Las herramientas predictivas de riesgo, una alternativa diagnóstica en la retención de caninos maxilares

Se describen, en la literatura médica, predictores radiográficos que constituyen herramientas diagnósticas útiles para la retención de los caninos maxilares. Sin embargo, en la especialidad de ortodoncia las investigaciones sobre las herramientas predictivas de riesgo son escasas. Por ello se decide realizar una revisión bibliográfica con el objetivo de recopilar información acerca de la utilidad de las herramientas predictivas de riesgo en el diagnóstico de la retención de los caninos maxilares. Se realizó una búsqueda de información de artículos en idioma español e inglés, utilizándose las bases de datos SciELO, PubMed, Cochrane y Scopus. Para lograr un tratamiento óptimo de la anomalía debe priorizarse un buen diagnóstico, basado en métodos clínicos y radiográficos, pero se hace notoria la ausencia de herramientas que identifiquen individuos con alto riesgo en la comunidad. Los modelos o escalas de riesgo pueden ser útiles en este aspecto, para detectar precozmente el trastorno eruptivo y priorizar así intervenciones preventivas, que eviten el uso excesivo de medios auxiliares de diagnóstico y la sobrecarga de los sistemas de salud. Las herramientas predictivas de riesgo constituyen una alternativa para la clasificación adecuada de la población con alto riesgo de retención de caninos maxilares. Un instrumento de tal magnitud es de gran utilidad tanto en los servicios de Estomatología General como en los de Ortodoncia.

Radiographic predictors that are useful diagnostic tools for the retention of maxillary canines are described in the literature. However, in the specialty of orthodontics, research on risk predictive tools is scarce. Therefore, it was decided to carry out a bibliographic review with the objective of collecting information about the usefulness of risk predictive tools in the diagnosis of retention of maxillary canines. A search for information on articles in Spanish and English was carried out, using the SciELO, PubMed, Cochrane and Scopus databases. To achieve optimal treatment of the anomaly, a good diagnosis should be prioritized, based on clinical and radiographic methods, but the absence of tools that identify individuals at high risk in the community is notorious. Models or risk scales can be useful in this aspect, to detect the eruptive disorder early and thus prioritize preventive interventions that avoid the excessive use of diagnostic aids and the overload of health systems. Predictive risk tools are an alternative for the adequate classification of the population with high risk of retention of maxillary canines. An instrument of this magnitude is very useful both in General Dentistry and Orthodontics services.

Evaluation of maxillary canine and molar movement during the first phase of extraction space closure: a multilevel analysis

ABSTRACT Objective: This study was designed to analyze and compare the cusp and apex movements of the maxillary canines and first molars during canine retraction in the first step of extraction space closure, and to evaluate if these teeth follow a curvilinear (acceleration and/or deceleration) movement rate. Material and Methods: Twenty-five patients (23.3 ± 5.1 years of age) were enrolled. The retraction of the maxillary canines was accomplished using nickel-titanium closed coil springs (100gf) on 0.020-in stainless steel archwire. Oblique cephalograms were traced and superimposed on the anatomic best fit of the maxilla (before the retraction [T0], and after one month [T1], three [T3], five [T5] and seven [T7] months). Statistics was based in a normally distributed data. Multilevel procedures were used to derive polynomials for each of the measurements. Student's t-test and one-way repeated measures ANOVA were conducted. The level of significance of 5% was adopted. Results: Canine cusps and apexes did not follow a quadratic curve regarding horizontal movement (neither accelerate nor decelerate). Canine and molar cusps showed more horizontal movement than apexes (4.80 mm vs. 2.78 mm, and 2.64 mm vs. 2.17 mm, respectively). Conclusions: Canine did not accelerate or decelerate overtime horizontally; the cusps and apexes of the canines and molars showed more horizontal movement and larger rate at the beginning of canine retraction, followed by significantly smaller and constant movement rate after the first month.

