with MC brackets (p=0.0008) and CB (p=0.0003) showed higher biofilm formation. Conclusion: thus, brackets of MC with NiTi and NiCr wires showed lower biofilm formation, regardless of the ligature and cross-sectional or gauge of the wire and, MC and CB brackets with NiCr wires and SSL ligatures were more likely to accumulate biofilms (AU)

Objetivo: neste estudo, a formação de biofilme por Candida albicans em aparelhos ortodônticos fixos foi avaliada. Material e Métodos: um total de 300 bráquetes metálicos convencionais (MC), cerâmicos (CB), autoligados (SLB), com fios de níquel-titânio (NiTi) e níquel-cromo (NiCr) e tipos de ligaduras foram organizados em trinta grupos (n=10). Bráquetes, fios e ligaduras foram unidos, esterilizados, colocados em placas de 24 poços, contaminados com suspensões padronizadas de C. albicans (107 células/mL) e incubados a 37°C por 48 h para a formação de biofilmes. Os biofilmes formados foram rompidos por meio de um homogeneizador ultrassônico e suspensões foram diluídas e semeadas em ágar Sabouraud-dextrose para determinar as unidades formadoras de colônias por mL. A microscopia eletrônica de varredura foi realizada antes e após a formação do biofilme. Resultados: foi observada menor formação de biofilme no grupo MC em comparação aos grupos CB e SLB (p<0,0001). A formação de biofilme foi semelhante nos grupos SLB e CB (p=0,855). Em geral, os fios de seção transversal .018"x.025" apresentaram maior formação de biofilme quando associados aos três tipos de bráquetes. Os conjuntos com fios de NiCr e ligaduras SSL com bráquetes MC (p=0,0008) e CB (p=0,0003) apresentaram maior formação de biofilme. Conclusão: bráquetes MC com fios de NiTi e NiCr apresentaram menor formação de biofilme, independente da ligadura e secção transversal ou bitola do fio e, braquetes MC e CB com fios de NiCr e ligaduras SSL foram mais propensos a acumular biofilmes.(AU)

Stress distribution in lower second molar mesialization using mini-implants: a pilot study using 3D finite element analysis / Distribuição de tensões na mesialização do segundo molar inferior usando mini-implantes: um estudo piloto usando análise de elementos finitos 3D

Objective: to analyze the stress distribution in a 3D model that simulates second molar mesialization using two different types of mini-implants. Material and Methods: a mandible bone model was obtained by recomposing a computed tomography performed by a software program. The cortical and trabecular bone, a lower second molar, periodontal ligament, orthodontic tube, resin cement and the mini-implants were designed and modeled using the Rhinoceros 4.0 software program. The characteristics of self-drilling orthodontic mini-implants were: one with 7 mm length, 1 mm transmucosal neck section and 1.6 mm diameter and another with 5 mm length and 1.5 mm diameter. A total of 235.161 and 224.505 elements were used for the mesh. These models were inserted into the bone block and then subjected to loads of 200 cN (centinewton). The results were calculated and analyzed by the Ansys 17.0 software program for qualitative verification through displacement and maximum principal stress maps. Results: it was possible to observe that the periodontal ligament presented low displacement and stress values. However, the physiological values presented are among those capable to provide orthodontic movement, with compression and tensile area visualization staggered between 0.1 and -0.1 MPa (megapascal). Conclusion: within the limitations of the study, the mini-implants tested showed similar results where the load on the tooth allowed dental displacement (molar mesialization), with a tendency to rotate it, theoretically allowing the second molar to take the location of the first molar. (AU)

Objetivo: analisar a distribuição de tensões em um modelo 3D que simula a mesialização do segundo molar usando dois tipos diferentes de mini-implantes. Material e Métodos: um modelo de osso mandibular foi obtido por recomposição de uma tomografia computadorizada realizada por um software. O osso cortical e trabecular, um segundo molar inferior, ligamento periodontal, tubo ortodôntico, cimento resinoso e os mini-implantes foram projetados e modelados no software Rhinoceros 4.0. As características dos mini-implantes ortodônticos auto perfurantes foram: um com 7 mm de comprimento, 1 mm de secção transmucosa e 1,6 mm de diâmetro e outro com 5 mm de comprimento e 1,5 mm de diâmetro. Para a malha, foram utilizados 235.161 e 224.505 elementos. Esses modelos foram inseridos no bloco ósseo e então submetidos a cargas de 200 cN (centinewton). Os resultados foram calculados e analisados pelo software Ansys 17.0 para verificação qualitativa por meio de mapas de deslocamento e tensões máximas principais. Resultados: foi possível observar que o ligamento periodontal apresentou baixos valores de deslocamento e tensões. Porém, os valores fisiológicos apresentados são capazes de proporcionar movimentação ortodôntica, com visualização da área de compressão e tração escalonada entre 0,1 e -0,1 MPa (megapascal). Conclusão: dentro das limitações do estudo, os mini-implantes testados apresentaram resultados semelhantes onde a carga sobre o dente permitiu o deslocamento dentário (mesialização do molar), com tendência a girá-lo, permitindo teoricamente que o segundo molar ocupe do lugar do primeiro molar (AU)

Cambios en el pH salival de pacientes con ortodoncia fija, tras la aplicación de dos tipos de enjuagues bucales / Changes in salivary pH in patients with fixed orthodontics following the use of two types of mouthwashes

