Clinical effect of Piezocision combined with a microporous technique on periodontal tissue reconstruction during anterior displacement of mandibular molars in adults / 中国基层医药

Objective:To investigate the clinical effectiveness of Piezocision combined with a microporous technique in accelerating periodontal tissue reconstruction during the anterior migration of mandibular molars in adults.Methods:A prospective, randomized, controlled study was conducted on 30 adult orthodontic patients recruited from Shaoxing Hospital of Traditional Chinese Medicine between January 2020 and September 2022. The inclusion criteria were patients who were unable to retain their first molars due to severe caries or long-term absence and were not suitable for implantation. Using the random number table method, the patients were randomly assigned to two groups: a simple orthodontic control group (Group A, n = 15) and a group that received Piezocision combined with a microporous technique (Group B, n = 15). After treatment, a comparison was made between the two groups in terms of mesial movement distance of the mandibular second molar, plaque index, gingival index, periodontal pocket depth, width of keratinized gingiva, gingival recession, clinical attachment loss, mesial root resorption of the mandibular second molar, alveolar bone height (measured as the distance from the center of the lower incisor to the anterior margin of the chin, referred to as the LM-AC distance), mandibular bone height (measured by the distance from the distal or mesial surface of the root to the alveolar bone margin, denoted as the CEJ-AC distance), and orthodontic satisfaction. Results:The mesial movement distances of the mandibular second molar in Group A patients were (0.86 ± 0.13) mm, (2.75 ± 0.24) mm, (3.54 ± 0.24) mm, and (4.67 ± 0.13) mm at 4, 6, 8, and 12 weeks, respectively. These values were significantly greater than those observed in Group B, which were (0.43 ± 0.06) mm, (1.27 ± 0.14) mm, (1.85 ± 0.53) mm, and (2.65 ± 0.06) mm ( t = 6.83, 14.13, 18.24, 23.78, all P < 0.001). Prior to treatment, there were no statistically significant differences in plaque index, gingival index, periodontal pocket depth, width of keratinized gingiva, gingival recession, or clinical attachment loss between the two groups (all P > 0.05). After treatment, Group A did not exhibit statistically significant differences in plaque index, gingival index, width of keratinized gingiva, and gingival recession compared with baseline values (all P > 0.05). However, in Group A, periodontal pocket depth and clinical attachment loss significantly increased compared with pretreatment levels ( t = -2.57, -7.50, both P < 0.05). After treatment, Group B exhibited significantly increased values for periodontal pocket depth, width of keratinized gingiva, gingival recession, and clinical attachment loss compared with baseline levels ( t = -8.66, -5.57, -45.33, -9.72, all P < 0.001). Furthermore, these values were significantly higher in Group B compared with those in Group A ( t = -4.28, -3.18, 10.00, 10.69, all P < 0.001). A statistically significant difference was also observed between the two groups in terms of mesial root resorption of the mandibular second molar ( t = 4.14, P < 0.001). However, there was no statistically significant difference in LM-AC distance between the two groups after treatment ( P > 0.05). Conclusion:The combination of Piezocision and a microporous technique can effectively accelerate the anterior migration of mandibular molars in adults while maintaining the health of periodontal tissues. This approach holds great potential for clinical promotion.

The effects of invisible orthodontic appliances without brackets and labial fixed orthodontic appliances on periodontal status and root resorption in orthodontic patients / 中国医师杂志

Objective:To compare the effects of invisible orthodontic appliances without brackets and labial fixed orthodontic appliances on periodontal status and root resorption in orthodontic patients.Methods:A retrospective study was conducted on 102 orthodontic patients who visited the Affiliated Hospital of Jining Medical University from January 2019 to October 2022. According to different treatment methods, they were divided into group A ( n=52) and group B ( n=50). Group A was treated with invisible orthodontic appliances without brackets, while group B was treated with labial fixed orthodontic appliances. We compared two groups of treatment completion time, root resorption, and periodontal health indicators before and after treatment, including plaque index (PLI), gingival index (GI), gingival sulcus bleeding index (SBI), and levels of inflammatory factors in gingival crevicular fluid, including interleukin-1β (IL-1β) and soluble intercellular adhesion molecule-1 (sICAM-1). Results:The completion time of treatment in the Group A was longer than that in the group B [(34.62±4.28)months vs (28.93±3.11)months] ( P<0.01). After treatment, the incidence of root resorption in the group A was 50.96%, while in the group B it was 78.00%. The group A was significantly lower than the group B ( P<0.05), with no root resorption greater than 3 mm in the group A and 0.50% in the group B. After treatment, the levels of PLI, GI, SBI, and IL-1β and sICAM-1 in gingival crevicular fluid increased in both groups, with the group A being lower than group B [(1.26±0.39)points vs (1.73±0.54)points, (1.33±0.25)points vs (2.06±0.46)points, (1.73±0.40)points vs (2.48±0.50)points, (173.74±25.81)ng/ml vs (196.33±31.52)ng/ml, (42.28±5.16)μg/L vs (56.59±7.38)μg/L] (all P<0.05). Conclusions:Although invisible orthodontic appliances without brackets cannot shorten the completion time of treatment, they have advantages in inhibiting root resorption, improving periodontal health, and reducing inflammatory reactions. Clinically, appropriate appliances can be selected based on the specific situation of patients.

