Orthodontic movement after regenerative endodontic procedure in mature permanent tooth associated with dens invaginatus: a case report with 4-year follow-up.

BACKGROUND: Regenerative endodontic procedures (REPs) are innovative treatments aimed at restoring damaged dental structures. However, the effect of orthodontic movement on REP-treated teeth is not well understood and may have significant long-term consequences. This study aimed to evaluate the impact of orthodontic movement on a mature permanent tooth associated with dens invaginatus that has undergone a regenerative endodontic procedure (REP). CASE PRESENTATION: This report describes the case of a 13-year-old healthy male who presented with pulp necrosis and a chronic apical abscess (tooth number 2.2). Following REP according to the American Association of Endodontists' guidelines, the patient began non-extraction orthodontic treatment with fixed appliances after a 9-month healing period, which lasted 17 months in the upper arch. Subsequent follow-ups at 24, 36 and 48 months post-REP revealed an asymptomatic state with minimal cervical discoloration and diminished cold sensitivity. Radiographic analyses revealed periapical healing, mild apical remodeling on tooth 2.2, and moderate apical remodeling on other maxillary incisors. The treated tooth displayed a positive response to both REP and orthodontic treatment, yet further research is required to determine the long-term effects of orthodontics on REP-treated teeth. CONCLUSION: Orthodontic movement following REPs in mature permanent teeth is feasible and do not seem to prone teeth to orthodontic tooth resorption. Our experience indicates that a 9-month healing period allows successful orthodontic outcomes following REPs. Nonetheless, the predictability of outcomes and the ideal healing period before orthodontic movement is initiated remain to be established.

Effective Parameters for Orthodontic Tooth Movement Acceleration with Photobiomodulation: An Umbrella Review.

Objective: To answer this research question: What are the effective wavelength, power, and energy density parameters for achieving dental movement acceleration? Background Data: Photobiomodulation (PBM) has been clinically studied for its ability to accelerate dental movements in orthodontics. However, its effectiveness is dose dependent. Methods: The search was carried out in PubMed, SCOPUS, and ISI Web of Science. The quality of the included systematic reviews was performed using the AMSTAR 2 tool. The risk of bias was assessed using the ROBIS tool. Results: In total, 29 articles in PubMed, 75 in Scopus, and 61 in ISI Web of Science. Finally, only five systematic reviews were included. Conclusions: The results showed the range from 730 to 830 nm as the most effective range of wavelength to accelerate the orthodontic dental movement. A power range of 0.25-200 mW, with emphasis on the direct correlation between power, wavelength, and energy density. Energy density has not been adequately reported in the most randomized controlled clinical trials.

Is it possible to anchor a tooth with photobiomodulation?

During orthodontic treatment, we can achieve differential movements by using photobiomodulation (PBM) as an adjuvant before applying force. We can expect a greater bone density that initially resists movement while applying PBM to the other teeth to achieve an accelerating effect. The proposed protocol is to use an 810 nm laser at 0.1W power, applying between 4 and 6J per tooth for 22 s on the vestibular and lingual root surfaces, following the axial axis of the tooth. The energy density depends on the tip selected in the instrument. Normal bone remodeling cannot be avoided by applying high doses of PBM. PBM should be applied before orthodontic force to reduce tooth movement. In addition, PBM can be used during force application to teeth that require acceleration to achieve differential movement in orthodontic treatments. The protocol is the same in both scenarios.

What changes in the biology of bone movement induced with mini-implants/miniplates is the synchronicity

ABSTRACT Introduction: Induced tooth-bone movement occurs by a synchronicity of dental and bone phenomena, thanks to the osteocytic network, which is a three-dimensional network that controls the bone shape or design. Objective: To describe the tooth-bone movement induced by enhanced anchorage, divided into three distinct moments: zero, start and stop. Question: From this description, the main question arises: with the use of mini-implants/miniplates, what changes in the biology of induced tooth-bone movement? The answer is: nothing changes, either biologically or microscopically. Conclusion: This technique optimizes the treatment time, and the range of therapeutic possibilities is broadened, thanks to the synchronicity of phenomena - which remain the same, in all teeth and bones, yet in a synchronized manner. Bone anchorage represents synchronicity in induced tooth-bone movement.

RESUMO Introdução: A movimentação osseodentária induzida ocorre meio de uma sincronicidade de fenômenos dentários e ósseos, graças à rede osteocítica, uma rede tridimensional de controle do formato ou design ósseo. Objetivo: Descrever a movimentação osseodentária induzida com ancoragem ampliada, dividindo-a em três momentos distintos: zero, start e stop. Questionamento: Dessa descrição origina-se a principal pergunta: com o uso de mini-implantes/miniplacas, o que muda na biologia da movimentação osseodentária induzida? A resposta é: não muda nada, nem biologicamente, nem microscopicamente. Conclusão: O que se otimiza, com essa técnica, é o tempo de tratamento, e se amplia o leque de possibilidades terapêuticas, graças à sincronicidade dos fenômenos - que continuam sendo os mesmos, em todos os dentes e nos ossos, só que de forma sincronizada. A ancoragem óssea representa a sincronicidade na movimentação osseodentária induzida.

