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

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

A new way of analyzing tooth movement using universal coordinate system geometry single point superposition in a 3D model

ABSTRACT Introduction: Superposing 3D models is an imminent need. However, current methods rely on marking multiple points on the maxilla and mandible, which could increase point marking and overlapping errors. Objective: This study aimed at developing a method for superimposing 3D models of the maxillary and mandibular arches with Autodesk Inventor® engineering software, using a single universal coordinate system (UCS) point superposition. Methods: A total of 104 STL (stereolithography) models of the maxillary and mandibular arches exported from My iTero® platform were retrospectively selected, in which T0 and T1 were the initial and refinement periods, respectively (n=26 per group). The X, Y, and Z coordinates associated with a single point in each arch were inserted into the models with SlicerCMF® software for model orientation. The arch models with UCS registration were transferred to Autodesk Inventor® for superimposition and to measure tooth movements performed during Invisalign® treatment. Arch expansion, intrusion and rotation were analyzed by two examiners. The statistics were performed using intraclass correlation coefficients (ICC), Dahlberg's formula, and t-test (p<0.05). Results: A reliable method of superimposing 3D digital models using a single UCS point in the maxilla and mandible was developed. ICC showed excellent intra- and inter-examiner correlation (ICC>0.90). A systematic error was not found concerning linear and angular measurements (<1mm and <1.5°, respectively). Digital dental movements could be analyzed, including arch expansion, dental intrusion, and tooth rotation. Conclusions: The developed method was proven reliable and reproducible for superimposing 3D models of the maxillary and mandibular arches by using UCS system.

RESUMO Introdução: A sobreposição de modelos 3D é uma necessidade iminente. No entanto, os métodos atuais dependem da marcação de múltiplos pontos na maxila e na mandíbula, o que pode aumentar a incorporação de erros no processo de sobreposição. Objetivo: O objetivo desse estudo foi desenvolver um método para sobrepor modelos 3D das arcadas superior e inferior utilizando o software de engenharia Autodesk Inventor®, por meio da marcação de um único ponto em cada arcada, usando o sistema de coordenadas universal (UCS). Métodos: No total, 104 modelos STL das arcadas superior e inferior exportados da plataforma My iTero® foram selecionados retrospectivamente, onde T0 foi o período inicial e T1, o de refinamento (n=26 por grupo). As coordenadas X, Y e Z associadas a um único ponto em cada arcada foram inseridas nos modelos usando o software SlicerCMF®. Os modelos com os pontos UCS demarcados foram transferidos para o software Autodesk Inventor® para realizar a sobreposição e medir os movimentos dentários realizados durante o tratamento com Invisalign®. Os movimentos de expansão, intrusão e rotação foram analisados por dois examinadores. A análise estatística foi realizada usando os coeficientes de correlação intra-classe (ICC), fórmula de Dahlberg e teste t (p<0,05). Resultados: Foi desenvolvido um método confiável de sobreposição de modelos digitais 3D usando um único ponto UCS na maxila e mandíbula. O ICC apresentou excelente correlação intra e inter-avaliadores (ICC>0,90). Não foi encontrado erro sistemático nas medidas lineares e angulares (<1mm e <1,5°, respectivamente). Os movimentos dentários puderam ser analisados por meio do método proposto, incluindo expansão da arcada, intrusão e rotação dentária. Conclusão: O método desenvolvido provou ser confiável e reprodutível para sobreposição de modelos 3D das arcadas superior e inferior usando o sistema UCS com marcação de ponto único.

Influence of risedronate on orthodontic tooth movement in rodents: a systematic review and case report

ABSTRACT Introduction: Bisphosphonates have an inhibitory impact on osteoclastic activity, reducing bone resorption. However, the influence of risedronate on tooth movement is not well-defined. Objective: This systematic review assessed the effect of risedronate intake on orthodontic tooth movement. A case report was also provided. Methods: Two independent reviewers searched six databases (PubMed, Web of Science, Ovid, Lilacs, Scopus, and Open Grey). The searches were carried out in April/2020, and an update was set in place in June/2023. Therefore, the searches considered a timeline from the databases' inception date until June/2023, with no publication date and/or language restrictions. The clinical question focused on evaluating the orthodontic tooth movement and relapse movement (Outcome) in animals (Population) exposed to risedronate (Exposure), compared to control groups (Comparison). The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were applied, and the protocol was registered in PROSPERO (CRD42020168581). The risk of bias was determined using the Systematic Review Centre for Laboratory Animal Experimentation protocol (SYRCLE). Results: Two studies in rats and one in guinea pigs were included in the systematic review. The studies reported a decrease in orthodontic tooth movement, a reduction in the relapse movement, and a reduced number of positive tartrate-resistant acid phosphatase (TRAP) cells, with a significantly reduced number of bone gaps after the administration of risedronate in rats. A case report illustrated the effects of risedronate administration in one patient. Conclusion: Based on the systematic review, risedronate seems to impair orthodontic tooth movement and relapse due to a decrease in bone resorption cells.

