Relationship Between Diabetes Mellitus and Periodontal/Peri-Implant Disease: A Contemporaneous Review.

The prevalence of diabetes mellitus (DM), a major chronic disease and a leading cause of death and disability around the world, is rising. According to the latest data, the global prevalence of DM has increased to 463 million (9.3% of adults) in 2019 and is estimated to reach 700 million by 2045. Periodontal disease, result of periodontium inflammation, is a common, chronic disease and has long been considered one of the complications of DM. Moreover, literature reflects a spectrum of conflicting viewpoints on the effect of diabetic conditions on the implant treatment strategies. The current review aims to update the recent epidemiologic evidence regarding the relationship between DM and periodontal/peri-implant disease, emphasising the effects of glycaemic control on the severity of these diseases and describing the pathobiological mechanisms underlying this association. This review's findings indicate a bidirectional relationship between DM and periodontal/peri-implant disease and that this relationship seems causal, implying that controlling these two diseases might help prevent each other's incidence. Additionally, the severity of periodontal/peri-implant disease is directly related to metabolic control. Although patients with diabetes can obtain implant success similar to those in systemically healthy individuals, an increased risk of peri-implantitis has been reported in DM patients. Therefore, the importance of glycaemic control and maintaining proper oral hygiene cannot be overstated.

The association between high-density lipoproteins and periodontitis.

Periodontitis is one of the most typical chronic dental diseases. This inflammatory disease can change various functions of immune cells and impair lipid metabolism through proinflammatory cytokines. High-Density Lipoprotein (HDL) is considered protective of the cardiovascular system. It has anti-thrombotic and anti-inflammatory effects. In this article, we have reviewed the association between periodontitis and HDL. Various studies have demonstrated a reverse relationship between inflammatory cytokines and HDL. HDL contains antioxidative enzymes and proteins, whereas periopathogens impair HDL's antioxidant function. The presence of periodontal bacteria is associated with a low HDL level in patients with periodontitis. Genetic variants in the interleukin-6 (IL)-6 gene and cytochrome (CYP)1A1 rs1048943 gene polymorphism are associated with HDL levels and periodontal status. Studies showed that HDL levels improve after treatment for periodontitis. On the one hand, periodontal pathogenic bacteria and their metabolites and pro-inflammatory cytokines from periodontal infection can result in various disorders of lipid metabolism and lipid peroxidation. On the other hand, hyperlipidemia and lipid peroxidation stimulate proinflammatory cytokines, resulting in oxidative stress and delayed wound healing, making individuals susceptible to periodontitis.

The Role of High-density Lipoprotein in Oral and Dental Diseases.

High-density lipoprotein (HDL) is the smallest and densest of the lipoproteins. Beyond its well-known cardiovascular protective function, it has other actions, including structural function, anti-inflammatory, antioxidant, anti-thrombotic effects, transport of bioactive molecules, and induction of signal transduction pathways. Further, there is a mutual connection between oral health and general health. Hence HDL could be a potentially crucial factor relating oral health to general health. As far as we know, no comprehensive study has been carried out to date, which has explored the association between HDL concentration and oral diseases including lichen plan, recurrent aphthous ulcers, candidiasis, implant osseointegration, oral cancer and precancerous conditions. Here in this review, we summarized the relationship between HDL and oral health, suggesting a significant association between HDL concentration and oral health.

The efficacy of herbal medicine in the treatment of recurrent aphthous stomatitis: A systematic review of randomized clinical trials.

This systematic review was undertaken with the main aim of assessing the therapeutic effects of herbal medicines in recurrent aphthous stomatitis (RAS). A comprehensive search was performed in PubMed, Scopus, ISI Web of Science, and Google Scholar up to July 2021 to identify randomized clinical trials investigated the effects of herbal medicines on RAS. Thirty-three papers comprising 2,113 patients met the eligibility criteria, of which 30 studies had a high quality based on the Jadad scale. Totally, 22 out of 30 studies which assessed the pain showed that herbal agents significantly decreased the pain compared with the control group or placebo. In 17 out of 25 studies that evaluated ulcer size, herbal agents significantly reduced the size of ulcers compared with the control or placebo groups. In 15 out of 18 studies that assessed the healing time, herbal agents significantly reduced healing time in the intervention groups compared with the placebo or control groups. Few adverse events were reported only in four studies. Findings of the current review indicated medicinal plants and phytochemicals as effective and safe agents that for the treatment of RAS.

