Histological Evaluation of the Effect of Alendronate on the Maxillary Bone of Wistar Rats Combined with Orthodontic Movement of Intense Force / Evaluación Histológica del Efecto del Alendronate en el Hueso Maxilar de Ratas Wistar Combinado con Movimiento de Ortodoncia de Fuerzas Intensas

SUMMARY: To evaluate the histological adverse effects of alendronate administered systemically and topically in combination with orthodontic movement by intense force. Thirty-six 24-week-old female Wistar rats, ovariectomized, were used and divided into three groups (n = 12/group): control, locally treated with saline (0.07 ml/kg/week) (group 1) and experimental, treated with alendronic acid systemically (0.07 mg/kg/week) (group 2) and locally (7 mg/kg/week) (group 3). At 14 days, an orthodontic anchor was installed in the right first molar, and a force of 144 cN was applied for 28 days. The samples were processed for histological evaluation. Descriptive statistics, Shapiro-Wilk tests, one-way ANOVA with Bonferroni correction, one-way repeated measures ANOVA and chi-square tests were performed. All tests were statistically significant at p <0.05. The adverse events found in all groups were inflammation and osteoclastic activity. In the bisphosphonate-treated groups, there were statistically significant differences (p = 0.005) in the osteoclastic activity between the two hemiarcates. All rats in group 2 presented paralytic ileus. Compared to local administration, systemic treatment with alendronic acid produces more adverse effects, such as inflammation, fibrinoid necrosis, and osteoclastic activity. During the application of intense forces, it was not possible to show that there is necrosis associated with bisphosphonates.

Evaluar los efectos adversos histológicos del alendronato administrado sistémica y tópicamente en combinación con movimientos ortodóncicos de fuerza intensa. Treinta y seis ratas Wistar hembras de 24 semanas de edad, ovariectomizadas, fueron utilizadas y divididas en tres grupos (n = 12/grupo): control, tratado localmente con solución salina (0,07 ml/kg/semana) (grupo 1) y experimental, tratados con ácido alendrónico por vía sistémica (0,07 mg/kg/semana) (grupo 2) y local (7 mg/kg/semana) (grupo 3). A los 14 días se instaló un anclaje de ortodoncia en el primer molar derecho y se aplicó una fuerza de 144 cN durante 28 días. Las muestras fueron procesadas para evaluación histológica. Se realizó estadística descriptiva, pruebas de Shapiro-Wilk, ANOVA de una vía con corrección de Bonferroni, ANOVA de medidas repetidas de una vía y pruebas de chi-cuadrado. Todas las pruebas fueron estadísticamente significativas con un p <0,05. Los eventos adversos encontrados en todos los grupos fueron inflamación y actividad osteoclástica. En los grupos tratados con bisfosfonatos hubo diferencias estadísticamente significativas (p = 0,005) en la actividad osteoclástica entre los dos hemiarcados. Todas las ratas del grupo 2 presentaron íleo paralítico. En comparación con la administración local, el tratamiento sistémico con ácido alendrónico produce más efectos adversos, como inflamación, necrosis fibrinoide y actividad osteoclástica. Durante la aplicación de fuerzas intensas, no fue posible demostrar que existe necrosis asociada con los bisfosfonatos.

Channa Striata and Hyperbaric Oxygen Therapy Combination for Pressure Areas in Orthodontic Treatment

ABSTRACT Objective: To study the effect of using a combination of Channa Striata gel and hyperbaric oxygen therapy on pressure areas during orthodontic treatment. Material and Methods: The study was conducted using the ARRIVE Essential 10 guidelines. In this study, 35 3-4 months male guinea pigs (Cavia Cobaya) weighing 300-400 grams were used and divided into 5 groups (n=7). Decalcification was performed to dissolve the dental calcium and jawbone to cut the tissue properly. The decalcification was performed for 30 days. Then preparations were made with HE (Hematoxylin Eosin), observed using a microscope, and counted the number of osteoclasts and macrophages on a light microscope with 400 times magnification. The results of the preparations were analyzed using the SPSS program. Results: The Kruskal-Wallis test of macrophage cells and the ANOVA test of osteoclast cells showed significant results between all groups (p<0.05). Conclusion: The effect of hyperbaric oxygen therapy 2,4 ATA administered on days 8-14 and Channa Striata extract gel administered on days 3-14 can increase the number of macrophages in the periodontal ligament and osteoclasts in the alveolar bone in the pressure area during orthodontic tooth movement.

Expansion treatment using Invisalign®: Periodontal health status and maxillary buccal bone changes. A clinical and tomographic evaluation / Tratamiento de expansión con Invisalign®: estado de salud periodontal y cambios óseos maxilares. Evaluación clínica y tomográfica

ABSTRACT The aim of this study was to evaluate changes in periodontal status and maxillary buccal bone by considering clinical and tomographic parameters during the first year of orthodontic expansion with Invisalign® aligners. Upper first (1PM) and upper second (2PM) premolars of 19 patients with orthodontic expansion requirement treated with Invisalign® aligners were evaluated. Plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL) and cone beam tomographic (CBCT) records were collected at 76 sites before starting treatment (T0) and at 12 months (T1). Bone height was measured from cementoenamel junction (CEJ) to the crest cortical bone (CC). Bone thickness was measured at two levels: 4 mm (CEJ+4) and 6 mm (CEJ+6) apical to the CEJ. A descriptive analysis was made of the variations of bone thickness and height in a series of cases. The average expansion was 1.93 mm for 1PM and 167 mm for 2PM. Arithmetic mean of distance CEJ-CC in 1PM was 3.05 mm at T0, and remained at 3.05 mm at T1. Arithmetic mean of distance CEJ-CC in 2PM was 2.06 mm at T0 and 2.31 at T1. Post-expansion, most of the analyzed sites (86%) exhibited a bone thickness of ≥0.5 mm. The greatest variations between T0 and T1 were observed at the level of 1PM CEJ+ 4 and 2PM CEJ+ 6. The minimal changes in the clinical records (GI, PI, PPD and CAL) between T0 and T1 were compatible with the maintenance of gingivalperiodontal health. Invisalign® for expansion movements did not produce substantial changes in the evaluated periodontal clinical parameters or in the bone measurements. Removable appliances reduce plaque retentive factors and favor adequate oral hygiene.

