Influence of genetics on the occurrence of enamel hypomineralization affecting permanent and primary teeth: A scoping review.

BACKGROUND: Molar incisor hypomineralization (MIH) is prevalent worldwide and is a challenge for clinicians who provide oral care to children. Molar incisor hypomineralization has been considered a multifactorial disturbance that results from a combination of environmental and genetic factors. AIM: This scoping review followed the Joanna Briggs Institute protocol and aimed to identify the available evidence of the genetic influence on the etiology of MIH. DESIGN: The search strategy was conducted in multiple databases, including PubMed, BVS, Embase, Web of Science, and Scopus. Two trained reviewers, requiring a third reviewer in case of disagreements, collected evidence. RESULTS: Of 563 retrieved studies, 17 were included in the review. From 14 studies performed in humans, 10 investigated DNA polymorphisms, one analyzed DNA methylation, one aimed model of inheritance, and two focused on the phenotype in twins or in the family. Three animal studies were based on the null expression of genes. CONCLUSION: This scoping review, based on the studies that used different methodologies, reinforces the hypothesis of a genetic contribution to the multifactorial etiology of MIH. The available data are limited in terms of size and origin of the samples. Hence, further genetic studies are still required.

Comparison between dentistry and nondentistry undergraduate students' selfperception regarding the aesthetics of their own smile and facial profile

Introduction: the study aimed to compare how undergraduate dentistry students (DS) and non-dentistry students (NDS) analyze and classify their own smile and facial profile. Materials and Methods: the cross-sectional study questionnaire included topics for the identification of the respondent; Likert scale and aesthetic component of the Index of Orthodontic Treatment Need (IOTN) to assess satisfaction with one's own smile; facial profile attractiveness using Turkkahraman and Gokalp scale and previous history of orthodontic treatment. Intra and intergroup data were analyzed by chi-square test with 95% confidence (p<0.05) using SPSS 13.0 software. Results: 483 questionnaires were answered, 166 from DS and 317 from NDS. Most participants considered their occlusion as ideal and pleasant (DS - 79.27%; NDS - 79.8%) and their profile as slightly convex (DS - 80.6%; NDS - 76%). The slightly convex profile was also preferred by both groups for both genders. 71% of the DS and 66.0% of the NDS reported having undergone orthodontic treatment. Most respondents were satisfied or very satisfied with their smile, however the NDS had a higher prevalence of students very satisfied with their smile (p<0.05). Conclusion: the choice of course does not seem to have any influence on the analysis and classification of the smile and facial profile, perhaps because most of them have already undergone orthodontic treatment.

Introdução: o objetivo deste estudo foi observar como estudantes de graduação analisam e classificam seu próprio sorriso e perfil facial, comparando os resultados entre estudantes de odontologia (EO) com não estudantes de odontologia (NEO). Materiais e Métodos: o questionário respondido pelos participantes incluiu tópicos para identificação dos indivíduos; escala Likert e componente estético do Índice de Necessidade de Tratamento Ortodôntico (IOTN) para avaliar a satisfação com o próprio sorriso; atratividade facial com escala de Turkkahraman and Gokalp e história prévia de tratamento ortodôntico. Os dados intra e intergrupos foram analisados pelo teste qui-quadrado com 95% de confiança (p<0,05) utilizando o software SPSS 13.0. Resultados: foram obtidas 483 respostas, sendo 166 do grupo EO e 317 do grupo NEO. A maioria dos participantes considerou sua oclusão ideal e agradável (EO - 79,27%; NEO - 79,8%) e seu perfil levemente convexo (EO - 80,6%; NEO - 76%). O perfil levemente convexo também foi preferido por ambos os grupos para ambos os sexos. 71% dos EO e 66,0% dos NEO relataram ter feito tratamento ortodôntico. A maioria dos respondentes estava satisfeita ou muito satisfeita com seu sorriso, porém o NEO teve maior prevalência de alunos muito satisfeitos com seu sorriso em relação ao grupo EO (p<0,05). Conclusão: a escolha do curso parece não ter influência na análise e classificação do sorriso e perfil facial, talvez porque a maioria dos participantes já tenha realizado tratamento ortodôntico.

Post-trauma complex orthodontic approach: the impact of psychological issues of bullying on treatment decision.

OBJECTIVE: This article aims to discuss the multidisciplinary approach required in the treatment of cases of impaction and ankylosis of permanent teeth, associated with a history of trauma, considering the psychological state of the child and family when faced with a traumatic case of bullying, by reporting the complex treatment of a central incisor needing to be orthodontically moved across the midline. CONCLUSION: This clinical case was a major challenge, which included complex multidisciplinary procedures. Results and stability after 26 months of retention indicated successful orthodontic space closure of two maxillary teeth, without the use of implants or prostheses, in an adolescent patient who had a history of dental trauma, alveolar bone loss, and an uncertain initial prognosis.

Evaluation of two stereophotogrametry software for 3D reconstruction of virtual facial models.

