Efficacy of ClinproTMXT Varnish surrounding brackets on the enamel surface of white spot lesion.

Orthodontics patients usual develop demineralization and present cavity caries lesions after six months. Minimally invasive procedures have been the goal in modern dental practice. The aim of this study was to evaluate the effect of ClinproTMXT Varnish, on the enamel surface roughness and severity of white spot lesions. Twenty premolars were submitted to bond brackets and experimental induction of demineralization and randomly divided into 2 groups: GI - fluoride varnish (Colgate Duraphat®); GII - Ionomeric Sealant (ClinproTMXT Varnish). The treatment was applied around the brackets. The surface roughness of specimens was analyzed, before treatment and 12 weeks after treatment by laser confocal microscopy, and the severity of the white spot lesion was by laser fluorescence device. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney Test, at 5% significance, roughness percentage reduction was performed. The severity of demineralization decreased in both, GI (p = 0.005) and GII (p = 0.019). Enamel superficial roughness levels decreased in GI and GII. As well as the roughness percentage, being more expressive in the ClinproTMXT Varnish group (85,09%). Colgate Duraphat® or Clinpro™ XT Varnish reduced the severity of the demineralization and decreased the superficial roughness on the enamel. The Clinpro™ XT Varnish was superior to superficial roughness on enamel.

Effect of chlorhexidine mouthwashes on periodontal parameters and extrinsic tooth staining in orthodontic patients.

INTRODUCTION: Periodontal health and biofilm control are primordial to success in orthodontic treatment. This study aimed to evaluate the effect of chlorhexidine (CHX) mouthwashes on periodontal status and extrinsic tooth staining in orthodontic patients. METHODS: Thirty-three patients of both sexes, aged 11-33 years, under orthodontic treatment with fixed appliances at <16 months, were randomly distributed into 2 groups. In the control group, patients received mechanical hygiene instruction, and in the experimental group, patients also used CHX wash twice a week for 60 days. The effectivity of the protocols was evaluated using the plaque, gingival, gingival bleeding, and discoloration indexes before the hygiene protocol was applied, 15, 30, and 60 days after protocol implementation. RESULTS: In the experimental group, there was a decrease in the plaque, gingival, and gingival bleeding indexes at the different evaluation periods (P <0.05). In addition, there was a significant difference in the discoloration index at 60 days compared with initial time points after implementing hygiene protocols in the experimental group (P <0.05). In contrast, there were no significant differences in plaque, gingival, gingival bleeding, and discoloration indexes in the control group at any time (P >0.05). CONCLUSIONS: CHX mouthwash administered 30 days, twice a week, significantly improved the periodontal status with mild brown staining. After this period, expressive extrinsic tooth staining was observed.

Efficacy of ClinproTMXT Varnish surrounding brackets on the enamel surface of white spot lesion

Abstract Orthodontics patients usual develop demineralization and present cavity caries lesions after six months. Minimally invasive procedures have been the goal in modern dental practice. The aim of this study was to evaluate the effect of ClinproTMXT Varnish, on the enamel surface roughness and severity of white spot lesions. Twenty premolars were submitted to bond brackets and experimental induction of demineralization and randomly divided into 2 groups: GI - fluoride varnish (Colgate Duraphat®); GII - Ionomeric Sealant (ClinproTMXT Varnish). The treatment was applied around the brackets. The surface roughness of specimens was analyzed, before treatment and 12 weeks after treatment by laser confocal microscopy, and the severity of the white spot lesion was by laser fluorescence device. The data were analyzed by non-parametric Wilcoxon and Mann-Whitney Test, at 5% significance, roughness percentage reduction was performed. The severity of demineralization decreased in both, GI (p = 0.005) and GII (p = 0.019). Enamel superficial roughness levels decreased in GI and GII. As well as the roughness percentage, being more expressive in the ClinproTMXT Varnish group (85,09%). Colgate Duraphat® or Clinpro™ XT Varnish reduced the severity of the demineralization and decreased the superficial roughness on the enamel. The Clinpro™ XT Varnish was superior to superficial roughness on enamel.