RESUMEN El objetivo de este estudio fue evaluar los cambios en el estado periodontal y hueso facial maxilar a través de parámetros clínicos y tomográficos durante la expansión ortodóncica con alineadores Invisalign® en el primer año de tratamiento. Se evaluaron los primeros (1PM) y segundos (2PM) premolares superiores pertenecientes a 19 pacientes con requerimiento de expansión ortodóncica tratados con alineadores Invisalign®. Se registraron los índices de placa (IP), índice gingival (IG), profundidad al sondaje (PS) y nivel de inserción (NI) y registros tomográficos de haz cónico (CBCT) en 76 sitios antes de comenzar el tratamiento (T0) y a los 12 meses (T1). Se midió la altura ósea desde el límite amelocementario (LAC) hasta la cortical de la cresta (CC) y el espesor en dos niveles; a 4 mm (LAC+4) y a 6 mm (LAC+6) hacia apical del LAC. Se realizó un análisis descriptivo de las variaciones de la altura y espesor óseo en una serie de casos. La expansión promedio para 1PM fue de 1,93 mm y para 2PM fue de 1,67 mm. La media aritmética de LAC-CC en primeros premolares fue de 3,05 mm en T0 y se mantuvo el valor de 3,05 mm en T1. La media aritmética de LAC-CC en segundos premolares fue de 2,06 mm en T0 y 2,31 en T1. Post expansión, la mayoría de los sitios (86%) analizados exhibieron un espesor óseo ≥0,5 mm. Las mayores variaciones entre T0 y T1 se observaron a nivel de 1PM CEJ+4 y 2PM CEJ+6. Los registros clínicos (PI, GI, PPD y CAL) evidenciaron mínimos cambios entre T0 y T1, compatibles con el mantenimiento de la salud gíngivo-periodontal. El uso de Invisalign ® para movimientos de expansión no produjo cambios sustanciales en los parámetros clínicos periodontales evaluados ni en las mediciones óseas. La aparatología removible reduce los factores retentivos de placa bacteriana y facilita una adecuada higiene oral.

Prospective clinical study of transverse development with orthodontics with self-ligating brackets / Estudio clínico prospectivo del desarrollo transversal con ortodoncia con brackets autoligables

ABSTRACT Orthodontics with low friction, low force, passive self-ligating brackets produces alveolar-dental remodeling, resulting in an increase in the transverse diameter of the dental arches, especially in the premolar sector. The aim of this study was to compare the modifications of the transverse diameter in the pre- and post-dental alignment cast models with orthodontics with passive self-ligating brackets in patients with moderate to severe dental discrepancy. The study included 28 patients of both sexes aged 16 to 48 years with dental discrepancies between -6 and -16 mm, treated with self-ligating Damon brackets and thermally activated Nickel- Titanium-Copper arches. With a digital pachymeter, Mitutoyo brand, five measurements were taken per dental arch: distance between canines (C), first premolars (1PM), second premolars (2 PM), first molars (1M) and second molars (2M), before and after orthodontic alignment. The variations were statistically evaluated by Student T Test for paired samples. Average distance between teeth varied with dental alignment in both jaws. The greatest increases in transverse diameter were recorded in the premolar areas. Minor though statistically significant variations also occurred in the 2M of the maxilla and in the C of the mandible In alignment with passive self-ligating brackets, there is an increase in the transverse diameter due to the development of the dental arches, mainly in the premolar sector of both jaws and also at the level of the canines in the mandible.

RESUMEN La ortodoncia con brackets autoligables pasivos, de baja fricción y baja fuerza, produce remodelación alvéolodentaria; con aumento del diámetro transversal de las arcadas, especialmente en el sector de los premolares. El objetivo de este trabajo fue comparar las modificaciones del diámetro transversal en los modelos de yeso pre y post alineación dentaria con ortodoncia con brackets autoligables pasivos en pacientes con discrepancia dentaria moderada a severa. El estudio incluyó 28 pacientes de ambos sexos de entre 16 y 48 años de edad con discrepancia dentaria entre -6 y -16mm, tratados con brackets autoligables sistema Damon y arcos termo activables de Níquel-Titanio-Cobre. Con un paquímetro digital marca Mitutoyo, se tomaron 5 medidas por arcada: distancia entre caninos (C), primeros y segundos premolares (1 PM y 2 PM) y primeros y segundos molares (1M y 2M); pre y post alineación ortodóncica. Las variaciones registradas fueron evaluadas estadísticamente mediante Student T Test para muestras apareadas. La distancia promedio entre dientes varió con la alineación dentaria en ambos maxilares. Los mayores aumentos del diámetro transversal se registraron en las zonas de los premolares. Se produjeron también variaciones menores, aunque estadísticamente significativas, en los 2M del maxilar superior y en los C del maxilar inferior. En la alineación con brackets autoligables pasivos, hay incremento del diámetro transversal por desarrollo de las arcadas, principalmente en el sector premolar de ambos maxilares y en el maxilar inferior también a nivel de los caninos.

