Analgesia por láser de baja potencia en pacientes con tratamiento ortodóncico / Low power laser analgesia in patients with orthodontic treatment i: en

Introducción: El dolor es el síntoma más común luego de la primera activación de la aparatología ortodóncica. El tratamiento analgésico más utilizado es el paracetamol; sin embargo, su uso inhibe la actividad de la ciclooxigenasa y la síntesis de prostaglandinas, lo que puede afectar el mecanismo del movimiento dental y el remodelado óseo. Objetivo: Evaluar la efectividad del láser de baja potencia para el alivio del dolor en pacientes con tratamiento ortodóntico. Métodos: Se realizó un estudio cuasiexperimental de intervención terapéutica, desde enero hasta diciembre de 2020, en 40 pacientes atendidos en la consulta de ortodoncia del Hospital General Docente Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, en quienes se aplicaría fuerza ortodóncica por primera vez. Estos fueron distribuidos de forma aleatoria en 2 grupos de 20 integrantes cada uno: el de estudio, tratado con láser de baja potencia, y el de control, que recibió medicación convencional (paracetamol). Para la validación estadística de la información se emplearon el porcentaje y la prueba de la t de Student para muestras independientes, con 95 % de confiabilidad. Resultados: Luego de tres sesiones terapéuticas, 90,0 % del grupo de estudio refirió no presentar dolor o sentirlo de forma leve, mientras que del grupo de control solo 10,0 % de los pacientes fue ubicado en cualquiera de las dos categorías anteriores. Existió diferencia significativa entre ambos grupos (p=0,00). Conclusiones: Se demostró que el láser, como terapia alternativa, fue más efectivo que el paracetamol.

Introduction: Pain is the most common symptom after the first activation of orthodontic appliance. The most widely used analgesic treatment is paracetamol; however, its use inhibits cyclooxygenase activity and prostaglandin synthesis, which can affect the mechanism of tooth movement and bone remodeling. Objective: To evaluate the effectiveness of low power laser for pain relief in patients with orthodontic treatment. Methods: A quasi-experimental study of therapeutic intervention was carried out, from January to December 2020, in 40 patients treated at the orthodontic clinic of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital in Santiago de Cuba, in whom orthodontic force was applied for the first time. These were randomly distributed into 2 groups of 20 members each: the study group, treated with low-power laser, and the control group, that received conventional medication (paracetamol). For statistical validation of data, the percentage and the Student's t test for independent samples were used, with 95 % confidence interval. Results: After three therapeutic sessions, 90.0% of the study group reported not presenting pain or feeling it slightly, while only 10.0% of patients in control group were put in any of the two previous categories. There was a significant difference between both groups (p=0.00). Conclusions: Laser, as an alternative therapy, was shown to be more effective than paracetamol.

Orthodontists' preferences in the use and timing of appliances for the correction of malocclusions in growing patients / Preferencias de los ortodoncistas en el uso y momento oportuno de uso de aparatos para la corrección de maloclusiones en pacientes en crecimiento

Objective: To evaluate orthodontists' preferences in the use and timing of appliances for the correction of Class II and Class III malocclusions in growing patients and the sociodemographic factors that influence these preferences. Material and Methods: Active members of the Colombian Orthodontics Society (SCO) were invited to complete a previously validated survey on the use of Class II and Class III correctors in growing patients. Results: 180 orthodontists responded (80 male, 100 female). The appliances used most frequently in the treatment of Class II malocclusion were Planas indirect tracks (32.78%) and Twin-blocks (30.56%). Facemasks (62.22%) and Progenie plates (25%) were the most prevalent appliances used in the treatment of Class III malocclusions. Regarding treatment timing, 52% of the orthodontists stated that Class II malocclusions must be treated during late mixed dentition or early permanent dentition, 42% stated that treatment for Class III malocclusions should occur during early mixed dentition. Appliance use and treatment timing were significantly associated with sex (p= 0.034), years of practice (p= 0.025), and area of work (private clinics or public institutions), (p= 0.039). Conclusion: Twin-blocks and Facemask appliances were the preferred appliances for Class II and Class III treatment, respectively, in growing patients. Most of the orthodontists believed that Class II malocclusions must be treated during late mixed dentition and that Class III malocclusions must be treated during early mixed dentition. Sociodemographic variables are related factors that influence orthodontists' preferences in the use of these appliances.

Objetivo: Evaluar las preferencias de los ortodoncistas en el uso y momento oportuno de uso de aparatología para la corrección de maloclusiones Clase II y Clase III en pacientes en crecimiento y los factores sociodemográficos que influyen en estas preferencias. Material y Métodos: Se invitó a miembros activos de la Sociedad Colombiana de Ortodoncia (SCO) a completar una encuesta previamente validada, sobre el uso de correctores para Clase II y Clase III en pacientes en crecimiento. Resultados: Respondieron un total de 180 ortodoncistas (80 hombres, 100 mujeres). La aparatología más utilizada en el tratamiento de las maloclusiones de Clase II fueron pistas indirectas de Planas (32,78%) y bloques gemelos (30,56%). La máscara facial (62,22%) y las placas progenie (25%) fueron los aparatos más utilizados en el tratamiento de las maloclusiones de Clase III. En cuanto al momento oportuno del tratamiento, el 52% de los ortodoncistas afirmó que las maloclusiones de Clase II deben tratarse durante la dentición mixta tardía o la dentición permanente temprana, el 42% afirmó que el tratamiento para las maloclusiones de Clase III debe ocurrir durante la dentición mixta temprana. El uso de aparatos y el momento oportuno del tratamiento se asociaron significativamente con el sexo (p= 0,034), los años de práctica (p= 0,025) y el área de trabajo (clínicas privadas o instituciones públicas) (p= 0,039). Conclusión: Los aparatos bloques gemelos y la máscara facial fueron los preferidos para el tratamiento de Clase II y Clase III, respectivamente, en pacientes en crecimiento. La mayoría de los ortodoncistas consideran que las maloclusiones de Clase II deben tratarse durante la dentición mixta tardía y que las maloclusiones de Clase III deben tratarse durante la dentición mixta temprana. Las variables sociodemográficas son factores relacionados que influyen en las preferencias de los ortodoncistas en el uso de estos aparatos.