RESUMO Introdução: Os bifosfonatos têm um impacto inibitório na atividade osteoclástica, reduzindo a reabsorção óssea. No entanto, a influência do risedronato no movimento dentário não está bem definida. Objetivo: Esta revisão sistemática avaliou o efeito do uso de risedronato no movimento ortodôntico dos dentes. Um relato de caso também é apresentado. Métodos: Dois revisores independentes pesquisaram seis bases de dados (PubMed, Web of Science, Ovid, Lilacs, Scopus e Open Grey), considerando o período de abril de 2020 até junho de 2023, sem restrições de data e/ou idioma de publicação. A questão clínica focou em avaliar o movimento ortodôntico dos dentes e movimento de recidiva (resultado) em animais (população) expostos ao risedronato (exposição) em comparação com grupos de controle (comparação). Foram aplicadas as Diretrizes Preferenciais para Revisão Sistemática e Metanálise (PRISMA) e um protocolo foi registrado no PROSPERO (CRD42020168581). O risco de viés foi determinado utilizando o protocolo do Centro de Revisão Sistemática para Experimentação em Animais de Laboratório (SYRCLE). Resultados: Dois estudos em ratos e um em porquinhos-da-índia foram incluídos na revisão sistemática. Os estudos relataram uma diminuição no movimento ortodôntico dos dentes, uma redução no movimento de recidiva e um número reduzido de células positivas à fosfatase ácida tartarato-resistente (TRAP) com um número significativamente reduzido de falhas ósseas após a administração de risedronato em ratos. Um relato de caso ilustrou os efeitos da administração de risedronato em uma paciente. Conclusão: Com base na revisão sistemática, o risedronato parece interferir no movimento ortodôntico dos dentes e na recidiva devido a uma diminuição nas células de reabsorção óssea.

Indices in dental image exams for bone mineral density evaluation of aromatase inhibitor users

Abstract We evaluated the accuracy of radiomorphometric indices (RI) and fractal dimension (FD) for screening bone mineral density (BMD) in postmenopausal patients who had breast cancer and were using aromatase inhibitors (AI). The sample consisted of 40 participants. Digital panoramic radiography (DPR) and cone beam computed tomography (CBCT) were evaluated along with dual-energy X-ray absorptiometry (DXA), which is the gold standard for detecting low BMD. According to the T-scores of DXA, the subjects were assigned into two groups: with normal BMD and with low BMD (osteopenia and osteoporosis). The area under the curve (AUC), sensitivity, and specificity with their respective confidence intervals were determined for DPR and CBCT. For DPR indices, AUC ranged from 52.6 to 75.8%. The mandibular cortical width (MCW) had the highest AUC. For FD, the total trabecular index had the highest sensitivity, while the index anterior to the mental foramen (MF) had the highest specificity. In CBCT, the AUC ranged from 51.8 to 62.0%. The indices with the highest AUC were the molar (M) and anterior (A). The symphysis (S) index had the highest sensitivity and the posterior (P) index had the highest specificity. Sensitivity and specificity were adequate for the computed tomography index (Inferior; CTI [I]). Therefore, MCW, FD of the mandible angle, and total trabecular ROI in DPR and the CTI (I), M, P, and A indices in CBCT proved to be promising tools in distinguishing individuals with low BMD. Cutoff point for these indices could be a useful tool to investigate low BMD in postmenopausal women taking AI.

Irisin effects on bone: systematic review with meta-analysis of preclinical studies and prospects for oral health

Abstract: Bone quality is an important issue in dentistry. Low bone density may be associated with more severe periodontitis, and may influence implant therapy success. Recent evidence suggests that physical activity can improve alveolar bone quality. Irisin is an exercise-mediated peptide that might be involved in this process. We assessed the effect of exercise and that of intra-peritoneal irisin administration on bone quality in healthy and osteoporosis-induced rodents. This study was registered at PROSPERO (CRD42020184140), and followed PRISMA guidelines. A search by two independent examiners was conducted in five databases and gray literature up to July 2021, without restrictions regarding language or date of publication. Initially, they analyzed retrieved titles and abstracts (n=3,844) based on eligibility criteria. Of this total, 19 studies remained for full-text reading, and 16 proceeded to the data extraction and quality assessment phases. Meta-analyses were conducted (n= 6 studies) to establish the effects of irisin administration on cancellous bone mineral density (BMD). Exercise or irisin administration enhanced bone quality, but the meta-analysis showed that BMD increased only slightly in osteoporotic rodents (BMD: mean difference 0.03 mg/cm3 - 95% CI 0.01-0.05). This indicates that they had no significant benefits on the bones of healthy animals. Implications of key findings evidence the potential of irisin as an agent able to mitigate bone loss caused by osteoporosis, an outcome that could favor dental rehabilitation. More studies investigating the effect of irisin on alveolar bone are needed to elucidate its therapeutic viability and implications.