Una Descripción General y Actualizada de Miniplacas y Minitornillos. Efectos Dentoalveolares y Esqueléticos / A General and Updated Description of Miniplates and Miniscrews. Dentoalveolar and Skeletal Effects

RESUMEN: En ortodoncia, las miniplacas se utilizan como dispositivo de anclaje temporal (TAD) para la realización de movimientos dentales que permiten el uso de fuerzas ortopédicas en ellos. En comparación con los mini tornillos, las miniplacas tienen la ventaja de una tasa de falla muy baja, pero la desventaja es que para la extracción se necesita el mismo acto quirúrgico que se realizó para la instalación. El objetivo de este estudio es realizar una revisión bibliográfica de las indicaciones de miniplacas en pacientes con mordidas abiertas, clase II y anomalías de clase III, y buscar cómo las miniplacas han mejorado los tratamientos de ortodoncia. La información principal se reunió buscando en PubMed con las palabras clave enumeradas a continuación. Afirmamos que las miniplacas están indicadas para la retracción en masa de la arcada, donde se observó que la fuerza de 150 g aplicada en los molares superiores es suficiente no solo para empujar los molares hacia atrás en una clase I corregida, sino también para iniciar la retracción de premolares, caninos e incisivos. En pacientes con mordida abierta, las miniplacas se definen como un método seguro, una alternativa rápida y menos costosa a la cirugía ortognática. Y en pacientes de las clases II y III se utilizan sin producir efectos dentoalveolares que sustituyan a los dispositivos extraorales como máscaras, con dispositivos intraorales y elásticos (BAMP).

ABSTRACT: In orthodontics, miniplates are used as a Temporary Anchoring Device (TAD) for the purpose dental movements, allowing the use of orthopedic forces. In comparison with mini-screws, miniplates have the advantage of a very low rate of failure. Nonetheless, their removal requires the same surgical procedure as during installation, which is an obvious disadvantage. The aim of this study is to review the indications of miniplates in patients with open bite, class II and class III anomalies, and review how miniplates improved orthodontics treatments. Information was obtained by a search in PubMed with the keywords listed below. Miniplates are indicated for retraction in mass of the arcade, where it was seen that the force of 150 g applied on maxillary molars, is sufficient not only to push the molars back into a corrected class I, but also to initiate retraction of premolars, canines, and incisors. In open-bite patients, mini plates, are achieved as a safe method, that is quick and a less expensive alternative to orthognathic surgery. Further, in class II and III patients they are used without producing dentoalveolar effects replacing extraoral devices as facemasks, with intraoral devices and elastics. (BAMP).

Class II malocclusion treatment changes with the Jones jig, Distal jet and First Class appliances

Abstract Objective Maxillary molar distalization with intraoral distalizer appliances is a non-extraction orthodontic treatment used to correct molar relationship in patients with Class II malocclusion presenting maxillary dentoalveolar protrusion and minor skeletal discrepancies. This study compares the changes caused by three distalizers with different force systems. Methodology 71 patients, divided into three groups, were included. The Jones jig group (JJG, n=30; 16 male, 14 female, 13.17 years mean age) was treated with the Jones jig for 0.8 years. The Distal jet group (DJG, n=25; 8 male, 17 female, 12.57 years mean age) was treated with the Distal jet for 1.06 years. The First Class group (FCG, n=16; 6 male, 10 female, 12.84 years mean age) was treated with the First Class for 0.69 years. Intergroup treatment changes were compared using one-way ANOVA, followed by post-hoc Tukey's tests. Results Intergroup comparisons showed significantly greater maxillary incisor protrusion in DJG than in FCG (2.56±2.24 mm vs. 0.74±1.39mm, p=0.015). The maxillary first premolars showed progressive and significantly smaller mesial angulation in JJG, FCG and DJG, respectively (14.65±6.31º, 8.43±3.99º, 0.97±3.16º; p<0.001). They also showed greater mesialization in JJG than FCG (3.76±1.46 mm vs. 2.27±1.47 mm, p=0.010), and greater extrusion in DJG compared to JJG (0.90±0.77 mm vs 0.11±0.60 mm, p=0.004). The maxillary second premolars showed progressive and significantly smaller mesial angulation and mesialization in JJG, FCG and DJG, respectively (12.77±5.78º, 3.20±3.94º, -2.12±3.71º and 3.87±1.34 mm, 2.25±1.40 mm, 1.24±1.26 mm, respectively; p<0.001). DJG showed smaller distal angulation of maxillary first molars (-2.14±5.09º vs. -7.73±4.28º and -6.05±3.76º, for the JJG and FCG, respectively; p<0.001) and greater maxillary second molars extrusion (1.17±1.41 mm vs -0.02±1.16 mm and 0.16±1.40 mm, for the JJG and FCG, respectively; p=0.003). Overjet change was significantly larger in DJG compared to FCG (1.79±1.67 mm vs 0.68±0.84; p=0.046). Treatment time was smaller in FCG (0.69±0.22 years vs 0.81±0.33 years and 1.06±0.42 years, comparing it with the JJG and DJG, respectively; p=0.005). Conclusion The three appliances corrected the Class II molar relationship by dentoalveolar changes. The Distal jet produced smaller molar distal angulation than the Jones jig and First Class. The First Class appliance showed less anchorage loss, greater percentage of distalization and shorter treatment time than the Jones jig and Distal jet.