Resumo Pacientes ortodônticos geralmente desenvolvem desmineralização e apresentam lesões de cárie após seis meses de tratamento. Procedimentos minimamente invasivos têm sido o objetivo na prática odontológica moderna. O objetivo deste estudo foi avaliar o efeito do ClinproTM XT selante ionomérico, ao redor do bráquete, com relação a rugosidade superficial do esmalte e a severidade da lesão induzida. Vinte pré-molares foram submetidos a colagem de bráquetes e indução experimental de desmineralização e divididos aleatoriamente em 2 grupos: GI - verniz fluoretado (Colgate Duraphat®); GII - Selante Ionomérico (ClinproTM XT). O tratamento foi aplicado ao redor dos bráquetes. A rugosidade da superfície dos espécimes foi analisada, antes do tratamento e 12 semanas após o tratamento por microscopia confocal a laser e severidade da lesão de mancha branca por dispositivo de fluorescência a laser. Os dados foram analisados pelo teste não paramétrico de Wilcoxon e Mann-Whitney, a 5% de significância. A taxa de redução da lesão foi calculada. A severidade da desmineralização diminuiu tanto no GI (p = 0,005) quanto no GII (p = 0,019). Os níveis de rugosidade superficial do esmalte diminuíram no GI e GII, assim como o percentual de rugosidade, sendo mais expressivo no grupo ClinproTMXT (85,09%). Colgate Duraphat® e Clinpro™ XT reduziram a severidade da desmineralização e diminuíram a rugosidade superficial do esmalte. O selante ionomérico Clinpro™ XT foi superior na redução percentual de rugosidade.

Self-ligating brackets exhibit accumulation of high levels of periodontopathogens in gingival crevicular fluid.

Different types of brackets seem to influence the disruption of the oral microbial environment. Therefore, the aim of this study was to evaluate the influence of self-ligating brackets on the gingival crevicular fluid levels of the putative periodontal pathogens Aggregatibacter actinomycetemcomitans sorotype a (Aaa), Tannerella forsythia, Fusobacterium nucleatum, and Porphyromonas gingivalis. Sixty samples of crevicular fluid of twenty patients (11 boys and 9 girls) were analysed at baseline (T0) and after 30 (T1) and 60 (T2) days of bonding of the self-ligating (In-Ovation®R, Dentsply, GAC or SmartClip™, 3 M Unitek, Monrovia, CA, USA) and of one conventional bracket (Gemini™, 3 M Unitek, Monrovia, CA, USA) used with elastomeric ligatures. Total DNA from samples was extracted using CTAB-DNA precipitation method and Real-time PCR was performed to analyse bacterial level. Non-parametric Friedman and Wilcoxon tests were used for data analysis (p value of < 0.05). F. nucleatum presented a different level among the different brackets at T1 (p = 0.025), the highest level in the Gemini™ bracket when compared to the SmartClip™ bracket (p = 0.043). P. ginigvalis levels increased in the In-Ovation®R (p = 0.028) at T1. The subgingival levels of bacterial species associated with periodontal disease P. ginigvalis increased in the self-ligating brackets In-Ovation®R.Clinical Relevance: Some kinds of brackets could provide more retentive sites than others, and it seems to modulate the subgingival microbiota, since, in this study, we could observe the increase of the species associated with periodontal disease. Preventive protocols should be adopted in the use of self-ligating brackets.

Estrogen deficiency during puberty affects the expression of microRNA30a and microRNA503 in the mandibular condyle.

BACKGROUND: The aim of this study was investigated if estrogen deficiency during puberty affects the expression of miRNA30a and miRNA503 in maxillary and mandibular growth centers, and also evaluated if ERα and ERß are correlated with miRNA30a and miRNA503 expressions. METHODS: Samples from 12 female Wistar rats randomized into experimental group (OVX) and control group (SHAM). At an age of 45 days animals were euthanized for miRNA expression analyses. RT-qPCR was performed to determine miRNA30a and miRNA503 expression in growth sites: midpalatal suture, condyle, mandibular angle, symphysis/parasymphysis and coronoid process. The data was carried out using the parametric tests at 5% of significance level. RESULTS: miRNA 30a and miRNA503 presented higher levels in the condylar site in SHAM group when compared with OVX (p = 0.002 and p = 0.020, respectively). In the growth centers, a statistical significant difference was observed only for miRNA30a (p = 0.004), when compared mandibular angle with condyle the in OVX group (p = 0.001). A strong positive correlation between miRNA503 and ERα in the condyle of OVX group was observed (r = 0.90; p = 0.039 and it also between miRNA503 and ERß in the coronoid process of the OVX group (r = 0.88; p = 0.05). CONCLUSION: The results suggested that estrogen regulates specific miRNAs in maxillary and mandibular growth centers, which may participate in posttranscriptional regulation of estrogen-regulated genes.