Introducción: Los enjuagues bucales contribuyen a la inhibición de la formación de la placa bacteriana y, por tanto, pueden ayudar a mantener el pH salival cercano a neutro. Objetivo: Identificar cambios en el pH salival de pacientes portadores de aparatología ortodóncica fija, después del enjuague con una solución de Stevia rebaudiana Bertoni y un enjuague comercial de aceites esenciales. Métodos: Se realizó un experimento clínico con un diseño factorial mixto en pacientes portadores de aparatología ortodóncica fija. Una vez firmado el consentimiento informado, treinta y dos pacientes fueron asignados aleatoriamente a uno de 2 grupos: la solución de S. rebaudiana B. al 2 por ciento o un enjuague comercial de aceites esenciales. Se utilizaron 15 ml de enjuague durante 60 s en todos los pacientes. El pH salival fue medido por dos observadores independientes calibrados, utilizando papel medidor de pH antes del enjuague (medición basal) y después del enjuague, a los 5 y 20 min. Los datos fueron analizados mediante el ANOVA mixto. Resultados: Se encontró una interacción estadísticamente significativa entre el tipo de tratamiento y el momento de medición del pH. Los pH medio de los grupos S. rebaudiana y aceites esenciales fueron respectivamente en la medición basal: 6,61 y 6,52 (p = 0,72); a los 5 min: 7,61 y 7,77 (p = 0,40); y a los 20 min: 7,72 y 6,82 (p < 0,001). Conclusiones: Ambos enjuagues tenían el efecto de aumentar el pH salival a niveles alcalinos a los 5 min, pero solo el enjuague de S. rebaudiana B. al 2 por ciento mantuvo el pH básico a los 20 min(AU)

Introduction: Mouthwashes contribute to the inhibition of bacterial plaque formation and, therefore, may help to maintain salivary pH close to neutral. Objective: To identify changes in salivary pH in patients with fixed orthodontics after using a Stevia rebaudiana Bertoni solution and a commercial essential oil mouthwash. Methods: A clinical experiment with a mixed factorial design was carried out in patients with fixed orthodontic appliances. Once informed consent was signed, thirty-two patients were randomly assigned to one of 2 groups: 2 % S. rebaudiana B. solution or a commercial essential oil mouthwash. Fifteen ml of mouthwash was used for 60 s in all patients. Salivary pH was measured by two independent calibrated observers using pH-measuring paper before rinsing (basal measurement) and after rinsing, after 5 and 20 min. The data were analyzed by mixed ANOVA. Results: A statistically significant interaction was found between the type of treatment and the time of pH measurement. The medium pH of the S. rebaudiana and essential oil groups were respectively as per basal measurement: 6.61 and 6.52 (p = 0.72); after 5 min: 7.61 and 7.77 (p = 0.40); and after 20 min: 7.72 and 6.82 (p < 0.001). Conclusions: Both mouthwashes had the effect of increasing salivary pH to alkaline levels after 5 min, but only the 2 percent S. rebaudiana B. mouthwash maintained the basic pH after 20 min(AU)

Prevalencia de Porphyromonas gingivalis en un grupo de pacientes con aparatología fija de ortodoncia / Prevalence of Porphyromonas gingivalis in a group of patients with fixed orthodontic appliances

Introducción: existen diversos patógenos que pueden afectar no sólo la salud periodontal, sino también la salud general de los pacientes. Objetivo: determinar la Porphyromonas gingivalis (PG) en el primer molar superior derecho de adolescentes, de entre 12 y 18 años, con al menos un mes de tratamiento de ortodoncia con aparatología fija. Material y métodos: se realizó un estudio observacional, descriptivo, transversal de casos en un grupo de 26 adolescentes con tratamiento de ortodoncia, compuesto de brackets metálicos, tubos o bandas, arcos NiTi termoactivos, módulos, cadenas o ligaduras; sin importar sexo, edad, tiempo de tratamiento o maloclusión. Se formaron dos pares de grupos 1 y 2 (15 mujeres y 11 hombres), A y B (13 mujeres y 13 hom- bres) comparando los resultados obtenidos entre los grupos. Resulta- dos: dentro del grupo 1 y 2 la detección molecular de microorganismos arroja que 80% fueron positivas a la PG, 58.33% presenta maloclusión y en promedio 89% de las pacientes son positivas a PG. La detección molecular del grupo A y B indica que 54.54% fueron positivos a PG, mientras que 83.3% presenta maloclusión y en promedio 47% son positivos a PG. Conclusión: la explicación de los eventos moleculares que se desencadenan en la cavidad oral y los sistemas afectados por PG contribuyen a la prevención de complicaciones al tener una mejor comprensión de los fenómenos infecciosos (AU)

Introduction: there are various pathogens that can affect not only periodontal health, but also the general health of patients. Objective: to determine Porphyromonas gingivalis (PG) in the upper right first molar of adolescents, between 12 and 18 years old, with at least one month of orthodontic treatment with fixed appliances. Material and methods: a cross-sectional descriptive observational study of cases was carried out in a group of 26 adolescents with orthodontic treatment, consisting of metal brackets, tubes or bands, thermoactive NiTi archwires, modules, chains or ligatures; regardless of sex, age, treatment time or malocclusion. Two pairs of groups 1 and 2 (15 women and 11 men), A and B (13 women and 13 men) were formed, comparing the results obtained between the groups. Results: within group 1 and 2, the molecular detection of microorganisms shows that 80% were positive for PG, 58.33% presented malocclusion and an average of 89% of patients were positive for PG. The molecular detection of group A and B indicates that 54.54% were positive for PG while 83.3% presented malocclusion and on average 47% were positive for PG. Conclusion: the explanation of the molecular events that are triggered in the oral cavity and the systems affected by PG contribute to the prevention of complications by having a better understanding of the infectious phenomena (AU)

Effectiveness of chlorhexidine oral rinse in preventing plaque accumulation and gingivitis in patients undergoing orthodontic treatment- a systematic review and meta analysis / Eficacia del enjuague oral de clorhexidina en la prevención de la acumulación de placa y la gingivitis en pacientes en tratamiento de ortodoncia: una revisión sistemática y metaanálisis