El impacto de la hipomineralización molar incisivo en la calidad de vida de los niños brasileños / O impacto da hipomineralização molar incisivo na qualidade de vida de crianças brasileiras / The impact of molar incisor hypomineralization in the quality of life in Brazilian school children

El objetivo de este estudio fue verificar la prevalencia de HMI, la severidad y el impacto en la calidad de vida de niños de 8 a 10 años. Un total de 864 niños de ambos sexos fueron evaluados en la ciudad de Vila Velha, ES. La valoración clínica del HMI estuvo de acuerdo con los criterios diagnósticos de la EAPD. Como criterio de exclusión de la investigación se consideraron niños con déficit cognitivo, neuropsicomotor y pacientes con aparatología de ortodoncia. La condición leve o severa se determinó evaluando la necesidad de tratamiento 1 y la afectación de los incisivos y molares permanentes. Para evaluar el impacto en la calidad de vida se aplicó el Cuestionario de Percepción Infantil, con 29 preguntas relacionadas con síntomas orales, limitaciones funcionales, bienestar emocional y social. Los resultados se analizaron después de las pruebas estadísticas: Chi Cuadrado, Fischer y Poisson. Se encontró una frecuencia de 183 niños (21 %) con HMI, 125 (68,3 %) con el tipo severo que necesita tratamiento. En la aplicación de CPQ, la sensibilidad y el dolor en los dientes afectados tuvieron una puntuación más alta, y cuando asociado con la presencia o ausencia del HMI, los individuos afectados tuvieron un mayor impacto en este dominio (P = 0,04). Se concluye que el HMI afecta la población estudiada en condición severa, requiriendo cuidados odontológicos preventivos y reparadores, y puede tener un impacto negativo en la calidad de vida de los estudiantes en relación a su salud bucal, en cuanto a síntomas bucales.

O objetivo deste estudo foi verificar a prevalência da HMI, a severidade e o impacto na qualidade de vida, em crianças dos 8 aos 10 anos de idade. Foi avaliado um total de 864 crianças de ambos os sexos, na cidade de Vila Velha, ES. A avaliação clínica da HMI foi de acordo com os critérios diagnósticos da EAPD. Como critério de exclusão da investigação foram consideradas crianças com déficits cognitivos, neuropsicomotores e portadoras de aparelhos ortodônticos. A condição leve ou severa foi determinada através da avaliação da necessidade de tratamento 1 e do envolvimento de molares e incisivos permanentes. Para avaliar o impacto na qualidade de vida, foi aplicado o Questionário de Percepção Infantil, composto por 29 perguntas relacionadas aos sintomas orais, limitações funcionais, bem-estar emocional e social. Os resultados foram analisados após os testes estatísticos: Chi Square, Fischer e Poisson. Foi encontrada uma frequência de 183 crianças (21 %) com HMI, com 125 (68,3 %) com o tipo severo a necessitar de tratamento. Na aplicação do CPQ, a sensibilidade e a dor nos dentes afetados apresentaram uma pontuação mais elevada, e quando este instrumento foi associado à presença ou ausência do HMI, os indivíduos afetados também tiveram um maior impacto neste domínio (P = 0,04). Concluímos que a HMI afeta a população estudada na condição do tipo severa, exigindo cuidados dentários preventivos e restauradores, e pode ter um impacto negativo na qualidade de vida dos estudantes em relação à sua saúde oral, no que diz respeito aos sintomas orais.

Purpose of this study was to verify the prevalence of MIH, the severity and the impact on the quality of life, in children from 8 to 10 years of age. Materials and methods: A total of 864 children of both genders, in the city of Vila Velha, ES, were evaluated. The clinical assessment followed the diagnostic criteria of the EAPD. As exclusion criterion of the research were children with cognitive deficits, neuropsychomotor and carriers orthodontic appliances. The mild or severe conditions were determined by assessing the need for treatment (WHO) and involvement of permanent molars and incisors. To evaluate the impact on quality of life, the Child Perception Questionnaire was applied, composed of 29 questions elaborated to observe the child's perception regarding oral symptoms, functional limitations, well-being Emotional and social. For statistical analysis, Chi, Square, Fischer and Poisson tests were used. Results: A frequency of 183 children (21%) with MIH was found, with 125 (68.3%) with the severe type requiring treatment. In the application of CPQ, the sensitivity and pain in affected teeth presented a higher score, and when this instrument was associated with the presence or absence of MHI, the affected individuals also had a greater impact in this domain (P = 0.04). Conclusions: The MIH affects the studied population in severe condition, requiring preventive and restorative dental care, and can negatively impact the quality of life of the students in relation to their oral health, as far as oral symptoms are concerned

Modified short version of the oral health impact profile for patients undergoing orthodontic treatment

Aim: To derive and validate a short version of the Oral Health Impact Profile (OHIP) in Spanish to measure oral health quality of life (OHRQoL) for subjects wearing fixed orthodontic appliances. Methods: Cross-sectional study (data for sensitivity to change analysis were collected longitudinally). The data of 400 subjects (27.34 years, SD 11.66 years, 231 women, and 169 men) were used to develop a short-form instrument, and the data of 126 other subjects (25.95 years, SD 12.39 years, 62 women, and 64 men) were used for its validation. The original OHIPs were translated into Spanish using an iterative forward-backward sequence. After face and content validity were evaluated by an expert committee, an exploratory factorial analysis (EFA) was used to derive the Spanish short-form instrument (OHIP-S14 Ortho). To validate the OHIP-S14 Ortho, validity (content validity assessed by EFA, construct validity assessed by confirmatory factor analysis (CFA), discriminative validity assessed by the Kruskal-Wallis test, and reliability (internal consistency assessed by Cronbach's α test-retest, and inter-observer reliability assessed by correlation coefficients) were evaluated. Sensitivity to change and usefulness of the scale were also evaluated. Results: The OHIP-S14 Ortho included only six of the items in Slade´s original OHIP-14 short-form. A two-factor structure with adequate discriminative validity was found. High internal consistency (α=0.912), excellent inter-observer (Lin's correlation=0.97±0.011; rho= 0.97), test-retest agreement (Lin's correlation=0.80±0.059) and adequate sensitivity to change were also found. Conclusions: The OHIP-S14 Ortho is a valid and reliable instrument to measure OHRQoL in Spanish-speaking patients with fixed orthodontic appliances