RESUMO Objetivo: O objetivo deste estudo foi analisar a movimentação das cúspides e dos ápices de caninos e primeiros molares superiores durante a retração de caninos na primeira fase do fechamento do espaço pós-extração, e avaliar se esses dentes apresentam mudança na taxa de movimentação (aceleração e/ou desaceleração). Material e Métodos: Vinte e cinco pacientes (idade = 23,3 ± 5,1 anos) foram incluídos. A retração dos caninos superiores foi realizada com molas helicoidais fechadas de níquel-titânio (100gf) em arco 0,020" de aço inoxidável. Foram feitos traçados cefalométricos de telerradiografias oblíquas e sobrepostos ao melhor ajuste anatômico da maxila (antes da retração [T0]; após um mês [T1], três meses [T3], cinco meses [T5] e sete meses [T7]). A estatística foi baseada em dados com distribuição normal. Procedimentos multiníveis foram usados para derivar polinômios para cada uma das medidas. Teste t de Student e ANOVA de uma via para medidas repetidas foram realizados, adotando-se um nível de significância de 5%. Resultados: As cúspides e os ápices dos caninos não seguiram uma curva quadrática em relação ao movimento horizontal (sem aceleração ou desaceleração). As cúspides dos caninos e molares apresentaram mais movimento horizontal do que os ápices (4,80 mm vs. 2,78 mm e 2,64 mm vs. 2,17mm, respectivamente). Conclusões: A movimentação horizontal dos caninos não acelerou ou desacelerou ao longo do tempo; as cúspides e os ápices dos caninos e molares apresentaram maior movimento horizontal e maior taxa de movimentação no início da retração dos caninos, seguida por uma taxa de movimentação significativamente menor e constante após o primeiro mês.

Effects of the changes of thickness and placement position of rectangular attachment on canine tooth torsion correction / 中国组织工程研究

BACKGROUND: Using interproximal enamel reduction, adding attachments and over-correction are major methods to improve the efficiency of correcting tooth torsion when using clear aligners in the clinic. However, the choice and placement of attachments depend on the experience and habits of orthodontists, and whether the effects are different has not been reported. OBJECTIVE: To explore the effects of rectangular attachment with different thicknesses and locations on the left maxillary canine tooth torsion in clear aligner by three-dimensional finite element analysis. METHODS: The finite element models of the clear aligner-attachment-maxillary canine-periodontal ligament-spongy bone-cortical bone and the clear aligner-maxillary canine-periodontal ligament-spongy bone-cortical bone were established according to the scanning data of in vitro maxillary canine. The models with attachments were divided into four groups based on different thicknesses of attachment, namely 0.5, 0.75,1.0, and 1.5 mm groups. The placement positions were divided into five areas: mesial, distal, occlusal, median, and gingival of canine. 2° clockwise rotation of the tooth axis (X axis) was applied to the clear aligner. The action of the appliance and the canine were calculated by MSC.Marc.Mentat software. Then, the nephograms of stress and displacement, and the maximum stress and displacement values were collected. RESULTS AND CONCLUSION: (1) Whether the rectangular attachment was used or not, the two models’ distribution of canine’s displacement and periodontal stress were the same. The stress values of periodontal ligament were all higher than those without rectangular attachment. (2) With the thickness of rectangular attachment increasing, the maximum displacement values of the canine increased gradually, which were 42.94, 49.32, 52.52 and 59.39 urn, respectively. (3) When the rectangular attachment was placed in different positions, the maximal displacement of canine teeth the attachment of which was placed on the median was almost the same with that of the gingival side. While the changes in the mesial and distal directions were irregular. (4) The use of rectangular attachments makes no effect on the movement of instant canines, which only plays a synergistic role in the control of canine tooth torsion. The thickness of the attachment has a certain effect on the torsion of appliance. When the thickness increases, the maximum displacement of the canine tooth and the stress of the periodontal ligament are increased. In the vertical direction, the closer of the placement is to the crown, the better the control of the rotated canine is.

Distancia intercanina en niños con dentición temporal, mixta y permanente / Intercanine distance in children with temporary, mixed and permanent dentition

RESUMEN Introducción: Los valores de la distancia intercanina representan una referencia auxiliar útil, para predecir problemas de deficiencia de espacio relacionados con el crecimiento transversal de los maxilares. Objetivo: Determinar los valores de la distancia intercanina en niños con oclusión normal en ambas arcadas dentarias y distintos períodos de dentición. Métodos: Fue realizado un estudio de tipo descriptivo y transversal. El universo estuvo comprendido por 6 033 escolares, de los cuales se obtuvo una muestra aleatoria estratificada de 525 niños con edades de 3, 6, 9 y 12 años, seleccionados de acuerdo con las etapas de desarrollo dental: dentición temporal, mixta temprana, tardía y permanente. Fue realizado un examen clínico facial y bucal, para lo cual se aplicaron los criterios de inclusión. Las variables fueron: edad, sexo y distancia intercanina superior e inferior. Para valorar la posible existencia de asociación entre la distancia intercanina y el sexo, así como con la edad, se utilizó la prueba t de Student para muestras independientes y el análisis de varianza (ANOVA), respectivamente. Resultados: La distancia intercanina superior a los 3 años fue: 27,3 mm, 6 años: 30,42 mm, 9 años: 31,67 y 12 años: 32,93 mm, e inferior (23,19 mm, 24,66 mm, 25,61 y 25,98 mm) para los 3, 6, 9, y 12 años, respectivamente. El sexo masculino mostró los mayores valores. Se comprobaron diferencias significativas en relación con el sexo en la distancia intercanina superior a los 6 y 12 años (p= 0,000) y en la inferior en las mismas edades (p= 0,001 y p=0,01), entre las edades (p= 0,000) tanto en superior como inferior. Conclusiones: La distancia intercanina se incrementa en ambos maxilares conjuntamente con la edad. Se comprueba un predominio de mayor anchura del sexo masculino a los 6 y 12 años en ambos maxilares(AU)