Novo método de sobreposição mandibular usando o programa Autodesk Inventor® para avaliação da acurácia do protocolo G8 da Invisalign® / New mandibular superposition method using Autodesk Inventor® software to evaluate the accuracy of the Invisalign® G8 protocol

O uso de alinhadores transparentes tem se tornado um fenômeno mundial na clínica ortodôntica e muitos esforços e recursos têm sido consumidos para que o resultado do tratamento seja o mais acurado possível. Em 2021 a Invisalgn® lançou protocolo G8 prometendo melhor previsibilidade no tratamento. É através da sobreposição de imagens que estes resultados podem ser avaliados. Na literatura, encontram-se relatos de diversos métodos e softwares que buscam confiabilidade para sobreposição de modelos tridimensionais (3D), entretanto não há consenso sobre estes métodos. Desta forma, os objetivos deste estudo foram: (1) Desenvolver novo método de sobreposição de modelos 3D com Autodesk Inventor®, (2) avaliar a reprodutibilidade do Autodesk Inventor® utilizando o sistema de coordenadas universais (UCS) associado a único ponto para sobreposição de modelos ortodônticos 3D da mandíbula e maxila, (3) avaliar a reprodutibilidade do Autodesk Inventor® na sobreposição de modelo ortodôntico 3D da maxila e mandíbula, (4) Comparar a acurácia do protocolo G8 através do resultado previsto pelo ClinCheck® com o resultado real obtido nos movimentos de intrusão e expansão dentária posterior. Para responder os objetivos 1, 2 e 3, foram selecionados 11 pares de modelos em STL (estereolitografia) de ambos os arcos exportados pelo software My Itero® e tratados com Invisalign® em dois tempos: início (T0) e refinamento (T1). As sobreposições foram realizadas utilizando os softwares Slicer® (versão 4.1) e Autodesk Inventor® usando como referência os planos dos 3 eixos cartesianos UCS (X, Y e Z) associado a um ponto na segunda ruga palatina na maxila e, na mandíbula, um ponto na linha muco gengival lingual. Após a sobreposição os movimentos de translação buco-lingual dos caninos, pré-molares e molares superiores e inferiores, intrusão, rotação dos caninos e incisivos mandibulares foram analisados por dois examinadores calibrados. Para responder o objetivo 4, a acurácia foi comparada nos movimentos alcançados e previstos pelo ClinCheck® entre três casos em que o protocolo G8 foi ativado e 8 casos em que não foi ativado para a expansão posterior maxila e mandíbula, intrusão de caninos e incisivos inferiores. Os resultados do objetivo 1, 2 e 3 foram coeficientes de correlação intraclasse (ICC) maior que 0,90 em todas as medidas, não foi observado erro sistemático avaliado pela fórmula de Dahlberg. Nos resultados do objetivo 4 não foram observadas diferenças estatísticas significativas entre os grupos. A acurácia no grupo G8 quando comparada ao grupo não G8 para expansão posterior na mandíbula e maxila aumentou 12.7% e 7,8% respectivamente, mas não houve diferenças estatísticas significante. Para o movimento de intrusão, a acurácia do grupo G8 foi 7,7% maior que a do grupo não G8 sem diferença estatística entre eles. Não foram observadas diferenças estatísticas significativas nos movimentos dos dentes dos grupos G8 e não G8. Concluiu-se que o método desenvolvido se mostrou reprodutível para sobreposição de modelos tridimensionais. O protocolo G8, quando ativado, não apresenta maior acurácia para o tratamento com Invisalign®.