High Mobility Group Box 1 and Heat Shock Protein-70 Expression Post (-)-Epigallocatechin-3-Gallate in East Java Green Tea Methanolic Extract Administration During Orthodontic Tooth Movement in Wistar Rats

Abstract Objective: To investigate the expression of High Mobility Group Box 1 (HMGB1) and Heat Shock Protein-70 (HSP-70) during orthodontic tooth movement (OTM) after (-)- Epigallocatechin-3-Gallate (EGCG) in East Java Green Tea (Camelia Sinensis) Methanolic Extract (GTME) administration in vivo. Material and Methods: 28 Wistar rats (Rattus Novergicus) was used and divided into 4 groups accordingly: K- without EGCG and OTM; K+ with OTM, without EGCG for 14 days; T1with OTM for 14 days and EGCG for 7 days; treatment group 2 (T2) with OTM and EGCG for 14 days. OTM animal model was achieved through the installation of the OTM device by means of NiTi close coil spring with 10g force placed between the first incisor and first maxillary molars. The samples were terminated on Day 14. The pre-maxillary was isolated for the immunohistochemical examination. Analysis of Variance (ANOVA) then continued with Tukey Honest Significant Difference (HSD) (p<0.05) was performed to analyze the data. Results: The highest HMGB1 and HSP-70 expression were found in the K+ group pressure side, meanwhile the lowest HMGB1 and HSP-70 expression were found in K- group tension side in the alveolar bone. There was a significant decrease of HMGB1 and HSP-70 expression in T2 compared to T1 and K+ with significant between groups (p<0.05; p=0.0001). Conclusion: The decreased expression of HMGB1 and HSP-70 in alveolar bone of OTM wistar rats due to post administration of GTME that consisted EGCG.

Pain Perception and Rate of Canine Retraction Through Self-Ligating Brackets and Conventional Elastomeric Ligation System: A Split Mouth Study

Abstract Objective: To evaluate the rate of tooth movement and the pain perception via self-ligating (SL) and conventional elastomeric ligation brackets (CB) system. Material and Methods: This study has been conducted at the Orthodontic Department of Baqai Dental College, Baqai Medical University. The sample size of this study comprised 40 patients, falling between the age of 12-30 years without any sex discrimination. Shapiro-Wilk was used to check the distribution of data. Non-parametric Mann Whitney U test was applied to evaluate the pain associated with SL and CB brackets system. To analysis the canine retraction Wilcoxon test was applied for the comparison of CB and SL brackets system. For all statistical analyses, the p-value of <0.05 was considered significant. Results: Pain level associated with retraction via CB and SL shows significant differences. However, the rate of canine retraction via CB and SL shows no significant differences at stages T0-T1 and T1-T2. However, stage T2-T3 shows a significant difference. Conclusion: As pain during orthodontic treatment is mostly associated with the level of compression of the periodontal ligament, it may be hypothesized that lower frictional forces generate less compression of the periodontal ligament and blood vessels, and so alter the type of pain experienced.

Teoría Bifásica del Movimiento Dentario Aplicada Mediante Micro-Osteo-Perforaciones / Teeth Movement Bifasic Theory Applied by Micro-Osteo-Perforations

RESUMEN: Un desafío común en la ortodoncia es la realización de cierres de espacio en brechas largas con pérdida ósea significativa producto de extracciones tempranas, sitio de extracciones traumáticas o expansiones en adultos con tabla vestibular delgada. El propósito de este artículo es difundir una teoría del movimiento dental desarrollada a partir de una serie de investigaciones que intentan probarla en animales como seres humanos. Las dos fases de remodelación de hueso son la "activación - reabsorción" (proceso catabólico) y "activación-formación" (proceso anabólico) de las superficies del hueso, resultando en los cambios de tamaño, forma y posición del hueso. La inflamación es necesaria para el movimiento dentario. Se puede estimular ambas fases mediante pequeñas perforaciones del hueso que pueden ser realizadas de forma segura en la superficie vestibular o lingual de las tablas corticales pudiendo ser superficiales o profundas. Se muestran ejemplos clínicos de pacientes tratados con el enfoque de la Teoría bifásica mediante estimulación ósea transgingival. Se concluye que esta teoría bifásica permite explicar la favorable respuesta que se observa en situaciones clínicas complejas cuando se estimula el movimiento con micro-osteoperforaciones.

ABSTRACT: A common challenge in orthodontics is the task of space closures in long gaps with significant bone loss due to early extractions, site of traumatic extractions or expansions in adults with thin vestibular table. The purpose of this article is to disseminate a theory of dental movement developed from a series of investigations that try to test it in animals as human beings. The two phases of bone remodeling are the "activation - resorption" (catabolic process) and "activation-formation" (anabolic process) of bone surfaces, resulting in changes in bone size, shape and position. Inflammation is necessary for tooth movement. Both phases can be stimulated by small perforations of the bone that can be performed safely on the vestibular or lingual surface of the cortical boards, which may be superficial or deep. Clinical examples of patients treated with the biphasic theory approach by transgingival bone stimulation are shown. It is concluded that this biphasic theory allows to explain the favorable response observed in complex clinical situations when the movement is stimulated with micro-osteoperforations.

