Do premolar extractions necessarily result in a flat face? No, when properly indicated.

The esthetic benefits are among the main goals of orthodontic treatment; therefore, tooth extractions have been avoided as a protocol for orthodontic treatment because they may impair the facial profile. The present article discusses aspects as the magnitude and response of soft tissue profile due to changes in incisor positioning, and the effect of different sequences of premolar extraction. One case report illustrates the subject, with favorable and stable esthetic and occlusal outcomes five years after orthodontic treatment with extraction of second premolars.

Do premolar extractions necessarily result in a flat face? No, when properly indicated

Abstract The esthetic benefits are among the main goals of orthodontic treatment; therefore, tooth extractions have been avoided as a protocol for orthodontic treatment because they may impair the facial profile. The present article discusses aspects as the magnitude and response of soft tissue profile due to changes in incisor positioning, and the effect of different sequences of premolar extraction. One case report illustrates the subject, with favorable and stable esthetic and occlusal outcomes five years after orthodontic treatment with extraction of second premolars.

Resumo Os benefícios estéticos estão entre os principais objetivos do tratamento ortodôntico. Por isso, as extrações dentárias têm sido evitadas como protocolo de tratamento ortodôntico, pois podem prejudicar o perfil facial. No presente artigo, serão discutidos aspectos como a magnitude da resposta do perfil de tecidos moles em decorrência das mudanças na posição dos incisivos e os efeitos de diferentes sequências de extrações de pré-molares. Um caso clínico ilustrará o tema, com resultados estéticos e oclusais favoráveis e estáveis cinco anos após o tratamento ortodôntico com extrações de segundos pré-molares.

Tomographic Evaluation of the Lower Incisor's Bone Limits in Mandibular Symphysis of Orthodontically Untreated Adults.

The amount of available bone in the lower incisor region is critical for periodontal preservation when planning large anteroposterior dental movements. The aims of this study were to evaluate bone limits of the lower incisors in the mandibular symphysis and to verify whether they are influenced by facial growth patterns, lower incisor inclinations, skeletal anteroposterior relationships, or patient age. Tomographic images of 40 orthodontically untreated patients were evaluated and measurements of width and height of the mandibular symphysis, thickness on the lingual and labial sides of the alveolar bone, and thickness of the entire alveolar bone were performed in sagittal view. The following cephalometric measurements were also evaluated: growth pattern (FHI), lower incisor inclination (IMPA), and skeletal anteroposterior relationships (AO-BO). Pearson's correlation test was used to assess associations among bone measurements, cephalometric measurements, and patients' ages. Weak to moderate positive correlations between FHI and bone measurements on the labial side of the incisors and total alveolar width were found. The height of the symphysis had a moderate negative correlation with FHI. It was concluded that patient age, FHI, and IMPA influenced bone limits of the lower incisors in the mandibular symphysis, while AO-BO had no influence.

Temperature Rises in the Pulp Chamber with Different Techniques of Orthodontic Adhesive Removal.

INTRODUCTION: The aim of this in vitro study was to compare the temperature rises in the pulp chamber and time spent with different techniques for orthodontic resin adhesive removal. METHODS AND MATERIALS: Adhesive removal was performed in 20 extracted human maxillary second premolars with five techniques: high-speed tungsten carbide burs with water-cooling (BurH-cool) and without cooling (BurH), low-speed carbide burs (BurL), low-speed aluminum-oxide discs (DiscL), and low-speed fiberglass burs (BurFGL). Pulp chamber temperature was measured with a thermocouple probe and time spent was recorded with a digital stopwatch. Comparisons of temperature rise and time between the techniques were performed with Analysis of variance and Tukey's Honestly test. Correlation between variables was investigated with Pearson's correlation coefficient. RESULTS: Temperature rise and time were statistically different between techniques and showed a positive correlation between them (r=0.826) (P<0.01). BurH-cool provoked the lowest temperature rise and BurFGL the highest (P<0.01). Temperature rises were higher with DiscL than with BurH and BurL (P<0.01), which showed no statistical differences between them (P>0.05). The fastest technique was BurH-cool followed by BurL, BurH, DiscL and BurFGL (P<0.01). CONCLUSION: BurH-cool, BurH and BurL are safe adhesive removal techniques, whereas DiscL and BurFGL may damage pulp tissues. Time spent on adhesive removal has direct effect on temperature rise in the pulp chamber.

Craniofacial and dental manifestations of triple X syndrome associated with congenital hypothyroidism: a case report.

Triple X syndrome (47,XXX) is a numerical chromosomal alteration that affects 1/1,000 women, in which the woman is born with an extra X chromosome. Some oral changes have been reported in the literature, as hypodontia, influence on deposition of crown enamel and discrepancies in cephalometric measurements. Other systemic complications may lead to oral abnormalities similar to those seen in triple X patients, such as congenital hypothyroidism (CH). This paper reports a triple X syndrome case associated with CH later treated. Besides delay in cognitive and intellectual development, the patient had changes in teeth development and in cephalometric measurements with deficiencies in the maxilla and mandible. This is the first report of a triple X syndrome associated with CH. Both conditions may result in changes in dentofacial development.

