Effect of ibuprofen and low-intensity pulsed ultrasound on the reduction of pain after initial archwire placement: a double-blind randomized clinical trial / Efecto del ibuprofeno y el ultrasonido pulsado de baja intensidad en la reducción del dolor después de la colocación inicial del arco de ortodoncia: un ensayo clínico aleatorizado doble ciego

Objective: This study aimed to compare the effect of ibuprofen and low intensity pulsed ultrasound (LIPUS) on the reduction of pain after the placement of initial archwire in orthodontic patients. Material and Methods: This double-blind clinical trial study was carried out on 60 female candidates for fixed orthodontic treatment referring to the Orthodontic Department of School of Dentistry in Mashhad University of Medical Sciences, Mashhad, Iran, during 2015-2016. The subjects were divided into four groups of ibuprofen, LIPUS, placebo, and mock LIPUS. A questionnaire and a rectangular and flexible cubic silicone were given to each patient to record the severity of pain based on the visual analog scale at specified time points (i.e., 2 h, 6 h, at bedtime, 2nd, 3rd, and 7th days after archwire placement) when biting the silicone block with the anterior and posterior teeth and without biting at all. Repeated measures analysis of variance was used in order to compare the pain severity at different time points. Results: The comparison of pain severity at various time points showed that the highest and lowest mean scores of pain were reported at bedtime and seven days after the intervention (p<0.001). In each of the three conditions (i.e., biting the silicone block with the anterior and posterior teeth and without biting the teeth) at six time points (i.e., 2 h, 6 h, at bedtime, 2nd, 3rd, and 7th days following archwire placement), no significant difference was observed in the severity of pain (p>0.05). Conclusion: In conclusion, LIPUS (with a frequency of 1 MHz and an intensity of 100 mW) and ibuprofen have no significant effects on reduction of the pain severity at different time points and various conditions in orthodontic patients.

Objetivo: Este estudio tuvo como objetivo comparar el efecto del ibuprofeno y el ultrasonido pulsado de baja intensidad (LIPUS) en la reducción del dolor después de la colocación del arco inicial en pacientes de ortodoncia. Material y Métodos: Este estudio de ensayo clínico doble ciego se llevó a cabo en 60 candidatas a tratamiento de ortodoncia fija referidas al Departamento de Ortodoncia de la Facultad de Odontología de la Universidad de Ciencias Médicas de Mashhad, Mashhad, Irán, durante 2015-2016. Los sujetos se dividieron en cuatro grupos: ibuprofeno, LIPUS, placebo y LIPUS simulado. Se entregó un cuestionario y un bloque de silicona cúbica rectangular y flexible a cada paciente para registrar la intensidad del dolor según la escala analógica visual en puntos de tiempo específicos (es decir, 2 h, 6 h, hora de acostarse, 2do, 3er y 7mo día después de la colocación del arco) al morder el bloque de silicona con los dientes anteriores y posteriores, y sin morder en absoluto. Se utilizó el análisis de varianza de medidas repetidas para comparar la intensidad del dolor en diferentes momentos.Resultados: La comparación de la intensidad del dolor en varios puntos de tiempo mostró que las puntuaciones medias de dolor más altas y más bajas se informaron a la hora de acostarse y siete días después de la intervención (p<0,001). En cada una de las tres condiciones (es decir, al morder el bloque de silicona con los dientes anteriores y posteriores, y sin morder) en seis momentos (2 h, 6 h, antes de acostarse 2do, 3er y 7mo día después de la colocación del arco), no se observó diferencia significativa en la severidad del dolor (p>0.05).Conclusión: En conclusión, LIPUS (con una frecuencia de 1 MHz y una intensidad de 100 mW) y el ibuprofeno no tienen efectos significativos en la reducción de la severidad del dolor en diferentes puntos de tiempo y diversas condiciones en pacientes de ortodoncia.

Comparison of the High Cycle Fatigue Behavior of the Orthodontic NiTi Wires: An in Vitro Study

Abstract Objective: To compare the high-cycle fatigue behavior of four commercially available NiTi orthodontic wires. Material and Methods: Twelve NiTi orthodontic wires, round, 0.016-in, three per brand, were selected and divided into four groups: G1 - Heat-activated NiTi, G2 - Superelastic NiTi, G3 - Therma-Ti, and G4 - CopperNiTi. The atomic absorption spectrometry method was used to determine the chemical composition of investigated NiTi wires. We also performed a fatigue test at three-point bending using a universal testing machine for 1000 cycles in a 35 °C water bath. For the first and thousandth cycle, the average plateau load and the plateau length were determined in the unloading area of the force versus displacement diagram. In addition, we calculated the difference between the average plateau load of the first and thousandth cycle (∆F), as well as the difference between the plateau length of both cases (∆L). Results: According to our results, there were no significant differences between the average plateau load of the first and thousandth cycles of each group (p>0.05) and in the plateau length of the first and thousandth cycles of the groups (p>0.05). Conclusion: There were no significant differences between the groups changing the superelasticity property after high-cycle fatigue.

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.

3D technology to measure dental arches and create a template for lingual brackets technique

ABSTRACT Objective: This study aims at identifying anatomical dimensions of dental arches, based on landmarks currently used in the lingual orthodontic technique, and create an archwire form template to be used in orthodontic clinics. Methods: Maxillary and mandibular dental casts of 140 Caucasian individuals with natural and normal occlusion were digitized (3D), and the images were analyzed with Delcam Power ShapeTM 2010 software. The dental arch shapes and sizes were obtained from 14 landmarks selected on the lingual surface of the teeth. Points and segments defined by the software were used to create an archwire form template. Results: Various dental arch patterns were found for both maxilla and mandible. The smallest sizes were found in females, and the largest were found in male subjects. Six categories were defined for each gender, three for the maxilla and three for the mandible (Small, Medium and Large). A template was created with eighteen anatomic lingual archwire designs, nine for the maxilla and nine for the mandible, for both genders. Conclusions: Landmarks evaluated in this study showed dental arch differences between genders. This information enables making orthodontic lingual archwires that are more compatible with the anatomical forms and sizes of the maxilla and mandible. The findings also allowed the creation of a template for an anatomic lingual metallic archwire form to be used in the lingual technique.