Three-dimensional assessment of external apical root resorption after maxillary posterior teeth intrusion with miniscrews in anterior open bite patients

ABSTRACT Objective: The objective of this study was to assess the external apical root resorption (EARR) of the maxillary posterior teeth after intrusion with miniscrews. Methods: Fifteen patients (13 females and 2 males) with age ranging from 14.5 to 22 years (mean 18.1 ±2.03 years) were selected to participate in this study. All patients presented with anterior open bite of 3 mm or more. An intrusion force of 300 g was applied on each side to intrude the maxillary posterior teeth. Cone beam computed tomography (CBCT) scans were taken pretreatment and post-intrusion and were analyzed to evaluate the EARR. Results: The maxillary posterior teeth were intruded in average 2.79 ± 0.46 mm (p< 0.001) in 5.1 ± 1.3 months, and all examined roots showed statistically significant EARR (p< 0.05) with an average of 0.55 mm, except the distobuccal root of the left first permanent molars and both the palatal and buccal roots of left first premolars, which showed no statistically significant changes. Conclusions: The evaluated teeth presented statistically significant EARR, but clinically, due to the small magnitude, it was not considered significant. Moreover, the CBCT provided a good visualization of all roots in all three planes, and it was effective in detecting minimal degrees of EARR.

RESUMO Objetivo: o objetivo desse estudo foi verificar a existência de reabsorção radicular apical externa (RRAE) em dentes posterossuperiores após intrusão ancorada em mini-implantes. Métodos: quinze pacientes (13 mulheres e 2 homens) com a idade variando entre 14,5 e 22 anos (média de 18,1 ± 2,03 anos) foram selecionados para participar desse estudo. Todos os pacientes possuíam mordida aberta anterior de 3mm ou mais. Uma força de 300 gramas foi aplicada em cada lado para intruir os dentes posterossuperiores. Tomografias computadorizadas de feixe cônico (TCFC), adquiridas antes do tratamento e após a intrusão, foram comparadas para se avaliar a RRAE. Resultados: os dentes posterossuperiores foram intruídos em média 2,70 ± 0,46 mm (p< 0,001) em 5,1 ± 1,3 meses, e todas as raízes examinadas mostraram RRAE estatisticamente significativa (p< 0,05), com média de 0,55 mm, exceto pela raiz distovestibular dos primeiros molares permanentes esquerdos, e pelas raízes palatina e vestibular dos primeiros pré-molares esquerdos, que não apresentaram mudanças estatisticamente significativas. Conclusões: os dentes avaliados apresentaram RRAE estatisticamente significativa, a qual, porém, não foi considerada clinicamente significativa, devido à sua reduzida magnitude. Além disso, a TCFC possibilitou uma boa visualização de todas as raízes nos três planos espaciais, e foi eficaz para detecção de níveis mínimos de RRAE.

A CBCT evaluation of molar uprighting by conventional versus microimplant-assisted methods: an in-vivo study

ABSTRACT Objective: The aim of this prospective study was to compare the three-dimensional effects of the conventional helical uprighting spring (CA) and the mini-implant assisted helical uprighting spring (MIA), using CBCT scans. Methods: Twenty patients with mesially tipped second mandibular molars were divided into two groups: CA group, in which 10 patients were treated using a conventional helical uprighting spring with conventional anchorage; and MIA group, in which 10 patients were treated using a mini-implant supported uprighting spring. Molar uprighting was observed in both groups for a period of four months. Two standardized 11×5-cm CBCT sections of the mandible were taken, being one prior to uprighting and one at the end of the four month follow-up. Statistical analyses at the beginning of treatment and after a 4 month follow-up were performed, with a significance level of p< 0.05. Results: The mean amount of change in mesiodistal angulation in the MIA group was 8.53 ± 2.13o (p< 0.001) and in the CA group was 9.8 ± 0.5o (p< 0 .001). Statistically significant differences were found between the two groups with regard to buccolingual inclination of canine, first and second premolars (p< 0.05), second molar (p< 0.001) and extrusion of second molar (p< 0.05). Conclusions: The mean amount of change in the mesial angulation of the second molar in the CA as well as the MIA groups was similar. MIA, which used mini-implant as a source of anchorage, was more effective in preventing movement of the anchorage teeth as well as preventing extrusion of the second molar in the vertical plane, when compared to the CA group, which used dental units as a source of anchorage.

RESUMO Objetivo: o objetivo deste estudo prospectivo foi comparar, usando imagens de TCFC, os efeitos tridimensionais da mola convencional de verticalização (CA) e da mola de verticalização com ancoragem em mini-implantes (MIA). Métodos: vinte pacientes com segundos molares inferiores inclinados mesialmente foram divididos em dois grupos: grupo CA, no qual 10 pacientes foram tratados usando mola helicoidal de verticalização com ancoragem convencional; e grupo MIA, com 10 pacientes tratados usando mola de verticalização ancorada em mini-implantes. A verticalização dos molares foi observada nos dois grupos por um período de quatro meses. Foram obtidas duas secções tomográficas da mandíbula, com dimensões padronizadas de 11 x 5 cm, uma antes da verticalização e outra ao fim dos quatro meses de acompanhamento. As análises estatísticas ao início do tratamento e após os quatro meses de acompanhamento foram realizadas a um nível de significância de p< 0,05. Resultados: a média das alterações na angulação mesiodistal do grupo MIA foi de 8,53 ± 2,13o (p< 0,001), e do grupo CA foi de 9,8 ± 0,5o (p< 0,001). Diferenças estatisticamente significativas foram encontradas entre os dois grupos em relação à inclinação vestibulolingual do canino, do primeiro e segundo pré-molares (p< 0,05) e do segundo molar (p< 0,001), bem como para a extrusão do segundo molar (p< 0,05). Conclusões: a alteração média na angulação mesial do segundo molar nos grupos CA e MIA foi semelhante. O método MIA, que usou mini-implantes como ancoragem, foi mais efetivo na prevenção da movimentação dos dentes de ancoragem, bem como na prevenção da extrusão do segundo molar no plano vertical, quando comparado com o grupo CA, em que dentes foram usados como fonte de ancoragem.