The use of clear aligners has become a worldwide phenomenon in orthodontic practice and much effort and resources have been expended to ensure that the treatment outcome is as accurate as possible. In 2021 Invisalgn® released the G8 protocol promises better treatment predictability. It is through image superimposition that these results can be evaluated. In the literature, there are reports of various methods and software that seek reliability for superimposing three-dimensional (3D) models, but there is no consensus on these methods. Thus, the objectives of this study were: (1) Develop a new method for superimposing 3D models with Autodesk Inventor®, (2) evaluate the reproducibility of Autodesk Inventor® using the universal coordinate system (UCS) associated with a single point for superimposing 3D orthodontic models of the mandible and maxilla (3) Evaluate the reproducibility of Autodesk Inventor® in superimposing orthodontic 3D models of the maxilla and mandible, (4) Compare the accuracy of the G8 protocol through the result predicted by ClinCheck® with the actual result obtained in intrusion movements and posterior dental expansion. To answer the objectives 1, 2 and 3, 11 pairs of STL (Stereo- lithography) models of both arches exported by My Itero® software and treated with Invisalign® were selected at two times: initial (T0) and refinement (T1). The superpositions were performed using the Slicer® (version 4.1) and Autodesk Inventor® software using as reference the planes of the three Cartesian axes (X, Y and Z) associated with a point on the second palatal crease in the maxilla and, in the mandible, a point on the lingual mucous gingival line. After superimposition, the bucco-lingual translation movements of the canines, premolars and upper and lower molars, intrusion, rotation of the canines and mandibular incisors were analyzed by two calibrated examiners. To answer the objective 4, the accuracy was compared in the movements achieved and predicted by ClinCheck® between three cases in which the G8 protocol was activated and 8 cases in which it was not activated for maxillary and mandibular posterior expansion, canine and mandibular incisor intrusion. The results of objectives 1, 2 and 3 were intraclass correlation coefficients (ICC) greater than 0.90 in all measurements, no systematic error evaluated by the Dahlberg formula was observed. In the results of objective 4, no statistically significant differences were observed between the groups. The accuracy in the G8 group when compared to the non-G8 group for posterior expansion in the mandible and maxilla increased by 12.7% and 7.8% respectively but without statistically significant differences. For intrusion movement, the accuracy of the G8 group was 7.7% higher than the non G8 group with no statistical difference between groups. No statistically significant differences were observed in the tooth movements of the G8 and non-G8 groups. It was concluded that the developed method proved reproducible for three- dimensional model superimposition. The G8 protocol, when activated, does not present greater accuracy for treatment with Invisalign®

Do submerged roots hinder orthodontic treatment or the use of implants?

ABSTRACT Introduction: In clinical practice, submerged roots are found with high frequency, and their presence can change the planning of dental movements and implant placement. Objectives: To provide explanations of possible developments in the area involved, according to the evolutionary stage of the process, at the time of diagnosis. Discussion: After atrophy of the periodontal ligament and epithelial remnants of Malassez, ankylosis of the bone with the submerged root occurs, and initiates a process of replacement resorption. Until this process reaches the most advanced stage, this area represents an increased "bone" density, and if some care is not taken, this can generate resorption problems in the tooth to be moved. Whereas implants can be placed, despite the presence of the submerged root, irrespective of the stage of evolution. Conclusion: It is natural for the onset of alveolodental ankylosis and tooth replacement resorption to occur in submerged roots, and its stage of evolution will be decisive in the approach to be adopted in clinical planning.

RESUMO Introdução: A frequência, na prática clínica, das raízes submersas é elevada, e sua presença pode modificar o planejamento de movimentações osteodentárias e da instalação de implantes. Objetivo: Apresentar as explicações das possíveis evoluções na área envolvida, de acordo com o estágio evolutivo do processo, no momento do diagnóstico. Discussão: Depois da atrofia do ligamento periodontal e dos restos epiteliais de Malassez, o osso anquilosa-se com a raiz submersa, e se inicia a reabsorção por substituição. Até se chegar ao estágio mais avançado, essa área representa uma densidade "óssea" aumentada, o que pode gerar problemas reabsortivos no dente a ser movimentado, caso alguns cuidados não sejam tomados. Por outro lado, os implantes podem ser aplicados, apesar da presença da raiz submersa, independentemente da fase evolutiva. Conclusão: É natural que, em raízes submersas, se instale a anquilose alveolodentária e a reabsorção dentária por substituição, e o seu estágio evolutivo será determinante na conduta a ser adotada no planejamento clínico.

Do orthodontic tooth movements induce pulp necrosis? A systematic review.

BACKGROUND: Orthodontic tooth movements are performed by applying forces on teeth, which may cause alterations within the dental pulp. Previously published systematic reviews on the subject only included a small number of studies that assessed pulp status through reliable diagnostic methods. Since then, new evidence has been published, and a further systematic review on the subject is necessary. OBJECTIVES: To evaluate whether there is scientific evidence to support the possibility that orthodontic tooth movements could induce pulp necrosis. METHODS: A systematic search of articles published until June 2020 was performed using MeSH and free terms in the PubMed, Cochrane Library, LILACS, SciELO, Web of Science, EMBASE, Open Grey and Grey Literature databases. Randomized clinical trials (RCTs), nonrandomized clinical trials (nRCTs) and longitudinal (prospective or retrospective) studies that evaluated the pulp status of teeth subjected to orthodontic movements using laser Doppler flowmetry or pulse oximetry were included. The revised Cochrane risk of bias tools for randomized trials (RoB 2) and nonrandomized interventions (ROBINS-I) were used to assess the quality of the included studies. Relevant findings were summarized and evaluated. The overall quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. RESULTS: Initial screening of databases resulted in 353 studies. In total, 285 studies were excluded because they were duplicates. Of 68 eligible papers, fourteen met the inclusion criteria and were selected for full-text reading. Two studies were excluded due to the methods used to evaluate pulp status. Twelve studies (five RCTs, one nRCT and six prospective) were included. Four RCTs were classified as having an unclear risk of bias and one as having a high risk of bias. The nRCT was classified as having a low risk of bias. Two prospective studies were classified as having a moderate risk of bias and four as having a serious risk of bias. The GRADE analysis demonstrated a low to very low quality of evidence. DISCUSSION: Significant limitations regarding the randomization processes within the included RCTs and a lack of control of confounders on most nonrandomized and longitudinal studies were verified. CONCLUSIONS: This systematic review indicates that orthodontic movements do not induce loss of pulp vitality with low to very low certainty of evidence.