Comparison of speech changes caused by four different orthodontic retainers: a crossover randomized clinical trial

ABSTRACT Objective: This study aimed to compare the influence of four different maxillary removable orthodontic retainers on speech. Material and Methods: Eligibility criteria for sample selection were: 20-40-year subjects with acceptable occlusion, native speakers of Portuguese. The volunteers (n=21) were divided in four groups randomized with a 1:1:1:1 allocation ratio. The four groups used, in random order, the four types of retainers full-time for 21 days each, with a washout period of 7-days. The removable maxillary retainers were: conventional wraparound, wraparound with an anterior hole, U-shaped wraparound, and thermoplastic retainer. Three volunteers were excluded. The final sample comprised 18 subjects (11 male; 7 female) with mean age of 27.08 years (SD=4.65). The speech evaluation was performed in vocal excerpts recordings made before, immediately after, and 21 days after the installation of each retainer, with auditory-perceptual and acoustic analysis of formant frequencies F1 and F2 of the vowels. Repeated measures ANOVA and Friedman with Tukey tests were used for statistical comparison. Results: Speech changes increased immediately after conventional wraparound and thermoplastic retainer installation, and reduced after 21 days, but not to normal levels. However, this increase was statistically significant only for the wraparound with anterior hole and the thermoplastic retainer. Formant frequencies of vowels were altered at initial time, and the changes remained in conventional, U-shaped and thermoplastic appliances after three weeks. Conclusions: The thermoplastic retainer was more harmful to the speech than wraparound appliances. The conventional and U-shaped retainers interfered less in speech. The three-week period was not sufficient for speech adaptation.

RESUMO Objetivo: Este estudo teve como objetivo comparar a influência na fala causada por quatro diferentes contenções ortodônticas removíveis superiores. Material e Métodos: Os critérios de elegibilidade para seleção da amostra foram: indivíduos com 20 a 40 anos de idade, com oclusão aceitável, falantes nativos de português. Os voluntários (n=21) foram divididos em quatro grupos, randomizados com proporção de alocação de 1:1:1:1. Os quatro grupos utilizaram os quatro tipos de contenção, em ordem aleatória e em período integral por 21 dias cada, com período de wash-out de sete dias. As contenções superiores removíveis foram: wraparound convencional, wraparound com orifício anterior, wraparound em U e contenção termoplástica. Três voluntários foram excluídos. A amostra final foi composta por 18 indivíduos (11 homens; 7 mulheres) com idade média de 27,08 anos (DP=4,65). A avaliação da fala foi realizada em gravações de trechos vocais, realizadas antes, imediatamente após e 21 dias após a instalação de cada contenção, com análise perceptivo-auditiva e acústica das frequências formantes F1 e F2 das vogais. ANOVA de medidas repetidas e teste de Friedman com Tukey foram utilizados para comparação estatística. Resultados: As alterações de fala aumentaram imediatamente após a instalação das contenções wraparound e termoplástica, e reduziram após 21 dias, mas não para níveis normais. Porém, esse aumento foi estatisticamente significativo apenas para as contenções wraparound com orifício anterior e termoplástica. As frequências dos formantes das vogais foram alteradas no momento inicial e, após três semanas, as alterações se mantiveram com as contenções convencional, em forma de U e termoplástica. Conclusões: A contenção termoplástica foi mais prejudicial à fala do que os aparelhos wraparound. Oswraparounds convencional e em forma de U interferiram menos na fala. O período de três semanas não foi suficiente para adaptação da fala.

Application progress of Ilizarov technique in orthopedics / 中国基层医药

Ilizarov technique is designed based on the "tension-stress principle". Application of the Ilizarov technique can help form a stable mechanical structure through external fixation. It only creates small wounds, without peeling off the surrounding tissue and periosteum. It connects different types of fixation pins and bone or soft tissue to form a traction force, which continuously stimulates the regeneration of bone and tissue and improves the local blood supply and early functional rehabilitation exercises, forming a complete set of minimally invasive orthopedic treatment systems. Ilizarov technique has achieved good results in fracture healing, deformity correction, tissue repair, osteomyelitis, bone nonunion, bone defect, and bone tumor. This paper will summarize the clinical application and research of the Ilizarov technique in orthopedics and explore the key problems of the Ilizarov technique that need to be solved at present.

Clinical application of open vertical helical loop in the treatment of ectopic eruption of first permanent molar / 中国医师杂志

Objective:To explore the clinical application effect of open vertical helical loop to correct ectopic eruption of the first permanent molar, and to provide reference for the selection of treatment timing and methods for ectopic eruption of the first permanent molar.Methods:A total of 30 patients with unilateral or bilateral ectopic eruption of maxillary first permanent molars, aged from 7 to 8.5 years old, who visited the Affiliated Hospital of Jining Medical University from 2020 to 2021, were retrospectively selected. The first permanent molars were moved to their normal positions by bonding buccal tubes between the second primary molars and the first permanent molars with a vertical loop. We compared and analyzed the mesial inclination angle of the first permanent molar, the length of the lateral dental arch, and the root resorption status of the second deciduous molar before and after treatment.Results:All 30 patients underwent complete orthodontic treatment, with the first permanent molar adjusted to its normal position. The inclination angle of the first permanent molar after treatment was (91.3±5.1)°, which was statistically significant compared to (78.1±6.3) ° before treatment ( t=-10.023, P=0.014); The length of the lateral dental arch after treatment was (34.0±1.0)mm, which was significantly increased compared to (31.61±1.1)mm before treatment, and the difference was statistically significant ( t=-25.96, P=0.007). After treatment, the degree of root resorption of the affected second molar significantly increased compared to that before treatment (χ 2=12.002, P<0.001); There was no statistically significant change in root resorption before and after treatment of the healthy second molar ( P=0.818). Conclusions:The use of open vertical helical loop correction for ectopic eruption of maxillary first permanent molar can effectively adjust the mesial inclination angle of patients with ectopic eruption of maxillary first permanent molar. However, close attention should be paid to the root resorption of the second primary molar, and early detection and treatment should be carried out in clinical practice. If the root resorption of the second primary molar is severe after treatment, a retainer should be made in a timely manner to maintain the arch length.