ABSTRACT Introduction: Intercanine distance values are a useful auxiliary reference to predict space deficiency problems related to transverse maxillary growth. Objective: Determine intercanine distance values for children with normal occlusion in both dental arches during the different dentition periods. Methods: A descriptive, cross-sectional study was conducted. The study universe was 6 033 schoolchildren, from whom a stratified random sample was selected of 525 children aged 3, 6, 9 and 12 years, corresponding to the stages of dental development: temporary, early mixed, late mixed and permanent dentition. Facial and oral clinical examination was performed, based on the inclusion criteria. The variables studied were age, sex, upper intercanine distance and lower intercanine distance. The possible association between intercanine distance and sex and age was determined with Student's independent samples t-test and analysis of variance (ANOVA), respectively. Results: Upper intercanine distance was 27.3 mm at 3 years, 30.42 mm at 6 years, 31.67 mm at 9 years and 32.93 mm at 12 years. Lower intercanine distance was 23.19 mm, 24.66 mm, 25.61 mm and 25,98 mm at 3, 6, 9 and 12 years, respectively. Male subjects exhibited greater values. Significant differences were found with respect to sex in upper intercanine distance at 6 and 12 years (p= 0.000) and in lower intercanine distance at the same ages (p= 0.001 and p=0.01), as well as in upper and lower intercanine distance across the different ages (p= 0.000). Conclusions: Intercanine distance increases in both jaws with age. A predominance was found of a greater width in the male sex in both jaws at 6 and 12 years of age(AU)

Restablecimiento de guía anterior dental mediante restauraciones directas / Anterior dental guide reestablishment by direct restorations

OBJETIVO: evaluar la presencia de desoclusión en dientes molares durante los movimientos excursivos, después del restablecimiento de la guía anterior dental, para brindar estabilidad oclusal y estética en pacientes mujeres que asisten a la clínica de Rehabilitación Oral y Estética de la Universidad Mayor de San Simón. MÉTODOS: la presente investigación es de tipo descriptivo, transversal. Los sujetos de estudio fueron pacientes mujeres que acuden a la Clínica de Posgrado Rehabilitación Oral y Estética de la Universidad Mayor de San Simón, quienes presentan desgaste dental patológico tipo I en los dientes caninos e incisivos; durante la gestión 2016. RESULTADOS: se demuestra la presencia de 100% de desoclusión, durante los movimientos excéntricos de protrusiva; 80% de desoclusión en movimientos excéntricos de lateralidad derecha, debido a que 20% de los pacientes estudiados, no pueden realizar la desoclusión en lateralidad derecha por falta de alineación tridimensional (curva de Wilson ) en el lado derecho. Y 100% de desoclusión en movimientos excéntricos de lateralidad izquierda; restablecida la guía anterior dental con resinas fotopolimerizables. CONCLUSIONES: la guía anterior dental como un factor de la desoclusión tanto en movimientos protrusivos como movimientos laterales, es un mecanismo importante de protección hacia los dientes posteriores y a la articulación temporomandibular, lo que trasciende en la necesidad imperiosa de la rehabilitación de la misma, en el desgaste dental patológico tipo I donde el desgaste es menos severo y no hay pérdida de dimensión vertical de oclusión, con restauraciones directas, porque existe menos desgaste de estructura dental. Es un tratamiento reversible, estético y genera resultados funcionales adecuados.