Aim: The aim of this review was to systematically assess and report the effectiveness of chlorhexidine (CHX) mouthwash in preventing plaque accumulation and gingivitis in patients undergoing orthodontic treatment. Material and Methods: The review was prepared according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines and registered under PROSPERO database (CRD42020170776). Four electronic databases were systematically searched along with a complimentary manual search of orthodontic journals until June 2022. Only Randomized Control Trials (RCTs) reporting on antiplaque and antigingivitis efficacy of Chlorhexidine mouthwash compared with placebo or control in orthodontic patients were included. Risk of bias assessment was done using Cochrane ROB-2. Quantitative analysis (Random-Effects Model and Standard Mean Difference (SMD)) with 95 % confidence interval was used. Results: Six RCTs were included for qualitative analysis and four were included for quantitative analysis with a total of 211 participants. Out of six studies, 3 were judged to have a low risk of bias, two had some concerns and one of them had high risk of bias. Random effects meta-analysis performed for anti-plaque effect reported a significant reduction of -1.2 SMD for CHX at 4 to 6 weeks with low heterogeneity (I2-35%). The anti-gingivitis effect at 4 to 6 weeks was significant for CHX with a SMD of -1.03 and a moderate heterogeneity (I2-65%). Conclusion: On analyzing the available evidence a moderate level of certainty supports a short-term reduction in plaque accumulation and gingivitis in orthodontic patients subjected to rinsing with chlorhexidine oral rinse.

Objetivo: El objetivo de esta revisión fue evaluar e informar sistemáticamente la efectividad del enjuague bucal con clorhexidina (CHX) para prevenir la acumulación de placa y la gingivitis en pacientes que reciben tratamiento de ortodoncia. Material y Métodos: La revisión se preparó de acuerdo con las pautas de Preferred Reporting Items for Systematic Reviews (PRISMA) y se registró en la base de datos PROSPERO (CRD42020170776). Se realizaron búsquedas sistemáticas en cuatro bases de datos electrónicas junto con una búsqueda manual gratuita de revistas de ortodoncia hasta junio de 2022. Solo se incluyeron ensayos controlados aleatorios (ECA) que informaron sobre la eficacia antiplaca y antigingivitis del enjuague bucal con clorhexidina en comparación con placebo o control en pacientes de ortodoncia. La evaluación del riesgo de sesgo se realizó mediante Cochrane ROB-2. Se utilizó un análisis cuantitativo (modelo de efectos aleatorios y diferencia de medias estándar (SMD)) con un intervalo de confianza del 95 %. Resultados: Se incluyeron seis ECA para el análisis cualitativo y cuatro para el análisis cuantitativo con un total de 211 participantes. De los seis estudios, se consideró que tres tenían un bajo riesgo de sesgo, dos tenían algunas preocupaciones y uno de ellos tenía un alto riesgo de sesgo. El metanálisis de efectos aleatorios realizado para el efecto antiplaca informó una reducción significativa de -1,2 SMD para CHX a las 4 a 6 semanas con baja heterogeneidad (I2-35%). El efecto antigingivitis a las 4 a 6 semanas fue significativo para CHX con una SMD de -1,03 y una heterogeneidad moderada (I2-65%). Conclusión: Al analizar la evidencia disponible, un nivel de certeza moderado apoya una reducción a corto plazo en la acumulación de placa y gingivitis en pacientes ortodóncicos sometidos a enjuague con enjuague bucal con clorhexidina.

A double-blinded randomized clinical trial of pain perception during orthodontic treatment / Ensaio clínico randomizado duplo cego de percepção da dor durante tratamento ortodôntico

Introduction: Orthodontic movement can cause painful symptoms, especially in the early stages of treatment. Objective: This study aimed to compare the performance of chewing gum and ibuprofen in pain control during the initial period of orthodontic treatment. Material and method: A randomized blind clinical trial, with an allocation ratio of 1:1, was developed with patients aged ≥18 years old. The sample size was established considering a significance level of 5% and test power of 80%, resulting in a minimum of 30 volunteers per group (n=90). Participants were paired regarding sex, age, the severity of malocclusion, defined by the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN), and crowding, determined by Little's irregularity index. The sample was randomly allocated to three groups: Group I (control) placebo; Group II chewing gum; and Group III Ibuprofen. Pain perception was evaluated by the Visual Analog Scale (VAS) in the first 24, 36, and 48 hours after activation of the orthodontic appliance. The data were analyzed by generalized linear models for repeated measures in time. Result: No statistically significant difference (p>0.05) was observed among the groups for the methods of pain therapy evaluated in 24, 36, and 48 hours post-activation. Conclusion: There was no difference among the method used for pain control during the orthodontic treatment.

Introdução: A movimentação ortodôntica pode causar sintomatologia dolorosa, principalmente nas fases iniciais do tratamento. Objetivo: Este estudo teve como objetivo comparar o desempenho da goma de mascar e do ibuprofeno no controle da dor durante o período inicial do tratamento ortodôntico. Material e método: Foi desenvolvido um ensaio clínico randomizado cego, com razão de alocação de 1:1, com pacientes com idade ≥ 18 anos. O tamanho da amostra foi estabelecido considerando um nível de significância de 5% e poder do teste de 80%, resultando em um mínimo de 30 voluntários por grupo (n=90). Os participantes foram pareados quanto ao sexo, idade, gravidade da má oclusão, definida pelo Componente de Saúde Bucal (DHC) do Índice de Necessidade de Tratamento Ortodôntico (IOTN), e apinhamento, determinado pelo índice de irregularidade de Little. A amostra foi distribuída aleatoriamente em três grupos: Grupo I (controle) placebo; Goma de mascar Grupo II; e Grupo III Ibuprofeno. A percepção da dor foi avaliada pela Escala Visual Analógica (EVA) nas primeiras 24, 36 e 48 horas após a ativação do aparelho ortodôntico. Os dados foram analisados por modelos lineares generalizados para medidas repetidas no tempo. Resultado Não foi observada diferença estatisticamente significativa (p>0.05) entre os grupos para os métodos de terapia da dor avaliados em 24, 36 e 48 horas pós-ativação. Conclusão: Não houve diferença entre o método utilizado para controle da dor durante o tratamento ortodôntico.