OBJECTIVE: The present study aimed to evaluate the accuracy of 3D facial soft tissue virtual models produced by two photogrammetry softwares (AgiSoft Photoscan and 3DF Zephyr Free), when compared to those created by cone beam computed tomography (CBCT). METHODS: Ten patients were submitted to two sequences of photographs performed with a DSLR camera (with and without the aid of a ring flash) and CBCT scans. Each photo series for each patient was processed with the softwares, and at the end, five models of each patient were generated: 1) CBCT, 2) AAL (Agisoft Ambient Light), 3) AFL (Agisoft Flash Light), 4) ZAL (Zephyr Ambient Light), and 5) ZFL (Zephyr Flash Light). Color coded maps and root-mean-square (RMS) distances were used to compare the photogrammetry models to the CBCT ones. RESULTS: One sample t-test showed significant differences between all methods versus CBCT. The worst results were seen in the ZAL group (discrepancies up to 5.17mm), while the best results were produced by AAL group (discrepancies up to 2.11mm). CONCLUSIONS: It can be concluded that this type of virtual facial models are reasonably accurate, although not perfect, and considering its lower biological and financial cost, they may play an important role in specific situations.

Do low-cost 3-dimensional printers produce suitable dental models?

INTRODUCTION: When choosing a 3-dimensional printer for dental models, the cost-benefit ratio should be evaluated. The purpose of this study was to evaluate the accuracy, precision, cost, and time taken to prepare and print using different low-cost techniques (2 digital light processing [DLP] and 1 fused filament fabrication [FFF] printer) compared with the reference proven to be clinically accepted (PolyJet). METHODS: For this purpose, the upper and lower virtual models of 5 patients were printed using: (1) DLP printer Moonray, (2) DLP printer Anycubic, (3) DLP printer Moonray with Anycubic resin, (4) Filament printer UpMini 2 (FFF), and (5) Polyjet printer Objet Eden500V. One of the virtual models was also printed 4 consecutive times on each printer to allow consistency assessment. Afterward, the 14 printed resin models were scanned, and their accuracy was evaluated by model superimposition using Geomagic Qualify software (3D Systems, Rock Hill, SC). A digital caliper was also used to obtain linear measurements. All measurements were carried out by a calibrated examiner. RESULTS: The results showed that all printers produced similar results, although Moonray with Anycubic resin showed loss of accuracy and Anycubic showed inconsistent vertical dimensions. The printing cost and time consumed from each pair of models were calculated for the overall printing process, analyzing which would have the best cost-benefit ratio. CONCLUSIONS: Polyjet printing was considered the fastest method but with the highest cost. FFF printing was the lowest printing and input cost but was considerably more time-consuming. There was a balance in both DLP printers, and they were considered the best cost-benefit ratio for small independent dental offices.

Reliability of a digital system for models measurements in BBO grading: A pilot study.

INTRODUCTION: Currently, no method is considered effective for the evaluation of digital models in the Certification Examination of the Brazilian Board of Orthodontics (BBO), considering the parameters of the currently used manual method. OBJECTIVE: Thus, the aim of this study is to verify the reliability of an evaluation method for digital models that could be used in the BBO exam, compared to the gold standard. METHODS: Measurements were performed by five previously calibrated examiners. Samples of ten sets of plaster models of the final phase of orthodontic treatment were measured using a manual method (Objective Grading System, OGS). These models were digitized using a 3D scanner and exported to Geomagic Qualify software, in which the measurements were made with the proposed digital method. These measurements were repeated using five models, after fifteen days. The intra-examiner performance with this method was analyzed with a paired t-test, whereas the inter-examiner analysis was carried out with analysis of variance and Tukey's test. To compare the manual and digital methods, a paired t-test and Pearson's correlation analysis were performed. RESULTS: A statistically significant difference was found. The results showed that, when compared to the manual method, the digital method was effective in measuring the OGS in four of the seven variables studied: Marginal Ridge, Overjet, Occlusal Contact, and Interproximal Contact. The variables Alignment, BL inclination, and Occlusal Relationship showed a great amount of dispersion in the findings. CONCLUSION: Further studies are needed to develop an adequate digital methodology that can be used for all OGS variables.

Post-trauma complex orthodontic approach: the impact of psychological issues of bullying on treatment decision

ABSTRACT Objective: This article aims to discuss the multidisciplinary approach required in the treatment of cases of impaction and ankylosis of permanent teeth, associated with a history of trauma, considering the psychological state of the child and family when faced with a traumatic case of bullying, by reporting the complex treatment of a central incisor needing to be orthodontically moved across the midline. Conclusion: This clinical case was a major challenge, which included complex multidisciplinary procedures. Results and stability after 26 months of retention indicated successful orthodontic space closure of two maxillary teeth, without the use of implants or prostheses, in an adolescent patient who had a history of dental trauma, alveolar bone loss, and an uncertain initial prognosis.

RESUMO Objetivo: O presente artigo tem como objetivo discutir a abordagem multidisciplinar necessária no tratamento de casos de impacção e anquilose de dentes permanentes, associados a histórico de trauma, considerando o estado psicológico da criança e da família diante de situações traumáticas de bullying, por meio do relato do tratamento complexo de um incisivo central que precisava ser movido ortodonticamente através da linha média. Conclusão: Esse caso foi um grande desafio, que incluiu procedimentos multidisciplinares complexos. Os resultados e a estabilidade após 26 meses de contenção indicaram fechamento ortodôntico bem-sucedido do espaço de dois dentes superiores, sem o uso de implantes ou próteses, em uma paciente adolescente que apresentava histórico de trauma dentário, perda de osso alveolar e prognóstico inicial incerto.