The effects of herbal medicines on cancer therapy-induced oral mucositis: A literature review.

Cancer therapy-induced oral mucositis (OM) is one of the most troublesome morbidities after radio-chemotherapy. Age, nutritional status, tumor type, oral hygiene, and treatment method are the determinants for OM incidence. In addition, oxygen-free radicals can act as a trigger for an inflammatory milieu that causes OM. Based on the debilitating nature of OM, finding a safe and inexpensive agent with anti-inflammatory, anti-microbial, and antioxidative properties can be valuable for this situation. Considering the harmful effects of some chemical agents, herbal medicine has been suggested as a potential alternative owing to unique properties such as safety, availability and low cost. Many studies have illustrated several pharmacological properties of herbal medicines in recent years, such as anti-inflammatory, anti-microbial, and antioxidative activities, which are essential factors in the palliation of cancer therapy-induced OM. This review aimed to evaluate herbal medicines' effects on cancer therapy-induced OM. According to this comprehensive review, it is concluded that medicinal plants and phytochemicals can be used as practical agents in the palliation of cancer therapy-induced OM without any serious side effects.

The Effects of Curcumin in the Treatment of Gingivitis: A Systematic Review of Clinical Trials.

Different modalities of treatments are available for management of gingival disease but most have adverse effects. Curcumin has anti-inflammatory properties and can be used for management of various inflammatory processes. This systematic review evaluates the effects of curcumin as an adjuvant to oral hygiene on plaque index (PI), gingival index (GI), gingival bleeding index (GBI), and inflammation in patients with gingivitis. A comprehensive search was conducted using PubMed/MEDLINE, Cochrane, SCOPUS, and Google Scholar. Based on the Population, Intervention, Control, and Outcome (PICO) model, clinical trials which tested the effects of curcumin as an adjunctive product or alone in control of gingival inflammation up until 21 February 2020 with language restrictions were selected. From the 422 papers found, 14 met the eligibility criteria. In most of these studies, curcumin treatment achieved significant reductions in PI, GI, GBI, and microbial colony count and was as effective as chlorhexidine mouthwash, with no serious adverse effects. We conclude that treatment with curcumin for gingivitis is safe as a natural herbal compound and is as effective as chlorhexidine mouthwash.

Does Curcumin Have an Anticaries Effect? A Systematic Review of In Vitro Studies.

BACKGROUND: Dental caries is one of the most important oral health problems and a common infectious microbial disease. Streptococcus mutans (S. mutans) has been regarded as the primary etiologic factor in the formation of dental caries. Curcumin (CUR) has an antibacterial action and could be used in the eradication of S. mutans to control dental caries. This systematic review was undertaken with the aim of evaluating the anticaries effect of CUR. METHODS: A comprehensive search was conducted in the PubMed/Medline, Cochrane - CENTRAL, and Scopus databases. Based on the PICO model, studies which evaluated the anticaries effects of CUR up until 24 February 2020 with language restrictions were selected for this systematic review. RESULTS: From 753 papers found, 13 met the eligibility criteria and were included. In 12 out of 13 included studies, CUR had significant antibacterial and anticaries effects. CUR had inhibitory effects on S. mutans growth, acid production, ATPase and sortase A activity, biomass, viability and metabolism reduction of biofilm, reduced exopolysaccharide production of biofilms, changes in biofilm structure, and had anti-adhesion effects against S. mutans. CONCLUSION: This systematic review suggests promising antibacterial and anticaries effects of CUR including inhibition of S. mutans growth, acid production, ATPase and sortase A activity. This review provides unique information regarding the potential role of CUR in the prevention and treatment of dental carries as a natural, accessible, safe, and inexpensive agent to increase oral and dental health. However, clinical randomized controlled trials are needed to confirm these results.