The impact of oral hygiene instruction on plaque control in orthodontic patients: a cross-sectional study / O impacto da instrução de higiene oral no controle da placa bacteriana em pacientes ortodônticos: um estudo transversal

Objective: Deficient dental plaque control is common in adolescents, mainly among those wearing orthodontic apparatus. This study aimed to compare plaque control and oral hygiene habits in adolescents with and without fixed orthodontic appliances. Additionally, it was investigated whether personalized oral hygiene instruction (OHI) could be a predictor for reducing dental plaque accumulation in orthodontic patients. Material and Methods: Sixty-nine patients, aged 12 to 20 years, were evaluated in a public organization which provides dental care. A questionnaire of oral hygiene habits was applied, and the number of natural teeth and number of teeth with visible biofilm were obtained during clinical examination. A comparative analysis of sociodemographic and clinical data was performed, splitting this population into two groups: those who used fixed orthodontic appliances (n=40) and those who did not (n=29). Results: There were no differences in oral hygiene habits among groups. The Poisson regression showed that adolescents with fixed appliances were 54% more likely to have dental plaque buildup compared to those who did not. Among individuals wearing orthodontic appliance, those who had not received personalized OHI before or during orthodontic treatment were 78% more likely to have a greater number of teeth with bacterial plaque compared to instructed ones. Conclusion: Especially among the adolescents wearing fixed orthodontic appliances, those who have not received personalized OHI were almost twice as likely to have a greater number of teeth with dental biofilm accumulation. Dentists and dental hygienists play a prominent role in motivating and improving the quality of individual oral hygiene (AU)

Objetivo: O controle deficiente da placa dental é comum em adolescentes, principalmente entre aqueles que usam aparelhos ortodônticos. Este estudo teve como objetivo comparar o controle da placa e os hábitos de higiene oral em adolescentes com e sem aparelhos ortodônticos fixos. Além disso, foi investigado se a instrução de higiene oral (IHO) personalizada poderia ser um preditor para reduzir o acúmulo de placa dental em pacientes ortodônticos. Material e métodos: Sessenta e nove pacientes, de 12 a 20 anos, foram avaliados em uma organização pública que presta atendimento odontológico. Foi aplicado um questionário sobre hábitos de higiene oral, e o número de dentes naturais e o número de dentes com biofilme visível foram obtidos durante o exame clínico. Foi realizada uma análise comparativa dos dados sociodemográficos e clínicos, dividindo essa população em dois grupos: aqueles que usavam aparelhos ortodônticos fixos (n = 40) e aqueles que não o usavam (n = 29). Resultados: Não houve diferenças nos hábitos de higiene oral entre os grupos. A regressão de Poisson mostrou que os adolescentes que tinham aparelhos fixos apresentaram 54% mais chance de ter mais acúmulo de placa dental comparados aos que não tinham. Entre os indivíduos que usavam aparelhos ortodônticos, aqueles que não receberam IHO personalizada antes ou durante o tratamento ortodôntico apresentaram 78% mais chance de ter maior número de dentes com placa bacteriana em comparação com os que a receberam. Conclusão: Especialmente entre os adolescentes que usavam aparelhos ortodônticos fixos, aqueles que não receberam IHO personalizada tiveram quase duas vezes mais chances de ter um número maior de dentes com acúmulo de biofilme dental. Dentistas e higienistas dentais desempenham um papel proeminente na motivação e na melhoria da qualidade da higiene oral do indivíduo. (AU)

Qualidade de vida de adolescentes em tratamento ortodôntico corretivo com aparelho fixo: avaliação longitudinal utilizando um instrumento condição específica / Quality of life of individuals undergoing orthodontic treatment with fixed appliance: a longitudinal evaluation using a condition specific questionnaire