Quantification of pro-inflammatory cytokines and osteoclastogenesis markers in successful and failed orthodontic mini-implants.

OBJECTIVES: Miniscrew has been frequently used, considering that anchorage control is a critical point in orthodontic treatment, and its failure, the main adverse problem. Using two groups of stable (successful) and unstable (failed) mini-implants, this in vivo study aimed to quantify proinflammatory cytokines IL-1 α, IL-6, IL-17, and TNF-α and osteoclastogenesis marker RANK, RANKL, and OPG in gingival tissue, using the real-time polymerase chain reaction technique. METHODOLOGY: Thirteen patients of both sexes (11-49 years old) under orthodontic treatment were selected, obtaining 11 successful and 7 failed mini-implants. The mini-implants were placed and removed by the same surgeon, in both jaws. The mean time of permanence in the mouth was 29.4 months for successful and 7.6 months for failed mini-implants. At removal time, peri-mini-implant gingival tissue samples were collected and processed for quantification of the proinflammatory cytokines and osteoclastogenesis markers. Nonparametric Wilcoxon rank-sum test considering the clusters and Kruskal-Wallis test were used for statistical analysis (α=0.05). RESULTS: No significant difference (p>0.05) was observed between the groups for either quantification of cytokines or osteoclastogenesis markers, except for IL-6 (p<0.05). CONCLUSIONS: It may be concluded that the expression of IL-1α, IL-17, TNF-α, RANK, RANKL, and OPG in peri-implant gingival tissue were not determinant for mini-implant stability loss, but the higher IL-6 expression could be associated with mini-implant failure.

Microbial species associated with dental caries found in saliva and in situ after use of self-ligating and conventional brackets.

OBJECTIVES: Enamel demineralization is among the main topics of interest in the orthodontic field. Self-ligating brackets have been regarded as advantageous in this aspect. The aim of this study was to evaluate the break homeostasis in the oral environment and the levels of microorganisms associated with dental caries among the different types of brackets. MATERIAL AND METHODS: Twenty patients received two self-ligating brackets: In-Ovation®R, SmartClipTM, and one conventional GeminiTM. Saliva was collected before bonding (S0), 30 (S1) and 60 (S2) days after bonding. One sample of each bracket was removed at 30 and 60 days for the in situ analysis. Checkerboard DNA-DNA Hybridization was employed to evaluate the levels of microbial species as-sociated with dental caries. Data were evaluated by nonparametric Friedman and Wilcoxon tests at 5% significance level. RESULTS: The salivary levels of L. casei (p=0.033), S. sobrinus (p=0.011), and S. sanguinis (p=0.004) increased in S1. The in situ analyses showed alteration in S. mutans (p=0.047), whose highest levels were observed to the In-Ovation®R. CONCLUSIONS: The orthodontic appliances break the salivary homeostasis of microorganisms involved in dental caries. The contamination pattern was different between self-ligating and conventional brackets. The In-Ovation®R presented worse performance considering the levels of cariogenic bacterial species.

Orthodontic appliances did not increase risk of dental caries and periodontal disease under preventive protocol.