OBJETIVE: to evaluate the de-occlusion presence in molar teeth during the excursion movements, after the reinstatement of the anterior dental guide, to give occlusal and aesthetic stability to female patients who attend the clinic of Oral and Aesthetic Rehabilitation Clinic of Universidad Mayor de San Simon. METHODS: the current research is a descriptive and transversal type. The subject of study were female patients, that attend the Postgraduate Clinic Oral and Aesthetic Rehabilitation of San Simon University who have a pathological tooth wear in canino teeth, and incisive teeth during 2016 administration. RESULTS: it is shown the presence of the de- occlusion in 100% during the protrusive eccentric movements, 80% in eccentric movements of rigth laterality because of the non-existent tridimensional alignment (Wilson's curve) in the right side. And 100% in eccentric movements of the left laterality; the anterior dental guide was reinstated with light-curing resins. CONCLUSIONS: the anterior dental guide asa de-occlucsion factor in both movements, protrusive and lateral, is an important protection mechanism for the posterior teeth and for temporomandibular joint. It transcends the urgent need for the rehabilitation of it, in pathological tooth wear type I where the wear is less severe and there is no loss of vertical dimension of occlusion, with direct restorations, because there is less wear of dental structure. It is a reversible and aesthetic treatment and it generates adequate functional results.

Risk of developing palatally displaced canines in patients with early detectable dental anomalies: a retrospective cohort study

ABSTRACT The early recognition of risk factors for the occurrence of palatally displaced canines (PDC) can increase the possibility of impaction prevention. Objective To estimate the risk of PDC occurrence in children with dental anomalies identified early during mixed dentition. Material and Methods The sample comprised 730 longitudinal orthodontic records from children (448 females and 282 males) with an initial mean age of 8.3 years (SD=1.36). The dental anomaly group (DA) included 263 records of patients with at least one dental anomaly identified in the initial or middle mixed dentition. The non-dental anomaly group (NDA) was composed of 467 records of patients with no dental anomalies. The occurrence of PDC in both groups was diagnosed using panoramic and periapical radiographs taken in the late mixed dentition or early permanent dentition. The prevalence of PDC in patients with and without early diagnosed dental anomalies was compared using the chi-square test (p<0.01), relative risk assessments (RR), and positive and negative predictive values (PPV and NPV). Results PDC frequency was 16.35% and 6.2% in DA and NDA groups, respectively. A statistically significant difference was observed between groups (p<0.01), with greater risk of PDC development in the DA group (RR=2.63). The PPV and NPV was 16% and 93%, respectively. Small maxillary lateral incisors, deciduous molar infraocclusion, and mandibular second premolar distoangulation were associated with PDC. Conclusion Children with dental anomalies diagnosed during early mixed dentition have an approximately two and a half fold increased risk of developing PDC during late mixed dentition compared with children without dental anomalies.

Odontometric analysis of permanent canines in a brazilian population for the investigation of sexual dimorphism / Análise odontométrica de caninos permanentes de uma população brasileira aplicada ao dimorfismo sexual

Objective: The present study aimed to investigate the potential of permanent canines for sexual dimorphism in a Brazilian population. Methods: The sample consisted of 172 dental casts from females (n=102) and males (n=70) aged between 13 and 49 years old. Each dental cast underwent mesiodistal (MD) and buccolingual (BL) measurement of the permanent canines using a digital caliper and a bow compass. MD and BL dimensions were compared between sex groups using Student's t-test for independent samples. Results: Statistically significant differences were observed comparing the odontometric information between females and males (p<0.05). Conclusion: These findings indicate that permanent canines have metric characteristics to enable sexual dimorphism, becoming useful for Brazilian forensic services.

Objetivo: O presente estudo objetivou avaliar o potencial de caninos permanentes para dimorfismo sexual aplicado à prática forense. Métodos: A amostra consistiu de 172 modelos de gesso odontológicos de pacientes do sexo feminino (n=102) e masculino (n=70) de idades entre 13 e 49 anos. Cada modelo odontológico foi submetido à mensuração dos diâmetros mesiodistal (MD) e bucolingual (BL) utilizando um paquímetro digital e um compasso de ponta seca. Os valores obtidos para cada diâmetro foram comparados entre sexos por meio do teste T de Student para amostras independentes. Resultados: Diferenças com significância estatística foram observadas comparando os achados obtidos para os sexos feminino e masculino (p<0.05). Conclusão: Estes resultados indicam que os caninos permanentes apresentam características morfométricas capazes de diferenças sexos, sendo uma ferramenta útil para os serviços de Odontologia e Antropologia Forense do Brasil.

Implante dentário e coroa provisória imediata após a extração de canino decíduo e canino permanente impactado na mesma sessão cirúrgica: controle clínico após dez anos / Immediate dental implant and provisional crown after extraction of deciduous and permanent canine impacted teeth in the same surgical step: a 10-year clinical follow-up

Uma paciente de 32 anos de idade compareceu para tratamento em função da mobilidade do canino decíduo e, após a análise radiográfica, constatou-se o canino permanente impactado. Após o planejamento ortodôntico conjunto, estes elementos foram extraídos e um implante colocado em carga imediata com biomaterial para preenchimento do defeito. A restauração cerâmica definitiva foi realizada sobre um pilar de zircônia e os controles após dez anos ainda mostram excelente resultado estético.