Alteración del colágeno en la Hipertrofia Gingival en pacientes con ortodoncia: caracterización histológica e inmunohistoquímica / Collagen alteration in gingival hypertrophy in orthodontic patients: histological and immunohistochemical characterization

Resumen Introducción: La hipertrofia gingival (HG) es el aumento del volumen de la encía asociado a ciertas enfermedades sistémicas, hereditarias (idiopático), ingesta de algunos medicamentos o a factores locales como el tratamiento ortodóntico, capaz de provocar cambios histológicos en el tejido conectivo gingival. Objetivo: Describir las características histológicas e identificar el colágeno tipo I y tipo III en tejidos gingivales de sujetos con hipertrofia gingival portadores de ortodoncia. Materiales y método: Se diseñó un estudio de casos y controles que incluyó el análisis de biopsias de tejido gingival de 12 pacientes sometidos a cirugías periodontales. La muestra se dividió en dos grupos: individuos sanos (control; n= 6) y pacientes con HG portadores de ortodoncia (pacientes; n= 6). Las muestras fueron procesadas e incluidas en parafina. Las tinciones Masson-Goldner y rojo sirius/verde rápido fueron empleadas. El colágeno tipo I y tipo III fueron identificados mediante inmunohistoquímica con anticuerpos monoclonales. Resultado: En los pacientes con HG portadores de ortodoncia se observó un epitelio hiperplásico y tejido conectivo denso con abundantes fibras de colágeno distribuidos aleatoriamente. La inmunodetención de colágeno tipo I indicó la presencia de abundantes fibras desorganizadas y el colágeno tipo III fue inmunolocalizado subyacente a la membrana basal, vasos sanguíneos y toda la extensión del tejido conectivo de los pacientes con HG con tratamiento ortodóntico. Conclusión: La acumulación de fibras de colágeno, particularmente del colágeno tipo I y tipo III, son hallazgos histológicos que caracterizan la HG en pacientes portadores de ortodoncia. Futuros estudios son necesarios para dilucidar el fenotipo de los fibroblastos gingivales y la probable pérdida homeostática entre la producción y degradación de colágeno en esta patología.

Abstract Introduction: Gingival hypertrophy (GH) is the increase in the volume of the gingiva associated with certain systemic, hereditary (idiopathic) diseases, the intake of some medications or local factors such as orthodontic treatment, capable of causing histological changes in the gingival connective tissue. Objective: To describe the histological characteristics and identify type I and type III collagen in gingival tissues of subjects with gingival hypertrophy wearing orthodontics. Method: A case-control study was designed that included the analysis of gingival tissue biopsies from 12 patients submitted to periodontal surgeries. The sample was divided into two groups: healthy individuals (Control; n= 6) and patients with GH wearing orthodontics (Patients; n= 6). The samples were processed and embedded in paraffin. Masson-goldner and sirius red/fast green stains were used. Type I and type III collagen were identified by immunohistochemistry with monoclonal antibodies. Result: A hyperplastic epithelium and dense connective tissue with abundant randomly distributed collagen fibers were observed in patients with orthodontic GH. Immunodetention of type I collagen indicated the presence of abundant disorganized fibers and type III collagen was inmunolocalized underlying the basement membrane, blood vessels and the entire extension of the connective tissue of patients with GH orthodontic. Conclusion: The accumulation of collagen fibers, particularly type I and type III collagen, are histological findings that characterize GH in orthodontic wearers. Future studies are necessary to elucidate the phenotype of gingival fibroblasts and the probable homeostatic loss between collagen production and degradation in this pathology.

Mucositis periimplantaria asociada a ortodoncia correctiva / Peri-implant mucositis associated to corrective orthodontics

Introducción: Los minitornillos de ortodoncia son dispositivos temporales de anclaje utilizados ampliamente en ortodoncia correctiva. Sin embargo, se ha reportado en la literatura que su tasa clínica de éxito no es completa debido a que pueden existir fallas relacionadas con la pérdida de su estabilidad. Varios factores pueden comprometer el anclaje y están relacionados con el tipo de implante, su manejo quirúrgico y el hospedero. Dentro de este último, se encuentra la inflamación del tejido periimplantario o mucositis que, aunque reversible, es necesario su tratamiento temprano para evitar su progresión a la afectación de tejido duro (periimplantitis). Objetivo: Describir un caso clínico de mucositis periimplantaria asociada a un dispositivo de anclaje ortodóntico temporal. Presentación del caso: Paciente femenina que acudió a la consulta por presentar dolor en la zona anterior del maxilar superior. Durante el examen intraoral se observó que usaba aparatos de ortodoncia con mecanismo de anclaje: dos minitornillos de ortodoncia ubicados al nivel de los caninos superiores. Se realizó la remoción quirúrgica de los minitornillos de ortodoncia, se le indicó el uso de antibióticos y se realizó estudio histopatológico para descartar malignidad. Se diagnosticó con mucositis periimplantaria. Conclusiones: La remoción quirúrgica de los minitornillos de ortodoncia es una excelente alternativa para evitar la progresión de la lesión hacia los tejidos duros. A través de esta técnica lograron eliminar signos de dolor, enrojecimiento y sangrado(AU)

Introduction: Orthodontic miniscrews are temporary anchorage devices widely used in corrective orthodontics. However, it has been reported in the literature that their clinical success rate is not high, due to failures related to the loss of stability. Anchorage may be affected by factors associated to the type of implant, its surgical management and the host. Host-related factors include peri-implant tissue inflammation or mucositis, which though reversible, its early treatment is necessary to prevent expansion into and damage to the hard tissue (peri-implantitis). Objective: Describe a clinical case of peri-implant mucositis associated to a temporary orthodontic anchorage device. Case presentation: A female patient attends clinical consultation with pain in the anterior zone of her upper maxilla. Intraoral examination revealed the presence of orthodontic appliances with an anchorage mechanism: two orthodontic miniscrews located at the level of the upper canines. Surgical removal was performed of the orthodontic miniscrews, antibiotics were indicated and histopathological testing was conducted to rule out malignancy. The patient was diagnosed with peri-implant mucositis. Conclusions: Surgical removal of orthodontic miniscrews is an excellent alternative to prevent the progress of the lesion into hard tissues. Pain signs, reddening and bleeding were all eliminated with the technique applied(AU)