Reliability of a digital system for models measurements in BBO grading: A pilot study

ABSTRACT Introduction: Currently, no method is considered effective for the evaluation of digital models in the Certification Examination of the Brazilian Board of Orthodontics (BBO), considering the parameters of the currently used manual method. Objective: Thus, the aim of this study is to verify the reliability of an evaluation method for digital models that could be used in the BBO exam, compared to the gold standard. Methods: Measurements were performed by five previously calibrated examiners. Samples of ten sets of plaster models of the final phase of orthodontic treatment were measured using a manual method (Objective Grading System, OGS). These models were digitized using a 3D scanner and exported to Geomagic Qualify software, in which the measurements were made with the proposed digital method. These measurements were repeated using five models, after fifteen days. The intra-examiner performance with this method was analyzed with a paired t-test, whereas the inter-examiner analysis was carried out with analysis of variance and Tukey's test. To compare the manual and digital methods, a paired t-test and Pearson's correlation analysis were performed. Results: A statistically significant difference was found. The results showed that, when compared to the manual method, the digital method was effective in measuring the OGS in four of the seven variables studied: Marginal Ridge, Overjet, Occlusal Contact, and Interproximal Contact. The variables Alignment, BL inclination, and Occlusal Relationship showed a great amount of dispersion in the findings. Conclusion: Further studies are needed to develop an adequate digital methodology that can be used for all OGS variables.

RESUMO Introdução: Ainda não há um método considerado eficaz para análise dos modelos digitais no exame do Board Brasileiro de Ortodontia (BBO), considerando-se os parâmetros do método manual atual. Objetivo: Assim, o presente estudo objetiva verificar a confiabilidade de um método de avaliação em modelos digitais para o exame do BBO, comparando com o padrão-ouro. Métodos: As medições foram realizadas por 5 examinadores, previamente calibrados. A amostra de 10 pares de modelos de gesso da fase final do tratamento ortodôntico foi medida no método manual (Sistema Objetivo de Avaliação, SOA). Os modelos foram digitalizados por meio de um scanner 3D e exportados para o software Geomagic Qualify, onde foram feitas as medidas no método digital proposto. As medidas foram refeitas em 5 modelos após 15 dias. A análise intraexaminador desse método foi realizada por meio do teste t pareado; já a interexaminadores, feita com ANOVA e teste de Tukey, sendo encontrada diferença estatisticamente significativa. Para a comparação dos métodos manual e digital, foram utilizados o teste t pareado e a correlação de Pearson. Resultados: Uma diferença estatisticamente significativa foi encontrada. Os resultados mostraram que, comparada ao método manual, a metodologia digital mostrou-se eficaz para medição do SOA em quatro das sete variáveis estudadas: Margem interproximal, Sobressaliência, Contato oclusal e Contato interproximal. As variáveis Alinhamento, Inclinação V-L e Relação oclusal mostraram muita dispersão nos achados. Conclusão: Mais estudos são necessários para o desenvolvimento de uma metodologia digital adequada em todas as variáveis do SOA.

Evaluation of two stereophotogrametry software for 3D reconstruction of virtual facial models

ABSTRACT Objective: The present study aimed to evaluate the accuracy of 3D facial soft tissue virtual models produced by two photogrammetry softwares (AgiSoft Photoscan and 3DF Zephyr Free), when compared to those created by cone beam computed tomography (CBCT). Methods: Ten patients were submitted to two sequences of photographs performed with a DSLR camera (with and without the aid of a ring flash) and CBCT scans. Each photo series for each patient was processed with the softwares, and at the end, five models of each patient were generated: 1) CBCT, 2) AAL (Agisoft Ambient Light), 3) AFL (Agisoft Flash Light), 4) ZAL (Zephyr Ambient Light), and 5) ZFL (Zephyr Flash Light). Color coded maps and root-mean-square (RMS) distances were used to compare the photogrammetry models to the CBCT ones. Results: One sample t-test showed significant differences between all methods versus CBCT. The worst results were seen in the ZAL group (discrepancies up to 5.17mm), while the best results were produced by AAL group (discrepancies up to 2.11mm). Conclusions: It can be concluded that this type of virtual facial models are reasonably accurate, although not perfect, and considering its lower biological and financial cost, they may play an important role in specific situations.

RESUMO Objetivo: O presente estudo teve como objetivo avaliar a acurácia de modelos virtuais 3D de tecidos moles faciais produzidos por dois softwares de fotogrametria (AgiSoft Photoscan e 3DF Zephyr Free), em comparação aos gerados por tomografia computadorizada de feixe cônico (TCFC). Métodos: Dez pacientes foram submetidos a duas sequências de fotografias realizadas com câmera DSLR (com e sem auxílio de ring flash) e a TCFC. Cada série de fotografias de cada paciente foi processada com os softwares e, ao fim, foram gerados cinco modelos de cada paciente: 1) TCFC; 2) AAL (Agisoft Ambient Lighting); 3) AFL (Agisoft Flash Light); 4) ZAL (Zephyr Ambient Lighting); e 5) ZFL (Zephyr Flash Light). Mapas codificados por cores e distâncias quadráticas médias (RMS) foram usados para comparar os modelos de fotogrametria com os de TCFC. Resultados: O teste t para uma amostra mostrou diferenças significativas entre todos os métodos versus a TCFC. Os piores resultados foram observados no grupo ZAL (discrepâncias de até 5,17 mm), enquanto os melhores resultados foram produzidos pelo grupo AAL (discrepâncias de até 2,11 mm). Conclusões: Pode-se concluir que esse tipo de modelos faciais virtuais é razoavelmente preciso, embora não sejam perfeitos; e, considerando-se seu menor custo biológico e financeiro, podem desempenhar um papel importante em situações específicas.