Release of leachable products from resinous compounds in the saliva of children with anterior open bite treated with spur

Abstract To evaluate the release of bisphenol-A glycidyl methacrylate (BisGMA), triethylene glycol dimethacrylate (TEGDMA), bisphenol A (BPA), and phthalates of the composite resin used in the bonding of spurs applied in the treatment of children with anterior open bite and its effects on human keratinocytes. Methodology Saliva samples of 22 children were collected before spur attachment (baseline) and 30 minutes (min) and 24 hours (h) after spur bonding. Analysis was performed using high-performance liquid chromatography (HPLC) coupled to tandem mass spectrometry (HPLC-MS/MS) and gas chromatography coupled to mass spectrometry (GC-MS). Standardized resin increments were added to three different dilutions of the cell culture medium. Keratinocytes (HaCaT) were cultivated in the conditioned media and evaluated for cell viability (MTT) and cell scratch assay. Results The levels of BisGMA (1.74±0.27 μg/mL), TEGDMA (2.29±0.36 μg/mL), and BPA (3.264±0.88 μg/L) in the saliva after 30 min, in comparison to baseline (0±0 μg/mL, 0±0 μg/mL, and 1.15±0.21 μg/L, respectively), presented higher numbers. After 24 h, the levels of the monomers were similar to the baseline. Phthalates showed no significant difference among groups. HaCat cells showed increased viability and reduced cell migration over time after exposure to methacrylate-based resin composites. Conclusion Resin composites, used to attach spurs in children with anterior open bite during orthodontic treatment, release monomers after polymerization and can influence the behavior of human keratinocytes, even at very low concentrations. Orthodontists should be aware of the risks of the resinous compounds release and preventive procedures should be held to reduce patient exposure.

Microbial contamination and disinfection methods of pacifiers

Objectives To evaluate the microbial contamination of pacifiers by Mutans Streptococci(MS) and the efficacy of different methods for their disinfection.Methods Twenty-eight children were assigned to a 4-stage changeover system with a 1-week interval. In each stage, children received a new pacifier and the parents were instructed to maintain their normal habits for 1 week. After this time, the pacifiers were subjected to the following 4 disinfection methods: spraying with 0.12% chlorhexidine solution, Brushtox® or sterile tap water, and immersion in boiling tap water for 15 minutes. Microbiological culture for MS and Scanning Electron Microscopy (SEM) were performed. The results were analyzed statistically by Friedman’s non-parametric test (a=0.05).Results The 0.12% chlorhexidine spray was statistically similar to the boiling water (p>0.05) and more effective than the Brushtox®spray and control (p<0.05). The analysis of SEM showed the formation of a cariogenic biofilm in all groups with positive culture.Conclusions Pacifiers become contaminated by MS after their use by children and should be disinfected routinely. Spraying with a 0.12% chlorhexidine solution and immersion in boiling water promoted better disinfection of the pacifiers compared with a commercial antiseptic toothbrush cleanser (Brushtox®).

Efficacy of antimicrobial sprays for disinfection of children's toothbrushes: a randomized clinical trial

The objective of this study was to evaluate the efficacy of three spray antimicrobial solutions for the disinfection of childrenÆs toothbrushes. A 4-stage changeover system was used. The solutions studied were: BrushtoxTM (Spray 1), CosmocilTM + basic formula (Spray 2), basic formula (Spray 3), and control û sterile water (Spray 4). Forty children used the solutions in all stages. In each stage, the children received a new toothbrush and performed a single 1-min brushing. Thereafter, the solutions were sprayed six times at different positions on the toothbrush bristles. After four hours, microbiologic culture of the toothbrushes was performed. BrushtoxTM, CosmocilTM + basic formula, and basic formula presented a similar effect on prevention of cariogenic biofilm formation which was better than basic formula alone or sterile water. BrushtoxTM showed the best antimicrobial efficacy.

Influência da deficiência de estrógeno na movimentação ortodôntica / The influence of estrogen deficiency in orthodontic tooth movement

O perfil dos pacientes que procuram tratamento ortodôntico mudou nas últimas décadas. O número de pacientes adultos e idosos do sexo feminino cresceu consideravelmente. Esta mudança na demanda trouxe desafios biológicos para o atendimento ortodôntico, por muitas vezes tratarem-se de pacientes com alterações sistêmicas ou sob uso de medicamentos controlados. Dentre estes, podese citar a deficiência de estrógeno e a osteoporose, comuns nessa faixa etária, e que podem interferir na movimentação dentária ortodôntica (MDO). Esta revisão de literatura se propõe a descrever os aspectos biológicos da movimentação ortodôntica e a identificar como a deficiência de estrógeno e a osteoporose podem interferir na remodelação óssea e, consequentemente, na MDO. Este artigo objetiva ainda alertar o ortodontista da importância de se avaliar cuidadosamente a condição sistêmica dos pacientes com possível deficiência de estrógeno/osteoporose, para um correto diagnóstico e elaboração do plano de tratamento.