Improvement on oral health related quality of life after orthosurgical treatment: a mixed methods study

Abstract The aim of this study was to understand the influence of orthosurgical treatment on oral health-related quality of life (OHRQoL) in patients with Class II and III skeletal malocclusion by conducting a mixed method case series study. Nineteen patients submitted to orthosurgical treatment in a private practice in Brazil were included in the sample. Data were collected retrospectively and interviews were held from March 2020 to July 2021. Patients answered to the Oral Health Impact Profile (OHIP-14) in the first part of the interview and subsequently answered the qualitative questions. The overall mean of OHIP-14 after treatment was 4.21 (SD 4.68). The qualitative data were analyzed according to thematic analysis and four themes emerged from the interviews: a) concept of quality of life, b) pre-treatment life, c) post-treatment life, and d) positive and negative aspects of treatment. Quality of Life was reported by the patients as the absence of feeling pain, having emotional and physical health, having a satisfactory esthetic appearance and self-esteem. Before treatment, most Class II patients used to complain about breathing and sleeping problems, while Class III patients complained more intensely about esthetics. Pain was a common problem reported by both Class II and Class III patients. In general, improvement was perceived in self-esteem, esthetics, function and pain. Complaints about negative aspects of the treatment were restricted to the postoperative period. The orthosurgical treatment was important for improving the OHRQoL of patients in terms of esthetic, functional and psychosocial aspects.

Orthodontic biomechanics with intermaxillary elastics

ABSTRACT Introduction: Intermaxillary elastics are orthodontic resources widely used in various malocclusions. Their main advantages are low cost, easy insertion and removal by patients, and application versatility. As main disadvantages, we can highlight the need for cooperation from patients and the side effects normally present in treatments with this resource. Knowledge of the biomechanics involved in the use of intermaxillary elastics is essential to take full advantage of the desired effects and avoid unwanted effects in their use. Objective: Therefore, the objective of this article is to describe the anchorage preparation, connection methods, time and force of use, and side effects involved in the use of intermaxillary elastics for the treatment of anteroposterior, vertical and transverse problems. For that, clinical cases and biomechanics schemes will be presented, in which all these details will be described.

RESUMO Introdução: Os elásticos intermaxilares são recursos ortodônticos amplamente utilizados nas diversas más oclusões. Possuem como principais vantagens o baixo custo, fácil inserção e remoção pelos pacientes, e versatilidade de aplicação. Como desvantagens podemos destacar a necessidade de cooperação dos pacientes e os efeitos colaterais normalmente presentes nos tratamentos com esse recurso. O conhecimento da biomecânica envolvida no uso dos elásticos intermaxilares é fundamental para se obter o máximo de efeitos desejados e evitar os efeitos indesejados na sua utilização. Objetivo: O objetivo desse artigo é descrever o preparo da ancoragem, as formas de conexão, o tempo e a força de uso, além dos efeitos colaterais envolvidos na utilização dos elásticos intermaxilares para tratamento de problemas anteroposteriores, verticais e transversais. Para isso, serão apresentados casos clínicos e esquemas de biomecânica em que todos esses detalhes serão descritos.

Therapeutic Possibilities for Maxillary Lateral Incisor Agenesis: a Literature Review / Possibilidades Terapêuticas para Agenesia de Incisivo Lateral Superior: uma Revisão de Literatura

Tooth agenesis or hypodontia is a developmental anomaly, where there is absence of one or more dental elements. The absence of maxillary lateral incisor can be uni or bilateral, has an incidence of 20% and is more frequent in females. Is directly related to the establishment of malocclusions and aesthetic dissatisfaction, so it is important to evaluate multidisciplinary parameters for a treatment decision. The objective of the present study is to establish, according to the present literature, clinical criteria for the therapeutic approach of opening or closing dental space of the Maxillary Lateral Incisor Agenesis. A systematized literature review was carried out in online databases: PubMed, Embase and Lilacs. Health descriptors and free terms were combined with Boolean operators to search: "Tooth Agenesis" or "Anodontia" and "Lateral Incisors" and "Treatment" and "Opening Space" or "Space Closure". Clinical studies that presented diagnostic criteria and therapeutic possibilities for Maxillary Lateral Incisor Agenesis, in English and without publication time frame, were included. During the clinical examination, skeletal, dental and periodontal parameters must be carefully observed. The intervention will always consist of a multidisciplinary approach, which may involve orthodontics, prosthetics, dentistry, periodontics and implantology for functional and aesthetic rehabilitation. The interceptive approach is based on early diagnosis and maintenance of the dental space, so orthodontic corrective treatment can be minimized later on. Late intervention includes closing the space with the reanatomization of adjacent dental elements or opening the space for implant and prosthesis installation. (AU)

A agenesia dentária ou hipodontia é uma anomalia de desenvolvimento, onde há ausência de um ou mais elementos dentários. A ausência do incisivo lateral superior possui uma incidência de 20%, mais frequente no sexo feminino e pode ser unilateral ou bilateral e estão diretamente relacionadas ao estabelecimento de maloclusões e insatisfação estética, assim, é importante que os profissionais saibam avaliar os parâmetros multidisciplinares para uma tomada de decisão sobre seu tratamento. O objetivo do presente estudo é estabelecer, segundo a literatura presente, os critérios clínicos para a tomada de decisão terapêutica de abertura ou fechamento de espaço para a Agenesia de Incisivo Lateral Superior. Foi realizada uma Revisão Sistematizada da Literatura nas bases de dados online: PubMed, Embase e Lilacs. Foram combinados descritores em saúde e termos livres com operadores boleanos para realizar a pesquisa nas bases de dados: "Tooth Agenesis" or "Anodontia" and "Lateral Incisors" and "Treatment" and "opening space" or "space closure". Foram incluídos estudos clínicos que apresentaram critérios para o diagnóstico e possibilidades terapêuticas para a Agenesia do Incisivo Lateral Superior, na língua inglesa e sem recorte temporal de publicação. Durante o exame clínico devem ser observados minuciosamente os parâmetros esqueléticos, dentários e periodontais. A intervenção sempre consistirá na abordagem multidisciplinar, podendo envolver ortodontia, prótese, dentística, periodontia e implantodontia para a reabilitação funcional e estética. A abordagem interceptativa consiste em diagnosticar precocemente e manter o espaço dentário, para que possa minimizar terapias ortodônticas corretivas de maior magnitude posteriormente. A intevenção tardia engloba o fechamento do espaço com a reanatomização dos elementos dentários adjacentes e abertura do espaço para instalação de implante e prótese. (AU)