RESUMO Objetivo: O presente estudo tem como objetivo encontrar as formas anatômicas e dimensões das arcadas dentárias com base em pontos de referência utilizados na técnica ortodôntica lingual, e criar um diagrama com um maior número de arcos metálicos para serem utilizados na clínica ortodôntica. Métodos: 140 modelos de indivíduos caucasianos com oclusão normal e natural foram digitalizados (3D) e as imagens, analisadas com o software Delcam Power ShapeTM 2010. A determinação das formas e tamanhos das arcadas dentárias foi obtida a partir de 14 pontos selecionados na superfície lingual dos dentes. Outros pontos e segmentos foram utilizados, com o auxílio do software, para definir um diagrama. Resultados: Foram encontrados diferentes tamanhos de arcadas dentárias linguais, tanto para a maxila quanto para a mandíbula. Os menores tamanhos foram os femininos, e os maiores, os masculinos. Definiram-se seis tamanhos para cada sexo, sendo três para a maxila e três para a mandíbula, nomeados como P, M e G. Foi criado um diagrama com dezoito desenhos de arcos linguais anatômicos, nove para a maxila e nove para a mandíbula, para ambos os sexos. Conclusões: A posição dos pontos de referência nesse estudo evidenciou diferenças entre os sexos, o que permitiu a criação de arcos mais compatíveis com as formas e dimensões anatômicas da maxila e mandíbula. A diferença entre os tamanhos das arcadas dentárias linguais possibilitou a criação de um diagrama com formas de arcos metálicos linguais anatômicos para serem utilizados na técnica lingual, para auxiliar o profissional a criar os seus próprios arcos.

Effect of fluoride on mechanical properties of NiTi and CuNiTi orthodontic archwires: an in vitro study

ABSTRACT Introduction: After debonding, white spot may appear on the area below the bracket, which is the early clinical sign of carious lesion. There is increased caries risk underneath and adjacent to orthodontic bands and brackets, which call for maximum use of caries preventive procedures using various fluoride application methods. Objective: The aim of the study was to evaluate alterations in the mechanical properties (modulus of elasticity and yield strength) in loading and unloading phases for different orthodontic archwires (nickel-titanium [NiTi] and copper-nickel-titanium [CuNiTi]) when exposed routinely to fluoride prophylactic agents for a predetermined period of time. Methods: Preformed rectangular NiTi and CuNiTi wires were immersed in fluoride solution and artificial saliva (control) for 90 minutes at 37ºC. After immersion, specimens were tested using a 3-point bend test on a universal testing machine. Results: There is a significant reduction in the unloading yield strength when the NiTi and CuNiTi wires were exposed to APF gel. Conclusion: The result suggests that use of topical fluoride agents affect the mechanical properties of the wires, leading to increase in treatment duration. Fluoride prophylactic agents must be used with caution in patients undergoing orthodontic treatment. Injudicious use of these agents may cause corrosive effects on the orthodontic wire surfaces, with alteration in their mechanical properties.

RESUMO Introdução: Após a remoção dos braquetes, manchas brancas podem aparecer na área embaixo deles, as quais são o sinal clínico inicial da lesão cariosa. Existe um maior risco de cáries embaixo e ao redor das bandas e braquetes ortodônticos, o que exige a máxima utilização de procedimentos preventivos de cárie, usando diferentes métodos com aplicação de flúor. Objetivo: O objetivo do presente estudo foi avaliar alterações nas propriedades mecânicas (módulo de elasticidade e resistência ao escoamento), nas fases de carregamento e descarregamento de diferentes fios ortodônticos (níquel-titânio [NiTi] e níquel-titânio com adição de cobre [CuNiTi]), quando expostos rotineiramente a agentes profiláticos fluoretados, utilizados durante um período de tempo predeterminado. Métodos: Os fios pré-contornados retangulares de NiTi e CuNiTi foram imersos em solução fluoretada e saliva artificial (controle) durante 90 minutos a 37°C. Após a imersão, as amostras foram testadas utilizando-se um teste de flexão em três pontos, em uma máquina universal de testes. Resultados: Houve uma redução significativa na resistência ao escoamento na fase de descarregamento quando os fios de NiTi e CuNiTi foram expostos ao gel fluoretado. Conclusão: O resultado sugere que o uso tópico de agentes fluoretados afeta as propriedades mecânicas dos fios, levando a um aumento na duração do tratamento. Os agentes profiláticos fluoretados devem ser utilizados com cautela em pacientes submetidos a tratamento ortodôntico. O uso indiscriminado desses agentes pode causar efeitos corrosivos na superfície dos fios ortodônticos e consequente alteração das suas propriedades mecânicas.

Can we expect similar behavior among CuNiTi 35°C wires?

ABSTRACT Objective: This paper aims to verify the thermodynamic, mechanical and chemical properties of CuNiTi 35ºC commercial wires. Methods: Forty pre-contoured copper-nickel-titanium thermodynamic 0.017 x 0.025-in archwires with an Af temperature of 35°C were used. Eight wires from five different manufacturers (American Orthodontics® [G1], Eurodonto® [G2], Morelli® [G3], Ormco® [G4] and Orthometric® [G5]) underwent cross-sectional dimension measurements, tensile tests, SEM-EDS and differential scanning calorimetry (DSC) tests. Parametric tests (One-way ANOVA and Tukey post-test) were used, with a significance level of 5%, and Pearson's correlation coefficient test was performed between the Af and chemical elements of the wires. All sample tests and statistical analyses were double-blinded. Results: All wires presented standard dimensions (0.017 x 0.025-in) and superelastic behavior, with mean plateau forces of: G1 = 36.49N; G2 = 27.34N; G3 = 19.24 N; G4 = 37.54 N; and G5 = 17.87N. The Af means were: G1 = 29.40°C, G2 = 29.13°C and G3 = 31.43°C, with p>0.05 relative to each other. G4 (32.77°C) and G5 (35.17°C) presented statistically significant differences between each other and among the other groups. All samples presented Ni, Ti, Cu and Al in different concentrations. Conclusions: The chemical concentration of the elements that compose the alloy significantly influenced the thermodynamic and mechanical properties.