The Clinical Use of Curcumin for the Treatment of Recurrent Aphthous Stomatitis: A Systematic Review of Clinical Trials.

Recurrent aphthous stomatitis (RAS) lesions are inflammatory painful oral ulcers with uncertain etiology. Curcumin acts as an effective anti-inflammatory and antibacterial agent in the treatment of various oral diseases. This systematic review aimed to assess the effects of curcumin on RAS. A systematic search of the medical databases, PubMed, Scopus, ISI, Science Direct, and Google Scholar was performed up to March 30, 2020, to identify clinical trials assessing the effect of curcumin on aphthous ulcers. Nine studies comprising of 469 participants met all criteria and were analyzed. Treatment with curcumin significantly reduced aphthous ulcer size (seven studies), pain intensity (eight studies), number of aphthous ulcers (three studies), erythematous halo (one study), and erythema and exudate of the aphthous (one study). In four studies, the effect of curcumin on aphthous ulcer was assessed in comparison to the effects of the standard medication, triamcinolone. In all of these studies, curcumin had similar beneficial effects on the aphthous ulcer as measured by ulcer size, number, and pain. Only three studies were categorized as high quality using the Jadad scale. Within the limitations of this review, it can be concluded that curcumin may have a beneficial role in the treatment of recurrent aphthous ulcers. However, more randomized clinical trials are needed to validate these findings.

The Effects of Nutraceuticals and Herbal Medicine on Candida albicans in Oral Candidiasis: A Comprehensive Review.

Candida albicans is part of the healthy flora in the oral cavity. It can also cause opportunistic infection, which can be deleterious. The most typical type of chronic oral candidiasis is denture stomatitis, and C. albicans is identified as the most crucial organism in this situation. Due to the development of the resistant form of candida, using conventional drugs can sometimes be ineffective. Herbs and naturally imitative bioactive compounds could become a new source for antimycotic therapy. Several review studies suggest that herbal medicine and natural bioactive compounds have antibacterial, antiviral and antifungal effects. Thus, it is hypothesized that these natural products might have beneficial effects on pathogenic oral fungal flora such as C. albicans. Although the effects of herbs have been investigated as antifungal agents in several studies, to the best of our knowledge, the effects of these natural products on C. albicans have not yet been reviewed. Thus, the aim of this study was to review the anti-candida activity (especially C. albicans in oral candidiasis) of herbal medicines and natural bioactive compounds. It is concluded that, in general, medicinal plants and nutraceuticals such as garlic, green tea, propolis, curcumin, licorice root, cinnamon, resveratrol, ginger, and berberine are useful in the treatment of C. albicans in oral candidiasis and could be considered as a safe, accessible, and inexpensive management option in an attempt to prevent and treat oral diseases. However, most of the evidence is based on the in vitro and animal studies, so more clinical trials are needed.

Effect of Resin Infiltration Technique on Improving Surface Hardness of Enamel Lesions: A Systematic Review and Meta-analysis.

OBJECTIVE: White spot lesion (WSL) is recognized as the first clinical sign of enamel caries; it is a very critical phase because it can be prevented from progression to frank caries by changing the surrounding destructive environment. The present study was undertaken to systematically review the effect of resin infiltration (RI) technique on surface hardness (SH) of WSL. METHODS: Five electronic databases were searched with proper key words. Related titles and abstracts, up to October 2018, were screened, selected, and subjected to quality assessments. After collecting data, meta-analyses were carried out to compare the effect of RI with untreated WSL and sound enamel by using the STATA software. RESULTS: A total of 4567 articles were included in the study after initial search. Finally, 10 studies were reliable enough in methodology to be included in the study. Metadata analyses, carried out on 7 studies that compared SH of RI group with untreated samples, showed a significant increase in SH with 3.66 mean difference (95% confidence interval = 2.56‒4.77, Q value = 36.07, I2 = 83.4%). However, meta-analysis on 4 studies that compared SH of RI with sound enamel showed a significant decrease in SH with -2.35 overall mean difference (95% confidence interval = -3.91-0.98, P = .00, Q value = 31.75, I2 = 90.6%). CONCLUSION: The RI technique can enhance SH of WSL; however, regaining the SH of RI-treated WSLs similar to sound enamel is doubtful. Application of RI is more effective than other methods, including application of fluoride, enamel pro-varnish, adhesive, and colloidal silica infiltration for enhancing SH of WSLs.