Virtual orthodontic setup in orthodontic camouflage planning for skeletal Class III malocclusion

ABSTRACT The purpose of this paper was to emphasize the importance of the orthodontic setup in treatment planning for skeletal Class III malocclusion correction in an adult patient with moderate lower anterior crowding and anterior crossbite associated with two supernumerary lower incisors.

RESUMO O objetivo desse artigo é enfatizar a importância do setup ortodôntico no planejamento do tratamento da má oclusão de Classe III esquelética de uma paciente adulta com apinhamento anteroinferior moderado e mordida cruzada anterior associada à presença de dois incisivos inferiores supranumerários.

Twenty-year clinical experience with fixed functional appliances

ABSTRACT Introduction: Considering the large number of fixed functional appliances, choosing the best device for your patient is not an easy task. Objective: To describe the development of fixed functional appliances as well as our 20-year experience working with them. Methods: Fixed functional appliances are grouped into flexible, rigid and hybrid. They are different appliances, whose action is described here. Four clinical cases will be reported with a view to illustrating the different appliances. Conclusions: Rigid fixed functional appliances provide better skeletal results than flexible and hybrid ones. Flexible and hybrid appliances have similar effects to those produced by Class II elastics. They ultimately correct Class II with dentoalveolar changes. From a biomechanical standpoint, fixed functional appliances are more recommended to treat Class II in dolichofacial patients, in comparison to Class II elastics.

RESUMO Introdução: considerando-se o grande número de aparelhos propulsores mandibulares, não é uma tarefa fácil escolher o melhor deles para o seu paciente. Objetivo: descrever o desenvolvimento desses aparelhos e a experiência clínica de vinte anos dos autores na sua utilização. Métodos: os aparelhos funcionais fixos aqui apresentados foram classificados em flexíveis, rígidos e híbridos, e o modo de ação de cada um deles foi descrito e ilustrado por meio de quatro casos clínicos. Conclusões: os aparelhos propulsores rígidos fornecem mais resultados esqueléticos do que os flexíveis e os híbridos. Esses últimos têm efeito semelhante ao uso de elásticos com direção de Classe II e, basicamente, corrigem a má oclusão de Classe II com alterações dentoalveolares. Do ponto de vista biomecânico, os propulsores fixos estão mais indicados para tratar a Classe II em pacientes dolicofaciais do que os elásticos de Classe II.

Comparative study of root resorption between two methods for accelerated orthodontic tooth movement

Objective: the aim of this study was to assess apical root resorption (RR) following the application of micro-osteoperforation (MOP) and piezocision (PzC) assisted orthodontics for the acceleration of tooth movement (TM). materials and methods: a total number of 16 patients seeking orthodontic therapy were included in this study. all patients had undergone 1st premolars extraction and were indicated for canine retraction. these patients were divided into two groups; one was treated using MOP in one side while the other side served as control. in the other group PzC was performed in one side with no intervention done on the other side. cone-beam computed tomography (CBCT) scans were obtained for every patient before and after canine retraction in order to evaluate amount of RR. results: in the MOP group, there was no significant difference in canine root length between experimental and control sides. whereas, in the PzC group, there was a statistically significant decrease in root length in the experimental side compared with the control side. when comparing both groups, the experimental PzC side showed a statistically significant decrease in root length compared to experimental MOP side postoperatively. conclusion: experimental PzC showed statistically significant decreases in canine root length compared to both experimental MOP and control side after canine retraction.

Impact of two early treatment protocols for anterior dental crossbite on children's quality of life

ABSTRACT Objective: To assess the impact of two early treatment protocols for anterior dental crossbite on children's quality of life. Methods: Thirty children, 8 to 10 years of age, with anterior dental crossbite, participated in this study. Individuals were divided into two groups: Group 1 - 15 children undergoing treatment with an upper removable appliance with digital springs; Group 2 - 15 children undergoing treatment with resin-reinforced glass ionomer cement bite pads on the lower first molars. Quality of life was evaluated using the Brazilian version of the Child Perceptions Questionnaire (CPQ8-10), which contains four subscales: oral symptoms (OS), functional limitations (FL), emotional well-being (EW), and social well-being (SW). A higher score denotes a greater negative impact on children's quality of life. Children answered the questionnaire before treatment (T1) and twelve months after orthodontic treatment onset (T2). Descriptive statistics, the Wilcoxon test and analysis of covariance (ANCOVA) were performed. Results: Children's mean age was 9.07 ± 0.79 years in Group 1 and 9.00 ± 0.84 years in Group 2. For Group 1, the FL and EW subscale scores and the overall CPQ8-10 were significantly higher in T1 as compared to T2 (p= 0.004, p= 0.012 and p= 0.015, respectively). For Group 2, there were no statistically significant differences. The ANCOVA showed no significant difference regarding quality of life at T2 between groups, after controlling for quality of life measures at T1. Conclusions: The difference regarding the impact on quality of life between groups is not related to the protocol used.