RESUMO Objetivo: O presente artigo teve como objetivo verificar as propriedades termodinâmicas, mecânicas e químicas de fios CuNiTi 35°C comerciais. Métodos: Foram utilizados 40 arcos termodinâmicos pré-contornados de cobre-níquel-titânio de 0,017" x 0,025" e temperatura Af de 35°C. Oito fios de cinco fabricantes diferentes (American Orthodontics® [G1], Eurodonto® [G2], Morelli® [G3], Ormco® [G4] e Orthometric® [G5]) foram submetidos a medições de suas secções transversais, testes de tração, MEV-EDS e calorimetria diferencial (DSC). Foram utilizados testes paramétricos (One-way ANOVA e pós-teste de Tukey), com nível de significância de 5%, e foi realizado o teste do coeficiente de correlação de Pearson entre a temperatura Af e os elementos químicos dos fios. Todos os testes das amostras e análises estatísticas foram duplo-cegos. Resultados: Todos os fios apresentavam dimensões padronizadas (0,017" x 0,025") e comportamento superelástico, com forças médias de platô de G1 = 36,49 N; G2 = 27,34 N; G3 = 19,24 N; G4 = 37,54 N; e G5 = 17,87 N. As médias de Af foram: G1 = 29,40°C, G2 = 29,13°C e G3 = 31,43°C, com p> 0,05 entre si. G4 (32,77°C) e G5 (35,17°C) apresentaram diferenças estatisticamente significativas entre si e entre os demais grupos. Todas as amostras apresentaram Ni, Ti, Cu e Al em diferentes concentrações. Conclusões: A concentração química dos elementos que compõem a liga influenciou significativamente as propriedades termodinâmicas e mecânicas.

Separation of aligning and leveling stages to control mandibular incisor inclination: A randomized clinical trial

ABSTRACT Objective: To determine whether separating the alignment and leveling phases can reduce proclination of the mandibular incisors. Methods: Eligibility criteria included Class I subjects with an irregularity index of 3-5 mm, 3-4 mm curve-of-Spee (COS), and non-extraction treatment. Thirty adults were randomly allocated into two groups: (1) Control group was leveled and aligned simultaneously with flat archwires progressively to 0.016x0.022-in stainless-steel; (2) Experimental group was aligned first with 0.014-in-superelastic NiTi with mild accentuated COS, then leveled using 0.016x0.022-in beta-titanium accentuated COS archwires and gradually reduced the curve until flat. Mandibular incisor position and inclination were evaluated by cephalometric analysis. COS and irregularity index were evaluated in study models. Assessment was conducted twice after 0.016-in NiTi and after 0.016x0.022-in stainless-steel archwire placements. Dental changes from cephalograms and models were compared within group using paired t-test and between groups using independent t-test. Results: Control group: Round-wire-phase, mandibular incisors tipped labially (4.38° and 1 mm) with intrusion (-1.13 mm); Rectangular-wire-phase, mandibular incisors further intruded and proclined (-0.63 mm and 1.38°). Experimental group: During aligning with round accentuated COS archwires, mandibular incisors tipped very slightly labially (0.75° and 0.50 mm) with no significant intrusion; during leveling with rectangular archwires, incisors majorly intruded (1.75 mm) with slight proclination (1.81°). The experimental group had significant less incisor proclination (control: 5.76°, experimental: 2.56°) with more incisor intrusion (control: -1.75 mm, experimental: -2.13 mm). The COS in experimental group showed significant greater reduction (-2.88 mm) than that of the control group (-1.69 mm). Conclusion: In control group, mandibular incisor proclination was markedly observed in round archwires, with further proclination caused by rectangular archwires. In experimental group, minimal proclination was exhibited when accentuated COS round archwires were used for aligning. Leveling with rectangular archwires caused less proclination with more COS reduction.

RESUMO Objetivo: Avaliar se separar os estágios de alinhamento e nivelamento reduz a projeção dos incisivos inferiores. Métodos: Os critérios de inclusão foram indivíduos Classe I com índice de irregularidade de 3-5mm, Curva de Spee (CS) de 3-4mm e tratamento sem extrações. Trinta adultos foram alocados aleatoriamente em dois grupos: o Grupo Controle (1) foi simultaneamente alinhado e nivelado com arcos planos progressivamente até atingir o 0,016" x 0,022" de aço inoxidável; o Grupo Experimental (2) foi inicialmente alinhado com arcos superelásticos NiTi 0,014" com CS levemente aumentada, em seguida nivelado com arcos de beta-titânio 0,016" x 0,022" com CS acentuada, que foi gradualmente reduzida até ficar plana. A posição e inclinação dos incisivos inferiores foram avaliadas por meio de análise cefalométrica. A CS e o índice de irregularidade foram avaliados por meio de modelos de estudo. A avaliação foi realizada duas vezes, sendo após a inserção dos arcos NiTi 0,016" e dos arcos 0,016" x 0,022" de aço. As mudanças dentárias visualizadas nos cefalogramas e nos modelos foram comparadas dentro dos grupos utilizando teste t pareado e entre os grupos utilizando o teste t independente. Resultados: Grupo Controle: estágio de arco redondo: os incisivos inferiores se inclinaram vestibularmente (4.38° e 1 mm) e intruíram (-1,13mm); estágio de arco retangular: os incisivos inferiores intruíram e se projetaram adicionalmente (-0.63mm e 1,38°). Grupo Experimental: Durante o alinhamento com arcos redondos e CS acentuada, os incisivos inferiores se inclinaram levemente para vestibular (0,75° e 0,50mm), sem intrusão significativa; durante o nivelamento com arcos retangulares, os incisivos, em sua maioria, intruíram (1,75mm), com uma leve projeção (1,81°). O grupo experimental apresentou projeção dos incisivos significativamente menor (controle: 5,76°; experimental: 2,56°), com maior intrusão dos incisivos (controle: -1,75mm; experimental: -2,13mm). A CS no Grupo Experimental apresentou redução significativamente maior (-2,88 mm) do que no grupo controle (-1,69 mm). Conclusão: No Grupo Controle, foi observada de forma notória a projeção dos incisivos inferiores nos arcos redondos, com projeção adicional causada pelos arcos retangulares. No Grupo Experimental, foi observada uma projeção mínima quando foram utilizados arcos redondos com CS acentuada para alinhamento. O nivelamento com arcos retangulares causou menos projeção com maior redução da CS.