The effects of statins on dental and oral health: a review of preclinical and clinical studies.

The statin family of drugs are safe and effective therapeutic agents for the treatment of arteriosclerotic cardiovascular disease (CVD). Due to a wide range of health benefits in addition to their cholesterol lowering properties, statins have recently attracted significant attention as a new treatment strategy for several conditions, which are not directly related to normalizing a lipid profile and preventing CVD. Statins exert a variety of beneficial effects on different aspects of oral health, which includes their positive effects on bone metabolism, their anti-inflammatory and antioxidant properties, and their potential effects on epithelization and wound healing. Additionally, they possess antimicrobial, antiviral, and fungicidal properties, which makes this class of drugs attractive to the field of periodontal diseases and oral and dental health. However, to the best of our knowledge, there has been no comprehensive study to date, which has investigated the effects of statin drugs on different aspects of dental and oral health. Therefore, the primary objective of this paper was to review the effect of statins on dental and oral health. Results of our extensive review have indicated that statins possess remarkable and promising effects on several aspects of dental and oral health including chronic periodontitis, alveolar bone loss due to either extraction or chronic periodontitis, osseointegration of implants, dental pulp cells, orthodontic tooth movement, and orthodontic relapse, tissue healing (wound/bone healing), salivary gland function, and finally, anti-cancer effects. Hence, statins can be considered as novel, safe, inexpensive, and widely-accessible therapeutic agents to improve different aspects of dental and oral health.

Bond strength of composite resin to white mineral trioxide aggregate: Effect of different surface treatments.

BACKGROUND: The main aim of restorative dentistry is to restore and preserve dental health with the use of appropriate restorative modalities to protect the pulp and restore its function. This study compared the effect of different surface treatments of mineral trioxide aggregate (MTA) on the bond strength of composite resin to MTA. MATERIALS AND METHODS: Forty cylindrical acrylic blocks with a hole were prepared and filled by ProRoot MTA. The samples were assigned to four groups: Group 1 - no surface treatment; Group 2 - phosphoric acid etching; Group 3 - sandblasting; and Group 4 - hydrofluoric acid (HF) etching, rinsing, and silane application. OptiBond Solo Plus adhesive was utilized in all the groups. Then, composite resin cylinders were bonded to sample surfaces. The samples were thermocycled and tested for microshear bond strength using a universal testing machine at a crosshead speed of 1 mm/min. Data were analyzed with Kruskal-Wallis and Mann-Whitney tests. Scanning electron microscopy images were prepared for each study group after surface treatments. RESULTS: Means and standard deviations of bond strength values in study groups 1-4 were 14.83 ± 7.76, 21.85 ±7.99, 6.48 ± 3.89, and 26.01 ± 11.09 Mpa, respectively. CONCLUSIONS: Within the limitations of this study, phosphoric acid etching or HF etching plus silanization was preferred to surface treatment of MTA before composite resin bonding.

Interfacial fracture toughness of universal adhesive systems treated with an antioxidant.