Previsibilidade de movimentos dentários com alinhadores estéticos ­ acelerando a curva de aprendizagem / Predictability of orthodontic movement with aesthetic aligners ­ accelerating the learning curve

Resumo A utilização correta dos alinhadores transparentes está diretamente ligada com a velocidade da curva de aprendizagem pela qual passam os profissionais. As maiores dificuldades parecem ser a indicação correta dos casos, o gerenciamento do fluxo digital e o manejo clínico, que estão intrinsecamente ligados ao conhecimento do funcionamento da técnica, ou seja, das propriedades de liberação de forças (propriedades mecânicas dos materiais termoplásticos), quando utilizadas em um contexto de customização por meio de sistemas CAD/CAM. Para um melhor entendimento do tema em relação aos tipos de movimentos dentários, esse artigo estabelece uma classificação de dificuldade em três categorias, variando de acordo com a quantidade de alinhadores necessários: até 10 fases (placas) para casos simples (movimentos pontuais), até 20 fases para os casos moderados e acima de 20 alinhadores para casos complexos computando-se sempre por arcada dentária (AU)

Abstract The correct use of clear aligners is directly linked to the speed of the learning curve that professionals go through. The biggest difficulties seem to be the correct indication of the cases, the management of the digital workflow and the clinical management, which are intrinsically linked to the knowledge of the technique's details, that is, the force-delivery properties (mechanical properties of thermoplastic materials), when used in a context of CAD/CAM systems customization. For a better understanding of the topic in relation to the types of tooth movement when using aligners, this article establishes a classification of difficulty into three categories, varying according to the number of aligners needed: up to 10 phases for simple cases, up to 20 phases for moderate cases, and above 20 aligners for more complex cases, always computing the aligner's number by each dental arch. (AU)

Láser de baja potencia y aceleración de movimientos dentarios en ortodoncia: revisión sistemática / Low-level laser accelerating dental movements in orthodontics: systematic review

Según la literatura científica, ¿El láser de baja potencia propicia la aceleración de los movimientos dentarios durante el tratamiento ortodóntico? El objetivo de este trabajo buscasistematizar sobre la capacidad del láser de baja potencia en la aceleración de los movimientos dentarios durante el tratamiento ortodóncico. Para ello, se realizó una revisión sistemática, una búsqueda empleando buscadores booleanos en la plataforma de PubMed. Las palabras clave empleadas para fueron: orthodontic movement, orthodontic tooth movement, orthodontic, orthodontic treatment, low level laser therapy, low level laser,laser therapy y la combinación entre ellos. Las investigaciones incluidas trataron el tema de la aceleración del movimiento dentario durante el tratamiento de ortodoncia empleando láser de baja potencia. Se incluyeron en este estudio publicaciones de revistas indexadas en PubMed, ensayos clínicos, en idioma inglés y que correspondieran a artículos publicados desde el año 2000 a la fecha. A si también,se realizó evaluación del riesgo de sesgo. Las variables analizadas fueron: autor principal, título, año, tipo de artículo, revista, país de investigación y si los artículos demuestran que el láser de baja potencia aumenta el movimiento dentario durante el tratamiento ortodóncico. Los resultados arrojaron que el 60% de los estudios incluidos concluyen que el láser de baja potencia acelera el movimiento dentario durante el tratamiento de ortodoncia; el 30% de estos no encontraron cambios significativos con relación a los grupos estudiados con los de control y un 10% resultó en conclusiones dudosas. Por lo tanto, a pesar de que los resultados son alentadores por la tendencia en que el láser de baja potencia si acelera los movimientos ortodónticos, sería necesaria la presencia de un número superior de estudios clínicos aleatorizados para un esclarecimiento específico de las bondades que aporta esta terapia al sector.

According to scientific literature, does low-power laser promote acceleration of tooth movements during orthodontic treatment? The objective for this work seeksto systematize the ability of the low-power laser to accelerate tooth movements during orthodontic treatment.For this,a systematic review was carried out, a search using Boolean search engines on the PubMed platform. The keywords used for were: orthodontic movement, orthodontic tooth movement, orthodontic, orthodontic treatment, low level laser therapy, low level laser, laser therapy and the combination between them. The included investigations dealt with the issue of acceleration of tooth movement during orthodontic treatment using low-power laser, were from journals indexed in PubMed, clinical trials, in English, and corresponded to articles published since 2000 to date. Assessment of risk of bias was performed. The variables analyzed were: main author, title, year, type of article, journal, country of research, and whether the articles show that low-power laser increases tooth movement during orthodontic treatment.The results showed that 60% of the included studies conclude that the low-power laser accelerates tooth movement during orthodontic treatment, 30% of these did not find significant changes in relation to the groups studied with those of control and 10% resulted in dubious conclusions. Thus, although the results are encouraging due to the trend in which the low-power laser does accelerate orthodontic movements, the presence of a higher number of randomized clinical studies would be necessary for a specific clarification of the benefits that this therapy brings to the patient. sector.