Evaluation of dental school student's satisfaction regarding their own smile esthetics and facial profile

Introduction: Facial aesthetics is especially important in a person's life. However,what is considered aesthetic by the orthodontist does not always correspond withthe patient's opinion, since aesthetics is very subjective. Thus, the aim of this studyis to evaluate the perception of dentalgraduate students in relation to their ownsmile and facial profile, analyzing if there would be any difference between thisself-evaluation associated with the year students are attending in dental schooland the technical knowledge progressively acquired. Materials and methods: Atransverse observational study was performed, in which a questionnaire wasapplied to all dentistry students at the State University of Rio de Janeiro. Thequestionnaire inquired about: student's current semester, age, gender, nationality,and previous history of orthodontic treatment. It also contained a Likert scale ofsatisfaction about their smile, the aesthetic component of the Index of OrthodonticTreatment Need (IOTN) for students to compare with their smile, and a scale forfacial profile comparison. The chi-squared test was applied using the SPSS 13.0software and all analyzes were performed with 95% confidence (p < 0.05). Results:A total of 253 questionnaires were distributed and 166 were filled out. Amongthose, 103 people reported having had orthodontic treatment before. The level ofsatisfaction with their own smile was high, reaching 78% in the first year of thecourse, 63% in the second, 87% in the third, and 72% in the fourth year. There wasa preference for a slightly convex profile for both genders. It is observed that 62%of the sample reported having been submitted to orthodontic treatment beforeand the percentage of white students who had received previous orthodontictreatment was substantially higher than other ethnicities. The qui-square testfound a significant statistical difference in ethnicity among students that hadreceived previous orthodontic treatment (p=0.008). Conclusion: There was nodifference in the aesthetic perception of the smile and profile in relation to theyear attended by dental school students, with the level of satisfaction with theirown smile being high.

Introdução: A estética facial apresenta grande importância na vida dos indivíduos. Entretanto, nem sempre o considerado estético pelo ortodontista corresponde com a opinião do paciente, visto que a estética é subjetiva. Assim,objetivou-se avaliar a percepção de graduandos da faculdade de Odontologia, em relação ao próprio sorriso e perfil facial, analisando se haveria diferença nesta percepção em relação ao período que cursariam e à medida que os conhecimentos são adquiridos. Materiais e Métodos: Desenvolveu-se este estudo observacional transversal, no qual distribuiu-se um questionário para todos os alunos do curso de Odontologia da Universidade do Estado do Rio de Janeiro. O questionário continha perguntas sobre o período cursado, idade, sexo, naturalidade, história prévia de tratamento ortodôntico, satisfação com o sorriso, índice de Necessidade de Tratamento Ortodôntico (IOTN) para ser comparado com o sorriso, além de escala para comparação do perfil facial. O teste do qui-quadrado foi aplicado no software SPSS 13.0 e todas as análises foram realizadas com 95% de confiança (p<0,05). Resultados: Foram preenchidos 166 dos 253 questionários distribuídos. Destes, 103 alunos relataram tratamento ortodôntico prévio. O grau de satisfação com o próprio sorriso foi alto, sendo de 78% no primeiro ano de faculdade, 63% no segundo, 87% no terceiro e 72% no quarto ano. Houve preferência pelo perfil levemente convexo para ambos os gêneros. Foi observado que 62% da amostra já havia feito tratamento ortodôntico, sendo a maioria da etnia branca. O teste qui-quadrado encontrou diferença estatisticamente significativa na etnia dos estudantes que receberam tratamento ortodôntico prévio (p=0,008). Conclusão: Não houve diferença na percepção estética do próprio sorriso e perfil em relação ao período cursado, sendo o grau de satisfação com o próprio sorriso bastante alto.

Three-dimensional accuracy of virtual planning in orthognathic surgery.

INTRODUCTION: This study aimed to assess the accuracy of virtual surgical planning (VSP) performed by Dolphin Imaging software (version 11.9; Dolphin Imaging and Management Solutions, Chatsworth, Calif). METHODS: Ten people requiring bimaxillary surgery and genioplasty were followed up prospectively. All patients had preoperative cone-beam computed tomography, plaster models, and photographs allowing for VSP. Interocclusal intermediate surgical splints were produced using a 3-dimensional (3D) printer. Postoperative images were acquired 15 days after surgery using cone-beam computed tomography. ITK-Snap (version 3.6; Cognitica, Philadelphia, Pa) allowed the segmentation of reliable 3D models. Geomagic Qualify 2013 (3D Systems, Rock Hill, SC) and MeshValmet (version 3.0) were used to identify the differences between VSP and actual surgical results through the root mean square values and the 3D translational displacement (3-axes) of the 3D centroid of each model. RESULTS: Discrepancies between the VSP and the actual result were found at the mandible (P = 0.013) and the chin (P = 0.013) when considering the root mean square values. In addition, 3D centroid differences were found in the transverse and sagittal direction of the right ramus (P = 0.034 and P = 0.005, respectively) and the sagittal aspect of the left ramus (P = 0.025). Considering 2 mm as a threshold of clinical relevance, almost all the bone fragments (maxilla, proximal, and distal mandibular segments) were accurately corrected by surgery, although not in the chin. CONCLUSIONS: On the basis of the obtained values, it is possible to consider the Dolphin Imaging software as clinically acceptable for performing virtual orthognathic surgical planning.

