Comparison of smile attractiveness in cases with gummy smile treated with botulinum toxin and maxillary impaction surgery: A retrospective study.

This study aimed to compare the smile's attractiveness in patients submitted to the treatment of gummy smiles with botulinum toxin or maxillary impaction surgery. The retrospective sample comprised 26 patients divided into two groups: Group 1 (BTX): 13 patients (12 females and 1 male) with a mean age of 28.06 years (s.d. = 6.09) and mean gingival exposure during smile of 5.18 mm (s.d. = 1.51) treated with botulinum toxin; Group 2 (SURGICAL): 13 patients (9 females and 4 males) with a mean age of 30.59 years (s.d. = 5.72) and mean gingival exposure during smile of 5.21 mm (s.d. = 1.55) treated with orthognathic maxillary impaction surgery. The group of evaluators comprised 317 participants, divided into 143 orthodontists (85 females and 58 males) with a mean age of 41.40 (s.d. = 9.30); 62 dentists (47 female and 15 male) with a mean age of 35.44 (s.d. = 10.44), and 112 lay people (74 female and 38 male) with a mean age of 46, 91 (s.d. = 10.11) in a questionnaire on Google Forms. Without knowing the therapy used, the evaluators assigned scores to the photographs of the posed smile taken before (T1) and after (T2) treatment. Intergroup comparison of smile attractiveness was performed using the t-independent, one-way ANOVA, and Tukey tests. There was a significant improvement in smile attractiveness with treatment in both groups; however, the improvement was significantly better in the surgical group than in the BTX group. Orthodontists rated smile attractiveness significantly higher than dentists and laypersons for the final phase of the BTX and surgical groups. There was a significant improvement in the smile attractiveness with botulinum toxin application and orthodontic-surgical treatment. However, orthognathic surgery promoted a greater improvement in smile attractiveness than the application of botulinum toxin.

Comparison of the efficiency of initial dental alignment with Invisalign® aligners changed every 7 or 14 days in mature adults: Randomized clinical trial.

OBJECTIVE: To compare the anterior crowding correction after sequential use of the first 5 aligners between two aligner exchange protocols (7 and 14 days) in mature adult patients. MATERIALS AND METHODS: Thirty-six patients over 35 years who received orthodontic treatment with Invisalign® were randomly allocated to two different aligner replacement sequence protocols: Group 1: exchange every 7 days (n = 18); and Group 2: exchange every 14 days (n = 18). All patients were scanned with iTero Element 5D® (Align Technology) in two treatment times: at pre-treatment (T1) and after using the first five aligners (T2). Little's Irregularity Index (LII) and arch widths were evaluated with OrthoCAD software. Intra and intergroup comparisons were performed with the dependent and independent t-tests. The results were considered significant for P < .05. RESULTS: Thirty-five patients completed the study. Both groups' maxillary and mandibular Irregularity Indexesi were significantly lower at T2. There was no significant difference in inter-canine, inter-premolar, and intermolar distances. G2 (14 days) presented a greater decrease in mandibular irregularity than G1 (7 days). CONCLUSION: Both exchange protocols (7 and 14 days) effectively correct anterior crowding in the initial phase of orthodontic treatment with aligners in mature adult patients. However, the 14-day exchange protocol provided a greater correction in mandibular anterior crowding in the evaluated period than the 7-day exchange protocol.

Evaluation of the attractiveness of lips with different volumes after filling with hyaluronic acid.

To compare the attractiveness of lips with different volumes after filling in the view of laypersons, dentists, and specialists. The sample comprised close-up frontal and lateral photographs of the lips of 16 women who underwent lip filling procedure with hyaluronic acid and was divided into 2 groups. Group 1: eight women with thinner lips at pretreatment. Group 2: eight female patients with thicker lips at pretreatment. Photographs from before and 10 days after lip filling were used to assess attractiveness randomly displayed in a Google Forms questionnaire and then sent via a messaging app to the evaluators. The evaluators' groups were general dentists, dentists with degrees in facial aesthetics, and laypersons. The attractiveness was evaluated with scores from 0 to 10 (0: least attractive and 10 the greatest). T-tests were used for the statistical comparisons. The group with thinner lips showed significantly improved attractiveness after filling. The group with thicker lips showed a worsening attractiveness after filling. The group with thicker lips had significantly higher attractiveness scores than those with thinner lips. There was no significant difference in the preference between men and women. The group of laypersons was more rigorous, giving significantly lower lip attractiveness scores. Thinner lips showed a significant improvement in attractiveness after filling. Thicker lips showed a worsening of the attractiveness score after filling. Before and after filling, thicker lips had significantly higher attractiveness scores than thinner lips.Clinical relevance: The amount of fillers applied to each patient must be individually evaluated.