Force degradation of elastomeric chains after storage time and mechanical brushing

Abstract The purpose of this in vitro study was to evaluate the force decrease of different elastomeric chains after different times: initial, 10 minutes, 1 day, 28 days and after mechanical brushing. Twenty orthodontic elastomeric chains segments were utilized for each commercial brand. Initially, the elastomeric chain of 15mm long were immediate stretched up to 20 mm in an Instron and the force was measured in gf. After all specimens were placed stretched on rectangular acrylic jigs with distance of 20 mm, immersed in deionized water at 37oC for 10 minutes and the force (gf) was measured again. Five test measurements of remaining force were made at the following time intervals: initial, 10 minutes, 1 day, 28 days and mechanical brushing. After 28 days, the acrylic plates with the specimens were adapted in the mechanical brushing machines (MSCT 3) and the elastomeric chains were submitted to mechanical brushing and the force (gf) measure again. The force (gf) was submitted to mixed-model ANOVA and Sidak post-hoc test (α=0.05). A statistically significant reduction in the force was found for all orthodontic elastomeric chain types after 1 day, 28 days and mechanical brushing (p<0.05). Morelli and 3M Unitek elastomeric chains showed significantly higher force than Abzil and GAC (p<0.05) after 1 day, 28 days and mechanical brushing. In conclusion, the force delivered by all elastomeric chains decayed rapidly over time. Morelli and 3M Unitek elastomeric chains consistently had a significantly greater force after mechanic brushing, while GAC the lowest.

Resumo O objetivo deste estudo in vitro foi avaliar a redução da força de diferentes cadeias elastoméricas após diferentes tempos: inicial, 10 minutos, 1 dia, 28 dias e após escovação mecânica. Vinte segmentos de cadeias elastoméricas ortodônticas foram utilizadas para cada marca comercial. Inicialmente, a cadeia elastomérica de 15 mm de comprimento foi esticada imediatamente até 20 mm na Instron e a força foi medida em (gf). Após, todas as amostras foram adaptadas esticadas em placas retangulares de acrílico na distância de 20 mm, imersas em água deionizada a 37o C por 10 minutos e a força (gf) foi medida novamente. Cinco medidas de força foram feitas nos seguintes intervalos de tempo: inicial, 10 minutos, 1 dia, 28 dias e após a escovação mecânica. Após 28 dias, as placas de acrílico com as amostras foram adaptadas na máquina de escovação (MSCT 3) e as cadeias elastoméricas foram submetidas a escovação mecânica e a medida de força (gf) novamente. Os dados da força (gf) foram submetidos a ANOVA modelo misto e teste post-hoc de Sidak (α = 0,05). Uma redução estatisticamente significativa na força foi encontrada para todos os tipos de cadeia elastomérica ortodôntica após 1 dia, 28 dias e escovação mecânica (p<0,05). As cadeias elastoméricas Morelli e 3M Unitek apresentaram força significativamente superior em relação a Abzil e GAC (p<0,05) após 1 dia, 28 dias e escovação mecânica. Em conclusão, a força distribuída por todas as cadeias elastoméricas decaiu rapidamente com o tempo. As cadeias elastoméricas Morelli e 3M Unitek consistentemente tiveram uma força significativamente maior após a escovação mecânica, enquanto GAC a mais baixa.

El uso de un cantiléver para el tratamiento ortodóncico del incisivo impactado en posición horizontal / Use of a cantilever for orthodontic treatment of the impacted incisor in a horizontal position

Introducción: La falta de un incisivo permanente no solo genera un efecto adverso en la estética facial, también altera la función, en especial, la guía incisiva. Los incisivos superiores pueden sufrir bloqueo mecánico o cambio en su erupción por un diente supernumerario, un golpe u otro factor. El tratamiento de elección es el quirúrgico-ortodóncico. El pronóstico dependerá de la edad, situación, posición del diente, morfología, tamaño, maduración radicular y método de tracción. Conocer el uso de una aparatología ortodóncica que sea fácil de manipular y pueda ser usada desde edades tempranas servirá de valioso aporte. Objetivo: Mostrar el uso exitoso de un cantiléver para traccionar ortodóncicamente un incisivo impactado en posición horizontal. Presentación del caso: Paciente de 8 años con maloclusión clase I, pieza 2.1 retenida en posición horizontal, presencia de supernumerario y persistencia de pieza 6.1. Se opta por extracción de supernumerario, liberación de pieza 2.1 y tracción ortodóncica. Se usó un cantiléver por vestibular confeccionado en arco de acero redondo 0.020" con dos círculos en cada extremo para brindar elasticidad y anclaje. La fuerza utilizada fue de 70 g, pasado 6 meses se alcanzó el plano de oclusión. Se cementaron brackets y tubos, se continuó con la secuencia de arcos, hasta llegar al arco acero 0.021"x0.025" durante 11 meses. Se obtiene una posición final óptima que favorece la formación radicular y cierre apical. Conclusiones: El uso del cantiléver para el tratamiento ortodóncico de incisivos permanentes impactados en posición horizontal demostró ser exitoso, fácil de manipular y controlar(AU)

Introduction: The lack of a permanent incisor not only generates an adverse effect on facial aesthetics but also alters its function, especially the incisor guidance. Upper incisors can suffer mechanical blockage or change in their eruption due to a supernumerary tooth, a blow or another factor. The treatment of choice is orthodontic-surgical. The prognosis depends on the age, tooth position, morphology, size, root maturation and traction method. Knowing the use of an orthodontic appliance, which is easy to handle and can be used from an early age, will be of valuable contribution. Objective: To show the successful use of a cantilever to enable orthodontic traction of an impacted incisor in a horizontal position. Case presentation: Eight-year-old patient with class I malocclusion, specimen 2.1 retained in a horizontal position, presence of supernumerary tooth and persistence of specimen 6.1. Extraction of the supernumerary, release of specimen 2.1 and orthodontic traction is chosen. A buccal cantilever made of a 0.020" round steel arch with two circles at each end was used to provide elasticity and anchoring. The force used was 70 g. Six months after, the occlusion plane was reached. Brackets and tubes were cemented and the sequence of arches was continued until the 0.021"x0.025" steel arch was reached in 11 months. An optimal final position is obtained, favoring root formation and apical closure. Conclusions: The use of the cantilever for orthodontic treatment of impacted permanent incisors in a horizontal position proved to be successful as well as easy to manipulate and control(AU)