O objetivo deste trabalho foi avaliar o impacto do primeiro ano de tratamento ortodôntico com aparelho fixo na qualidade de vida relacionada à saúde bucal (QVRSB) de adolescentes, através de um instrumento condição específica. Adolescentes entre 10-18 anos foram incluídos. Foram coletados dados para variáveis sociodemográficas sexo, idade, escolaridade dos pais, renda familiar (salário mínimo - SM) e número de indivíduos que dependiam daquela renda. Dados referentes às variáveis clínicas como extração de dentes com indicação ortodôntica, gravidade da má oclusão (avaliada com o Índice Estético Dental) e tempo de tratamento foram coletados. QVRSB foi avaliada através da versão brasileira do "Impact of Fixed Appliance Measure" (B-IFAM), com perguntas distribuídas em nove domínios: estética, limitação funcional, impacto na dieta, higiene oral, conservação do aparelho, impacto físico, impacto social, limitações do tempo e inconveniências de transporte/custo. As opções das respostas seguem a escala Likert de 1 a 5; 1=discordo totalmente e 5=concordo totalmente. Quanto maior o escore, mais negativa a percepção do adolescente para a QVRSB. Os participantes responderam ao questionário em T1, T2, T3 e T4 (1, 3, 6 e 12 meses após a colagem do aparelho). Esta tese deu origem a dois artigos científicos. Estatística descritiva foi realizada. Para as análises de comparação entre os sexos foram empregados teste de Pearson, teste t Student, teste de Fisher, regressão linear, cálculo da diferença clínica minimamente importante (DCMI) e do tamanho do efeito. A associação dos fatores sociodemográficos e clínicos com a QVRSB foi avaliada através da Análise de Covariância. O nível para significância estatística foi p<0,05. No primeiro artigo 38 meninas e 31 meninos foram avaliados. Meninas apresentaram um impacto mais negativo do uso do aparelho fixo no escore total do B-IFAM (p=0,006) e nos domínios impacto estético (p=0,034) e impacto físico (p=0,011), quando comparadas com meninos entre T2 e T4. Para os dois domínios, as diferenças entre meninos e meninas foram maiores que a DCMI e o tamanho do efeito moderado. No segundo artigo, 75 adolescentes foram avaliados. Indivíduos com ≤12 anos apresentaram uma percepção mais negativa do domínio impacto na dieta que indivíduos com >12 anos (p=0,026). Indivíduos cujos pais/responsáveis tinham escolaridade ≥8 anos apresentaram uma percepção mais negativa do domínio impacto na higiene do que indivíduos cujos pais/responsáveis tinham escolaridade <8 anos (p=0,024). Indivíduos cujas famílias tinham uma renda ≤2 SMs apresentaram uma percepção mais negativa do domínio impacto na conservação do que indivíduos cujas famílias tinham uma renda >2 SMs (p=0,016). Meninas apresentaram uma percepção mais negativa do domínio impacto físico do que meninos (p<0,018). Meninas, adolescentes cujas famílias tinham uma renda ≤2 SMs e adolescentes com má oclusão grave apresentaram uma percepção mais negativa do domínio inconveniências de transporte/custo do que meninos (p=0,011), adolescentes com má oclusão leve (p=0,026) e adolescentes cujas famílias tinham uma renda >2 SMs (p=0,003). Meninas apresentaram o escore total do B-IFAM significativamente maior do que meninos (p=0,041). Sexo, idade, gravidade da má oclusão dos adolescentes, escolaridade dos pais e renda familiar foram associados ao impacto do tratamento ortodôntico na QVRSB dos adolescentes.

The aim of this study was to evaluate the impact of the first year of orthodontic treatment with fixed appliances on adolescents' oral health-related quality of life (OHRQoL), in an assessment employing a condition-specific instrument. Adolescents between 10 and 18 years were included. Data on the sociodemographic variables, such as sex, age, parents' schooling, family income (minimum wage-MW), and number of individuals depending on this income were collected. Data on the clinical variables orthodontic extraction, malocclusion severity (assessed with the Dental Aesthetics Index), and treatment time were also collected. OHRQoL was evaluated with the Brazilian version of the "Impact of fixed appliance measure" (B-IFAM) with questions distributed across nine domains: aesthetics, functional limitations, dietary impact, oral hygiene impact, maintenance, physical impact, social impact, time constraints, and travel/cost/inconveniences. Response options followed a Likert scale ranging between 1 and 5; 1=strongly disagree and 5=strongly agree. The higher score, the more negative was the perception of the adolescent regarding his/her OHRQoL. Participants answered the questionnaire at T1, T2, T3, and T4 (1, 3, 6, and 12 months after fixed appliance bonding). Two scientific articles were drafted. Descriptive statistics was performed. For the analysis of comparison between girls and boys, Pearson's test, Student t test, Fisher's test, linear regression, calculation of the minimal clinically important difference (MCID) and effect size were performed. The association of sociodemographic and clinical variables with OHRQoL was evaluated with the Analysis of Covariance. Statistical significance was set at p<0.05. In the first article, 38 girls and 31 boys were assessed. Girls had a more negative impact of the fixed appliance wearing on the B-IFAM total score (p=0.006) and on the aesthetics (p=0.034) and physical impact (p=0.011) domains, when compared with boys between T2 and T4. For both domains, differences between boys and girls were greater than the MCID. The effect size was moderate. In the second article, 75 adolescents were assessed. Individuals who were ≤12 years had a more negative perception of the domain dietary impact than individuals who were >12 years (p=0.026). Individuals whose parents/caregivers had ≥8 years of schooling had a more negative perception of the domain oral hygiene impact than individuals whose parents/caregivers had <8 years of schooling (p=0.024). Individuals whose families had an income ≤2 MWs had a more negative perception of the domain maintenance impact than individuals whose families had an income >2 MWs (p=0.016). Girls had a more negative perception of the domain physical impact than boys (p<0.018). Girls, adolescents whose families had an income ≤2 MWs, and adolescents with severe malocclusion had a more negative perception of the domain travel/cost/inconveniences than boys (p=0.011), adolescents with slight malocclusion (p=0,026) and adolescents whose families had an income >2 MWs (p=0.003). Girls exhibited a total score of the B-IFAM significantly higher than boys (p=0.041). Adolescents' sex, age, and malocclusion as well as parents'/caregivers' schooling and family income were associated with the impact of orthodontic treatment on adolescents' OHRQoL.