Effects of different periodontal splints combined with orthodontic treatment on facial aesthetics in patients with sector displacement of periodontitis teeth / 中国医师杂志

Objective:To study the facial aesthetic effect of different periodontal splints combined with orthodontic treatment for patients with sector displacement of periodontitis teeth.Methods:A total of 186 patients with sector displacement of periodontitis teeth admitted to Hunan Second People′s Hospital from April 2018 to April 2020 were prospectively selected as the research objects. 186 patients were divided into observation group and control group by random number table method, with 93 cases in each group. Both groups were treated with orthodontic correction. The observation group was treated with orthodontic combined with super fiberglass periodontal splint, while the control group was treated with orthodontic combined with conventional periodontal splint. The treatment effect, serum inflammatory factors [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6) ], periodontal pocket depth, bleeding index and plaque index before and after treatment were compared between the two groups, and the satisfaction of the two groups was compared.Results:At half year and 1 year after treatment, the effective rate of the observation group was 91.40%(85/93) and 100%(93/93), which were significantly better than those of the control group [84.95%(79/93), 95.70%(89/93), all P<0.05]. The levels of serum TNF-α, CRP and IL-6 in the two groups at half year and 1 year after treatment were significantly lower than those before treatment (all P<0.05); the levels of serum TNF-α, CRP and IL-6 in the observation group was significantly lower than the control group, with statistically significant difference (all P<0.05). The periodontal pocket depth, bleeding index and plaque index of the two groups after treatment were also significantly lower than those before treatment (all P<0.05); the periodontal pocket depth, bleeding index and plaque index of the observation group was significantly lower than the control group, with statistically significant difference (all P<0.05). At half year and 1 year after treatment, the patients′ satisfaction in the observation group reached 91.40%(85/93) and 94.62%(88/93), respectively, which was also significantly better than that in the control group [81.72%(76/93), 89.25%(83/93), all P<0.05]. Conclusions:Compared with the conventional periodontal splint, the combination of super fiberglass periodontal splint can significantly improve the treatment effect and patient′s satisfaction.

Comparison of the effects of different orthodontic techniques on the levels of inflammatory factors in gingival crevicular fluid of orthodontic adolescents / 中国基层医药

Objective:To investigate the effects of bracket-free invisible orthodontic technique versus traditional fixed orthodontic technique on the levels of inflammatory factors in the gingival crevicular fluid of orthodontic adolescents. Methods:A total of 67 orthodontic patients who received their first orthodontic treatment in Huzhou Central Hospital from June to September 2020 were included in this study. They were randomly divided into an observation group ( n = 34) and a control group ( n = 33). The control group was treated with traditional fixed orthodontic treatment. The observation group was treated with invisible orthodontic treatment without brackets. At 0, 1, 2, 4, and 6 months of treatment, the level of inflammatory factors and periodontal index were compared. Results:At 0 and 1 month of treatment, there were no significant differences in the levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in the gingival crevicular fluid between the observation and control groups (all P > 0.05). At 2, 4, and 6 months of treatment, the levels of IL-1β, IL-6, and TNF-α in the observation group were significantly lower than those in the control group (IL-1β: t2 months = 5.56, P = 0.042; t4 months = 8.14, P = 0.019; t6 months = 9.87, P = 0.002. IL-6: t2 months = 7.15, P = 0.029; t4 months = 7.94, P = 0.021; t6 months = 9.16, P = 0.007. TNF-α: t2 months = 6.87, P = 0.039; t4 months = 7.65, P = 0.026: t6 months = 9.89, P = 0.001). In each group, gingival index (GI), sulcus bleeding index (SBI), probing depth (PD), and plaque index (PLI) increased significantly after treatment. At 0 and 1 month of treatment, there were no significant differences in GI, SBI, PD, and PLI between the two groups (all P > 0.05). At 2, 4, and 6 months of treatment, GI, SBI, PD, and PLI in the observation group were significantly lower than those in the control group (GI: t2 months = 3.62, P = 0.073; t4 months = 8.16, P = 0.018; t6 months = 8.54, P = 0.016. SBI: t2 months = 5.65, P = 0.042; t4 months = 7.56, P = 0.027; t6 months = 8.15, P = 0.019. PD: t2 months = 5.652, P = 0.042; t4 months = 7.56, P = 0.027, t6 months = 8.15, P = 0.019. PLI: t2 months = 9.57, P = 0.006; t4 months = 9.98, P = 0.002. t6 months = 9.94, P = 0.010). In addition, at 1 month of treatment, PLI in the observation group was significantly lower than that in the control group ( t = 9.99, P = 0.001). Conclusion:Bracket-free invisible orthodontic treatment provides better protection on periodontal tissue and has less impact on periodontal health than traditional fixed orthodontic treatment.

Differential Diagnosis of Skeletal Class II: Orthodontic-Surgical Approach with Surgery First / Diagnóstico Diferencial da Classe II esquelética: Abordagem Ortodôntico-Cirúrgica com Benefício Antecipado

Abstract Orthodontic-surgical treatment with the "Surgery First Approach" provides immediate facial aesthetic improvements and significantly reduces the patient's orthodontic treatment time, avoiding the transient worsening of the facial profile due to dental decompensation that occurs in surgical cases. Thus, this clinical case describes the retreatment of a 22-year-old female leukoderma patient, whose main complaint was related to the proclination of upper and lower incisors. The patient used a mio-relaxing plate for 30 days, which evidenced the skeletal mandibular deficiency and the ½ bilateral Class II malocclusion. Orthognathic surgery first approach associated with the extraction of the 4 premolars was chosen considering the patient's aesthetic demand. The use of a mio-relaxing plate in the diagnostic stage was essential for the real diagnosis of mandibular deficiency and the technique employed made it possible to conclude the treatment avoiding aesthetic commitment, with excellent results. (AU)