Effect of Conventional Versus Passive Self-Ligating Vestibular Appliances on Torque, Tip and Transverse Dental Changes in Patients Affected by Class I Malocclusion: A Retrospective Study

ABSTRACT Objective: To evaluate the effects of passive self-ligating appliances (PSLAs) and conventional ligating appliances (CLAs) during orthodontic treatment regarding torque, tip, and transversal dental changes. Material and Methods: Dental parameters were digitally acquired from pre- and post-treatment models of each subject belonging to two groups of patients treated with PSLAs (23 patients; 11 females and 12 males with a mean age of 14.2 ± 1.6 years) and CLAs (18 patients; 10 females and 8 males with a mean age of 14.3 ± 1.9 years), respectively. All subjects had Class I or slight Class II malocclusion (= 2mm), permanent dentition and no previous orthodontic treatment. After normality of data was assumed, a paired sample t-test rejected any side differences at T0 and, therefore, the data were grouped by tooth group. Statistical analyses were performed using a linear mixed-effect framework, assuming the appliance, time, and interactions as fixed effects and the tooth type as random effects. Finally, post-hoc effect analysis was used to contrast modeled marginal effects (p<0.05). Results: For both appliances, there is a general increase of both torque and transverse values at T1, especially for PSLAs. Tip shows a general reduction in the lateral sectors for both appliances is registered. The only significant statistical difference referred to appliances' efficacy is located to mandibular intermolar width. Conclusion: Both appliances have an expansive potential for both torque and transverse dental changes. No evident differences are detectable between appliances except for the rate of the mandibular intermolar width increase.

Comparative Analysis of Stiffness of Lingual Appliances: An in Vitro Study

ABSTRACT Objective: To analyze and compare the stiffness of different lingual appliances with different archwires. Material and Methods: The three-point bending test was used to analyze the stiffness of the lingual archwires for the different lingual systems: eBrace, Harmony, Incognito, and STb. The deflection load curve of each archwire was obtained to evaluate how the section, the material and the manufacturer affect the elasticity and stiffness characteristics of the wires. The comparison of the stiffness between different systems was carried out through a factor variance analysis with three factors (manufacturer, cross-section, and material), followed by the post-hoc Tuckey test. Results: An increase in the system's rigidity was reported as the wire section increases, regardless of the manufacturer. The stainless steel archwires have ever higher stiffness values than NiTi and TMA. The STb wires of CuNiTi material, by virtue of the characteristics of the thermal wires, have flatter and lower load-deflection curves than the NiTi wires of other manufacturers. Conclusion: Archwires section and material showed a significant influence on the stiffness of the lingual systems. Archwires of the same section and material but different manufacturers show different load-deflection curves of stiffness.

Difference in Orthodontic Patients' Perceptions of Essix and Hawley Retainers

Abstract Objective: To determine differences in how orthodontic patients perceive the aesthetics relating to the use of Essix and Hawley retainers. Material and Methods: Photographs of a female patient using an Essix retainer and a Hawley retainer, respectively, were assessed by 70 orthodontic patients aged between 21 and 55 years. All participants were provided with the same images of the two retainer types being worn and were asked to grade the aesthetics of each retainer using a visual analog scale. The significance of differences in orthodontic patient perceptions of aesthetics in the use of Essix and Hawley Retainers in the young adult and adult age groups were tested using the Mann-Whitney test with assumed significance p<0.01. Results: There were differences in participants' perceptions between the two retainers that were statistically significant, with responses varying between young adults aged 21 to 35 years and adults aged 36 to 55 years. According to the VAS, the two retainers' average scores in the total population are 82 for Essix Retainer and 60 for Hawley Retainer in both groups. Conclusion: The Essix retainer as a retention appliance is considered more aesthetically pleasing than the Hawley retainer among both young and middle-aged adults.

Digital Assessment of Dental Parameters in Italian and Mozambican Subjects with Ideal Occlusion and Permanent Dentition

ABSTRACT Objective: To obtain reference values for tip, torque and in-out from digital models of Italian and Mozambican subjects in ideal occlusion using a repeatable and validated method and to compare these measurements with previously reported values. Material and Methods: Dental parameters were acquired from digital models of each subject, categorized to one of two groups: Italians (23 males, 27 females; mean age 28.3 years, ±5.7 years) and Mozambicans (14 males, 15 females; mean age, 23.4 years, ±5.9), using VAM software. All subjects had ideal occlusion, permanent dentition and no previous orthodontic treatment, fillings or prostheses. After normality of data was assumed (p<0.05), a paired t-test was performed to detect any statistical differences between the two groups (p<0.05). Then, classical inference (t-test and power analysis) was used to compare our data to those reported by other authors. Results: Mozambicans' incisors were more proclined, while their upper molars appeared to be more prominent regarding Italians'. Italians shown greater tip values, especially at the upper first premolars and lower first molars. In-out values were comparable between the two groups, except for the upper molars (more prominent in Mozambicans) and lower first molar (more prominent in Italians). Unlike other reports, upper second molars displayed negative tip in our samples. Conclusion: Pre-adjusted appliances with standard prescription should not be expected to guarantee optimal outcomes. Prescriptions specific for ethnicities are recommended and reference values should be reconsidered.

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.