Comparison of Gingival Recession of Mandibular Incisors of Class III Patients Immediately after Compensatory or Surgical Orthodontic Treatment.

OBJECTIVE: This study aimed to compare gingival recession in mandibular anterior teeth in patients with Class III malocclusion, immediately after compensatory or surgical orthodontic treatment. MATERIALS AND METHODS: The sample consisted of 40 patients with Class III malocclusion, divided into two groups: Group 1 (compensatory), 20 patients treated with compensatory orthodontics, with a mean initial age of 20.26 years (standard deviation [SD] . = 7.44), mean final age of 23.07 years (SD = 7.32), and mean treatment time of 2.81 years (SD =0.84). Group 2 (surgical), who undergone orthodontic-surgical treatment, with a mean initial age of 23.08 years (SD =5.48), mean final age of 25.43 years (SD =5.12), and mean treatment time of 2.35 years (SD =1.56). Intraoral photographs taken before and after removal of the fixed orthodontic appliance were used to measure the gingival recession, from the cervical of the mandibular incisors from the most cervical point of the gingival margin to the cementoenamel junction. In the initial and final cephalograms, the position of the mandibular incisors was measured. The intergroup comparison was performed using the independent t-test. RESULTS: The results showed that there was no statistically significant difference in the gingival recession at the beginning, at the end, and of changes with treatment between the compensatory and surgical groups. CONCLUSION: It was concluded that the compensatory and surgical orthodontic treatments for Class III malocclusion showed similar results regarding the gingival recession of the mandibular incisors.

Smile attractiveness in class III patients after orthodontic camouflage or orthognathic surgery.

OBJECTIVE: The study's objective was to compare the smile attractiveness in patients with class III malocclusion treated with orthodontic camouflage or orthognathic surgery. MATERIAL AND METHODS: The sample consisted of 30 patients with class III malocclusion treated without extractions divided into two groups, according to the treatment performed: G1, orthodontic camouflage, consisting of 15 patients (9 female; 6 male) with mean initial age of 21.26 years (SD = 7.39) and mean final age of 24.52 years (SD = 7.10). The mean treatment time was 3.26 years (SD = 1.50). G2, ortho-surgical, consisting of 15 patients (8 females; 7 males), with mean initial age of 23.12 years (SD=7.37), mean final age of 25.82 years (SD = 7.14) and mean treatment time of 2.71 years (SD = 0.90). The smile attractiveness was evaluated in black and white photographs of posed smiles taken before and after treatment, with a numerical rating scale from 1 to 10, with 1 being the least attractive and 10 the greatest smile attractiveness. The smiles were evaluated in a questionnaire by 111 participants, 67 orthodontists (mean age 41.31 years, SD = 9.44) and 44 laypeople (mean age 41.41 years, SD = 14.38). Intergroup comparison was performed with independent t test. RESULTS: There was a significant improvement in the smile attractiveness with both camouflage and ortho-surgical treatments. The smile attractiveness was similar between the camouflage and surgical groups at the beginning. There was a significantly greater improvement in smile attractiveness with treatment in the surgical group than in the camouflage group, and at the end of treatment, the surgical group showed greater smile attractiveness than the camouflage group. Orthodontists considered the smiles more attractive both at the beginning and the end of treatment when compared to the assessment made by laypeople. CONCLUSION: The ortho-surgical treatment promoted a greater improvement in the smile attractiveness, and at the final stage, a greater smile attractiveness than the orthodontic camouflage. CLINICAL RELEVANCE: Smile attractiveness is an important characteristic of the final result of orthodontic treatment. Knowing which treatment protocol will provide a better improvement and outcome regarding smile esthetics is essential.

Maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion.