OBJECTIVES: To assess periodontal parameters and microbial species levels after orthodontic appliance placement in patients who received oral hygiene instructions and who were monitored and motivated throughout the study. MATERIALS AND METHODS: The Periodontal Index was recorded and saliva collection was performed before (T0) and 30 (T1), 60 (T2), and 90 (T3) days after orthodontic appliance placement in 15 patients (mean age 17.53 ± 8.0 years). Analysis was carried out using checkerboard DNA-DNA hybridization. Nonparametric statistical analysis was performed. RESULTS: The Periodontal Index did not change. The total amount of the purple and red complexes and Candida species showed a significant decrease from T2. The green, yellow, and orange complex showed a significant decrease at T3. The specific species analysis showed that Prevotella nigrescens, Pseudomonas putida, Fusobacterium periodonticum, Pseudomonas aeruginosa, Peptostreptococcus anaerobius, and Tanerella forsythia showed high incidence before bonding, and their levels decreased at T2 and T3. Only Porphyromonas gingivalis showed increased levels at T2 and displayed the highest level at T3. The Streptococcus group decreased their levels from T2 onward. CONCLUSIONS: A dynamic change in microbial levels was identified. The decrease in the levels of complexes present was only possible due to the mechanical method of oral hygiene implemented in this sample.

Microbial species associated with dental caries found in saliva and in situ after use of self-ligating and conventional brackets

Abstract Objectives Enamel demineralization is among the main topics of interest in the orthodontic field. Self-ligating brackets have been regarded as advantageous in this aspect. The aim of this study was to evaluate the break homeostasis in the oral environment and the levels of microorganisms associated with dental caries among the different types of brackets. Material and Methods Twenty patients received two self-ligating brackets: In-Ovation®R, SmartClipTM, and one conventional GeminiTM. Saliva was collected before bonding (S0), 30 (S1) and 60 (S2) days after bonding. One sample of each bracket was removed at 30 and 60 days for the in situ analysis. Checkerboard DNA-DNA Hybridization was employed to evaluate the levels of microbial species as-sociated with dental caries. Data were evaluated by nonparametric Friedman and Wilcoxon tests at 5% significance level. Results The salivary levels of L. casei (p=0.033), S. sobrinus (p=0.011), and S. sanguinis (p=0.004) increased in S1. The in situ analyses showed alteration in S. mutans (p=0.047), whose highest levels were observed to the In-Ovation®R. Conclusions The orthodontic appliances break the salivary homeostasis of microorganisms involved in dental caries. The contamination pattern was different between self-ligating and conventional brackets. The In-Ovation®R presented worse performance considering the levels of cariogenic bacterial species.

Quantification of pro-inflammatory cytokines and osteoclastogenesis markers in successful and failed orthodontic mini-implants

Abstract Objectives: Miniscrew has been frequently used, considering that anchorage control is a critical point in orthodontic treatment, and its failure, the main adverse problem. Using two groups of stable (successful) and unstable (failed) mini-implants, this in vivo study aimed to quantify proinflammatory cytokines IL-1 α, IL-6, IL-17, and TNF-α and osteoclastogenesis marker RANK, RANKL, and OPG in gingival tissue, using the real-time polymerase chain reaction technique. Methodology: Thirteen patients of both sexes (11-49 years old) under orthodontic treatment were selected, obtaining 11 successful and 7 failed mini-implants. The mini-implants were placed and removed by the same surgeon, in both jaws. The mean time of permanence in the mouth was 29.4 months for successful and 7.6 months for failed mini-implants. At removal time, peri-mini-implant gingival tissue samples were collected and processed for quantification of the proinflammatory cytokines and osteoclastogenesis markers. Nonparametric Wilcoxon rank-sum test considering the clusters and Kruskal-Wallis test were used for statistical analysis (α=0.05). Results: No significant difference (p>0.05) was observed between the groups for either quantification of cytokines or osteoclastogenesis markers, except for IL-6 (p<0.05). Conclusions: It may be concluded that the expression of IL-1α, IL-17, TNF-α, RANK, RANKL, and OPG in peri-implant gingival tissue were not determinant for mini-implant stability loss, but the higher IL-6 expression could be associated with mini-implant failure.

Cytokine profile changes in gingival crevicular fluid after placement different brackets types.