Síndrome da apneia obstrutiva do sono em crianças (SAOS) associada aos dispositivos ortopédicos orais hyrax e bionator de balters sobre respostas miofuncionais / Obstructive sleep apnea syndrome in children (OSAS) associated with Hyrax and Balters' Bionator oral orthopedic devices on myofunctional responses

O objetivo deste estudo foi avaliar a influência terapêutica dos dispositivos orais Hyrax e Bionator de Balters no tratamento da Síndrome da Apneia Obstrutiva do Sono (SAOS), sobre a melhora da SAOS observado pela polissonografia, atividade elétrica dos músculos masseter e temporal, força máxima de mordida, qualidade de vida, e diâmetro dos pontos cefalométricos. Foram selecionados 11 participantes de ambos os sexos, diagnosticados com SAOS através do exame polissonográfico tipo III e com necessidade de tratamento ortopédico facial. Foi feita a coleta dos dados, os responsáveis preencheram os questionários (Escala de Distúrbios do Sono em Crianças e OSA-18-PV), termo de consentimento livre e esclarecido aos responsáveis e para as crianças, documentação ortodôntica (incluindo a análise do diâmetro dos pontos cefalométricos - espaço nasofaríngeo anterior e posterior (NFA-NFP), assim como espaço bucofaríngeo anterior e posterior (BFA-BFP)), análises iniciais da eletromiografia dos músculos masseter e temporal e força máxima de mordida. Estas informações foram coletadas no início do tratamento e após 11 meses, assim como o exame polissonográfico tipo III. Os dados foram normalizados pelo apertamento com Parafilm M e submetidos à análise normalidade pelo teste de Kolmogorov-Smirnov, sendo observado os dados: valor de polissonografia; eletromiografia de masséter direito e esquerdo; eletromiografia de temporal direito e esquerdo; força de mordida em região de incisivo e molar esquerdo/direito, os questionários foram avaliados através de score e nota (0-10), e cefalometria (análise das distâncias NFA-NFP e BFABFP). Para estes dados, foi realizado o teste t de Student. Para os dados com distribuição não normal, foi realizado o teste de Wilcoxon. Todas as análises foram realizadas com nível de significância de 5%. Em relação ao exame polissonográfico e os questionários, houve diferença estatística evidenciando melhora na qualidade do sono dos indivíduos. A eletromiografia demonstrou que houve diferença estatística em repouso no músculo temporal direito, e na mastigação de uva passas, nos músculos masseter e temporal do lado direito. Na cefalometria, foi observada diferença estatística na distância entre os pontos NFA-NFP. Conclui-se que o uso dos dispositivos Hyrax e Bionator de Balters em crianças classe II e portadoras da SAOS é uma alternativa de tratamento segura e eficaz(AU)

The aim of the study was to evaluate the influence of oral devices Hyrax and Balters Bionator in the treatment of Obstructive Sleep Apnea Syndrome (OSAS), on the improvement of OSAS observed by polysomnography, electrical activity of the masseter and temporal muscles, maximum bite force, quality of life, and diameter of cephalometric points. Eleven participants of both genders, diagnosed with OSAS through type III polysomnographic examination and in need of facial orthopedic treatment, were selected. Data collection was performed, the guardians filled out the questionnaires (Sleep Disorders Scale in Children and OSA-18-PV), informed consent form to guardians and for children, cephalometric orthodontic documents - nasopharyngeal space anterior and posterior (NFA-NFP), as well as anterior and posterior buccopharyngeal space (BFA-BFP)), initial analysis of the electromyography of the masseter and temporal muscles and maximum bite force. This information was collected at the beginning of treatment and after 11 months, as well as the type III polysomnographic exam. Data were normalized by tightening with Parafilm M and analysis of normality using the Kolmogorov-Smirnov test, observing the following data: polysomnography value; right and left masseter electromyography; right and left temporal electromyography; bite force in the left/right incisor and molar region, the questionnaires were obtained through score and grade (0-10), and cephalometry (analysis of the NFA-NFP and BFA-BFP distances). For these data, the Student test was performed. For data with non-normal distribution, the Wilcoxon test was performed. All analyzes were performed with a significance level of 5%. Regarding the polysomnographic exam and the questionnaires, there was a statistical difference showing an improvement in the sleep quality of the respondents. The electromyography required that there was a statistical difference at rest in the right muscle, and when chewing raisins, in the masseter and temporal muscles on the right side. In cephalometry, a statistical difference was observed in the distance between the NFA-NFP points. It can be concluded that the use of the Balters Hyrax and Bionator devices in class II children and children with OSAS is a safe and effective treatment alternative(AU)

Effectiveness of three different types of educational methods on implementation of proper oral hygiene behaviour prior to orthodontic treatment

ABSTRACT Objective: The aim of this study was to compare three teaching methods' time and personnel requirements, and their effects on plaque and gingival indices. Methods: This study was a single-blind randomized controlled trial on fixed orthodontic appliance candidates (n = 90), assigned into a control group (n = 30) and two different study groups (n = 30 each). The control group received standard printed educational material and was assisted with verbal information. The study groups either received video-assisted or hands-on training about fixed orthodontic appliance and oral hygiene. The time requirements for all three educational interventions was recorded during the initial visit. The adequacy of oral hygiene was documented through plaque and gingival indices during the initial visit and eighth week of the treatment. The continuous variables were analyzed using 1-way ANOVA. Tukey HSD and Student t-tests were used for post-hoc comparisons (α?#8197;= 0.05). Also, a chi-square test was used for the analysis of categorical variables. Results: Standard education failed to maintain the plaque and gingival indices at the eighth week of the treatment. Although both video-assisted and hands-on training took a considerable amount of time, they served well in preserving both of the indices at the eighth week. The longer the educational intervention was, the better the preservation of the plaque and gingival indices. Conclusion: Educational intervention, either with video-assisted or hands-on programs, provided better results in oral hygiene depending on the time and personnel constraints of the orthodontist.