In Vivo Biological Evaluation of Orthodontically Moved Incisors after Replantation.

Background and Objectives: There is still considerable controversy regarding the possibility of submitting replanted teeth to orthodontic movement (OM). The purpose of the present study was to evaluate the tissue response after orthodontic movement on replanted teeth. Materials and Methods: Sixty Wistar rats were randomly assigned to four groups (n = 15): G1, replantation without OM after 30 days; G2, replantation with OM after 30 days; G3, replantation without OM after 60 days, and G4, replantation with OM after 60 days. The maxillary left central incisors were extracted and the teeth were stored in milk media. After 30 min, the teeth were replanted and fixed with non-rigid immobilization. All specimens were observed after 30 and 60 days of replantation and then subdivided into two subgroups (with OM or without OM). The animals were euthanized after seven days of the OM started, and the maxillary bone blocks were processed for histological evaluation. Results: The histological results showed periodontal ligament repair in both periods studied without OM; however, ankylosis and root resorption was seen in all orthodontically moved teeth. Conclusions: The orthodontic movement did not favor tissue response in all replanted teeth, regardless of the experimental periods.

Effective Wavelength Range in Photobiomodulation for Tooth Movement Acceleration in Orthodontics: A Systematic Review.

Objective: The present systematic review aims to establish an effective range of low-level laser therapy wavelengths to accelerate tooth movement in orthodontic treatments. Materials and methods: The electronic literature search was carried out in the following databases: PubMed, ISI Web of Science, Scopus, and Cochrane randomized controlled trials (RCTs). The protocol (CRD42019117648) was registered in PROSPERO. Results: According to PRISMA guidelines and after applying the inclusion criteria, nine RCTs were included. Three blind reviewers independently assessed the methodological quality and evidence level of selected articles. Evidence level classification was established according to the recommendations of SIGN 50 (Scottish Intercollegiate Guidelines Network 2012) and was high quality being ++, acceptable +, low quality -, unacceptable -, reject 0. Conclusions: The majority of RCTs related to accelerating the tooth movement in orthodontic treatments are ideally between 780 and 830 nm wavelengths. The average increase in speed movement calculated as a percentage of the control group in nine studies is 24%. Further studies are necessary to establish the exact dosimeter in photobiomodulation during orthodontic movement.

Effect of two corticotomy protocols on periodontal tissue and orthodontic movement

Abstract Objective To compare two corticotomy surgical protocols in rats to verify whether they alter conventional orthodontic movement. Methodology Sixty Wistar rats were divided into three groups - orthodontic movement (CG), orthodontic movement and corticotomy (G1) and orthodontic movement with corticotomy and decortication (G2) - and euthanized after 7 and 14 days. Tooth movement (mm), bone volume fraction and bone volume ratio to total volume (BV/TV), and bone mineral density (BMD) were evaluated by micro-CT. The total amount of bone was measured in square millimeters and expressed as the percentage of bone area in the histomorphometry. The number of positive TRAP cells and RANK/RANKL/OPG interaction were also investigated. Results Day 14 showed a statistically significant difference in orthodontic tooth movement in CG compared with G1 (7.52 mm; p=0.009) and G2 (7.36 mm; p=0.016). A micro-CT analysis revealed a difference between CG, G1 and G2 regarding BV/TV, with G1 and G2 presenting a lower BV/TV ratio at 14 days (0.77 and 0.73 respectively); we found no statistically significant differences regarding BMD. There was a difference in the total amount of bone in the CG group between 7 and 14 days. At 14 days, CG presented a significantly higher bone percentage than G1 and G2. Regarding TRAP, G2 had more positive cells at 7 and 14 days compared with CG and G1. Conclusion Corticotomy accelerates orthodontic movement. Decortication does not improve corticotomy efficiency.

Extreme root resorption in orthodontic practice: teeth do not have to be replaced with implants

ABSTRACT The replacement of natural teeth that have extreme external apical root resorption, induced by orthodontic treatment, with osseointegrated implants is not justifiable biologically or clinically. These teeth should be preserved and keep their normal functions, as there is no greater mobility, pain or color change. They may undergo usual procedures, such as bleaching, restorations with veneers and other esthetic procedures that may be necessary along life. The pulp of these teeth is normal. If mobility of a tooth with extreme resorption is identified, the cause of mobility should be investigated, as it is not associated with resorption, not even at advanced stages. Tooth mobility may be associated with recent removal of orthodontic appliance, occlusal trauma, chronic inflammatory periodontal disease, or even severe cervical bone loss. In such cases, the cause of mobility should be eliminated and possible sequelae should be corrected, because these, and not root resorption, may actually require retention.