INTRODUCTION: The objective of the present study was to compare the maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion (MARPE). METHODS: The sample comprised 37 patients with Class I malocclusion treated without tooth extraction, divided into 2 groups: group 1 comprises 21 patients with a mean age of 19.55 years (standard deviation = 1.31), submitted to orthodontic treatment with Damon self-ligating appliance, and evaluated until the end of the alignment and leveling stage. Group 2 comprises 16 patients with a mean age of 24.92 years (standard deviation = 7.60), with maxillary atresia, who underwent MARPE, and were evaluated after the removal of the expander. Buccal bone thickness; dental inclinations; and transverse distances of the maxillary arch, nasal base, and jugula widths were measured on cone-beam computed tomography scans before and after treatment. The intergroup comparison was performed with the independent t test. RESULTS: With treatment, there was a significantly greater decrease in buccal bone thickness of canines and premolars in the self-ligating group, the premolars presented a greater buccal inclination in the self-ligating group, and the intercanine and intermolar distances and nasal base and jugula widths showed significantly greater increases in the MARPE group than in the self-ligating group. CONCLUSIONS: MARPE treated more severe skeletal transverse maxillary discrepancies and obtained better results than self-ligating appliances in terms of buccal bone loss, tooth inclination, and transverse skeletal increase of the maxilla. MARPE presented more skeletal effects and self-ligating appliances, more dental effects.

Soft tissue profile changes in Angle class II patients treated with Twin Force or intermaxillary elastics-a comparison.

PROPOSITION: This study aimed to compare soft tissue profile changes in Angle class II malocclusion patients treated with a Twin Force appliance (Ortho Organizers, Inc., Carlsbad, CA, USA) or class II elastics. METHODS: The sample comprised 47 class II malocclusion patients treated orthodontically without extractions, divided into two groups. Group 1 (Twin Force): 25 patients were treated with the Twin Force, with initial and final mean ages of 17.91 and 20.45 years, respectively, and mean treatment time of 2.53 years. Group 2 (elastics): 22 patients were treated with class II elastics, with initial and final mean age of 15.87 and 18.63 years, respectively, and mean treatment time of 2.75 years. The lateral cephalograms were evaluated at the initial and final stages. Intragroup comparisons were performed with dependent t-tests and intergroup comparisons were performed with independent t-tests. RESULTS: Treatment-related changes in the Twin Force group included reduction of facial convexity, retrusion of the upper lip, increase of the H­Nose distance, and decrease in Sn­H distance, indicating improvement in facial profile. In the elastics group, treatment resulted in an increase in nasolabial angle, retrusion of the upper lip, increase of the H­Nose distance, and decrease in Sn­H distance, indicating improvement in facial profile. The Twin Force group showed a greater reduction of the facial convexity with treatment than the elastics group. CONCLUSIONS: Class II patients treated with the Twin Force appliance showed greater reduction in facial convexity than patients treated with class II elastics. The other soft tissue changes were similar for both groups.

The Use of Facemasks During the COVID-19 Pandemic by the Brazilian Population.

OBJECTIVE: To evaluate the use of facemasks by the Brazilian population during the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional study involved 1277 participants who answered a web-based open survey with questions about the use of facemasks during the COVID-19 pandemic. Descriptive statistics with percentages was performed, and the responses were analyzed with chi-square and independent t-tests. RESULTS: A total of 1277 answered the questionnaire, and most participants were female (81.8%). Almost all the participants (99.1%) reported wearing facemasks, and 34.2% are wearing just because it is mandatory; 65.8% would continue to wear masks even if it was not mandatory. Most subjects (50.4%) believe that masks' use effectively prevents infection by the novel coronavirus. Reusable fabric facemasks are the most used by the participants (49.5%). Almost all subjects were wearing masks to go to crowded and public places. Most respondents (67.3%) are bothered with the use of facemasks, and the most cited reason for the discomfort was feeling trapped or suffocated (58.9%). DISCUSSION: The use of facemasks can help prevent the COVID-19, but it is most effective at reducing the spread of the virus when the general population's compliance is high. Some factors that limit the population's compliance with the use of masks are discomfort and a sense of embarrassment. Media campaigns and public health promotion activities supported by governmental agencies can increase the use of facemasks by the population. CONCLUSION: The mean level of anxiety with the COVID-19 pandemic was 6.18. Almost all the participants were wearing facemasks, and they believe that its use effectively prevents infection by the novel coronavirus. Reusable fabric facemasks are the most used by the participants. Almost all subjects were wearing masks to go to crowded and public places. The great majority of the participants feel more protected with the use of facemasks.

Comparison of Profile Attractiveness between Class III Orthodontic Camouflage and Predictive Tracing of Orthognathic Surgery.