Resumo O tratamento ortodôntico-cirúrgico por meio do benefício antecipado proporciona melhorias estéticas faciais imediatas e reduz de maneira significativa o tempo de tratamento ortodôntico do paciente, evitando a piora transitória do perfil facial devido à descompensação dentária que ocorre em casos cirúrgicos. Assim, este caso clínico descreve o retratamento de uma paciente com 22 anos de idade, leucoderma, sexo feminino, que apresentava queixa principal relacionada à inclinação vestibular dos dentes anteriores. Após uso de placa miorrelaxante por 30 dias, verificou-se a presença de Classe II esquelética com deficiência mandibular e ½ Classe II dentária bilateral. Considerando a demanda estética da paciente, optou-se pela abordagem ortodôntico-cirúrgica com Benefício Antecipado associada à extração de 4 pré-molares para correção da inclinação dentária anterior. O uso da placa miorrelaxante foi fundamental para o diagnóstico real da deficiência mandibular e a técnica empregada possibilitou concluir o tratamento evitando o comprometimento estético pré-cirúrgico, com obtenção de excelentes resultados. (AU)

Tratamento Ortodôntico Pré-Protético / Preprosthetic Orthodontic Treatment

A Odontologia moderna busca atualmente tratamentos que restaurem função e estética dos elementos dentários, levando também em consideração os fatores biológicos envolvidos na saúde bucal. O tratamento reabilitador protético pode ser desafiador, principalmente em pacientes adultos, com perdas dentárias e problemas periodontais. Nesse sentido, a busca por uma somatória de bons resultados leva a equipe a unir especialidades como Periodontia, Dentística, Prótese, Implantodontia, Cirurgia Bucomaxilofacial e Ortodontia. Esta última vem sendo uma grande aliada para a reabilitação protética em etapas de diagnóstico e plano de tratamento, proporcionando melhores prognósticos estéticos e funcionais. O presente estudo trata-se de uma revisão da literatura realizada por meio de busca nas bases de dados PubMed e Google Scholar e tem como objetivo abordar os aspectos mais recentes do tratamento ortodôntico pré-protético, enfatizando as principais vantagens, indicações e as formas de estabelecer um plano de tratamento, bem como movimentações ortodônticas em pacientes com agenesia dentária anterior e a utilização de mini-implantes como auxiliares no plano terapêutico. O tratamento ortodôntico pré-protético é um tema considerado atual, e a individualidade de cada paciente faz com que a literatura concentre mais artigos de relato de caso, sendo, por isso, necessários mais estudos que englobem protocolos e indicações para os possíveis casos que venham a surgir na prática clínica. Conclui-se que a Ortodontia sendo inserida nas etapas de diagnóstico e plano de tratamento da reabilitação protética traz benefícios de grande valia na busca de um ambiente reabilitador mais fácil e com maiores garantias de sucesso estético e funcional.

Modern dentistry is currently seeking treatments that restore the function and aesthetics of dental elements, also considering the biological factors involved in oral health. Prosthetic rehabilitation treatment can be challenging, especially in adult patients with tooth loss and periodontal problems. In this sense, the search for a sum of satisfactory results leads the team to integrate specialties such as Periodontics, Dentistry, Prosthodontics, Implantology, Maxillofacial Surgery and Orthodontics. The latter has been a great ally for prosthetic rehabilitation in stages of diagnosis and treatment plan, providing better aesthetic and functional prognoses. The present study is a literature review performed by searching the PubMed and Google Scholar databases and aims to address the most recent aspects of preprosthetic orthodontic treatment, emphasizing the main advantages, indications, and ways of establishing a treatment plan, as well as orthodontic movements in patients with anterior tooth agenesis and the use of mini-implants as an aid in the therapeutic plan. Preprosthetic orthodontic treatment is considered a current topic, and the individuality of each patient means that the literature concentrates more in case report articles, thus further studies are needed that encompass protocols and indications for possible cases that may arise in clinical practice. We conclude that including orthodontics in the stages of diagnosis and treatment plan of prosthetic rehabilitation brings benefits of great value in the search for an easier rehabilitation environment with greater guarantees of aesthetic and functional success.

Assessment of the need for orthodontic treatment in a peruvian sample using the dental aesthetic index / Necesidad de tratamiento ortodóntico en una muestra peruana mediante el índice estético dental

Introduction: The Dental Aesthetic Index (DAI) is considered an essential tool in the association of the aesthetic and clinical elements of occlusion. It plays a key role in the timely and essential orthodontic treatment. Objective: to determine the orthodontic treatment required in students of a Peruvian public institution using the DAI. Material and Methods: A descriptive, observational, cross-sectional study was carried out during the months of June to July 2016 in a Peruvian educational institution. The sample consisted of 120 students. The use of the DAI allowed to assess the orthodontic treatment required, through the 10 occlusal conditions and regression indicators that constitute a linear formula, with the following components: no treatment required, elective treatment, desirable treatment, and priority treatment, according to the severity of the malocclusion as normal, defined, severe, and very severe, respectively. Results: 53.3% (64) of the students required priority orthodontic treatment due to presenting DAI=43.03. Between the ages of 12-14 years, 56.7% (34), 8.3% (5), and 28.3% (17) required priority, desirable, and elective orthodontic treatment, respectively. The need for priority orthodontic treatment was more prevalent in females accounting for 57.6% (38). 95% (57) of the students from rural areas required orthodontic treatment. Conclusion: The need for orthodontic treatment in a Peruvian sample using the Dental Aesthetic Index was priority orthodontic treatment, mostly in females with ages ranging between 12-14 years.