RESUMO Objetivo: avaliar o impacto de dois protocolos de tratamento precoce para a mordida cruzada anterior dentária na qualidade de vida de crianças. Métodos: trinta crianças de 8 a 10 anos de idade com mordida cruzada anterior dentária participaram desse estudo. Os indivíduos foram divididos em dois grupos: Grupo 1 - 15 crianças em tratamento com aparelho removível superior com molas digitais; Grupo 2 - 15 crianças em tratamento com batentes de cimento de ionômero de vidro resinoso nos primeiros molares permanentes inferiores. A qualidade de vida foi avaliada por meio da versão brasileira do Child Perceptions Questionnaire (CPQ8-10), o qual contém quatro subescalas: sintomas bucais (SB), limitações funcionais (LF), bem-estar emocional (BE) e bem-estar social (BS). Um escore mais alto indica um impacto mais negativo na qualidade de vida. As crianças responderam ao questionário antes do tratamento (T1) e 12 meses após o início do tratamento ortodôntico (T2). Estatística descritiva, o teste Wilcoxon e análise de covariância (ANCOVA) foram realizados. Resultados: a média de idade das crianças foi de 9,07 ± 0,79 anos no Grupo 1 e de 9,00 ± 0,84 no Grupo 2. Para o Grupo 1, os escores das subescalas LF e BE e o escore total do CPQ8-10 foram significativamente maiores em T1 do que em T2 (p= 0,004, p= 0,012 e p= 0,015, respectivamente). Para o Grupo 2, não houve diferença estatisticamente significativa. A ANCOVA não mostrou diferença significativa entre os grupos em relação à qualidade de vida em T2, após o controle para as medidas de qualidade de vida em T1. Conclusões: a diferença em relação ao impacto na qualidade de vida entre os grupos não foi relacionada ao protocolo de tratamento utilizado.

Extruded upper first molar intrusion: Comparison between unilateral and bilateral miniscrew anchorage

ABSTRACT Objective: The aim of his study was to evaluate the stress on tooth and alveolar bone caused by orthodontic intrusion forces in a supraerupted upper molar, by using a three-dimensional Finite Element Method (FEM). Methods: A superior maxillary segment was modeled in the software SolidWorks 2010 (SolidWorks Corporation, Waltham, MA, USA) containing: cortical and cancellous bone, supraerupted first molar, periodontal tissue and orthodontic components. A finite element model has simulated intrusion forces of 4N onto a tooth, directed to different mini-screw locations. Three different intrusion mechanics vectors were simulated: anchoring on a buccal mini-implant; anchoring on a palatal mini-implant and the association of both anchorage systems. All analyses were performed considering the minimum principal stress and total deformation. Qualitative analyses exhibited stress distribution by color maps. Quantitative analysis was performed with a specific software for reading and solving numerical equations (ANSYS Workbench 14, Ansys, Canonsburg, Pennsylvania, USA). Results: Intrusion forces applied from both sides (buccal and palatal) resulted in a more homogeneous stress distribution; no high peak of stress was detected and it has allowed a vertical resultant movement. Buccal or palatal single-sided forces resulted in concentrated stress zones with higher values and tooth tipping to respective force side. Conclusion: Unilateral forces promoted higher stress in root apex and higher dental tipping. The bilateral forces promoted better distribution without evidence of dental tipping. Bilateral intrusion technique suggested lower probability of root apex resorption.

RESUMO Objetivos: o presente estudo teve como objetivo avaliar, por meio da Análise de Elementos Finitos, as tensões geradas por forças ortodônticas intrusivas em um molar superior e no osso alveolar circundante. Métodos: um segmento maxilar foi modelado no software SolidWorks 2010 (SolidWorks Corporation, Waltham, MA, EUA), contendo: osso cortical e medular, primeiro molar extruído, tecido periodontal e acessórios ortodônticos. Um modelo de elementos finitos simulou forças intrusivas de 4 N no elemento dentário, aplicadas a partir de mini-implantes em localizações distintas. Três diferentes vetores para mecânica de intrusão foram simulados: ancoragem em mini-implante vestibular, ancoragem em mini-implante palatino ou a associação de ambas. Todas as análises foram realizadas em termos de tensão mínima principal e deformação total. A análise qualitativa foi feita por meio do mapeamento da distribuição das tensões em gradiente de cores. A análise quantitativa foi feita em software específico para leitura e resolução de equações numéricas (ANSYS Workbench 14, Ansys, Canonsburg, Pennsylvania, EUA). Resultados: as forças intrusivas aplicadas simultaneamente nos dois lados (vestibular e palatino) resultaram em uma distribuição mais homogênea das tensões geradas, sem zonas de acúmulo de tensão e com uma resultante vertical para a movimentação intrusiva. As forças aplicadas somente em um lado, vestibular ou palatino, resultaram em zonas de concentração de tensão, com maiores valores, e na inclinação do elemento dentário para o lado em que a força foi aplicada. Conclusão: as forças unilaterais promoveram maior tensão no ápice radicular e maiores inclinações do elemento dentário. Já as forças bilaterais promoveram melhor distribuição das tensões e não resultaram em inclinação do elemento dentário. Assim, as forças intrusivas ancoradas bilateralmente apresentam menor probabilidade de reabsorção do ápice radicular.

Movimento ortodôntico como auxiliar no tratamento periodontal cirúrgico: relato de caso / Orthodontic movement as an aid in surgical periodontal treatment: case report

Os pacientes adultos que procuram tratamento periodontal, geralmente trazem consigo outras situações bucais debilitantes, principalmente perdas e posicionamento inadequado dos dentes. Lançar mão dos mais variados recursos para resolver um determinado caso, torna-se uma necessidade. Através de um caso clínico, foi possível mostrar que o tratamento ortodôntico, ainda que para resolver problemas localizados, pode ser um recurso auxiliar importante na solução de sequelas no periodonto. Uma paciente de 43 anos, apresentava uma recessão severa na região do 31 e 41, ambos extruídos. Após controle periodontal, foi realizado o enxerto gengival livre. Dois meses depois foi dado início à mecânica ortodôntica, com aparelho fixo autoligado e forças leves. Como última etapa, buscou-se o recobrimento radicular, com a técnica de tunelização associada ao deslocamento coronário com tecido conjuntivo interposto. O procedimento demonstrou ser uma alternativa terapêutica razoável para a gravidade do caso (AU)