Complex clinical case with Class III and open bite: stability after seven years.

A healthy 15-year-old boy with anterior open bite, edge-to-edge transverse discrepancy, and Class III skeletal relationship sought a nonsurgical orthodontic treatment. The patient was treated with premolars extraction, a Hyrax expander and intrusion mechanics with vertical elastics. This mechanics allowed for excellent facial and occlusal results. The final occlusion presented Class I molar and canine relationships, ideal overjet and overbite, and straight facial profile. Analysis of the posttreatment and follow-up radiographs showed that the treatment outcomes remained stable seven years after active orthodontic treatment. Thus, although combined orthodontic and surgical treatment should be considered for patients with this skeletal malocclusion, this case report proves that well controlled orthodontic movement with the patient's cooperation can be a valid alternative treatment, with good and stable outcomes for patients who refuse surgery.

Measurement of the bone height of mandibular incisors and canines on computed tomography-Limitations according to bone thickness.

AIM: To verify the correlation between cone beam CT (CBCT) and spiral CT (SCT) images and direct measurement of the bone height and to verify whether bone thickness (BT) influences the accuracy of bone height measurement on CT. SETTING AND SAMPLE: One hundred and fourteen measurements were obtained in 10 dry human mandibles. MATERIALS AND METHODS: The alveolar bone height was measured on volumetric and linear images. RESULTS: Negative, average and significant correlations (-0.622** to -0.489**) were verified between BT and the absolute error. When the alveolar bone thickness was at least 0.6 mm, the mean differences were 0.16 and 0.28 mm on linear images and 0.12 and 0.03 mm on volumetric images for CBCT and SCT. Additionally, these values ranged from -0.46 to 0.79 and -0.32 to 0.88 mm on linear images and from -0.64 to 0.67 and -0.57 to 0.62 mm on volumetric images for CBCT and SCT. When the alveolar bone thickness was less than 0.6 mm, the CT evaluation varied from -1.74 to 5.42 and -1.64 to 5.42 mm on linear images and from -3.70 to 4.28 mm and -3.49 to 4.25 mm on volumetric images for CBCT and SCT. CONCLUSIONS: Spiral CT and CBCT images demonstrate significant correlation with direct measurement for the alveolar bone height. Measurement of the alveolar bone labial and lingual to the mandibular incisors and canines presented higher accuracy when its thickness was greater than 0.6 mm. When the thickness was less than 0.6 mm, bone dehiscence can be diagnosed despite bone being clinically present.

Herbst appliance with skeletal anchorage versus dental anchorage in adolescents with Class II malocclusion: study protocol for a randomised controlled trial.

BACKGROUND: The Herbst appliance is an orthodontic appliance that is used for the correction of class II malocclusion with skeletal discrepancies. Research has shown that this is effective. However, a potential harm is excessive protrusion of the lower front teeth. This is associated with gingival recession, loss of tooth support, and root resorption. This trial evaluates a method of reducing this problem. METHODS/DESIGN: The study is a single-center, randomised, assessor-blinded, superiority clinical trial with parallel 1:1 allocation. Male and female young people (10-14 years old) with prominent front teeth (class II, division 1) will be treated in one orthodontic clinic. Group 1 will be treated with the conventional Herbst appliance with dental anchorage and group 2 with the Herbst appliance with indirect skeletal anchorage for 12 months. The primary objective will be to compare the proclination of the lower incisors between the Herbst appliance with dental anchorage and skeletal anchorage. Secondary objectives will be to evaluate the changes occurring between the groups in the mandible, maxilla, lower and upper molars, and in gingival recession and root resorption at the end of the treatment. Additionally, the young patient's experience using the appliances will be assessed. The primary outcome measure will be the amount of lower incisor proclination at the end of treatment. This will be assessed by cone-beam computed tomography (CBCT) superimposition. Secondary outcome measures will be the changes in the mandible, maxilla, lower and upper molars at the end of treatment assessed by tomography superimposition and the young patient's experience using the appliances assessed by self-reported questionnaires and semi-structured interviews. The randomisation method will be blocked randomisation, using software to generate a randomised list. The allocation concealment will be done in opaque envelopes numbered from 1 to 40 containing the treatment modality. The randomisation will be implemented by the secretary of the Department of Orthodontics of Rio de Janeiro State University before the beginning of the study. The patients and the orthodontists who will treat the patients cannot be blinded, as they will know the type of appliance used. The technician who will take the CBCT image and the data analyst will be blinded to patients' group allocation. DISCUSSION: If this new intervention is effective, the findings can change orthodontic practice and may also be relevant to other forms of treatment in which appliances are fixed to the bones of the jaws. However, if the bone anchoring is not effective, the trial will provide much needed information on the use of this comparatively new development. TRIAL REGISTRATION: ClinicalTrials.gov, protocol ID: NCT0241812 . Registered on 26 March 2015.