RESUMO A troca de dentes naturais com reabsorções inflamatórias externas apicais extremas, induzidas ortodonticamente, por implantes osseointegráveis não se justifica, biológica ou clinicamente. Esses dentes devem ser mantidos, cumprindo suas funções normais, pois não apresentam aumento de mobilidade, nem dor ou alteração de cor, podendo ser submetidos a procedimentos comuns, como clareamento, facetas e outras abordagens estéticas necessárias ao longo da vida. A polpa desses dentes é normal. Se os dentes com reabsorção extrema se apresentarem com mobilidade, deve-se buscar a causa dessa mobilidade, que não está associada à reabsorção, mesmo quando avançada. A mobilidade dentária deve estar relacionada com a recente remoção do aparelho ortodôntico, trauma oclusal, doença periodontal inflamatória crônica ou, ainda, com perda óssea cervical severa. Nesses casos, para eliminar a mobilidade, deve-se eliminar a causa e corrigir as sequelas, que - essas sim - podem necessitar de contenção, mas não pela reabsorção radicular.

Do electrical current and laser therapies improve bone remodeling during an orthodontic treatment with corticotomy?

OBJECTIVES: Evaluate the bone remodeling during orthodontic movement with corticotomy when submitted to low-intensity electrical stimulation application (microcurrent-MC) and low-level laser therapy (LLLT). MATERIAL AND METHODS: One hundred and fifty Wistar rats were divided into the following 5 groups: (C) submitted to tooth movement; (Cort) tooth movement/corticotomy; (Cort-L) tooth movement/corticotomy/laser AsGaAl 808 nm (4.96J/50s); (Cort-Mc) tooth movement/corticotomy/microcurrent (10 µA/5 min); (Cort-L-Mc) tooth movement/corticotomy and laser/microcurrent alternated. Inflammation, angiogenesis, and osteogenesis were evaluated in the periodontal ligament (PDL) and alveolar bone on the 7th, 14th, and 21st days of orthodontic movement. RESULTS: The quantification of inflammatory infiltrate, angiogenesis and expression of TGF-ß1, VEGF, and collagen type I were favorably modulated by the application of therapies such as low-level laser therapy (LLLT), MC, or both combined. However, electrical stimulation increased fibroblasts, osteoclasts and RANK numbers, birefringent collagen fiber organization, and BMP-7 and IL-6 expression. CONCLUSIONS: Low-level laser therapy (LLLT) and MC application both improved the process of bone remodeling during orthodontic treatment with corticotomy. Still, electrical current therapy promoted a more effective tooth displacement but presented expected root resorption similar to all experimental treatments. CLINICAL RELEVANCE: It is important to know the effects of minimally invasive therapies on cellular and molecular elements involved in the bone remodeling of orthodontic treatment associated with corticotomy surgery, in order to reduce the adverse effects in the use of this technique and to establish a safer clinical routine.

Macroscopic and radiographic aspects of orthodontic movement associated with corticotomy: animal study.

INTRODUCTION: To quantify the rate of tooth movement in two corticotomy protocols in an experimental model in rats through macroscopic and radiographic analysis. METHODS: The animals were divided into three groups: orthodontic movement (CO), orthodontic movement plus corticotomy surgery (G2), and orthodontic movement and corticotomy surgery with decorticalization (G3).The euthanasia occurred in 7 and 14 days. The data were statistically analyzed (p < 0.05). RESULTS: The CO presented lower distance between the mesial surface of the first molar and the distal surface of the third molar when compared to the G2 (6.96 ± 0.24, p = 0.009) and G3 (6.93 ± 0.18, p = 0.016) in the macroscopic analysis. In the 7 days, there was no statistically significant radiographic difference between the three groups: CO(0.94 ± 0.21 mm2), G2(1.05 ± 0,27 mm2), and G3(1.08 ± 0.27 mm2).There was a statistically significant difference between CO (0.87 ± 0.12 mm2), G2 (1.00 ± 0.12 mm2), and G3 (1.11 ± 0.14 mm2) at 14 days. There was a statistically significant linear difference between the groups in all periods. CONCLUSION: Tooth movement and the region of interest were influenced by corticotomy, regardless of the surgical technique in the 14 days.

Effect of orthodontic force associated with cigarette smoke inhalation in healthy and diseased periodontium. A histometric and immunohistochemistry analysis in rats.