OBJECTIVE: The aim of this study was to compare the profile attractiveness between orthodontic camouflage of the Class III malocclusion and the predictive tracing simulating orthognathic surgery evaluated by dentists and laypeople. Settings and sample population. The sample consisted of 21 patients (9 male; 12 female) with Class III malocclusion treated with orthodontic camouflage and Class III intermaxillary elastics. Material and Methods. The mean initial age of the patients was 24.38 years (SD 3.32), and the mean ANB angle was -1.91° (SD 0.83°). Patients presented skeletal Class III and normal growth patterns. Initial and final lateral cephalograms of each patient were used. The initial cephalogram was used to perform the treatment simulation of orthognathic surgery, and its silhouette was compared to the silhouette obtained from the final cephalogram after Class III orthodontic camouflage. A subjective analysis of profile attractiveness was performed by 47 laypeople and 60 dentists, with scores from 1 (less attractive) to 10 (most attractive). Mann-Whitney tests were used to compare profile attractiveness between the orthodontic treatment and the predictive tracing groups and between dentists and laypeople. RESULTS: The predictive tracing of orthognathic surgery showed to be statistically significantly more attractive (mean score 4.57, SD 2.47) than that of the Class III camouflage orthodontic treatment (mean score 4.22, SD 2.40), with a mean numerical but significant difference of 0.35 (SD 2.01) (P < 0.001). Laypeople were more critical than dentists in evaluating profile attractiveness, but numerical difference between the groups was also small. CONCLUSION: The profile silhouette of predictive tracing simulating orthognathic surgery showed to be more attractive than that of Class III camouflage orthodontic treatment; however, differences were small but statistically significant. Laypeople showed to be more critical than dentists.

Urgencies and emergencies in orthodontics during the coronavirus disease 2019 pandemic: Brazilian orthodontists' experience.

INTRODUCTION: The present study aimed to evaluate the most common urgencies and emergencies in orthodontics during the coronavirus disease 2019 (COVID-19) pandemic and to assess how orthodontists in Brazil were dealing with patients and challenges. METHODS: Early in 2020, as the COVID-19 pandemic spread around the world, routine dental care was suspended in many countries, and only patients needing urgent or emergency care could be seen. During this period, orthodontists in Brazil were invited to participate in an anonymous online survey. Over 48 hours (May 1-3, 2020), 395 orthodontists (specialists, MScs, and PhDs) responded. They answered questions regarding dental office and appointments during the pandemic, the type of urgency or emergency care provided, the type of appliance and urgencies, etc. The level of concern about the impact of the pandemic on patients' orthodontic treatments and the financial impact on the dental office was also evaluated. Descriptive statistics were performed with percentages, and responses were compared between specialists, MScs, and PhDs, using chi-square tests. RESULTS: Specialists were the majority of respondents. Most orthodontists were handling only emergencies or urgencies. The most frequent urgencies were bracket breakage, archwire breakage, and breakage of molar tubes and/or bands. Stainless steel fixed appliances were the most common type of appliance related to unscheduled appointments. The majority of patients got in touch with the orthodontist using the professional WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif). Orthodontists were more concerned with the financial impact of the pandemic than with the orthodontic treatment itself. CONCLUSIONS: Breakage of brackets, archwires, or tubes and/or bands were the most common causes of urgency and/or emergency appointments during the pandemic. The level of concern about the financial impact of the stay-at-home orders and the COVID-19 pandemic was significantly greater for specialists and MScs than for PhDs.

Comparison of the facial profile attractiveness in Class III borderline patients after surgical or compensatory orthodontic treatment.

BACKGROUND: This study aimed to compare the facial profile attractiveness of Class III borderline patients after surgical or compensatory orthodontic treatment. MATERIAL AND METHODS: The sample consisted of 60 borderline Class III malocclusion patients, divided into two groups: Group 1 (Surgical): 30 patients (16 male; 14 female) treated with orthodontic fixed appliances and bimaxillary orthognathic surgery. Mean initial age was 20.05 years (s.d.=2.40) and mean treatment time was 2.23 years (s.d.=0.82). Group 2 (Compensatory): 30 patients (13 male; 17 female) treated compensatorily with fixed appliances and Class III elastics. Mean initial age was 18.53 years (s.d.=4.35) and mean treatment time was 2.08 years (s.d.=0.67). Silhouettes of the facial profile were constructed obtained from the pretreatment and posttreatment lateral cephalograms and evaluated by orthodontists (N=41, 22 females and 19 males, mean age of 35.65 years), assigning scores from 1 (least attractive) to 10 (most attractive). Intergroup comparison of profile attractiveness was performed by Mann-Whitney test. For intragroup comparison of initial and final stages, the Wilcoxon test was used. RESULTS: At initial stage, the compensatory group presented a statistically significant greater attractiveness of the profile than the surgical group. With treatment, the surgical group presented significantly more improvement in facial profile than the compensatory group. At the final stage, profile attractiveness of surgical and compensatory groups was similar. CONCLUSIONS: The facial profile attractiveness is similar in Class III patients after orthognathic surgery or compensatory orthodontic treatment. However, surgery provided more improvement in profile attractiveness than the compensatory treatment in Class III patients. Key words:Malocclusion, angle Class III, orthognathic surgery, corrective orthodontics.