An increasing number of adult patients are seeking for orthodontic treatment in the last decades, especially postmenopausal women. This represents a biological challenge for the orthodontic treatment, since these patients more often present systemic disorders or are routinely using controlling medication. Among them, estrogen deficiency and osteoporosis are commonly reported in elderly women. This review article elucidates the biological aspects of orthodontic tooth movement, emphasizing how the estrogen deficiency may interfere with this process. This literature review suggests that estrogen deficiency and the use of drugs for osteoporosis treatment may alter the bone remodeling and, consequently, the orthodontic tooth movement. The orthodontist must be aware of the patient’s systemic condition to better elaborate the correct treatment plan.

Mordida cruzada: definição, diagnóstico diferencial e tratamento / Crossbite: definition, etiology, differential diagnosis and treatment

Mordida cruzada é a condição na qual um ou mais dentes estão anormalmente aposicionados para vestibular ou lingual em relação ao(s) dente(s) antagonista(s). A etilogia das mordidas cruzadas podem estar associadas à retenção prolongada e perda prematura dos dentes decíduos, discrepância óssea dental negativa, deficiência de crescimento dos ossos, hábitos bucais, traumas, fissuras palatinas e intereferências oclusais. O diagnóstico da mordida cruzada deve ser feito a partir de dados obtidos no exame clínico (exame extrabucal, intrabucal e funcional) e radiográfico. Elas podem ser divididas em: mordida cruzada anterior: dentária, funcional (pseudo classe III) e esquelética (classe III verdadeira); mordida cruzada posterior: dentária, funcional e esquelética. O objetivo deste estudo consiste em definir e classificar os diferentes tipos de mordidas cruzadas, relatando sua etilogia e diagnóstico diferencial, para que o profissional possa estabelecer correto plano de tratamento para a correção da mordida cruzada.

A língua: características morfológicas normais e alterações / The tongue: normal morphological characteristics and anomalies

A língua é um orgão muito importante para a realização de funções como a mastigação, a deglutição, a fala, e participa de estímulos funcionais que atuam no crescimento e no desenvolvimento da face. É composto por músculos intrínsecos e extrínsecos que permitem sua movimentação tridimensional (altura, largura e comprimento). É necessário que se conheça a sua morfologia para se detectar anomalias como microglossia, macroglossia, anquiloglossia e língua geográfica. Por meio de exames morfológicos e funcionais, podemos verificar anormalidades em sua estrutura, obtendo-se um correto diagnóstico e tratamento adequado.

Scanning electron microscopy evaluation of the interface of three adhesive systems

O objetivo deste estudo foi avaliar através de microscopia eletrônica de varredura a interface de três sistemas adesivos, Scotchbond Multi-Purpose®, Optibond® and Denthesive Bond II®. Os sistemas adesivos e suas respectivas resinas compostas foram aplicados no terço cervical do canal radicular dos incisivos e caninos permanentes humanos, de acordo com as intruções do fabricante. As amostras foram incluídas em resina acrílica, cortadas transversalmente ao canal radicular e perpendicularmente à interface resina-dentina e analisadas através de microscopia eletrônica de varredura. Os sistemas adesivos Scotchbond Multi-Purpose® (SBMP) and Optibond® (OPB) apresentaram algumas características similares, camada híbrida homogênea e penetração de resina na dentina intertubular e peritubular. Entretanto, os tags apresentaram diferenças morfológicas, o sistema adesivo SBMP apresentou tags mais longos e em maior quantidade que o OPB. O sistema adesivo Denthesive Bond II® não mostrou as mesmas características em sua interface. Os túbulos dentinários não foram abertos e a smear layer não foi removida, devido à ausência de condicionamento ácido prévio da dentina, prejudicando a formação da camada híbrida. A análise da camada híbrida por microscopia eletrônica de varredura revelou diferentes padrões de hibridização, sugerindo que a união dentina-sistema adesivo-resina composta é influenciada por muito fatores, além disso, a padronização do substrato dentinário é impossível.

Faca de dois gumes / Double edged knife

Estudo realizado na FORP/USP mostra que a escova dental pode ser um bom abrigo para bactérias cariogênicas do grupo mutans e propicia a transmissão cruzada quando compartilhada por diferentes usuários. Utensílio tem de ser armazenado em local fresco e arejado, mas não totalmente exposto no toalete, pois corre o risco de ser infectado por coliformes