Long-term 3-dimensional stability of mandibular advancement surgery.

PURPOSE: To evaluate 3-dimensional changes in the position of the condyles, rami, and chin from 1 to 3 years after mandibular advancement surgery. MATERIALS AND METHODS: This prospective observational study used pre- and postoperative cone-beam computed tomograms of 27 subjects with skeletal Class II jaw relation and normal or deep overbite. An automatic technique of cranial base superimposition was used to assess positional and bone remodeling changes that were visually displayed and quantified using 3-dimensional color maps. Analysis of covariance with presence of genioplasty, age at time of surgery, and gender as explanatory variables was used to estimate and test adjusted mean changes for each region of interest. RESULTS: The chin rotated downward and backward 1 to 3 years after surgery. Changes of at least 2 mm were observed in 17% of cases. Mandibular condyles presented with displacements or bone remodeling of at least 2 mm on the anterior surface (21% of cases on the left side and 13% on the right), superior surface (8% on right and left sides), and lateral poles (17% on left side and 4% on right). Posterior borders of the rami exhibited symmetric lateral or rotational displacements in 4% of cases. CONCLUSION: In the hierarchy of surgical stability, mandibular advancement surgery is considered one of the most stable surgical procedures. However, 1 to 3 years after surgery, approximately 20% of patients had 2- to 4-mm changes in horizontal and vertical chin positions or changes in condylar position and adaptive bone remodeling.

Different strategies used in the retention phase of orthodontic treatment / Diferentes estratégias utilizadas na fase de contenção do tratamento ortodôntico

OBJECTIVE: To identify most frequent clinical conducts, considering the following variables: 1) used appliances; 2) time of use; 3) protocol of use in daily hours and evolution with along time; 4) percentage of patients in follow up 1 year after treatment; and 5) most frequent observed relapses.. METHODS: It was used a questionnaire distributed to all specialization course of Orthodontics inscribed in the Brazilian Federal Council of Dentistry until October of 2005. RESULTS AND CONCLUSION: It was obtained 91 valid questionnaires. For data analysis were used descriptive statistics and chi-square for linear tendency and chi-square for linear trend and chi-square for multivariate linear trend. We can conclude that: 1) on upper arch, the most used appliances were Hawley, wraparound and acetate plate; in the lower multi-stranded rod, steel rod not bonded to incisors and rod bonded to the incisors; 2) it was indicated its use for more than 24 months for the upper arch, with a trend toward its less use than in the lower arch; 3) the protocol of use in the upper arch begins with 24 hours/day, reducing after the second year; for the lower arch the protocol of hours/day was kept stable; 4) after 1 year of retention most than 50% of treated cases were re-examined; 5) most common relapses were crowding, giroversion and opening of diastemas.

OBJETIVO: identificar as condutas clínicas mais utilizadas, considerando-se as seguintes variáveis: 1) aparelhos utilizados; 2) período de utilização; 3) protocolo de utilização, em horas diárias, e sua evolução com o passar dos meses; 4) percentual de pacientes controlados 1 ano pós-tratamento; e 5) as recidivas mais frequentemente observadas. MÉTODOS: utilizou-se um questionário distribuído para todos os cursos de Especialização em Ortodontia cadastrados no CFO até outubro de 2005. RESULTADOS E CONCLUSÃO: foram obtidos 91 questionários válidos. Para a análise dos dados, utilizou-se estatística descritiva e os testes qui-quadrado para tendência linear e qui-quadrado para tendência linear multivariado. Concluiu-se que: 1) na arcada superior, os aparelhos mais utilizados foram o aparelho de Hawley, o wraparound e a placa de acetato; já na inferior, barra de fio multifilamentado, barra de aço sem colagem em incisivos e barra com colagem nos incisivos; 2) indicou-se sua utilização por mais de 24 meses para a arcada superior, com uma tendência de menor utilização nessa arcada do que na inferior; 3) o protocolo de utilização na arcada superior inicia-se com 24 horas/dia, reduzindo-se após o segundo ano; para a arcada inferior, o protocolo em horas/dia foi estável; 4) após um ano de contenção, foram reexaminados mais de 50% dos casos tratados; 5) as recidivas mais comuns foram apinhamento inferior, giroversões e reabertura de diastemas.

Digital live-tracking 3-dimensional minisensors for recording head orientation during image acquisition.

INTRODUCTION: Our objective was to test the value of minisensors for recording unrestrained head position with 6 degrees of freedom during 3-dimensional stereophotogrammetry. METHODS: Four 3-dimensional pictures (3dMD, Atlanta, Ga) were taken of 20 volunteers as follows: (1) in unrestrained head position, (2) a repeat of picture 1, (3) in unrestrained head position wearing a headset with 3-dimensional live tracking sensors (3-D Guidance trackSTAR; Ascension Technology, Burlington, Vt), and (4) a repeat of picture 3. The sensors were used to track the x, y, and z coordinates (pitch, roll, and yaw) of the head in space. The patients were seated in front of a mirror and asked to stand and take a walk between each acquisition. Eight landmarks were identified in each 3-dimensional picture (nasion, tip of nose, subnasale, right and left lip commissures, midpoints of upper and lower lip vermilions, soft-tissue B-point). The distances between correspondent landmarks were measured between pictures 1 and 2 and 3 and 4 with software. The Student t test was used to test differences between unrestrained head position with and without sensors. RESULTS: Interlandmark distances for pictures 1 and 2 (head position without the sensors) and pictures 3 and 4 (head position with sensors) were consistent for all landmarks, indicating that roll, pitch, and yaw of the head are controlled independently of the sensors. However, interlandmark distances were on average 17.34 ± 0.32 mm between pictures 1 and 2. Between pictures 3 and 4, the distances averaged 6.17 ± 0.15 mm. All interlandmark distances were significantly different between the 2 methods (P <0.001). CONCLUSIONS: The use of 3-dimensional live-tracking sensors aids the reproducibility of patient head positioning during repeated or follow-up acquisitions of 3-dimensional stereophotogrammetry. Even with sensors, differences in spatial head position between acquisitions still require additional registration procedures.