OBJECTIVE: The aim of this study was to examine the relationship between bracket design and ratio of five proinflammatory cytokine, in gingival crevicular fluid (GCF), and bacterial adhesion without tooth movement influence. DESIGN: The sample was comprised of 20 participants, aged 11 to 15 years old (mean age: 13.3 years±1.03). A conventional Gemini™ metallic bracket and two self-ligating brackets, In-Ovation®R and SmartClip™, were bonded to the maxillary incisors and canines. GCF was collected using a standard filter paper strip before and 60days after bonding. The cytokine levels (IL-12, IL-1α, IL-1ß, IL-6 and TNF-α) were performed by the LUMINEX assay. The levels of the red and orange bacterial complexes were analyzed by the Checkerboard DNA-DNA hybridization. The data of cytokine and bacterial complexes were carried out using the non-parametric tests at 5% of significance level. RESULTS: Increased cytokine levels were observed. However, only the SmartClip™ group showed a significantly increased level of TNF-α (p=0.046). The SmartClip™ brackets group presented higher levels of red complex bacteria. CONCLUSIONS: The bracket design affected cytokine levels and bacterial adhesion since it was observed that the proinflammatory cytokines released in GCF to the SmartClip™ group showed an increase in the TNF-α levels associated with higher bacterial levels, which possibly represents greater inflammatory potential. Thereby, the bracket design should be considered in patients with risk of periodontal disease and root resorption.

Microbial complexes levels in conventional and self-ligating brackets.

OBJECTIVES: The aims were to evaluate the levels of bacterial species in saliva and in situ and to assess whether the design of brackets influences the risk of developing periodontal disease. MATERIALS AND METHODS: Twenty patients (13.3 mean age) were bonded with self-ligating brackets and a conventional bracket. Saliva was collected before bonding and 30 and 60 days after bonding. One sample of each bracket was removed 30 and 60 days after bonding. The analysis was determined by checkerboard DNA-DNA hybridization. The data was evaluated by the non-parametric test. RESULTS: A significant increase in the levels of bacterial species in the saliva occurred in 15 of the 22 analyzed species. The self-ligating brackets presented the highest incidence percentages for the orange and red complexes 60 days after bonding. In situ analyses showed different patterns according to the bracket design. The levels of Campylobacter rectus showed significant differences (p = 0.011) 60 days after bonding among the three brackets; the highest values were observed in the In-Ovation®R bracket. CONCLUSIONS: The bracket design seems to influence the levels of bacterial species involved in periodontal disease. Considering the wide variety of bacterial species, additional studies are needed to aid in the establishment of effective protocols to prevent the development of periodontal disease during orthodontic treatment. CLINICAL RELEVANCE: A dynamic alteration in the oral microbiota may lead to inflammatory reactions in the supporting soft and hard tissues. The different types of brackets interfere with bacterial adherence. Bracket design should be considered in orthodontic treatment.

Orthodontic-surgical treatment of Class III malocclusion with mandibular asymmetry.

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone discrepancy may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 15 years and 1 month with Class III skeletal malocclusion, having narrow maxilla, posterior open bite on the left side, anterior crossbite and unilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the maxillary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patient's final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.

Orthodontic-surgical treatment of class III malocclusion with mandibular asymmetry

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone discrepancy may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 15 years and 1 month with Class III skeletal malocclusion, having narrow maxilla, posterior open bite on the left side, anterior crossbite and unilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the maxillary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patient's final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.

A maloclusão esquelética de Classe III pode apresentar diversas etiologias, sendo a deficiência maxilar a mais frequente. Discrepâncias esqueléticas podem ter impacto estético desfavorável, muitas vezes agravadas pela presença de assimetrias faciais acentuadas. Este tipo de maloclusão é geralmente tratado com a associação de Ortodontia e cirurgia ortognática para a correção da oclusão e da estética facial. Este relato de caso apresenta o tratamento de um paciente com 15 anos e 1 mês de idade, com maloclusão esquelética de Classe III, atresia maxilar, mordida aberta posterior do lado esquerdo, mordida cruzada anterior e mordida cruzada posterior unilateral, acentuada discrepância dento-alveolar negativa acentuada no arco maxilar e desvios das linhas médias superior e inferior. Ao exame clínico o paciente também apresentava deficiência maxilar, aumento do terço inferior da face, perfil ósseo e facial côncavos e assimetria facial, com desvio da mandíbula para o lado esquerdo. O tratamento foi realizado em três fases: preparo ortodôntico pré-cirúrgico, cirurgia ortognática e finalização ortodôntica. Analisando os registros finais do paciente, os principais objetivos estabelecidos ao início do tratamento foram alcançados com sucesso, promovendo ao paciente adequada função mastigatória e estética facial agradável.