RESUMO Objetivo: O objetivo do presente estudo foi comparar a duração e os pré-requisitos de equipe de três métodos de orientação ao paciente, e seus efeitos sobre os índices de placa e de sangramento gengival. Métodos: Esse foi um estudo controlado aleatório cego em candidatos (n=90) a tratamento ortodôntico fixo, que foram divididos em um grupo controle (n=30) e dois grupos de estudo (n= 30 cada). O grupo controle recebeu material educacional impresso e foi orientado com informações verbais. Os grupos de estudo receberam treinamento em formato de vídeo ou treinamento hands-on sobre o tratamento com Ortodontia fixa e higiene bucal. O tempo necessário para cada um dos três tipos de treinamento foi registrado durante a visita inicial. A qualidade da higiene bucal foi avaliada por meio dos índices de placa e de sangramento gengival durante a visita inicial e na oitava semana de tratamento. As variáveis contínuas foram analisadas utilizando-se one-way ANOVA. Os testes HSD de Tukey e t de Student foram utilizados para comparações post-hoc (α?#8197;= 0,05), e o teste qui-quadrado foi utilizado para análise das variáveis categóricas. Resultados: O método de ensino convencional fracassou em manter os índices de placa e de sangramento gengival até a oitava semana de tratamento. Apesar de tanto o método de treinamento com vídeos e de treinamento hands-on demandarem um tempo considerável, eles conseguiram manter ambos os índices até a oitava semana. Quanto mais longa a orientação realizada, melhor foi a manutenção dos índices de placa e de sangramento gengival. Conclusão: Tanto o método de treinamento com vídeo quanto no formato hands-on obtiveram melhores resultados de higiene bucal, mas dependem do tempo e das limitações de equipe de cada ortodontista.

Percepción del dolor, rasgos de personalidad y actitud del paciente hacia el tratamiento ortodóntico / Pain perception, personality traits and patient attitude toward orthodontic treatment

Introducción: El dolor inducido por los aparatos de ortodoncia es una de las principales razones que desalientan a los pacientes a buscar tratamiento ortodóntico y puede afectar negativamente su cooperación. Objetivo: Determinar la relación de la percepción del dolor, rasgos de personalidad y la actitud del paciente hacia el tratamiento ortodóntico. Métodos: Estudio transversal y observacional. La muestra estuvo conformada por dos grupos: I) 200 sujetos no tratados (78 varones y 122 mujeres; edad promedio 20,02 ± 2,67 años) y II) 200 sujetos tratados (64 varones y 136 mujeres; edad promedio 20,29 ± 3,88 años). El instrumento para la recolección de datos fue un cuestionario que incluía la evaluación de la expectativa del dolor para sujetos no tratados, experiencia de dolor para sujetos tratados, los perfiles de personalidad de los pacientes y actitudes hacia el tratamiento de ortodoncia. Resultados: No se encontró relación entre la percepción del dolor, los rasgos de personalidad y actitud del paciente hacia el tratamiento ortodóntico (p > 0,05). El estado de tratamiento (presentar ortodoncia) afectó la percepción del dolor hacia el tratamiento ortodóntico (p < 0,05), el género no afectó la percepción del dolor. El estado de tratamiento y el género masculino afectaron la actitud del paciente hacia el tratamiento ortodóntico (p < 0,05). Conclusiones: Los pacientes con mejor actitud mostraron menos dolor y los pacientes con mayor percepción del dolor mostraron una actitud negativa. Los niveles bajos de amabilidad tienen efecto sobre la percepción del dolor del paciente hacia el tratamiento ortodóntico(AU)

Introduction: The pain induced by orthodontic appliances is one of the main reasonswhy patients are reluctant to seek orthodontic treatment, and may negatively affect their cooperation. Objective: Determine the relationship between pain perception, personality traits and patient attitude toward orthodontic treatment. Methods: A cross-sectional observational study was conducted of a study sample composed of two groups: I) 200 untreated subjects (78 male and 122 female; mean age 20.02 ± 2.67 years) and II) 200 treated subjects (64 male and 136 female; mean age 20.29 ± 3.88 years). The data collection tool was a questionnaire including an evaluation of pain expectation for untreated subjects, pain experience for treated subjects, patients' personality profiles and attitudes toward orthodontic treatment. Results: No relationship was found between pain perception, personality traits and patient attitude toward orthodontic treatment (p > 0.05). Treatment status (untreated or treated) affected pain perception and the attitude toward orthodontic treatment (p < 0.05); gender did not affect pain perception. Treatment status and male gender affected patient attitude toward orthodontic treatment (p < 0.05). Conclusions: Patients with a better attitude experienced less pain, whereas patients with a greater pain perception showed a negative attitude. Low levels of kindness have an effect on pain perception and patient attitude toward orthodontic treatment(AU)

Mechanical and non-mechanical orthodontic procedures in relapse and retention: scoping review / Procedimientos ortodónticos mecánicos y no mecánicos en recidiva y retención: revisión de cobertura temática

Abstract Introduction: stability after orthodontic treatment is an important goal for orthodontists. This issue has been highly important in orthodontics, so its progress and content require constant analysis. Methods: a panoramic and analytical review of citations and keywords from Web of Science helped create a body of information on the current advances in research on this field. Results: several fields of research arise from the analysis, dealing with surgery as an approach, molecular concepts, orthodontists' experiences in professional practice, and the use of lasers and other applications. Conclusions: information on relapse and retention within orthodontics is still valid and requires further research on current issues to understand this complex phenomenon for both academia and clinical use.

Resumen Introducción: la estabilidad postortodóncica es uno de los objetivos que persigue el ortodoncista. Esta temática siempre ha tenido una importancia relevante en la ortodoncia y requiere continuo análisis de sus avances y contenidos. Métodos: mediante una revisión panorámica y analítica de citas y palabras clave desde Web of Science, se establece un cuerpo de información con base en el cual se plantea el avance actual de la investigación en este campo. Resultados: en el análisis emergen varios campos de investigación que tienen que ver con la cirugía como medio de abordaje, los conceptos moleculares, las experiencias de los ortodoncistas en la práctica profesional y el uso de láser y otras aplicaciones. Conclusiones: dentro de la ortodoncia, la información sobre recidiva y retención sigue vigente e invita a la construcción de trabajos en relación con las temáticas actuales para comprender este fenómeno complejo no solo para la academia, sino además para su utilidad clínica.