Introducción: El Índice Estético Dental (DAI) es considerada una herramienta indispensable en la aso-ciación de los elementos estéticos y clínicos de la oclusión, influyendo directamente en el tratamiento de ortodoncia oportuno y requerido. Objetivo: determinar el tratamiento de ortodoncia requerido en estudiantes de una institución pública peruana haciendo uso del DAI. Material y Métodos: Estudio de diseño descriptivo, observacional, con corte transversal, ejecutado durante los meses junio a julio de 2016, en una institución educativa peruana. La muestra fueron 120 estudiantes. La observación mediante el uso del instrumento DAI permitió valorar el tratamiento de ortodoncia requerido, mediante las 10 condiciones oclusales e indicadores de regresión que constituyen una fórmula lineal, con categorías de: No requiere tratamiento, tratamiento electivo, trata-miento deseable, tratamiento prioritario, de acuerdo a la severidad de la maloclusión presente como oclusión normal, definida, severa y muy severa, respectivamente. Resultados: Estudio de diseño descriptivo, observacional, con corte transversal, ejecutado durante los meses junio a julio de 2016, en una institución educativa peruana. La muestra fueron 120 estudiantes. La observación mediante el uso del instrumento DAI permitió valorar el tratamiento de ortodoncia requerido, mediante las 10 condiciones oclusales e indicadores de regresión que constituyen una fórmula lineal, con categorías de: No requiere tratamiento, tratamiento electivo, tratamiento deseable, tratamiento prioritario, de acuerdo a la severidad de la maloclusión presente como oclusión normal, definida, severa y muy severa, respectivamente. Conclusion: La necesidad de tratamiento ortodóntico en una muestra peruana mediante el Índice Estético Dental fue tratamiento de ortodoncia prioritario, predominando el género femenino entre los 12 -14 años.

Morphometric evaluation of the slot of aesthetic orthodontic brackets / Evaluación morfométrica de la ranura de brackets estéticos ortodóncicos

Introduction: Dental malocclusion is a public health problem and orthodontics is the specialty in charge of diagnosing and treating it, aesthetic brackets are an alternative, the costs are varied, which makes its precision doubtful. Objective: Evaluate the measurement and geometry of the slot of three brands of aesthetic brackets and verify their precision. Material and Methods: Twenty-four aesthetic Roth prescription 0.022" slot polycrystalline ceramic brackets were evaluated in three brands: American Orthodontics (United States), Morelli (Brazil) and Class One (China). Eight samples were measured per group in a specialized laboratory certified in measurement and calibration, the measurements of internal and external height were verified, per mesial and distal; and the parallelism of the slot of each bracket. The results were processed with SPSS 22 and tests of variance (ANOVA), Tukey and Student's t were used. Results:The measurements of the brackets' grooves do not correspond to the measurements announced by the manufacturers, these are greater, however, American Orthodontics is within the tolerance range (p<0.01); the slots in the mesio-distal direction and the lingual vestibule are not parallel in Morelli and Class One. Conclusion: The results of this study indicate that the slots of the supports are oversized, their geometry is not precise and varies greatly between brands and prices. The three-dimensional control of the tooth could be compromised.

Introducción: La maloclusión dental es un problema de salud pública y la ortodoncia es la especialidad encargada de diagnosticarla y tratarla, los brackets estéticos son una alternativa, los costos son variados lo que hace dudar su precisión. Objetivo: Evaluar la medida y geometría de la ranura de tres marcas de brackets estéticos y corroborar su precisión. Material y Métodos: Se evaluaron 24 brackets estéticos cerámicos policristalinos de ranura 0,022" prescripción Roth en tres marcas: American Orthodontics (Estados Unidos), Morelli (Brasil) y Class One (China). Se midieron ocho muestras por grupo en un laboratorio especializado y certificado en medición y calibración, se verificaron las medidas de altura interna y externa, por mesial y distal; y el paralelismo de la ranura de cada brackets. Los resultados fueron procesados con SPSS 22 y se utilizaron pruebas de varianza (ANOVA), Tukey y t de Student. Resultados: Las medidas de las ranuras de los brackets no se corresponden con la medida anunciada por los fabricantes, estas son mayores, sin embargo, American Orthodontics y Morelli se encuentra dentro del rango de tolerancia (p<0,01); las ranuras en sentido mesio distal y vestíbulo lingual no son paralelas estadísticamente en Morelli y Class One. Conclusión: Los resultados de este estudio indican que las ranuras de los soportes se encuentran sobredimensionadas, su geometría no es precisa y varía mucho entre marcas y precios. El control tridimensional del diente se podría ver comprometido.

Spontaneous Transversal Changes of Lower Arch Following Palatal Skeletal Expansion

ABSTRACT Objective: To evaluate how the lower arch spontaneously change after upper rapid palatal expansion in a group of patients with transversal skeletal deficit. Material and Methods: Twenty-four patients treated by the same orthodontist with a rapid palatal expander (RPE) bounded on a deciduous molar have been selected. The sample was divided into two groups: no treatment was provided for group one, while group two was treated using a lip bumper or Schwarz appliance. For each patient, dental casts were collected when the RPE was bounded (T0) and at the end of treatment, 9 months ± 3 months later (T1). Each outcome was analyzed, providing descriptive statistics, main effects significance tests and post-hoc analyses with the objective to evaluate the variations between pre-treatment (TO) and post-treatment (T1) of each of them. Results: If the linear measurements are considered, a significant beneficial effect on both arches is observed. However, the upper arch always shows a major increase of all values at T1 with respect to the lower arch. Even though the post-hoc tables indicate that time differences are all statistically significant across considered partitions, the lower arch's increase is more pronounced in group two, where patients were treated in both arches. If the angular measurements are concerned, the increase of lingual crown inclination was found in all patients, independently from the type of treatment in lower arch. Conclusion: All patients show normalization of upper diameters, regardless of whether the lower arch was treated or not.

Stress distribution analysis in anterior teeth caused by several retraction mechanics

ABSTRACT Introduction: Orthodontic retraction of the anterior teeth is indicated when the patient has a malocclusion with protrusion of the incisors. Several mechanics are indicated to perform this retraction. Objective: The objective of this study was to compare the strains generated by four different types of retraction mechanics along the roots of the anterior teeth. Methods: A photoelastic model simulating an arch with first premolars extraction was made. Sixty retraction archwires were prepared, including fifteen for each type of mechanics evaluated: sliding, teardrop loop spring, T-loop spring and double key loop archwire. The strains were observed in two perspectives: occlusal and oblique. In the occlusal perspective, strains were compared among the six anterior teeth. From the oblique perspective, strains were compared among the thirds of the left canine root. Results: In the occlusal perspective, the teardrop loop spring mechanics presented greater strains, followed by T-loop spring, double key loop archwire and sliding mechanics. In all mechanics, strains were more concentrated in the canines than in the incisors. From the oblique perspective, the teardrop loop mechanics generated greater strains in the cervical regions of the canine, and in the apical regions, no differences were found in strains among the four types of mechanics. In the same mechanics, greater strains were present in the cervical zones. Conclusion: The teardrop loop spring retraction mechanic presented the greatest mean strain, and the sliding retraction mechanic presented the lowest mean strain on the root of anteroinferior teeth in the occlusal and oblique perspectives.