The adult patients who search for a periodontal treatment usually have others debilitating oral situations, especially losses and inadequate teeth positions. Taking advantages of the most varied resources to solve a particular case becomes a necessity. Through a clinical case, it was possible demonstrate that orthodontic treatment, even solving localized problems also can be an important auxiliary resource to solve sequels in the periodontium. A 43 years old woman with a severe recession in region of 31 and 41elements and both were extruded. After periodontal control, the FGG technique was performed. Two months later the orthodontic mechanicalwas performed, with self-ligating system and little forces. As last step was tried the root coverage, using the tunneling technique: coronary displacement with interposed connective tissue. The technique showed being a reasonable alternative facing the severity of the case.(AU)

Efficiency of compensatory orthodontic treatment of mild Class III malocclusion with two different bracket systems

ABSTRACT Objective: The purpose of this study was to assess the efficiency of compensatory orthodontic treatment of patients with mild Class III malocclusion with two preadjusted bracket systems. Method: Fifty-six matched patients consecutively treated for mild Class III malocclusion through compensatory dentoalveolar movements were retrospectively evaluated after analysis of orthodontic records. The sample was divided into two groups according to the brackets used: Group 1 = non-Class III compensated preadjusted brackets, Roth prescription (n = 28); Group 2 = compensated Class III preadjusted brackets, Capelozza III prescription (n = 28). Cephalometric analysis, number of appointments and missed appointments, months using Class III elastics, and bond/band failures were considered. Treatment time, Peer Assessment Rating (PAR) index at the beginning (PAR T1) and end of treatment (PAR T2) were used to calculate treatment efficiency. Comparison was performed using a MANOVA at p< 0.05. Results: Missed appointments, bond or band failures, number of months using the Class III intermaxillary elastics, and cephalometric measurements showed no statistically significant difference (p> 0.05) between groups. Patients treated with Roth brackets had a treatment time 7 months longer (p= 0.01). Significant improvement in the patient's occlusion (PAR T2-T1) was observed for both groups without difference (p= 0.22). Conclusions: Orthodontic brackets designed for compensation of mild Class III malocclusions appear to be more efficient than non-compensated straight-wire prescription brackets. Treatment time for Class III patients treated with brackets designed for compensation was shorter than with Roth prescription and no difference in the quality of the occlusal outcome was observed. A prospective randomized study is suggested to provide a deeper look into this subject.

RESUMO Objetivo: o objetivo desse estudo foi avaliar a eficiência do tratamento ortodôntico compensatório de pacientes com má oclusão de Classe III suave usando dois diferentes sistemas de braquetes pré-ajustados. Métodos: foram avaliados retrospectivamente, após análise de registros ortodônticos, cinquenta e seis pacientes tratados consecutivamente de má oclusão de Classe III, por meio de movimentos de compensação dentária. A amostra foi dividida em dois grupos, de acordo com os braquetes utilizados: Grupo 1 - braquetes pré-ajustados não compensatórios para Classe III, prescrição Roth (n = 28); Grupo 2 - braquetes pré-ajustados para tratamento compensatório de Classe III, prescrição Capelozza Padrão III (n = 28). Considerou-se a análise cefalométrica, número de consultas realizadas e de consultas perdidas, meses de uso dos elásticos intermaxilares de Classe III e quebras de braquetes/bandas. Foram utilizados para calcular a eficiência do tratamento: tempo de tratamento, índice PAR (Peer Assessment Rating) ao início (PAR T1) e fim de tratamento (PAR T2). A comparação intergrupos foi realizada com o teste MANOVA, a p< 0,05. Resultados: não houve diferença estatisticamente significativa (p> 0,05) entre os grupos quanto às medidas cefalométricas, número de consultas perdidas, quebras de braquetes/bandas e tempo de uso dos elásticos de Classe III. Os pacientes tratados com braquetes Roth tiveram tempo de tratamento sete meses maior (p= 0,01). Observou-se melhora significativa na oclusão dos pacientes (PAR T2-T1) para ambos os grupos, sem diferença estatística significativa (p= 0,22). Conclusão: os braquetes ortodônticos projetados para compensação das más oclusões de Classe III parecem ser mais eficientes do que os pré-ajustados não compensatórios. O tempo de tratamento para pacientes Classe III tratados com braquetes projetados para compensação foi menor do que com a prescrição Roth, e nenhuma diferença na qualidade da oclusão final foi observada. Sugere-se um estudo prospectivo randomizado, para fornecer uma visão mais profunda sobre esse assunto.

High-intensity laser application in Orthodontics

ABSTRACT Introduction: In dental practice, low-level laser therapy (LLLT) and high-intensity laser therapy (HILT) are mainly used for dental surgery and biostimulation therapy. Within the Orthodontic specialty, while LLLT has been widely used to treat pain associated with orthodontic movement, accelerate bone regeneration after rapid maxillary expansion, and enhance orthodontic tooth movement, HILT, in turn, has been seen as an alternative for addressing soft tissue complications associated to orthodontic treatment. Objective: The aim of this study is to discuss HILT applications in orthodontic treatment. Methods: This study describes the use of HILT in surgical treatments such as gingivectomy, ulotomy, ulectomy, fiberotomy, labial and lingual frenectomies, as well as hard tissue and other dental restorative materials applications. Conclusion: Despite the many applications for lasers in Orthodontics, they are still underused by Brazilian practitioners. However, it is quite likely that this demand will increase over the next years - following the trend in the USA, where laser therapies are more widely used.