Método de extrusión dentaria unitaria con fines protésicos: caso clínico / Single tooth extrusion method for prosthetic purposes: a clinical case

La pérdida de estructura dentaria por debajo del margen gingival y de la cresta ósea alveolar, ya sea por caries, fracturas traumáticas, desgaste, reabsorción radicular o perforaciones iatrogénicas, dificulta el tratamiento protésico y requiere un abordaje multidisciplinario para conseguir resultados óptimos y estables a largo plazo. Se presenta el caso de una paciente adulta que acude a consulta con la pieza 2.3, que no permite una adecuada restauración protésica sin invadir el espacio biológico. Dentro del abanico de posibilidades terapéuticas se selecciona la extrusión dentaria unitaria guiada, para poder exponer un remanente dentario adecuado supragingival, y conseguir un adecuado efecto ferrule para la posterior rehabilitación protésica. La técnica presentada es eficaz, simple, cómoda, higiénica y útil en pacientes que no desean realizarse tratamiento de ortodoncia en ambas arcadas (AU)

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

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

Attractiveness of different esthetic orthodontic wires

ABSTRACT Objective: The aim of this study was to evaluate the attractiveness of different types of esthetic orthodontic wires by laypeople and dentists. Methods: Five different types of orthodontic wires were evaluated: three esthetic wires (Teflon-coated, epoxy resin-coated and rhodium-coated wires), and two metallic wires (stainless steel and NiTi), as control. Monocrystalline ceramic brackets were installed in the maxillary arch of a patient presenting good dental alignment. The five evaluated wires were attached to the orthodontic appliance with an esthetic silicone elastic and photographed. The photographs were evaluated by 163 individuals, 110 dentists and 53 laypeople. The data were statistically evaluated by two-way ANOVA and one-way ANOVA, followed by Tukey tests. Results: There was a statistically significant difference in the attractiveness among the wires evaluated; the most esthetic was the rhodium-coated wire, followed by the epoxy resin-coated wire and, finally, the Teflon-coated wire, with no significant difference from the stainless steel and NiTi control archwires. There was no significant difference between the groups of evaluators. Conclusion: The most attractive was the rhodium-coated wire, followed by the epoxy resin-coated wire and, finally, the least attractive wire was the Teflon-coated wire, without statistically significant difference to the stainless steel and NiTi wires, used as control.

RESUMO Objetivo: O objetivo do presente estudo foi avaliar a atratividade de diferentes tipos de fios ortodônticos estéticos, na opinião de leigos e dentistas. Métodos: Foram avaliados cinco tipos diferentes de fios ortodônticos: três fios estéticos (revestidos com teflon, revestidos com resina epóxi e revestidos com ródio) e dois fios metálicos (aço inoxidável e NiTi), como grupo controle. Braquetes de cerâmica monocristalina foram instalados na arcada superior de uma paciente com bom alinhamento dentário, e os cinco fios avaliados foram fixados ao aparelho ortodôntico com ligadura elástica estética de silicone e fotografados. As fotografias foram avaliadas por 163 indivíduos, sendo 110 dentistas e 53 leigos. Os dados foram avaliados estatisticamente pelos testes ANOVA a um e a dois critérios, seguidos pelo teste de Tukey. Resultados: Houve diferença estatisticamente significativa na atratividade entre os fios avaliados. O mais estético foi o fio revestido de ródio, seguido pelo fio revestido de resina epóxica e, finalmente, o fio revestido de teflon, sem diferença significativa entre os fios de aço inoxidável e os de NiTi. Não houve diferença significativa entre os grupos de avaliadores. Conclusão: O mais atraente foi o fio revestido de ródio, seguido pelo fio revestido de resina epóxica e, finalmente, o fio menos atraente foi o fio revestido de teflon, sem diferença estatisticamente significativa para os fios de aço inoxidável e os de NiTi, utilizados como controle.

Avaliação do grau de corrosão de fios ortodônticos submetidos a desafio de pH / Evaluation of the corrosion degree of orthodontic wires subjected to pH challenge

Introdução: a movimentação dentária requer a aplicação de um sistema de forças que é orientado com o uso de acessórios, incluindo fios ortodônticos. Existem diversos materiais e fabricantes disponíveis no mercado, por isso é importante que o profissional conheça a composição deste material, uma vez que estará em contato com a mucosa oral, podendo sofrer corrosão e liberação de íons metálicos. Objetivo: avaliar, in vitro, o grau de corrosão de duas ligas metálicas que compõem fios ortodônticos de três fabricantes diferentes, submetidos à ciclagem de pH. Metodologia: 60 corpos de prova foram confeccionados com dois tipos de ligas metálicas (NiTi e CrNiaço 302) produzidas por três fabricantes diferentes, divididos em 6 Grupos de Testes com 10 unidades cada. Os corpos-de-prova foram submetidos à ciclagem ácida de pH 4,3, diariamente, e mantidos em estufa a 37 ° C por 14 dias. A massa foi pesada antes e após a ciclagem, por meio de balança analítica de precisão. A avaliação das características visuais dos fios foi realizada por um único observador em lupa estereomicroscópica. Resultados: a ciclagem de pH dos fios ortodônticos não promoveu perda significativa de massa ou corrosão, apesar da análise das características visuais terem mudado após a ciclagem. Conclusão: com base nos resultados do protocolo experimental estabelecido no presente estudo, a análise do comportamento das ligas de aço NiTi e CrNi ­ 302 que compõem os fios ortodônticos, frente ao desafio ácido de pH 4,3, por duas semanas, concluiu-se que esses materiais não apresentaram perdas de massa, opacidade, brilho e lisura consideradas significativas. Outros estudos são recomendados para fornecer maiores esclarecimentos sobre o tema.