BACKGROUND: Secondary caries, degradation of the dentin-resin interface and fracture of the restoration are the most common forms of failure. The aim of this study was to assess the interfacial fracture toughness of three different adhesive approaches and to compare their fracture toughness after surface treatment with antioxidant. MATERIAL AND METHODS: Seventy two dentin blocks with 3×4mm dimension and 3mm thickness were prepared and attached to precured 3×4×12mm composite blocks from both sides. Six adhesive groups (N=12), All-bond universal, Scotchbond universal and Clearfil SE bond with or without antioxidant treatment (Sodium Ascorbate 10% )were applied to dentin surfaces, a 160µ polyethylene paper formed the chevron in adhesive-dentin interfaces. Chevron-notched beam fracture toughness was measured following a modified ISO 24370 standard. The uniform composite-dentin-composite block was subjected to a 4-point test in universal machine. Data were analyzed by Kruskal-Wallis, Wilcoxon signed-rank and Mann-Whitney tests (α =0.05). RESULTS: Different adhesive approaches yielded different significant in fracture toughness rates. A significant increase of fracture toughness was observed between adhesive groups after antioxidant surface treatment. The difference in fracture toughness between Scotchbond universal and All-bond universal were significant. CONCLUSIONS: The highest value of fracture toughness was reported for Clearfil SE bond and the lowest value was found for All-bond universal. Sodium ascorbate as antioxidant surface treatment had a significant effect in increasing the fracture toughness. Key words:Chevron-notched beam fracture toughness, fracture toughness, dentin, adhesive, antioxidant.

Chair time saving method for treatment of an impacted maxillary central incisor with 15-month follow-up.

Maxillary permanent incisors have a major role in facial esthetics. Impaction of them has great adverse effect on smile and causes serious concerns in patient and parents. Physical barriers (e.g., overretained primary teeth, supernumerary teeth, and pathologic lesions), space problems, developmental abnormalities, altered eruption sequence, trauma, palatal clefts, and genetics can act as etiologic factors. Currently, the conventional technique to treatment of impacted teeth consists of a combined orthodontic and surgical approach, to guide the impacted teeth in a constant position and surrounded by normal hard and soft tissues. Treatment is challenging because of some limitations such as patient's age, cooperation, anchorage, and mechanotherapy possibilities. Hence, sophisticated treatment planning is crucial. A 9-year-old girl with horizontally impacted maxillary left central incisor treated with surgical exposure and closed orthodontic forced eruption with 2 × 4 partial setup fixed appliances. Force was applied with 0.014 inch nickel-titanium wire as elastic overlay and handmade ligated bracket. To save chair time in each appointment, the overlay was activated by twisting of ligature wire extensions around it. After 16-month treatment, impacted incisor emerged in oral cavity, with accepted alignment and inclination. Handmade ligated bracket with ligature wire extensions is useful for the treatment of impacted teeth. Due to easy activation of overlay in this method, chair time become short in each appointment.

Effect of Intracanal Irrigants on Coronal Fracture Resistance of Endodontically Treated Teeth Undergoing Combined Bleaching Protocol: An In Vitro Study.

OBJECTIVES: Irrigation plays a critical role in endodontic treatment. Various single and combined irrigants and irrigation protocols are available. The aim of this study was to evaluate the effect of some common irrigation protocols on the coronal fracture resistance of endodontically treated teeth undergoing bleaching. MATERIALS AND METHODS: After preparation of access cavities in 120 maxillary premolars, the teeth were divided into five groups (n=24) based on the irrigation protocol; G1:2.5% sodium hypochlorite (NaOCl), G2: 2% chlorhexidine (CHX), G3: NaOCl+CHX, G4: NaOCl+ethylenediaminetetraacetic acid (EDTA), G5: NaOCl+EDTA+CHX. Each group was subdivided into 2 subgroups of A: non-bleached (NB) and B: bleached (B). In subgroup B, the teeth underwent in-office and at-home bleaching techniques using 38% hydrogen peroxide and 20% carbamide peroxide gels for 3 weeks. The teeth were restored with composite resin, thermocycled, incubated for 24 hours, and underwent fracture resistance tests. Data were analyzed with one-way analysis of variance (ANOVA) and t-test (α=0.05). RESULTS: T-test showed significant differences between every two corresponding groups (P<0.0001). In subgroup A, the minimum fracture resistance was recorded in G1. Also, G2 specimens exhibited a significantly higher fracture resistance compared to G1, G4, and G5. In subgroup B, G2 specimens exhibited a significantly higher fracture resistance compared to G1 and G4 that were irrigated using NaOCl and NaOCl+EDTA. CONCLUSIONS: It can be concluded that irrigation protocols can affect the coronal fracture resistance of bleached endodontically treated teeth, and specific irrigation protocols can be recommended for teeth undergoing bleaching.