Nuevas opciones de aparatos funcionales para tratar pacientes con retrognatismo mandibular / New functional appliance options for treating patients with mandibular retrognathia

RESUMEN Fundamento: El estudio sobre los aparatos actuales de la ortopedia funcional de los maxilares puede aportar nuevos conocimientos para el perfeccionamiento del tratamiento de pacientes con retrognatismo mandibular. Objetivo: Profundizar en los nuevos aparatos de la ortopedia funcional de los maxilares para el tratamiento de pacientes con retrognatismo mandibular. Desarrollo: Se realizó una revisión bibliográfica en las bases de datos SciELO, PubMed, Ebsco, Cumed y Lilacs. En la búsqueda se revisaron 37 artículos, de ellos más del 80 % son de los últimos cinco años. Se identificaron bases teóricas de la ortopedia funcional de los maxilares en el tratamiento de pacientes con retrognatismo mandibular y los aparatos que se utilizan en la actualidad. Conclusiones: Existen nuevas opciones de aparatos funcionales, en su mayoría fijos y clasificados como dentosoportados pasivos, para el tratamiento de pacientes con retrognatismo mandibular.

ABSTRACT Background: The study of the current jaw functional orthopedic appliances can provide new knowledge for the improvement of the patients' treatment with mandibular retrognathia. Objective: To study deeply the current jaw functional orthopedic appliances for the patients' treatment with mandibular retrognathia. Development: A bibliographic review was conducted in the SciELO, PubMed, Ebsco, Cumed and Lilacs databases. A total of 37 articles were reviewed, more than 80 % from the last five years. Theoretical bases on the jaw functional orthopedics in the patients' treatment with mandibular retrognathia and current appliances in use were identified. Conclusions: New functional appliance options, mostly fixed and classified as passive dent supportive, are available for the patients' treatment with mandibular retrognathia.

Revisión de los principales manejos ortodónticos interceptivos y correctivos no quirúrgicos de la maloclusión clase III / Review of the main non-surgical interceptive and corrective orthodontic management of Class III malocclusion

La maloclusión clase III se considera un reto en la práctica de todo ortodoncista. Una de las principales dudas al respecto reside en ¿cuándo es el mejor momento para intervenir? Exis- ten dos enfoques en el manejo ortodóntico del paciente: 1) la ortodoncia interceptiva; y 2) la ortodoncia correctiva. La or- todoncia interceptiva busca la prevención del establecimiento de la malolcusión. En este grupo, se encuentra el uso de más- cara facial con disyunción maxilar y el de aparatología fija (2x4 o 2x6). Por otro lado, la intervención correctiva hace re- ferencia al camuflaje de las características que trae consigo la maloclusión clase III ya establecida; dentro de este enfoque se encuentran las extracciones de piezas, el uso de minitornillos extraalveolares y la filosofía MEAW. Se puede concluir que el adecuado manejo de la maloclusión clase III radica en el oportuno y correcto diagnóstico, que debe realizarse a través de la minuciosa inspección de las características y hallazgos intra y extraorales de los pacientes (AU)

Class III malocclusion is considered a challenge in the practice of every orthodontist. One of the main questions is: when is the best time to intervene? There are 2 approaches to the orthodontic management of the patient: 1) interceptive orthodontics, and 2) corrective orthodontics. Interceptive or- thodontics seeks to prevent the establishment of malocclusion by means of the use of a facial mask with maxillary disjunc- tion, or the use of fixed appliances (2x4 or 2x6). Corrective intervention refers to camouflaging the characteristics of a Class III malocclusion that is already established. This ap- proach uses tooth extraction, extra-alveolar mini screws or the MEAW philosophy. To conclude, proper management of Class III malocclu- sion is based on timely, correct diagnosis, which must be made through careful inspection of the characteristics and intraoral and extraoral findings in patients (AU)

Correção da má oclusão de classe II com propulsor mandibular: revisão de literatura / Correction of class II malocclusion with mandibular trusters: literature review

Introdução: a má oclusão de classe II consiste no desequilíbrio da relação entre as arcadas, podendo ser causada por deficiência mandibular, protrusão maxilar, ou ambas, sendo caracterizada pelo molar inferior distalmente posicionado em relação ao molar superior. Objetivo: este estudo tem o objetivo de apresentar uma revisão de literatura sobre a eficiência dos propulsores mandibulares fixos disponíveis no mercado odontológico no tratamento da má oclusão de classe II. Métodos: a pesquisa foi realizada nas bases de dados Google Acadêmico, SciELO e PubMed, para filtragem dos artigos selecionados. Para revisão de literatura, foram utilizados 17 artigos. Entre os protocolos de tratamento de classe II, esses aparelhos se destacam por serem fixos, por esse motivo, não dependem da colaboração direta do paciente. Com o passar dos anos, os propulsores mandibulares fixos foram cada vez mais aprimorados, oferecendo mais simplicidade na sua instalação e maior conforto ao paciente. Considerações finais: concluiu-se que os aparelhos funcionais propulsores mandibulares fixos são uma ótima escolha para o tratamento compensatório na má oclusão de classe II, sendo eficazes na correção da relação dentária e dependendo de menor cooperação do paciente.(AU)

Introduction: class II malocclusion consists of an imbalance in the relationship between the arches, which can be caused by mandibular deficiency, maxillary protrusion, or both, and is characterized by the mandibular molar distally positioned in relation to the maxillary molar. Objective: this study aims to present a literature review on the efficiency of fixed mandibular thrusters available in the dental market in the treatment of Class II malocclusion. Methods: the research was carried out in the Google Scholar, SciELO and PubMed databases to filter the selected articles. For literature review, 17 articles were used. Among Class II treatment protocols, these devices stand out for being fixed, for this reason, they do not depend on the direct collaboration of the patient. Over the years, fixed mandibular thrusters have been increasingly improved, offering more simplicity in their installation and greater comfort to the patient. Final considerations: it was concluded that the fixed mandibular thrusters functional devices are a great choice for compensatory treatment in Class II malocclusion, being effective in correcting the dental relationship and depending on less patient cooperation.(AU)

Orthodontic Emergencies and Perspectives During and After the COVID-19 Pandemic: The Italian Experience