Introduction: the tooth movement requires the application of a force system that is guided with the use of accessories, including orthodontic wires. There are several materials and manufacturers available on the market, so it is important that the professional knows the composition of this material, since it will be in contact with the oral mucosa, and may suffer corrosion and release metal ions. Objective: to evaluate, in vitro, the degree of corrosion of two metal alloys that make up orthodontic wires from three different manufacturers, submitted to pH cycling. Methodology: 60 specimens were made from two types of metal alloys (NiTi and CrNi ­ steel 302) produced by three different manufacturers, divided into 6 Test Groups with 10 units each. The specimens were subjected to acid pH 4.3 cycling, daily, and kept in an oven at 37 ° C for 14 days. The mass was obtained before and after cycling, using a precision analytical balance. The evaluation of the visual characteristics of the wires was performed by a single observer using a stereomicroscopic loupe. Results: the pH cycling of orthodontic wires did not promote significant loss of mass or corrosion, despite the analysis of visual characteristics having changed after cycling. Conclusion: based on the results of the experimental protocol established in the present study, the analysis of the behavior of the NiTi and CrNi ­ 302 steel alloys that make up the orthodontic wires, facing the acid challenge of pH 4.3, for two weeks, it was concluded that these materials did not present loss of mass, opacity, brightness and smoothness considered significant. Other studies are recommended to provide further clarification on the topic.

Evaluation of zinc-oxide nanocoating on the characteristics and antibacterial behavior of nickel-titanium alloy

ABSTRACT Objective: To investigate the effect of ZnO nanocoating on mechanical properties of NiTi orthodontic wires and antibacterial activity. Methods: 0.016 x 0.022-in NiTi orthodontic wires were coated with ZnO nanoparticles using an electrochemical deposition method with three electrodes system in 0.1M Zn(NO3)2. Mechanical properties and frictional resistance of the coated wires were investigated using an universal testing machine. Antibacterial effect of ZnO coating was also investigated. Results: A stable adhered ZnO nanocoating on NiTi wires was obtained. The coated wires have a significant antibacterial activity against S. aureus, S. pyogens and E. coli, and a reduction of frictional forces by 34%. Conclusion: ZnO nanocoating may improve the antibacterial effects of NiTi wires and reduce the frictional resistance. Coating may be implanted in orthodontic practice for faster and safer treatment.

RESUMO Objetivos: Avaliar o efeito do nanorrevestimento de óxido de zinco (ZnO) sobre as propriedades mecânicas e propriedades antibacterianas de fios ortodônticos de NiTi. Métodos: Fios 0,016" x 0,022" de NiTi foram revestidos com nanopartículas de ZnO por meio de um método de deposição eletroquímica com um sistema de três eletrodos a 0,1M Zn(NO3)2. Uma máquina universal de testes foi utilizada para avaliar as propriedades mecânicas e a resistência friccional dos fios revestidos. Além disso, também foram analisadas as propriedades antibacterianas do revestimento de ZnO. Resultados: Obteve-se uma aderência estável das nanopartículas de ZnO sobre os fios NiTi. Os fios revestidos apresentaram atividade antibacteriana significativa contra S. aureus, S. pyogens e E. coli, e apresentaram uma redução de 34% na força de atrito. Conclusão: O revestimento com nanopartículas de óxido de zinco pode melhorar as propriedades antibacterianas e reduzir a resistência friccional dos fios de NiTi. Assim, o revestimento dos fios pode ser utilizado na Ortodontia visando tratamentos mais rápidos e seguros.

Secuencia de arcos para el alineado y nivelado / Archwire sequence for alignment and leveling

La secuencia de arcos en ortodoncia, sobre todo, durante el alineado y nivelado es un tema de gran interés. Para esta etapa se han sugerido fuerzas de 50 gf que no superan la presión hidrostática capilar y no producen reabsorción radicular. El Nitinol es la aleación indicada en sus distintas variantes. Las revisiones sistemáticas no han hallado ventaja de ninguna secuencia de arcos, incluso, equiparando arcos de acero con figuras con el Nitinol termoelástico. La selección de la secuencia de arcos para un paciente depende de las características de la maloclusión(AU)

The sequence of arches in orthodontics especially during alignment and leveling is a subject of great interest. For this stage 50 g forces that do not exceed the capillary hydrostatic pressure and do not produce root resorption have been suggested. Nitinol is the indicated alloy in its different variants. Systematic Reviews have found no advantage of any arch sequence even by matching steel arches with figures with thermoelastic Nitinol. The selection of arch sequence for a patient depends on the characteristics of malocclusion(AU)

Comparación del tamaño transversal de los arcos 0. 012, 0. 014 y 0. 016 de NiTi de tres marcas / Comparação do tamanho transversal dos arcos 0. 012, 0. 014 e 0.016 de NiTi de três marcas / Comparison of the cross-sectional size of the 0. 012, 0. 014 and 0. 016 NiTi archs of three brands

Objetivo: Determinar si existen diferencias en el tamaño de los arcos de NiTi en los calibres 0.012, 0.014 y 0.016 de tres marcas comerciales. Material y métodos: Se utilizaron 180 arcos de NiTi de las marcas American Orthodontics, TD Orthodontics y OrthoPremium. La estadística descriptiva, la ANOVA y el Post Hoc se realizaron en el programa SPSS 18. Resultados: los arcos de American Orthodontics presentaron diferencias estadísticas significativas en la parte anterior y posterior. En los arcos superiores de TD Orthodontics se encontró contracción en el calibre 0.016. En los arcos superiores OrthoPremium presento una contracción en la parte anterior y en el arco inferior de los 10 a los 40mm. Al comparar las tres marcas se encontraron diferencias estadísticas significativas (p<0.05) entre ellas con las pruebas de ANOVA. Conclusiones: existen diferencias en los tamaños de los arcos superiores e inferiores de cada marca y entre ellas.