Mapeamento 3D da progressão de lesões condilares em pacientes com artrite reumatoide inicial / 3D mapping of condyle morphological changes in patients with early rheumatoid arthritis

O objetivo deste trabalho foi mapear a progressão das alterações morfológicas que ocorrem nos côndilos mandibulares de pacientes com artrite reumatoide inicial (AR). 37 pacientes (22 mulheres e 15 homens, idade média de 57,08±14,88 anos) foram selecionados. O engajamento se deu aproximadamente 23 dias após o diagnóstico de AR, o qual baseou-se nos critérios revisados do Colégio Americano de Reumatologia (ACR). O tratamento também foi guiado por padrões estabelecidos pelo ACR. Foram adquiridas tomografias computadorizadas de feixe cônico em três tempos: ao início do tratamento (V1); um ano de acompanhamento (V2); e dois anos de acompanhamento (V3). Modelos 3D dos ramos mandibulares foram construídos. Utilizou-se a superposição regional por melhor adaptação realizada com o auxílio do software GeomagicStudio 10, para a comparação dos modelos. Uma metodologia de análise de forma computadorizada (com auxílio do software SPHARMPDM) foi empregada para a obtenção dos valores das remodelações ocorridas entre os períodos de avaliação (V1-V2; V2-V3; e V1-V3), nas regiões anatômicas de interesse (ROI) (porções posterior, medial, lateral, superior e anterior dos côndilos bilateralmente). A hipótese nula considerada e avaliada pelo teste de Wilcoxon foi de que as mudanças morfológicas ocorridas nas ROIs nos períodos estudados seria igual a zero. Para avaliar a ocorrência de correlações das alterações morfológicas ocorridas entre as ROIs nos períodos avaliados, além da influência da idade no processo de remodelação, foi utilizado teste de Spearmann. Investigou-se também influência do gênero nas remodelações condilares através do teste 2. Por fim verificou-se a semelhança morfológica entre formas condilares médias geradas pela computação aditiva de estruturas de um mesmo lado nos diferentes tempos de avaliação com o auxilio do software shapeAnalysisMANCOVA que realiza uma análise de covariância multivariada para a comparação das formas médias representativas de cada grupo. Concluiuse que após um ano de acompanhamento, a porção posterior (direita) e superior de ambos os lados sofreram reabsorção óssea significativa, e aproximadamente 26-32% dos pacientes sofreram reabsorções maiores que 1 mm nessas regiões. No período compreendido entre um e dois anos de acompanhamento observou-se reabsorções significativas na porção anterior (esquerda), superior (esquerda) e posterior de ambos os lados, e aproximadamente 17-26% dos pacientes sofreram reabsorções maiores que 1 mm nessas regiões. No período total de acompanhamento foram produzidas reabsorções significativas nas porções anterior, superior e posterior de maneira bilateral, e aproximadamente 21-42% dos pacientes sofreram reabsorções maiores que 1 mm nessas regiões. Em algumas regiões até 20% dos pacientes mostram aposições maiores que 1 mm. Observou-se grande variabilidade individual, sendo que em alguns casos houve reabsorções de quase 6 mm e aposições de quase 4mm. Não houve correlação forte entre as alterações morfológicas observadas nas ROI nos períodos compreendidos entre os tempos de avaliação. Não foi possível identificar uma correlação importante entre as alterações morfológicas com a idade dos pacientes, nem com o gênero. Não foi possível observar diferenças morfológicas entre as formas condilares médias.