BACKGROUND: The aim of the present study is to evaluate the effect of orthodontic forces in healthy or diseased periodontium of rats submitted/not submitted to cigarette smoke inhalation. MATERIAL AND METHODS: Fifty-six male Wistar rats were allocated into two groups of conditions: smoking and non-smoking. Each group was divided into the following subgroups: control (C), orthodontic tooth movement (OTM), ligature-induced periodontitis (P) and P+OTM (POTM), with n = 14 each. Periodontitis was induced in the lower first molar by cotton ligature, and a 4 mm closed stainless steel spring was used for orthodontic movement. Animals were exposed to the smoke of 10 cigarettes for 8 minutes, 3 times a day for 60 days before P induction and OTM. Evaluation parameters were macroscopic analysis of dental movement, bone loss and bone density. In addition, the receptor activator of nuclear factor-kappaB (RANK) immunostaining and RANK ligand/osteoprotegerin ratio in the furcation region were assessed. RESULTS: There was no statistically significant difference between groups, ie, smoking and non-smoking conditions (P = .338). Bone loss intragroup analysis between the P and POTM groups was not significant in smoking (P = 1) and non-smoking (P = .5) conditions; both were different from OTM and C in each condition. Regarding bone density, POTM and P were significant to C (P < .05). The POTM group was significant to the P and C (P = .001) regarding dental movement. The RANK ligand/osteoprotegerin ratio in the non-smoking condition was higher in P and POTM compared to C and OTM and to P and POTM in the smoking condition. RANK immunostaining was significant in the smoking condition for the P and POTM groups (P < .05). CONCLUSION: Within the limitations of the present study, it was concluded that cigarette smoke inhalation had no influence on the evaluated groups, even with the presence of low levels of nicotine, carbon monoxide and tar. The POTM groups did not present greater bone loss compared to P groups, thus periodontal disease is essential for bone loss.

Dehiscences and fenestrations: methodological care necessary to avoid errors in diagnosis and measurement

ABSTRACT The low prevalence of gingival recessions observed in orthodontic clinical practice may be assigned to the fact that in studies in which dehiscences and bone fenestrations are described as frequent, they were diagnosed based on: 1) dry skull studies; 2) areas with periosteal reflection together with flap; and 3) imaging techniques with low sensitivity to detect these defects, which have a delicate structure and function. In areas of pseudo-dehiscences and fenestrations, the periosteum and the alveolar cortical bone are very thin; also, they either have been removed during preparation of the dry specimens in the areas for analysis, or, alternatively, have not been investigated using an ideal imaging method.

RESUMO A ausência de prevalência elevada das recessões gengivais relacionadas à prática clínica ortodôntica se explica, provavelmente, porque, nos trabalhos em que as deiscências e fenestrações ósseas são descritas como frequentes, essas foram diagnosticadas a partir de: 1) estudos em crânios secos; 2) áreas com rebatimento periosteal junto com o retalho; e 3) uso de métodos imagiológicos que falham em sensibilidade para captá-las, pela sua delicadeza estrutural e funcional. Nessas áreas de pseudodeiscências e fenestrações, existe periósteo e cortical óssea alveolar muito fina, que foram eliminados nos procedimentos de preparação dos espécimes secos, nas áreas para a análise ou, então, não se aplicou um método imagiológico ideal.

Recuperación de la tabla ósea vestibular a través de ortodoncia: reporte de caso / Vestibular alveolar bone recovery using orthodontic treatment: case report

RESUMEN: En la actualidad, el trabajo interdisciplinario es fundamental para la resolución de casos complejos. En el tratamiento de las alteraciones bucales, distintas especialidades pueden aportar a la resolución de un caso. Muchas veces la ortodoncia y periodoncia actúan en combinación para devolver el estado de salud oral al paciente. El caso que se presenta a continuación corresponde al reporte clínico de una pieza dentaria que, encontrándose fuera del reborde alveolar, fue ubicada a través del tratamiento de ortodoncia en la posición adecuada, permitiendo así una recuperación ósea en la zona que mejora el pronóstico de la pieza y del implante en caso de requerirse un reemplazo.

ABSTRACT: Multidisciplinary work is currently very relevant for the resolution of complex cases. In the buccal alterations treatment, many dental specialties can contribute to resolve a case. Orthodontic and periodontic treatments work often together to recover the oral health of a patient. The following case is a report of a tooth with its apical portion outside the alveolar bone. It was repositioned by orthodontic treatment, resulting in bone recovery in that area. This improved the prognosis of the tooth and the implant in case a replacement was needed.

Reevaluation of the Strain Pressure Theory: Toward a Better Understanding the Biology of Tooth Movement / Reevaluación de la Teoría Presión - Tensión: Hacia una Mejor Comprensión de la Biología del Movimiento Dental