A 32 years-old patient was refered to the dental clinic due to mobility of a deciduous canine and after radiographic analysis an impacted permanent canine was observed. Upon an orthodontic decision making process, those teeth were extracted and a dental implant immediate loaded in addition to a biomaterial to fill the remaining defect. The ceramic definitive restoration was made over a zirconia abutment and the esthetic result is still excellent after 10 years of follow-up.

Lack of pulp sensitivity in maxillary canines submitted to orthodontic traction: a retrospective clinical study

Introduction : Orthodontic movement may cause a great number of tissue alterations in the dental pulp. However, these changes may not be entirely recognized owing to the difficulty in simulating clinical situations. Objective : The aim of this study was to clinically assess the incidence of negative pulp sensitivity to cold among maxillary canines in infraocclusion submitted to orthodontic traction. Material and methods: Two study groups were selected: an experimental group, comprising 32 canine teeth with complete root formation that had been submitted to orthodontic traction, and a control group, comprising 32 canine teeth with complete root formation that had never been submitted to any orthodontic movement. Results: Fourteen teeth from the experimental group showed lack of pulp sensitivity, whereas only one tooth from the control group showed negative pulp sensitivity. Fischer's exact test revealed a significant difference between the groups (p < 0.05). Conclusion: In conclusion, the teeth that had been submitted to orthodontic traction were more likely to lack sensitivity than those that had not been submitted to the same procedure.

Impaction of permanent upper canine causedby supernumerary tooth with talon cusp type III

Introduction: The talon cusp is defined as a developmental anomaly in which an accessory cusp-like structure projects in the area of the cingulum or cementoenamel junction in the anterior teeth attached to the lingual surface of the crown, ranging in size, shape, length and degree of union with the surface. Case report: This study aimed to report a case of a patient who came to Clinic for Preventive Dentistry of Federal University of Pernambuco, Recife-PE, Brazil, complaining of pain in the upper left region. The clinical exam observed the presence of a supernumerary tooth with talon cusp type III in the canine region which had a carious lesion in the developmental groove at the mesial surface and caused a prolonged retention of permanent tooth. Conclusion: With this we want to emphasize that the Dental Surgeon be aware of the changes caused by dental morphological variations, seeking to conduct a proper treatment plan, meeting the functional and aesthetic needs of the patient.

Evaluation of the mechanical behaviour of different devices for canine retraction

OBJECTIVE: To mechanically evaluate different systems used for canine retraction. METHODS: Three different methods for partial canine retraction were evaluated: retraction with elastic chain directly attached to bracket; elastic chain connected to bracket hook and with sliding jig activated with the aid of an elastic chain attached to a mini-implant. For this evaluation, a Typodont was adapted to simulate the desired movements when exposed to a heat source. After obtaining the measurements of the movements, statistical analysis was performed. RESULTS: The mini-implant/sliding jig system (Groups M 0.018-in and M 0.019 x 0.026-in) favored less extrusion and distal inclination of the canines in the retraction stage (p < 0.005). Meanwhile, the retraction system with elastic chain directly attached to the orthodontic brackets (Groups C 0.018-in and 0.019 x 0.026-in) favored greater inclination and extrusion than the others, followed by the system of elastic chain attached to the hook (Groups G 0.018-in and 0.019 x 0.026-in). CONCLUSIONS: Canine retraction with the mini-implant/sliding jig system showed the best mechanical control. The worst results were observed with a 0.018 archwire when the elastic chain was attached to the bracket.

A Case of Canine Tooth Syndrome due to Blow-out Fracture

PURPOSE: This is the first report of canine tooth syndrome associated with blow-out fracture in the Korean literature. METHODS: We examined a 13-year-old male patient complaining of intermittent ocular pain who had a past history of blow-out fracture in the left eye at the age of 6 years. He showed left hypertropia at the primary position and an inability to elevate the left eye in adduction. Orbital CT showed displacement of the superior portion of the ethmoid bone that comprises the medial aspect of the orbit wall and entrapment of the superior oblique muscle in association with the misaligning lesion. In conjunction with orbit CT findings and physical examination, we were able to make a diagnosis of Canine tooth syndrome. RESULTS: We anticipated surgical difficulty due to the surgical field having a lot of scar formation in situation 7 years after the trauma. In this case, we chose observation as our current treatment modality as this was not a case suitable for surgery.