ABSTRACT Objective: To investigate the types of dental emergencies that occurred during the lockdown period in Italy (12th March-4th May) and to investigate future therapeutic preferences related to the use of different types of appliances. Material and Methods: A questionnaire dedicated to assessing dental emergencies during the lockdown period and surveying the resumption of orthodontic practice was submitted to clinicians in digital form. The first part of the questionnaire, focused on the orthodontic emergencies that were encountered in relation to the different types of orthodontic appliances and how these were resolved. The second part of the questionnaire was devoted to the resumption of clinical practice; in particular, it was designed to assess whether and what percentage of clinicians are willing to change the duration of appointments in relation to the different types of appliance used, asking them whether their approach to orthodontic treatment would change in the coming months as compared to the pre-COVID-19 era. Results: Results show that in most cases (82%), the percentage of patients who experienced a dental emergency was less than 5% and that far fewer emergencies were attributable to removable (5.7%) than to fixed appliances (94.3%). Looking ahead, clinicians expressed a greater preference for using removable (60.8%) rather than fixed appliances (39.2%). Conclusion: During the lockdown, there relatively few orthodontic emergencies, many of which were handled by telephone consultation. However, a far lower percentage of emergencies were generated by removable (e.g., clear aligners) as opposed to fixed appliances (e.g., multibracket equipment), likely influencing the decision of the majority of clinicians to opt for removable appliances in the wake of the COVID-19 pandemic.

Attractiveness of the facial profile: comparison of Class II patients treated with Twin Force® or intermaxillary elastics

ABSTRACT Objective: To compare the facial profile attractiveness of Class II patients treated with Twin Force® or intermaxillary elastics. Methods: Sample comprised 47 Class II patients divided into two groups: G1) TWIN FORCE - 25 patients treated with fixed appliances and Twin Force® fixed functional appliance (mean initial age was 17.91 ± 7.13 years, mean final age was 20.45 ± 7.18 years, and mean treatment time was 2.53 ± 0.83 years); G2) ELASTICS - 22 patients treated with fixed appliances and Class II intermaxillary elastics (mean initial age was 15.87 ± 5.64 years, mean final age was 18.63 ± 5.79 years and mean treatment time was 2.75 ± 0.60 years). Lateral cephalograms from pretreatment and posttreatment were used. Cephalometric variables were measured and silhouettes of facial profile were constructed and evaluated by 48 laypeople and 63 orthodontists, rating the attractiveness from 0 (most unattractive profile) to 10 (most attractive profile). Intergroup comparisons were performed with Mann-Whitney and independent t-tests. Results: At pretreatment, facial profile of the Twin Force® group was less attractive than the Elastics group. Treatment with Twin Force® or Class II elastics resulted in similar facial profile attractiveness, but the facial convexity was more reduced in the Twin Force® group. Orthodontists were more critical than laypeople. Conclusions: Treatment with Twin Force® or Class II elastics produced similar facial profile attractiveness at posttreatment. Profile attractiveness was reduced with treatment in the elastic group, and improved in the Twin Force® group. Facial convexity was more reduced with treatment in the Twin Force® group.

RESUMO Objetivo: Comparar a atratividade do perfil facial em pacientes Classe II tratados com Twin Force® ou elásticos intermaxilares. Métodos: A amostra foi composta por 47 pacientes Classe II divididos em dois grupos: G1 - Twin Force® (25 pacientes tratados com aparelhos fixos e o aparelho funcional Twin Force®; idade inicial média de 17,91 ± 7,13 anos, idade final média de 20,45 ± 7,18 anos, e tempo médio de tratamento de 2,53 ± 0,83 anos); G2 - Elásticos (22 pacientes tratados com aparelhos fixos e elásticos intermaxilares de Classe II, idade inicial média de 15,87 ± 5,64 anos, idade final média de 18,63 ± 5,79 anos, e tempo médio de tratamento de 2,75 ± 0,60 anos). Foram usadas telerradiografias laterais pré- e pós-tratamento. As variáveis cefalométricas foram mensuradas, e silhuetas do perfil facial foram construídas e avaliadas por 48 leigos e 63 ortodontistas, que pontuaram a atratividade entre 0 (perfil menos atraente) e 10 (perfil mais atraente). As comparações intergrupos foram realizadas com os testes Mann-Whitney e t de Student para amostras independentes. Resultados: Na fase pré-tratamento, o perfil facial no grupo Twin Force® foi menos atrativo do que no grupo Elásticos. Os tratamentos com o Twin Force® ou com Elásticos de Classe II resultaram em atratividade semelhante do perfil facial, mas a convexidade facial foi mais reduzida no grupo Twin Force®. Os ortodontistas foram mais críticos do que os leigos. Conclusões: Apesar de os tratamentos com o Twin Force® ou com Elásticos de Classe II terem resultado em atratividade semelhante do perfil facial após o tratamento, a atratividade do perfil foi reduzida com o tratamento no grupo Elásticos e melhorou no grupo Twin Force®. A convexidade facial foi mais reduzida com o tratamento no grupo Twin Force®.