The aim of this report was to analyze the majority of publications referred to orthodontic movement Biological basis, principally strain- pressure theory taking account contemporaneous methodological study designs. The literature published in Pubmed from 1967 to 2014 was reviewed, in addition to well-known scientific reports that were not classified under this database like classical manuscripts since 1839. The comment items are: Limitations of animal models, Histological slices, what to watch for, Rats as an experimental model in orthodontics, Strain­pressure, the force used in these studies that fundament this theory, Reevaluation studies about strain-pressure theory in biology movement using contemporaneous models, Up to date concepts, Theory reevaluation the first step to understanding new acceleration concepts and Movement biology research, present and future. After analyzing those items we concluded: A 3D perspective is essential for a complete understanding of events in tooth movement involves two interrelated processes: the bending of alveolar bone and remodeling of the periodontal tissues. It's important to start, and acknowledge that the PDL cannot be divided into two different areas that react independently to an applied force. It´s a continuous periodontal compartment in OTM, rather than a pressure side and a tension side. When an orthodontic force is applied there are two simultaneous effects that correlate. Alveolar bone flexion and remodeling of the periodontal tissues. Alveolar Bone deformation compromising the main structures (PDL, bone and cement), compression and tension can coexist in different directions. The magnitudes of compression and tension are typically different in different directions. As the majority of research and studies indicate that fundamental movement biology are made on animal models, it is important to know that their results and conclusions, under the actual evidenced based practice guidelines do not allow to make clinical decisions even if they are included on systematic reviews.

El objetivo de esta revisión es analizar la mayoría de las publicaciones relacionadas a la fundamentación sobre el movimiento de ortodoncia, principalmente la teoría presión-tensión, teniendo en cuenta los diseños de estudios metodológicos contemporáneos. Se revisó la literatura publicada en la base de datos de MEDLINE, 1967-2013 , además de los informes conocidos que no fueron clasificados en esta base de datos como manuscritos clásicos desde 1839. Los temas principales en los que se divide el artículo son: Limitaciones de los modelos animales, cortes histológicos, las ratas como modelo experimental en ortodoncia, la fuerza utilizada en los estudios que fundamentan esta teoría, reevaluación sobre los estudios de la teoría presión ­tensión en modelos contemporáneos, conceptos actuales en biología del movimiento, reevaluación de la teoría: el primer paso para entender los nuevos métodos en aceleración del movimiento, conceptos e investigaciones en biología del movimiento: presente y futuro. Una perspectiva 3D es esencial para una comprensión completa de los acontecimientos. El movimiento dental implica dos procesos interrelacionados: la curvatura del hueso alveolar y la remodelación de los tejidos periodontales. Es importante empezar, y reconocer que el PDL no puede ser dividido en dos áreas diferentes que reaccionan de forma independiente a una fuerza aplicada. Está en un compartimiento continuo periodontal , en lugar de un lado de presión y un lado de tensión. Al aplicar una fuerza de ortodoncia hay dos efectos simultáneos: la flexión del hueso Alveolar y la remodelación de los tejidos periodontales. La deformación del hueso compromete las estructuras principales (PDL, hueso y cemento) y la compresión y la tensión pueden coexistir en diferentes direcciones.

Obesity and orthodontic treatment: is there any direct relationship?

ABSTRACT Obesity is a wide-spread condition directly or indirectly connected with an increase in the prevalence of a variety of human diseases. It affects over 50% of the western overall population. In 2017, a thorough analysis of 204 studies on obesity and cancer revealed that the condition increases the risk of the following types of cancer: stomach, colon, rectal, bile duct, pancreatic, esophagus, breast, endometrial, ovarian, kidney and multiple myeloma. The first study aiming at establishing a connection between obesity and the rate of induced orthodontic tooth movement was conducted by Saloom et al; however, it could not effectively nor significantly reveal any direct influence or effect. Despite being identified during the first week, differences could not be explained and treatment time remained unchanged. In spite of lack of studies in the literature on the connection between obesity and the rate of induced tooth movement, in clinical practice, courses or specialized training, we should not have protocols changed nor adopt any measures or expect significant differences between normal-weight and obese individuals. It should be emphasized that unsuccessful cases or cases of root resorption associated with treatment should not be assigned to obesity, since scientific data is insufficient to do so.

RESUMO A obesidade representa uma epidemia que afeta mais de 50% da população ocidental e está, direta ou indiretamente, relacionada com o aumento na prevalência de algumas doenças humanas. Em 2017, em uma análise minuciosa de 204 trabalhos sobre a obesidade e o câncer, observou-se que ela aumenta os riscos de câncer de estômago, cólon, reto, vias biliares, pâncreas, esôfago, mama, endométrio, ovário, rim e mieloma múltiplo. O primeiro trabalho que procurou relacionar a obesidade com a velocidade de movimentação dentária ortodôntica foi apresentado por Saloom et al., mas não conseguiu demonstrar, de forma efetiva e significativa uma influência ou efeito direto. As diferenças ocorreram apenas na primeira semana, e sem explicação, mas o tempo total do tratamento não foi alterado. Na prática clínica, em aulas ou nos treinamentos de especialistas, não devemos - tendo em vista a ausência na literatura que correlacione a obesidade e a velocidade da movimentação dentária induzida - mudar protocolos, adotar medidas ou ter expectativas de diferenças significativas entre pessoas com peso normal e obesas. Ressalta-se, ainda, que casos de insucesso e/ou de reabsorções radiculares associadas ao tratamento nesses pacientes não devem ser atribuídos à obesidade, pois não há base científica para isso.