Influence of premolar extractions on the facial profile evaluated by the Holdaway analysis / Influência de exodontias de pré-molares no perfil facial avaliada pela análise de Holdaway

PURPOSE: This retrospective study aimed at assessing patients treated with extraction of premolars through cephalometry in lateral teleradiography, comparing the effect of different tooth extraction protocols on the facial profile. METHODS: For this study, 87 patients (31 boys and 56 girls) were selected from the private practices of three dentists certified by the Brazilian Board of Orthodontics and Facial Orthopedics. These patients were treated with fixed edgewise appliance and divided into three groups, according to the sequence in which premolars were extracted "Group 40" comprised 22 patients treated with extractions of the first two superior premolars, adopted as the control group; "Group 44" comprised 43 patients treated with extractions of the four first premolars; and "Group 45" comprised 22 patients treated with extractions of first superior premolars and second inferior premolars. The Holdaway analysis was used to quantify and compare the group profiles before and after treatment. RESULTS: Student's t-tests showed a profile improvement in all groups. When groups were compared, ANOVA showed that only the Inferior sulcus to the H line showed differences in incremental changes resulting from the treatment. Group 44 showed a significantly higher difference than Group 40. CONCLUSION: We conclude that the protocols produce similar facial appearances.

OBJETIVO: Este trabalho retrospectivo tem como proposta avaliar pacientes tratados com exodontias de pré-molares através de cefalometria em telerradiografia de perfil, comparando o efeito de diferentes protocolos de exodontias no perfil. METODOLOGIA: Oitenta e sete pacientes (31 meninos e 56 meninas) foram selecionados da clínica particular de três ortodontistas diplomados pelo Board Brasileiro de Ortodontia e Ortopedia Facial. Estes pacientes foram tratados com aparelho fixo Edgewise foram divididos em três grupos, compreendendo a sequência de exodontia de pré-molares empregada Grupo 40 compreendendo 22 pacientes tratados com exodontia de primeiros pré-molares superiores, Grupo 44 compreendendo 43 pacientes tratados com exodontia de quatro primeiros pré-molares e Grupo 45 compreendendo 22 pacientes tratados com exodontia de primeiros pré-molares superiores e segundos inferiores. A Análise de Holdaway foi utilizada para quantificar e comparar os perfis antes e após o tratamento dos grupos. RESULTADOS: O teste t-Student mostrou melhora no perfil em todos os grupos. Quando comparados entre si, ANOVA revelou que apenas a medida sulco lábio inferior em relação à linha H apresentou diferenças nas mudanças incrementais proporcionadas pelo tratamento, em que o grupo 44 apresentou uma diferença significativamente superior ao grupo 40. CONCLUSÃO: A partir dos resultados concluiu-se que os protocolos produzem aparências faciais semelhantes.

A extração de segundos molares superiores para o tratamento da Classe II / Extraction of upper second molars for treatment of Angle Class II malocclusion

Este trabalho tem por objetivo apresentar uma abordagem alternativa para o tratamento ortodôntico das más oclusões de Classe II. Através de uma revisão da literatura, verificou-se que a extração de segundos molares superiores demonstrou ser uma alternativa viável para o tratamento desse tipo de má oclusão. Essa opção terapêutica possibilita maior rapidez na distalização dos primeiros molares com menor necessidade de cooperação por parte do paciente. Porém, a análise do grau de formação, posição intraóssea e morfologia do terceiro molar deve ser cuidadosamente realizada para proporcionar o correto posicionamento do mesmo no lugar do segundo molar extraído. Dois casos clínicos apresentarão a sequência do diagnóstico e tratamento com essa mecânica, exibindo resultados adequados dos pontos de vista funcional e estético.

The purpose of this article is to present an alternative approach to the orthodontic treatment of Angle Class II malocclusion. According to a literature review it was observed that the extraction of upper second molars has proven to be a viable alternative for the treatment of this type of malocclusion. This therapeutic option enables faster first molar retraction and requires less patient compliance. However, the level of development, intraosseous position and morphology of the third molar should be carefully evaluated to ensure its correct positioning in place of the extracted second molar. Two clinical case reports will demonstrate that the sequence of diagnosis and treatment used with this mechanics yields satisfactory functional and aesthetic results.

Extrusão dentária com finalidade restauradora / Tooth extrusion for restorative purpose

O objetivo deste trabalho é revisar a literatura sobre o tracionamento dentário para fins restauradores, apresentar considerações biológicas e mecânicas sobre este procedimento e demonstrar através de casos clínicos a aplicabilidade das técnicas.

The objective of this work is to revise the literature about dental traction for restorative purposes, to present biological and mechanical considerations on this procedure and to demonstrate through clinical cases the applicability of the technique.

Avaliação da prevalência de trismo em pacientes submetidos à exodontia de terceiros molares / Evaluation of the prevalence of trismus in patients submitted to third molar surgery

Objetivos: Avaliar o grau de abertura bucal pós-operatória e fatores que possam influenciá-la, em pacientes submetidos à remoção de terceiros molares inferiores e superiores no ambulatório de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Federal de Santa Maria, Rio Grande do Sul, Brasil. Método: Foram examinados pacientes submetidos à exodontia de terceiros molares inferiores e superiores no ambulatório de Cirurgia e Traumatologia Bucomaxilofacial da Universidade Federal de Santa Maria. A abertura bucal dos pacientes foi medida em milímetros minutos antes, dois e sete dias após a exodontia, com o uso de uma régua. Resultados: O trismo é uma ocorrência freqüente nas cirurgias de terceiros molares inclusos, ocorrendo em 56,5% dos pacientes no período de dois dias após a cirurgia, havendo uma redução na reavaliação após sete dias. Conclusão: Conclui-se que o trismo é uma ocorrência freqüente nas cirurgias de terceiros molares inclusos e que não foram encontradas relação significante entre o trauma da cirurgia e a presença de trismo.