The aim of this study was to map the progression of condyle morphological changes in patients with early rheumatoid arthritis (RA). For this purpose, 37 patients (22 women and 15 men, mean age 57.08±14.88 years) were selected. Patients entered this study at about 23 days after diagnosis of RA. They were diagnosed with RA according to the revised American College of Rheumatology (ACR) criteria and treatment protocols were also based on ACR guidelines. Cone Beam Computed Tomography exams were acquired at 3-time points: beginning of treatment (V1); 1-year follow-up (V2); and 2-year follow-up (V3). Rami 3D virtual models were built. Models orientation was based on a surface-to-surface registration technique, also known as best fit, which was carried out by the GeomagicStudio 10 software. An automated shape analysis method was carried out in order to quantitatively measure (measurements were done by means of using the software SPHARM-PDM) the remodeling process observed between the time points (V1-V2; V2-V3; e V1-V3), at the anatomical regions of interest (ROI) (condyle posterior, medial, lateral, superior, and anterior surfaces, bilaterally). The null hypothesis was that morphological changes at the ROIs between the time points would be zero, and was tested by a Wilcoxon non-parametric test. To test the correlation of morphological changes at the ROIs between time points and to identify the age role in the remodeling process, the Spearmann test was used. Gender influence on condylar remodeling was assessed by 2-test. Finally, mean shape surface models, which were generated by additive computation of same side structures between different time points, were compared by means of a multivariate analysis of covariance, which is available in the shapeAnalysisMANCOVA software. After 1-year follow-up, the posterior surface (right side) and the superior surface (both sides) showed statistically significant bone resorption; and approximately 26-32% of these patients underwent resorptions greater than 1 mm in these regions. Between 1-year and 2-year follow-up, the anterior surface (left side), the superior surface (left side) and the posterior surface (bilaterally) showed significant bone loss; and approximately 17-26% of these patients underwent bone resorptions greater than 1 mm in these regions. In the overall period, it was observed statistically significant resorptions in the anterior, superior, and posterior surfaces bilaterally; and approximately 21-42% of these patients underwent resorptions greater than 1 mm in these regions. In some regions up to 20% of the patients showed appositions greater than 1 mm. A highly variable individual response was observed, with some cases showing resorptions of almost 6 mm while others showing appositions of almost 4mm. None strong correlations were found between morphological changes observed at the ROIs among the time points. It was not possible to strongly correlate the morphological changes neither with age, nor with gender. The mean shape analysis did not show any differences among the average shapes.

Controlled tooth movement to correct an iatrogenic problem.

This case report describes the treatment of a 9-year old boy, who had his maxillary central incisors extruded by noncontrolled elastic mechanics to close a diastema. The article describes the consequences of this movement and how the problem was solved with controlled intrusion.

Comparação entre a radiografia de cavum e a cefalométrica de perfil na avaliação da nasofaringe e das adenoides por otorrinolaringologistas / Comparison between cavum and lateral cephalometric radiographs for the evaluation of the nasopharynx and adenoids by otorhinolaryngologists

INTRODUÇÃO: tanto a radiografia cefalométrica de perfil quanto a de cavum permitem a avaliação do espaço aéreo nasofaríngeo (EAN). Não é rara a solicitação dos otorrinolaringologistas de radiografia de cavum, mesmo o paciente possuindo uma cefalométrica. OBJETIVOS: objetivou-se (a) conhecer quais exames os otorrinolaringologistas solicitam para avaliar o EAN; (b) verificar o conhecimento da cefalométrica por otorrinolaringologistas; (c) comparar a avaliação de otorrinolaringologistas nas duas técnicas radiográficas para a medição e a visualização do EAN e da adenoide; (d) correlacionar os resultados do método de inspeção visual com os da medição de Schulhof. MÉTODOS: foram obtidas, no mesmo dia, radiografias cefalométricas e de cavum de 15 pacientes respiradores bucais. Essas foram cobertas com papel cartão, deixando visível apenas o EAN e adenoides e foram avaliadas por 12 otorrinolaringologistas. Estes respondiam sobre sua familiaridade com a cefalométrica, quais exames solicitam para visualizar EAN e adenoides e se utilizam algum método de medição do grau de obstrução. Avaliavam qual das radiografias apresentava a melhor visualização da adenoide e do EAN, e classificavam o tamanho dos mesmos em pequeno, médio ou grande, através de método visual. RESULTADOS: os resultados demonstraram que todos os otorrinolaringologistas costumam solicitar a radiografia de cavum. Apenas um solicita a cefalométrica, dois estão familiarizados com essa técnica e um utiliza algum método de medição do EAN. A cefalométrica foi preferida por 49,4 por cento dos otorrinolaringologistas, a de cavum por 22,8 por cento, enquanto 27,8 por cento não observaram diferença entre ambas. Foi encontrada baixa correlação entre o método de medição visual e o de Schulhof.

INTRODUCTION: The lateral cephalometric as well as the cavum radiograph allow the evaluation of the nasopharyngeal airway (NAW). Otorhinolaryngologists routinely use the cavum radiograph, even when the patient already has a lateral cephalometric headfilm. OBJECTIVES: The aim of this study was to (a) acknowledge which exams otorhinolaryngologists use for the evaluation and measurement of the NAW; (b) evaluate if the otorhinolaryngologists are acquainted to the cephalometric; (c) compare both radiographs to see which one is preferred to visualize the NAW and adenoids and (d) correlate the visual analysis to the measuring method of Schulhof. METHODS: For this purpose, the cephalometric and the cavum radiographs of 15 mouth-breathing children were taken on the same day. These radiographs were masked leaving only the NAW and the adenoids visible, and were blindly presented to 12 otorhinolaryngologists. They received the radiographs together with a questionnaire asking on their familiarity with the lateral cephalometric, which exams are used for NAW and adenoid evaluation and if they use any method for measuring the NAW obstruction level. They were also asked to visually classify the NAW and the adenoids according to their sizes into small, medium and large. RESULTS: The results demonstrated that all otorhinolaryngologists in the sample use the cavum radiograph. Only one uses the cephalometric radiograph and two are familiar to this technique. The cephalometric was preferred by 49.4 percent of the otorhinolaryngologists, the cavum by 22.8 percent and 27.8 percent did not see any difference between both methods. There was low correlation between the visual method and the Schulhof measuring method.