Influence of Intracanal Irrigants on Coronal Fracture Resistance of Endodontically Treated and Bleached Teeth: An In vitro Study.

BACKGROUND: Irrigation has a key role in the success of endodontic treatment. Intracanal irrigant solutions have adverse effects on the physical properties of dentin. AIM: The present study aimed to evaluate the effect of different irrigation protocols on coronal fracture resistance of endodontically treated teeth undergoing bleaching treatment. DESIGN AND MATERIALS AND METHODS: Access cavities were prepared in 120 maxillary premolars which were divided into two groups (n = 60) - Group A: nonbleached, Group B: bleached (B). Each group was subdivided into five subgroups based on irrigation protocol (n = 12); G1: normal saline (NS), G2: 2.5% sodium hypochlorite (NaOCl), G3: 10% citric acid (CA), G4: 17% ethylene diamine tetra acetic acid, and G5: NaOCl plus CA. In Group B, the teeth were bleached using 38% hydrogen peroxide and 20% carbamide peroxide gels as in-office and at-home bleaching techniques for 3 weeks. All the teeth were restored with composite resin, thermocycled, and incubated for 24 h. The specimens underwent fracture resistance tests. Data were analyzed with ANOVA, Tukey honestly significant difference test, t-test, and Chi-squared test (α =0.05). RESULTS: T-test showed significant differences between each two corresponding subgroups (P < 0.0001). In Group A, NS demonstrated significantly higher fracture resistance compared to others; however, minimum fracture resistance recorded in G2. In Group B, the maximum fracture resistance was recorded in G1, with the minimum being recorded in G5. Samples irrigated with NaOCl and NaOCl plus CA exhibited significantly lower fracture resistance compared to NS subgroup (P < 0.05). CONCLUSIONS: Within the limitations of this study, it can be concluded that the irrigation protocol used during endodontic treatment with/without bleaching can affect the coronal fracture resistance.

Comparison of the Dentin Bond Strength of Two Self-Etch Adhesives After Prolonged Air-Drying and Additional Light-Curing.

OBJECTIVES: It has been reported that the water, solvents, or the primer incorporated into adhesive resins decrease the polymerization, compromise the mechanical properties, reduce the bond strength, and lead to a poor bonding performance of self-etch adhesives. This article evaluated the effect of air-drying and light-curing duration of self-etch adhesives on the micro-shear bond strength between composite resin and dentin. MATERIALS AND METHODS: A total of 120 extracted sound human third molars were randomly divided into twelve groups (n=10). The occlusal dentin in each tooth was exposed. Clearfil SE Bond (CSEB) and Clearfil S3 Bond (CS3B) were used according to the manufacturer's instructions, followed by air-drying for 3 and 10 seconds in different groups. The adhesives were light-cured for 10, 20 and 40 seconds in different subgroups. Next, the composite resin (Clearfil AP-X) was placed on the dentin surface and was polymerized for 40 seconds. The micro-shear bond strength values were determined using a universal testing machine, and the results were statistically analyzed by three-way ANOVA and Tukey's post-hoc test (α=0.05). RESULTS: CSEB exhibited a significantly higher dentin bond strength than CS3B. Increasing the curing time of CSEB resulted in an increase in the bond strength, whereas an increase in the air-drying time did not affect the bond strength of the two adhesives. CONCLUSIONS: Within the limitations of this study, an increase in the curing time improved the bond strength of CSEB, whereas the air-drying time did not affect the bond strength of the evaluated adhesives.