Ameloplastia positiva en relación céntrica como método auxiliar durante la finalización en el tratamiento de ortodoncia en un paciente bruxista / Positive ameloplasty in centric relationship as an auxiliary method during finalization in the orthodontic treatment in a bruxist patient

A continuación se presenta un caso de un paciente de 12 años de edad, con antecedente de bruxismo, con biotipo mesofacial, tercio inferior dolicofacial, hipertonicidad muscular en maseteros, cierre labial forzado con incompetencia labial de 4 milímetros con dolor en sinoviales anteriores inferiores. Los objetivos de tratamiento consistieron en lograr relajación muscular y promover un posicionamiento condilar ortopédicamente funcional y estable, realizar control vertical para disminuir gap interlabial, alinear líneas medias, mantener clase I molar bilateral, clase I canina bilateral y clase I incisiva, crear overjet y overbite adecuados, con recuperación estética y función del segmento anterior. Debido a eventos adversos durante la etapa de cierre de espacios, la clase molar y canina I no se logró, pero se aseguró mediante ameloplastias positivas la función y estética adecuadas para tener un tratamiento de ortodoncia estable a largo plazo (AU)

The following is a case of a 12-year-old patient, with a history of bruxism, with a mesofacial biotype, lower third of the facial area, muscular hypertonicity in the masseters, a forced labial closure with a 4-millimeter labial incompetence with pain in inferior anterior synoviums. Treatment objectives consisted of achieving muscle relaxation and promoting orthopedically functional and stable condylar positioning, perform vertical control to decrease interlabial gap, align midlines, maintain bilateral molar class I, bilateral canine class I and incisive class I, create adequate overjet and overbite, with aesthetic recovery and function of the anterior segment. Due to adverse events during the closing phase of spaces, the molar and canine I class was not achieved, but positive function and aesthetics were ensured by positive ameloplasties in order to have a long-term stable orthodontic treatment (AU)

The evaluation of shear bond strength of resin-modified glass ionomer cement with the addition of 45S5 bioactive glass using two conventional methods / La evaluación de la resistencia al cizallamiento del cemento de ionómero de vidrio modificado con resina con la adición de vidrio bioactivo 45S5 utilizando dos métodos convencionales

Introduction: There is a high prevalence of enamel caries around brackets due to the young age of the majority of orthodontic patients, and to the difficulty of plaque removal in presence of orthodontic appliances. Recently, protective agents such as bioactive glasses (BGs) were introduced to enhance remineralization and prevent demineralization of tooth structures. This study aimed to assess the shear bond strength (SBS) of resin-modified glass ionomer cement (RMGIC) with addition of 45S5 BG to enhance its remineralizing potential using two conventional methods. Material and methods: This in-vitro experimental study evaluated three groups (n=20) of orthodontic brackets bonded to enamel using Transbond XT (group 1), light-cure RMGIC (group 2) and RMGIC with BG added (group 3). Samples underwent 7000 thermal cycles and their SBS was measured. The adhesive remnant index (ARI) score was also determined. Quantitative data were analyzed using one-way ANOVA while qualitative data were analyzed using a chi-square test. Discussion: The results showed no significant difference in SBS between study groups, however the ARI scores were significantly different among the groups. The RMGIC group showed the highest ARI while RMGIC doped with BG showed the lowest ARI score. Conclusion: Addition of 30% w/v 45S5 BG to RMGIC does not cause a significant change in SBS of orthodontic brackets bonded to enamel, while resulting in less amount of luting agent remnants on the enamel surface after debonding.

Introducción: Existe una alta prevalencia de caries del esmalte alrededor de los brackets debido a la corta edad de la mayoría de los pacientes de ortodoncia y a la dificultad de remoción de la placa en presencia de aparatos de ortodoncia. Recientemente, se introdujeron agentes protectores como los vidrios bioactivos (VB) para mejorar la remineralización y prevenir la desmineralización de las estructuras dentales. Este estudio tuvo como objetivo evaluar la resistencia al cizallamiento (RC) del cemento de ionómero de vidrio modificado con resina (CIVMR) con la adición de 45S5 BG para mejorar su potencial remineralizante utilizando dos métodos convencionales. Material y Métodos: Este estudio experimentalin vitro evaluó tres grupos (n = 20) de brackets de ortodoncia adheridos al esmalte usando Transbond XT (grupo 1), CIVMR fotopolimerizable (grupo 2) y CIVMR con VB agregado (grupo 3). Las muestras se sometieron a 7000 ciclos térmicos y se midió su RC. También se determinó la puntuación del índice de restos de adhesivo (IRA). Los datos cuantitativos se analizaron mediante ANOVA de una vía, mientras que los datos cualitativos se analizaron mediante una prueba de chi-cuadrado. Discusión: Los resultados no mostraron diferencias significativas en la RC entre los grupos de estudio, sin embargo, los puntajes IRA fueron significativamente diferentes entre los grupos. El grupo CIVMR mostró el ARI más alto mientras que CIVMR dopado con VB mostró el puntaje IRA más bajo. Conclusión: La adición de un 30% p/v de 45S5 VB a CIVMR no causa un cambio significativo en la RC de los brackets de ortodoncia adheridos al esmalte, mientras que resulta en una menor cantidad de remanentes de agente de fijación en la superficie del esmalte después del desprendimiento. Resistencia al Corte.

Impact of the SARS-Cov2 Pandemic on Orthodontic Therapies: An Italian Experience of Teleorthodontics

Abstract Objective: To assess the possibility of controlling patients at a distance according to principles of teleorthodontics to understand its possible usefulness in the future routine activity and the impact pandemic may have had on different types of orthodontic treatments. Material and Methods: One hundred orthodontic patients (57 F, 43 M, age 7-46) during quarantine were checked through videocalls and photos sent by patients following proper instructions. Three groups have been distinguished based on the type of therapy: A-fixed appliances; B-removable appliances; C-clear aligners. Relevant events about dental and gingival health, integrity of appliances, orthodontic therapies related symptoms and overall progress of treatments were recorded. Results: A and B groups reported higher percentages of gingival inflammation (27 and 22%), dental plaque (16 and 13%), deciduous tooth loss (8 and 16%). Bracket and attachment detachment were the most frequent events in A and C groups (22 and 23%). Pain and discomfort were reported in A and B groups (35 and 32%). Therapies continued to progress better in C (51% improved dental alignment) and B (31% improved malocclusions) groups. Conclusion: Orthodontics is safe and allows during emergencies to postpone checks. Everyday mobile-technology is useful in managing orthodontic patients unable to carry out in-person control. When their effectiveness equals other systems, treatments with clear aligners without attachments should be preferred in patients unavailable for regular checks.