Objective: To determine if there are differences between the 0.012, 0.014 and 0.016 NiTi archwires of three brands. Material and methods: 180 NiTi archwires of the following brands were used: American Orthodontics, TD Orthodontics and OrthoPremium. Descriptive statistics, ANOVA and Post Hoc were performed in the SPSS 18 program. Results: The American Orthodontics archwires presented significant statistical differences in the anterior and posterior parts. In the TD Orthodontics upper archwires, contraction was found in the 0.016 caliber. In the upper archwires, OrthoPremium presented a contraction in the anterior part and in the lower archwire of 10 to 40mm. When comparing the three brands, significant statistical differences (p <0.05) were found between them with the ANOVA tests. Conclusions: there are differences in the sizes of the upper and lower archwires of each brand and between them.

Objetivo: determinar se existem diferenças no tamanho dos arcos de NiTi em calibres 0, 12, 0, 14 e 0, 16 de três marcas comerciais. Material e métodos: foram utilizados 180 arcos NiTi das marcas American Orthodontics, TD Orthodontics e OrthoPremium. Estatística descritiva, ANOVA e Post Hoc foram realizadas no programa SPSS 18. Resultados: os arcos da American Orthodontics apresentaram diferenças estatísticas significativas na parte anterior e posterior. Nos arcos superiores da TD Ortodontia foi encontrada contração no calibre 0, 16. Nos arcos superiores, o OrthoPremium apresentou contração na parte anterior e no arco inferior de 10 a 40mm. Ao comparar as três marcas, foram encontradas diferenças estatísticas significativas (p <0,05) entre elas com os testes ANOVA. Conclusões: existem diferenças nos tamanhos dos arcos superior e inferior de cada marca e entre eles.

Efectos de la interrelación arco-bracket, desde el microscopio electrónico de barrido / Effects of the arch-bracket interrelation, from the scanning electron microscope

Los alambres en ortodoncia son elementos activos que tienen la capacidad de almacenar energía y liberar fuerzas. Los brackets permiten la unión directa y selectiva entre el arco de alambre y las piezas dentarias, lo que optimiza el efecto de presiones específicas de forma precisa y controlada, transmitiendo el movimiento en los tres sentidos del espacio. Durante el tratamiento de ortodoncia, estos elementos podrían sufrir alteraciones estructurales impidiendo el movimiento dental óptimo. En el presente trabajo de investigación, se analizó la respuesta que tienen el arco de acero inoxidable 0.019" × 0.025" y el slot de brackets de zafiro, en el sector anterior del maxilar superior, cuando ejercen fricción entre sí, antes y después de ser utilizados clínicamente en un tratamiento de ortodoncia. Para esto, las muestras fueron lavadas con alcohol absoluto al 96 % y secadas para ser observadas en el microscopio electrónico de barrido ambiental (MEB) (ESEM - environmental scanning electron microscope), modelo FEI ESEM QuantaTM 200. Los arcos rectangulares fueron analizados por sus cuatro caras y cuatro aristas (superior, inferior, interna y externa; respectivamente) y los slots de brackets de zafiro fueron observados en un corte sagital y dividido en forma lineal en tres mediciones (interna, media y externa). Los datos obtenidos fueron volcados en una planilla de tabulación de datos para su análisis estadístico, mediante el test de normalidad de Shapiro-Wilk para medidas no paramétricas y el test de Fisher. En conclusión, las zonas más afectadas por el desgaste fueron las caras y aristas internas del arco de acero de 0.019" × 0.025", y la medición interna del slot de brackets de zafiro. Ambas presentaban una pérdida de la solución de continuidad en su estructura, evidenciando un área de mayor fricción(AU)

Orthodontic wires are active elements that have the ability to store energy and release forces. The brackets allow the direct and selective bonding between the wire arch and teeth, optimizing the effect of specific pressures in a precise and controlled way, transmitting movement in the three directions of space. During orthodontic treatment, these elements could undergo structural changes preventing optimal dental movement. In the current research work, the response that the 0.019" × 0.025" stainless steel archwire and the sapphire bracket slot have in the anterior sector of the upper jaw when they exert friction on each other, before and after being clinically used in an orthodontic treatment was analyzed. For this purpose, the samples were washed in 96% absolute alcohol and dried to be observed under the environmental scanning electron microscope ESEM (MEB - microscopio electrónico de barrido ambiental), model FEI ESEM QuantaTM 200. The rectangular archwires were analyzed on their 4 faces and 4 edges (upper, lower, internal and external) and the sapphire brackets slots were observed in a sagittal section and linearly divided into three measurements (internal, medium and external). The data obtained were put in a data tabulation spreadsheet for its statistical analysis by using the Shapiro-Wilk normality test for nonparametric measures, and the Fisher test. In conclusion, the areas most affected by wear were the internal face and edges of the 0.019" × 0.025" steel arch and the internal measurement of the sapphire brackets slot. They both presented loss of continuity in their structure, providing evidence of an area of greater friction(AU)

Análisis de flexión en alambres de níquel-titanio con y sin propiedades de transformación térmica / Bending analysis of nickel-titanium wires with and no thermal transformation properties

Objetivo: Evaluar el comportamiento de los alambres de aleación de níquel-titanio con y sin propiedades de transformación térmica en la relación carga/deflexión. Materiales y método: Para ello, 30 segmentos de alambres de níquel-titanio con calibre .014" y 30 mm de largo fueron cortados, conformando 10 segmentos de alambre Flexy NiTi de Orthometric®, 10 segmentos Flexy Copper NiTi termoactivado y 10 segmentos CuNiTi de OrmcoTM. Se usó una máquina universal de ensayos Instron® para analizar el comportamiento de carga y deflexión de los segmentos en una prueba de tres puntos, registrando las fuerzas alcanzadas en 0,5 mm: 1 mm, 2 mm y 4 mm de deflexión. Resultados: Hubo una diferencia estadísticamente significativa entre todos los alambres y entre todas las deflexiones, ya que el alambre Flexy Cooper NiTi presentó la menor carga entre todas las deflexiones analizadas. Conclusión: Se concluye que los alambres termoactivados alcanzan fuerzas más leves, lo que los hace más apropiados para alineaciones iniciales, las cuales requieren un mayor rango de deflexión(AU)