RESUMO Introdução: A retração ortodôntica dos dentes anteriores é indicada quando o paciente apresenta má oclusão com vestibularização dos incisivos. Diferentes mecânicas são indicadas para realizar essa retração. Objetivo: O objetivo do presente estudo foi comparar as tensões geradas por quatro diferentes tipos de mecânicas de retração nas raízes dos dentes anteriores. Métodos: Um modelo fotoelástico foi confeccionado simulando uma arcada com os primeiros pré-molares extraídos. Foram preparados 60 arcos de retração, sendo quinze para cada tipo de mecânica avaliada: deslizamento, alça de Bull, alça em T e arco de dupla chave. As tensões foram observadas em duas perspectivas: oclusal e oblíqua. Na vista oclusal, as tensões foram comparadas entre os seis dentes anteriores. Na vista oblíqua, as tensões foram comparadas entre os terços radiculares do canino esquerdo. Resultados: Na vista oclusal, a mecânica com alça de Bull apresentou maiores tensões, seguida da alça em T, arco de dupla chave e mecânica de deslizamento. Em todas as mecânicas, as tensões se concentraram mais nos caninos do que nos incisivos. Na vista oblíqua, a mecânica com alça de Bull gerou maiores tensões nas regiões cervicais dos caninos; nas regiões apicais, não houve diferenças nas tensões entre os quatro tipos de mecânicas. Dentro de uma mesma mecânica, as maiores tensões estiveram presentes nas regiões cervicais. Conclusão: A mecânica de retração com alça de Bull apresentou a maior média de tensões, e a mecânica de retração por deslizamento apresentou a menor média de tensões na raiz dos dentes anteroinferiores, nas vistas oclusal e oblíqua.

Comparison of Bracket Position Accuracy with Different CAD/CAM Indirect Bonding Systems

ABSTRACT Objective To evaluate the accuracy of three different digital bracket positioning systems, comparing vertical, mesiodistal and buccolingual accuracy. Material and Methods The same case was sent to Orapix, Insignia, and Orthocad systems and the brackets were bonded to the malocclusion models.Damon 3 MX brackets were used with all systems and the brackets were bonded to the models with the same bonding protocol and materials. The comparison of the position of each single bracket was made with digital photography, and ImageJ software was used to find the length in pixels and then convert it to hundredths of a mm for vertical, mesiodistal and buccolingual displacement, compared to the setup. Results Insignia System reported the average higher vertical displacement (0.28 mm), compared with the other two appliances (0.22-0.23 mm), and showed the lowest average displacement for the mesiodistal and buccolingual positioning (0.14 and 0.07 mm, respectively).However, these slight bracket positioning variations between these bonding systems were not statistically different (p>0.05). Conclusion The three systems analyzed were shown to be accurate in positioning the brackets, and none of them was statistically better.

Bracket ortodóncico doble slot convencional / Standard double slot orthodontic bracket

La evolución de la ortodoncia, desde sus inicios, ha demostrado hechos destacables como el surgimiento de la técnica de arco recto, el desarrollo de prescripciones variadas, el uso de ranuras con diferentes dimensiones, sistemas de anclaje esquelético, tomografía... A pesar de ello, los diseños y las características que presentaban los brackets eran siempre los mismos y limitados. La historia de las grandes ideas es vasta, pero debían estar unidas en una sola pieza. Esto es lo que hicieron los autores de este artículo, al desarrollar un nuevo diseño de bracket que cuenta con dos slots centrales y cada una con diferentes dimensiones, un slot tiene dimensiones de 0.018 "X 0.030" y el otro 0.022 "X 0.028", abriéndse una gama de posibilidades. A partir de ahora contamos con una herramienta de trabajo con varios recursos, que genera grandes beneficios para profesionales y pacientes, y que gana cada día más seguidores (AU)

The evolution of orthodontics, since its beginnings, has demonstrated remarkable events such as the appearance of the straight wire technique, the development of varied prescriptions, the use of slots with different dimensions, skeletal anchoring systems, tomography ... Despite this, the designs and the features that the brackets presented were always the same and limited. The history of great ideas is vast, but they needed to be united in one piece. This is what the authors of this article did, when developing a new bracket design that features two central slots and each with different dimensions, one slot has dimensions of 0.018 "X 0.030" and the other 0.022 "X 0.028" with a fan of possibilities is being opened. Now, a work tool with several resources, which generates great benefits for professionals and patients is gaining more followers every day (AU)

Orthognathic surgery with anterior segmental osteotomy as alternative of treatment in patients with dento-skeletal deformity class III AP maxillary deficiency with dental compensation: case report / Cirugía ortognática con osteotomía segmentaria anterior como alternativa de tratamiento en pacientes con deformidades dento esqueletales (DDE) clases III por deficiencia AP maxilar compensados dentalmente: caso clínico

Introduction: Orthognathic surgery is a routine procedure carried out by maxillofacial surgeons in patients with dento-skeletal deformations (DSD) with the objective of achieving functional and esthetical satisfactory results. However, some in cases, due to the decision of the patient or the orthodontic team, the occlusion is tried to be compensated with the intention of avoiding surgery, without optimal results. As a consequence, some extra procedures are required in the surgery to correct and obtain better results. Objective: The aim of this case is to propose the anterior segmental osteotomy (ASO) as alternative of treatment in patients with dento-skeletal deformity class III with maxillary and para-nasal deficiency which have been orthodontically compensated. Material and methods: A 18 years old female with DED Class III due anterior-posterior (AP) maxillary and paranasal deficiency and AP mandibular excess. The surgery was carried out through Le Fort I osteotomy in combination with a segmentary osteotomy at the expense of first premolars and bilateral setback sagittal split osteotomy (BSSO). Clinical and imageology post operatory controls were made during the first 6 months and at two years. Results: Through the realization of the anterior segmental osteotomy the correction of occlusal and transversal alterations of the patient maxilla were performed and additionally favorable facial changes were obtained. Conclusion: The initial orthodontic management of patients with DSD will influence the surgical procedures and the achievement of a balance between esthetics and function. This illustrates why the treatment of these patients must be multidisciplinary; the treatment that was chosen in this case was innovative and could be an alternative for the treatments of patients with DED Class III.