Impact of coronavirus pandemic in appointments and anxiety/concerns of patients regarding orthodontic treatment.

OBJECTIVE: To evaluate the impact of the coronavirus pandemic and the quarantine in orthodontic appointments, and patients' anxiety and concerns about their ongoing orthodontic treatment. SETTINGS AND SAMPLE POPULATION: Patients from private dental clinics of two orthodontists that were undergoing active orthodontic treatment. MATERIAL AND METHODS: An online anonymous questionnaire regarding their anxiety about the coronavirus situation, availability/acceptance to attend an appointment, among others, was answered by orthodontic patients. Descriptive statistics with percentages was performed and responses were compared between sexes, cities, and association of the feelings/level of anxiety of patients and willingness to attend an appointment were performed with chi-square, independent t test, one-way ANOVA and Tukey's tests. RESULTS: The questionnaire was answered by 354 patients (231 female; 123 male) with mean age of 35.49 years. Most patients are respecting the quarantine, 44.7% related to be calm and 46.3% afraid or anxious. The level of anxiety was greater for females than males. There was significant association of the level of anxiety and the willingness to attend an appointment. The greatest concern of patients was delay in the end of treatment. CONCLUSION: The quarantine and coronavirus pandemic showed to have impact on orthodontic appointments and patients' anxiety. Patients willing to attend an orthodontic appointment presented significantly lower level of anxiety than patients that would not go or would go only in urgency/emergency. Females were more anxious than males about coronavirus pandemic, quarantine and impact on their orthodontic treatments. Delay in treatment was the greatest concern of patients undergoing orthodontic treatment.

Comparison of the Force Released by Intermaxillary Elastics Used for Different Time Periods.

OBJECTIVE: The objective of the present study was to compare the strength degradation of the force of intermaxillary elastic used for different periods. METHODS: The sample included intermaxillary elastics used for 20 adult patients with bilateral Class II or III malocclusion in orthodontic treatment with fixed appliances, with a mean age of 27.25 years. Latex orthodontic elastics with 3/16 inch of diameter were used, with an average stretching of three times its diameter. The elastics were used in the same patient bilaterally for different periods, with each pair of elastics used for 1, 12, 24, and 48h. Thus, the sample consisted of 200 elastics, with 40 being used in each period (one pair used by each patient) and 40 new elastics without use tested as control. Elastics were tested using a universal testing machine, stretched with a velocity of 30 mm/min, and the force was evaluated in stretches of 15, 20, 25, and 30 mm. The degradation force was compared in the four different times of use and control by one-way ANOVA (analysis of variance) and Tukey tests. RESULTS: There were significant differences among the groups in all evaluated stretches (15, 20, 25, and 30 mm). The control elastics presented higher average forces numerically and statistically significant for all tested times, except for the elastic used for 1h. The elastics used for 1, 12, and 24h had similar forces among them, with a significant difference to the elastics used for 48h. CONCLUSION: It is recommended to change the intermaxillary elastics after 24 h of use.

Factors Associated to Apical Root Resorption after Orthodontic Treatment.

OBJECTIVE: The aim of this study was to assess the possible factors associated to root resorption, common to daily clinical orthodontics, especially parafunctional habits. METHODS: A retrospective study of 600 patients (308 females and 292 males) previously treated orthodontically was conducted. The sample was divided into two groups related to the degree of root resorption at the ending of treatment according to Malmgren. Group 1 comprised 507 patients with a mean initial age of 14.21 years and who had absent or mild final external root resorption, characterized by grades 0, 1 and 2 of root resorption; Group 2 comprised 93 patients with initial mean age of 14.57 years and who had moderate or severe root resorption, characterized by grade 3 and 4. The groups were then compared in terms of age at the beginning and ending of the treatment, treatment time, gender, type of treatment (with and without extractions), parafunctional habits (bruxism, onychophagia, the habit of biting objects, tongue thrusting habit and thumb sucking habit), allergies and pretreatment root resorption. RESULTS: The results show that the initial age, gender, type of malocclusion, parafunctional habits and allergies do not represent a statistically significant risk of root resorption. CONCLUSION: Treatment time and type (with and without extractions) and the presence of external root resorption at the beginning of the treatment showed significant differences.