Comparison of changes in the dental transverse and sagittal planes between patients treated with self-ligating and with conventional brackets

ABSTRACT Introduction: Several advantages have been established regarding the efficiency of self-ligating brackets (SL). In spite of some controversy surrounding this question in the literature, clinical results confirm that "arch development" requires fewer extractions. Objective: The objective of this study was to compare changes in the transverse and sagittal planes in patients treated with conventional ligating brackets (CL)as well as in patients treated with SL brackets and oversized arches. Methods: A sample was selected from a pool of 300 consecutive cases treated by a single clinician: 51 patients with SL brackets and oversized wires, and 55 with CL brackets. These two groups were compared with a control group of 20 patients. All plaster models were scanned and dental landmarks were measured to identify changes from commencement (T0) to conclusion (T1) of treatment. Lateral cephalograms were analyzed for changes in the lower incisor (IMPA) and the first lower molar distal angulation (MAng). Intraoperator reliability was tested with linear regression analysis. To assure all groups were comparable at T0, an ANOVA test with a 95%confidence interval (CI) was performed for all values. To assess changes from T0 to T1 in all groups, a Student's t-test with 95% CI was used. Finally, results from the three groups were compared using an ANOVA-test (95% CI) and a post-hoc test. Results: Increases in all the transverse variables were recorded in the two groups treated (SL and CL), except for the lower intercanine distance in the SL group. IMPA difference from T0 to T1 was higher in the CL group, and molar distal angulation (MAng) took place in the SL group. Conclusions: Self-ligating brackets with oversized arches and conventional ligating brackets showed increases in all variables in the transverse plane, except for the SL group at the mandibular intercanine distance. In comparison with the CL group, fewer different IMPA values were observed in the SL group, in which distal molar angulation occurred.

RESUMO Introdução: Já foram enumeradas diversas vantagens quanto à eficiência dos braquetes autoligáveis (BAL). Apesar das controvérsias na literatura, resultados clínicos confirmam que o "desenvolvimento da arcada" demanda menos extrações. Objetivo: O objetivo deste estudo foi comparar as mudanças nos planos transversal e sagital em pacientes tratados com braquetes convencionais (BC) e pacientes tratados com BAL e arcos superdimensionados. Métodos: A amostra foi selecionada de um grupo de 300 pacientes tratados consecutivamente por um mesmo ortodontista: 51 pacientes com BAL e arcos superdimensionados, e 55 com BC. Esses dois grupos foram comparados a um grupo controle (GC) de 20 pacientes. Todos os modelos de gesso foram escaneados e pontos de referência dentários foram mensurados, para se identificar as mudanças entre o início (T0) e o fim do tratamento (T1). Radiografias cefalométricas laterais foram analisadas para identificar mudanças nos incisivos inferiores (IMPA) e na angulação distal dos primeiros molares inferiores (MAng). A confiabilidade intraexaminador foi testada por meio de uma análise de regressão linear. Para garantir que os grupos fossem comparáveis em T0, realizou-se o teste ANOVA com intervalo de confiança (IC) de 95% para todos os valores. Para avaliar as mudanças entre T0 e T1 em todos os grupos, foi utilizado o teste t de Student com IC de 95%. Por fim, os resultados dos três grupos foram comparados utilizando-se o teste ANOVA (IC 95%) e um teste post-hoc. Resultados: Foram registrados aumentos em todas as variáveis transversais nos dois grupos tratados (BC e BAL), com exceção da distância intercaninos inferiores no grupo BAL. As maiores diferenças de T0 para T1 ocorreram no IMPA do grupo BC e na angulação distal de molares (MAng) do grupo BAL. Conclusões: Ambos os grupos, BAL com arcos superdimensionados e BC, apresentaram aumento em todas as variáveis no plano transversal, com exceção da distância intercaninos inferiores no grupo BAL. Em comparação ao grupo BC, menores diferenças nos valores de IMPA foram observadas no grupo BAL, no qual aconteceu angulação distal de molares.

Impact of catastrophizing on pain during orthodontic treatment

ABSTRACT Objective: This study proposed to investigate the influence of catastrophizing and others factors related to pain during orthodontic treatment. Methods: 27 patients with 0.022 x 0.028-in Straight-wire brackets were evaluated during alignment and leveling phase with nickel-titanium wires. Visual Analog Scales measured the intensity of orthodontic pain at six moments after a clinical appointment: 6 first hours; 1, 2, 3, 5, and 7 days. Multiple linear regression and stepwise approach assessed the influence of the following variables on pain: catastrophizing, sex, age, duration of treatment, clinical appointment time (morning or afternoon), and wire diameter. Results: The highest pain intensity was reported 24 hours after activation. These data were used to analyze factors associated with pain level. Age (r = 0.062, p= 0.7586), sex (p= 0.28), catastrophizing (r = -0.268, p= 0.1765), and orthodontic wire diameter (r = 0.0245, p= 0.2181) were not correlated with orthodontic pain in the univariate statistics. Catastrophizing was included in the multiple regression model because it was of great interest. Duration of orthodontic treatment (r = 0.6045, p= 0.0008) and the time when orthodontic appliance was activated (p= 0.0106) showed statistical significant associations with pain, and were also included in the multivariate regression, which showed that about 32% of orthodontic pain could be explained by the duration of treatment (R2= 0.32, p= 0.0475). Catastrophizing (R2= 0.0006, p= 0.8881) and clinical appointment time were not significantly associated with pain (R2= 0.037, p= 0.2710). Conclusions: Pain after activation of fixed orthodontic appliance is not associated with catastrophizing as well as age, sex, orthodontic wire diameter, and period of activation.