Introducción: La cirugía ortognática es un procedimiento de rutina que realizan los cirujanos bucomaxilofaciales en pacientes con deformidades dento esqueletales (DDE) con la finalidad de lograr un resultado funcional y estético satisfactorio. Sin embargo, hay casos en los cuales, ya sea por decisión del paciente o por el ortodoncista, se intenta compensar la oclusión con el fin de evitar la fase quirúrgica no obteniendo los resultados más óptimos; y como consecuencia, se requiere de procedimientos adicionales a los convencionales en la cirugía para corregir y lograr el mejor resultado. Objetivo: El propósito de este caso es proponer la osteotomía segmentaria anterior (OSA) como alternativa de tratamiento en pacientes con Deformidad Dento Esqueletal clase III con deficiencia maxilar y paranasal los cuales han sido compensados ortodonticamente. Material y Métodos: Paciente femenina de 18 años de edad con Deformidad Dento Esqueletal Clase III por deficiencia AP maxilar y paranasal y exceso AP mandibular. Se realiza cirugía mediante osteotomía Le Fort I en combinación con osteotomía segmentaria a expensas de primeros premolares, osteotomía sagital de rama bilateral de retroposición. Se realizan controles post-operatorios clínico e imagenológicos durante los primeros 6 meses. Resultados: Por medio de la realización de la osteotomía segmentaria anterior se pudo realizar la corrección de las alteraciones oclusales y transversales del maxilar de la paciente, además de producir cambios faciales favorables. Conclusión: El manejo inicial de los pacientes con deformidades dento-esqueletales por parte del ortodoncista va influir en los procedimientos quirúrgicos y en lograr un balance entre lo estético y lo funcional, por lo que el tratamiento en estos pacientes es multidisciplinario; el tratamiento realizado en este caso en una solución innovadora y puede llegar a tomarse como alternativa en los tratamientos de las clases III.

Pain experience with micro-osteoperforations during Initial orthodontic alignment: a randomized clinical trial / Experiencia de dolor con micro-osteoperforaciones durante la alineación ortodóncica inicial: un ensayo clínico aleatorizado

Objetive: The objective of this clinical trial was to investigate the perception of pain during initial maxillary alignment with an adjunctive procedure of micro-osteoperforations (MOPs) compared to conventional orthodontics. Material and methods: This study design was a single-centre, two-arm parallel prospective randomised clinical trial. Thirty consecutive adult subjects (25 females and 5 males; mean age ± SD, 22.66 ± 3.27 years) with 5-8mm moderate upper labial segment crowding were randomly allocated using block randomisation into intervention and control group. All subjects had first premolar extractions, bonded conventional fixed appliances and 0.014-inch nickel-titanium archwire was placed for initial alignment. The intervention group received a 3-mm deep MOPs procedure under local anaesthesia using a Propel device (PROPEL Ortho Singapore) on the labiogingival aspect between the maxillary incisors. Both groups received a set of 100 mm visual analogue scale to complete over the first week, recording pain at 24 hours, 3 days and 1 week. Data were analysed using repeated-measures analysis of variance (ANOVA). Results: There was a statistically significant difference observed in perceived pain levels between MOPs and the control group on day 1, day 3 and day 7 postoperatively. Pain perception was significantly lower in the intervention group at all time points. Conclusion: Accelerating orthodontic tooth movement with MOPs did not accentuate pain perceived during initial maxillary alignment with fixed appliances.

Objetivo: El objetivo de este ensayo clínico fue investigar la percepción del dolor durante la alineación maxilar inicial con un procedimiento adyuvante de micro-osteoperforaciones (MOP) en comparación con la ortodoncia convencional. Material y Métodos: El diseño de este estudio fue un ensayo clínico aleatorizado prospectivo paralelo de dos brazos y un solo centro. Treinta sujetos adultos consecutivos (25 mujeres y 5 hombres; edad media ± DE, 22,66 ± 3,27 años) con apiñamiento moderado del segmento labial superior de 5-8 mm se asignaron al azar mediante la asignación al azar en bloques en el grupo de intervención y de control. A todos los sujetos se les realizaron extracciones de los primeros premolares, se colocaron aparatos fijos convencionales adheridos y se colocó un arco de níquel-titanio de 0,014 pulgadas para la alineación inicial. El grupo de intervención recibió un procedimiento de MOP de 3 mm de profundidad bajo anestesia local utilizando un dispositivo Propel (PROPEL Ortho Singapore) en la cara labial de los incisivos superiores. Ambos grupos recibieron un conjunto de escala analógica visual de 100 mm para completar durante la primera semana, registrando el dolor a las 24 horas, 3 días y 1 semana. Los datos se analizaron mediante análisis de varianza de medidas repetidas (ANOVA). Resultados: Se observó una diferencia estadísticamente significativa en los niveles de dolor percibido entre los MOP y el grupo de control el día 1, el día 3 y el día 7 del postoperatorio. La percepción del dolor fue significativamente menor en el grupo de intervención en todos los momentos. Conclusión: La aceleración del movimiento dental de ortodoncia con MOP no acentuó el dolor percibido durante la alineación maxilar inicial con aparatos fijos.