Effectiveness of Fully Customized Lingual Orthodontic Treatment: A Retrospective Pilot Study

ABSTRACT Objective: To investigate the effectiveness of Suresmile® lingual therapy on torque, tip, and rotations measures through digital evaluation of planning and post-treatment digital models. Material and Methods: A sample of 12 Caucasian adult patients (4 men; mean age 30.6 years ± 3.9 and 8 women; mean age 31.4 years ± 4.5) treated with the Suresmile® lingual orthodontic technique was retrospectively selected, regardless of the type of malocclusion. Digital planning was performed with Suresmile® software, while lingual therapy was accomplished with interactive self-ligating lingual brackets and customized Suresmile® arches. First, digital models of planning and post-treatment digital models were compared using VAM software (and the discrepancies were analyzed through MANOVA and four multivariate. Then, Tukey and Bonferroni's post-hoc tests are performed. Results: The accuracy average values are 60.11 ± 27.67% for torque, 53.52 ± 27.37% for tip and 59.19 ± 26.42% for rotation, while for inaccuracy values are 2.72° ± 2.23° for torque, 2.98° ± 2.16°for tip and 3.58° ± 3.29° for rotation. No significant differences have been recorded evaluating different sectors of both arches. Conclusion: This retrospective preliminary study highlight how overcorrections, especially in the Suresmile lingual technique, should be performed during orthodontic planning. Moreover, the study gets bases for further, more structured future studies that should involve larger and more homogeneous samples.

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.

Alteraciones dentarias en piezas sometidas a fuerzas de ortodoncia con técnica de Arco Recto / Dental alterations in pieces subjected to orthodontic forces with the straight wire technique

El objetivo fue evaluar radiográficamente las alteraciones dentarias en piezas sometidas a fuerzas ortodóncicas. Se analizaron 2871 piezas dentarias por observación radiográfica pre y post tratamiento. Variables registradas: sexo, edad, tipo de alteración, pieza dentaria y grado de reabsorción. Se calcularon intervalos de confianza 95% por método score de Wilson. Se utilizó prueba de bondad de ajuste Chi cuadrado, comparando frecuencias observadas con frecuencias esperadas bajo independencia. Se utilizó prueba de diferencia de proporciones, estadístico de Fisher y prueba Chi-cuadrado de asociación. Se concluyó que las alteraciones dentarias post tratamiento de ortodoncia son frecuentes y se originan en factores biológicos y mecánicos. La mayor tasa de prevalencia son las reabsorciones radiculares. Es responsabilidad del ortodoncista conocer todos los factores de riesgo con el fin de prevenirlas o detenerlas a tiempo (AU)

Adjunctive orthodontic management of a missing upper right central incisor in a 12-year-old male using a fixed orthodontic appliance

This article presents a successful orthodontic management of a 12-year-old male using a fixed orthodontic appliance (straight wire technique). His orthodontic treatment was hinged on creating enough space to accept an artificial tooth, correcting the horizontal and vertical relationships of the upper incisors to the lower and the midline shift. Ultimately, an esthetic smile was achieved; function and self-esteem were improved when the artificial tooth was finally fixed.

Improvement in awareness levels and periodontal health among patients undergoing fixed orthodontic appliance therapy with established gingivitis and periodontal health maintenance program: a questionnaire based study / Mejora de los niveles de conciencia y salud periodontal entre pacientes sometidos a terapia con aparatos de ortodoncia fijos con gingivitis establecida y programa de mantenimiento de la salud periodontal: un estudio basado en cuestionarios

Objetive: Home oral care practices in patients undergoing orthodontic therapy are often ineffective in maintaining optimal plaque control. The aim of the present study was to assess the effectiveness of periodontal maintenance program in subjects with established gingivitis undergoing fixed orthodontic appliance therapy for one year. Material and Methods: Forty patients undergoing fixed orthodontic appliance therapy with established chronic gingivitis were recruited for the study. As a part of a periodontal maintenance program, a pre-validated structured questionnaire evaluating oral hygiene and periodontal health was administered at the baseline as well as at the end of the study. At the baseline Gingival Bleeding Index, Gingival Index, and Bonded Bracket Plaque Index scores were recorded, Scaling and polishing procedure was performed followed by a customised Oral Hygiene Advice (OHA) session was conducted for all the study subjects. Clinical indices were assessed and OHA was conducted at the 3rd, 6th, 9th, and 12th months of orthodontic treatment visits. Results: There was significant improvement in the clinical indices and awareness regarding oral hygiene and periodontal health level in the patients at the end of the 12th month. Conclusion: The periodontal maintenance program appeared to be effective in improving the periodontal health and awareness health awareness level about oral hygiene among patients undergoing fixed orthodontic therapy at the end of 12 months in our study population.

Objetivo: Las prácticas de cuidado bucal en el hogar en pacientes sometidos a terapia de ortodoncia suelen ser ineficaces para mantener un control óptimo de la placa. El objetivo del presente estudio fue evaluar la efectividad del programa de mantenimiento periodontal en sujetos con gingivitis establecida sometidos a terapia con aparatos de ortodoncia fijos durante un año. Material y Métodos: Se reclutó para el estudio a 40 pacientes sometidos a terapia con aparatos de ortodoncia fijos y con gingivitis crónica establecida. Como parte de un programa de mantenimiento periodontal, se administró un cuestionario estructurado pre-validado que evaluaba la higiene bucal y la salud periodontal al inicio y al final del estudio. En la línea de base, se registraron las puntuaciones del índice de sangrado gingival, el índice gingival y el índice de placa de soporte adherido, se realizó el procedimiento de raspado y pulido seguido de una sesión personalizada de consejos de higiene oral (CHO) para todos los sujetos del estudio. Se evaluaron los índices clínicos y se llevó a cabo la CHO a los 3, 6, 9 y 12 meses durante las visitas de tratamiento de ortodoncia. Resultados: Hubo una mejora significativa en los índices clínicos y la conciencia sobre la higiene oral y el nivel de salud periodontal en los pacientes al final del 12º mes. Conclusión: El programa de mantenimiento periodontal pareció ser eficaz para mejorar la salud periodontal y el nivel de conciencia de la salud sobre la higiene bucal entre los pacientes sometidos a terapia de ortodoncia fija al final de los 12 meses en nuestra población de estudio.