RESUMO Objetivo: O presente estudo propôs-se a investigar a influência da catastrofização e outros fatores relacionados à dor durante o tratamento ortodôntico. Métodos: Foram selecionados 27 pacientes em tratamento com braquetes Straight-wire, slot 0,022" x 0,028", na fase de alinhamento e nivelamento com fios de níquel-titânio. Usando Escalas Visuais Analógicas, mensurou-se a intensidade da dor em seis momentos após a ativação do aparelho: primeiras 6 horas; após 1, 2, 3, 5 e 7 dias. Por meio de regressão linear múltipla e regressão stepwise, avaliou-se a influência das seguintes variáveis sobre a dor: catastrofização, sexo, idade, tempo de tratamento, turno de atendimento (manhã ou tarde) e diâmetro do fio ortodôntico. Resultados: A maior intensidade de dor foi relatada 24 horas após a consulta de ativação do aparelho. Assim, esses dados foram usados para analisar os fatores associados ao nível de dor. Na análise estatística univariada, idade (r = 0,062, p= 0,7586), sexo (p= 0,28), catastrofização (r = -0,268, p= 0,1765) e diâmetro do fio ortodôntico (r = 0,0245, p= 0,2181) não estavam associados à dor. Apesar disso, a catastrofização foi incluída no modelo de regressão múltipla, por ser uma variável de maior interesse nesse estudo. A duração do tratamento ortodôntico (r = 0,6045, p= 0,0008) e o turno no qual o aparelho foi ativado (p= 0,0106) mostraram associação estatisticamente significativa com a dor e também foram incluídos na regressão multivariada, que mostrou que cerca de 32% da ocorrência de dor no tratamento ortodôntico poderiam ser explicados pelo tempo de tratamento (R2= 0,32, p= 0,0475). Catastrofização (R2= 0,0006, p= 0,8881) e turno de ativação do aparelho (R2= 0,037, p= 0,2710) não tiveram influência significativa sobre a ocorrência de dor. Conclusão: A dor após a ativação do aparelho não está associada à catastrofização, bem como à idade, sexo, diâmetro do fio ortodôntico e turno de atendimento.

Antimicrobial Orthodontic Wires Coated with Silver Nanoparticles

Abstract Conventional orthodontic treatment with the use of stainless steel may be detrimental to oral health by promoting demineralizing lesions appearance and increasing adhesion and formation of bacterial biofilm, inducing the development of cavities. An alternative that has been researched to reduce the side effects of orthodontic treatment is the coating of materials with antimicrobial nanoparticles. Nanometric- sized particles increase their surface area and contact with the microbial membrane, consequently intensifying their bacteriostatic and bactericidal effect. In this work, hydrothermal synthesis, a "green" process was used to attach silver nanoparticles (AgNPs) to the surface of two different brands of orthodontic wires. The coated materials were analyzed for their physicochemical properties by scanning electron microscopy (SEM), X-ray diffraction (XRD) and differential scanning calorimetry (DSC), which showed the distribution of AgNPs along the wires without modifying their properties. In the microbiological test, one of the brands showed a statistically significant difference in microbial adhesion and biofilm formation by Staphylococcus aureus and Streptococcus mutans. Results lead to the conclusion that antimicrobial orthodontic wires coated with silver nanoparticles through hydrothermal synthesis is a promising material for the improvement of orthodontic treatment.

Impact of the First Archwires Placement on the Everyday Activities of Orthodontics Patients / Impacto de la Instalación de los Primeros Arcos en las Actividades de Vida Diaria en Pacientes de Ortodoncia

ABSTRACT: Orthodontic treatment (OT) is essential for the aesthetic and functional rehabilitation of the chewing apparatus, however it may lead to certain complications which can have a negative impact on patients' everyday lives. The study included patients of the Dental Teaching Clinic of Universidad de La Frontera who were undergoing OT for the first time, with the placement of their first orthodontic arch. To analyse the impact of the placement of the first arches on everyday activities (EDA), patients completed a questionnaire with questions relating to their oral condition, including: functional limitation, physical impairment, psychological malaise, physical pain and oral hygiene. The impact on EDAs was classified as high, moderate or low. The chisquared test, Student's t-test and Spearman's coefficient were applied, using a significance threshold of 5 %. Statistical analysis used the SPSS software, v. 22.0. The variables were analysed by sex and age-band. Difficulty in brushing their teeth, eating and speaking were the limitations on EDAs most frequently reported by the patients. Females presented higher scores than males (p=0.003), showing that they suffer a greater negative impact on EDAs than do males. The majority of the patients presented a low impact on EDAs after the placement of their first orthodontic arches. Physical pain after installation, and difficulty in adapting to the orthodontic apparatus were factors determining a negative impact on EDAs, affecting sleep, speech, eating and oral hygiene of patients after starting OT.

RESUMEN: El tratamiento ortodóntico (TO) es esencial para la rehabilitación estética y funcional del aparato masticatorio, sin embargo puede determinar algunas complicaciones que pueden impactar negativamente en la vida diaria de los pacientes. Fueron incluidos pacientes de la Clínica Odontológica Docente Asistencial de la Universidad de La Frontera que realizaban tratamiento ortodóntico por primera vez, con instalación del primer arco ortodóntico. Para análisis del impacto de la instalación de los primeros arcos en las actividades de vida diaria (AVD), los pacientes llenaron un cuestionario con preguntas relacionadas a su condición oral, incluyendo: limitación funcional, incapacidad física, incapacidad psicológica, dolor físico e higiene oral. El impacto en las AVDs fueclasificado como alto, moderado y bajo. Para análisis estadístico se utilizó el software SPSS v. 22.0. Fueron aplicadas las pruebas de chi-cuadrado, t-student y Spearman's coefficient, considerándose umbral de significación de 5 %. Para análisis estadístico se utilizó el software SPSS v. 22.0. Las variables fueron analizadas según sexos y rangos etarios. Dificultad para cepillar los dientes, para comer y hablar fueron las limitaciones en las AVDs más frecuentemente reportadas por los pacientes. Las mujeres presentaron mayores puntajes en relación a los hombres (p=0,003), lo que demostró que presentan mayor impacto negativo en las AVDs en relación a los hombres. La mayoría de los pacientes presentaron bajo impacto en las AVDs tras la instalación de los primeros arcos de ortodoncia. El dolor físico tras instalación y la dificultad en la adaptación con el aparato ortodóntico fueron factores que determinaron impacto negativo en las AVDs, afectando el sueño, el habla, la alimentación y la higiene oral de los pacientes que iniciaron el TO.