Effect of three nanobiomaterials on microhardness of bleached enamel.

OBJECTIVES: The aim of this in vitro study was to evaluate the effect of incorporating three different nanobiomaterials into bleaching material on microhardness of bleached enamel. MATERIALS AND METHODS: The crowns of 24 extracted sound human molars were sectioned. Sixty enamel specimens (2 × 3 × 4 mm) were selected and divided into five groups (n = 12): Group 1 received no bleaching procedure (control); Group 2 underwent bleaching with a 40% hydrogen peroxide (HP) gel; Groups 3, 4, and 5 were bleached with a 40% HP gel modified by incorporation of bioactive glass (BAG), amorphous calcium phosphate (ACP) and hydroxyapatite (HA), respectively. The enamel microhardness was evaluated. The differences in Knoop microhardness data of each group were analyzed by one-way ANOVA, followed by post hoc Tukey tests. RESULTS: Significant differences were observed between the study groups. The enamel microhardness changes in Groups 1, 3, 4, and 5 were significantly lower than that of Group 2 (p < 0.001). CONCLUSIONS: Within the limitations of this study, it can be concluded that incorporation of each one of the three tested biomaterials as remineralizing agents might be effective in decreasing enamel microhardness changes subsequent to in-office bleaching.

Bilateral en-masse distalization of maxillary posterior teeth with skeletal anchorage: a case report.

OBJECTIVE: The aim of this study was to introduce a new method for bilateral distal movement of the entire maxillary posterior segment. CASE REPORT: A 17-year-old girl with Class I skeletal malocclusion (end-to-end molar relationships, deviated midline and space deficiency for left maxillary canine) was referred for orthodontic treatment. She did not accept maxillary first premolars extraction. A modified Hyrax appliance (Dentaurum Ispringen, Germany) was used for bilateral distalization of maxillary posterior teeth simultaneously. Expansion vector was set anteroposteriorly. Posterior legs of Hyrax were welded to first maxillary molar bands. All posterior teeth on each side consolidated with a segment of 0.017 × 0.025-in stainless steel wire from the buccal side. Anterior legs of Hyrax were bent into eyelet form and attached to the anterior palate with two mini-screws (2 × 10 mm) (Jeil Medical Corporation Seoul, South Korea). Hyrax opening rate was 0.8 mm per month. Lateral cephalometric radiographs were used to evaluate the extent of distal movement. 3.5-mm distalization of posterior maxillary teeth was achieved in five months. RESULTS: A nearly bodily distal movement without anchorage loss was obtained. CONCLUSION: The mini-screw-supported modified Hyrax appliance was found to be helpful for achieving en-masse distal movement of maxillary posterior teeth.

Bilateral en-masse distalization of maxillary posterior teeth with skeletal anchorage: a case report

ABSTRACT Objective: The aim of this study was to introduce a new method for bilateral distal movement of the entire maxillary posterior segment. Case report: A 17-year-old girl with Class I skeletal malocclusion (end-to-end molar relationships, deviated midline and space deficiency for left maxillary canine) was referred for orthodontic treatment. She did not accept maxillary first premolars extraction. A modified Hyrax appliance (Dentaurum Ispringen, Germany) was used for bilateral distalization of maxillary posterior teeth simultaneously. Expansion vector was set anteroposteriorly. Posterior legs of Hyrax were welded to first maxillary molar bands. All posterior teeth on each side consolidated with a segment of 0.017 × 0.025-in stainless steel wire from the buccal side. Anterior legs of Hyrax were bent into eyelet form and attached to the anterior palate with two mini-screws (2 × 10 mm) (Jeil Medical Corporation Seoul, South Korea). Hyrax opening rate was 0.8 mm per month. Lateral cephalometric radiographs were used to evaluate the extent of distal movement. 3.5-mm distalization of posterior maxillary teeth was achieved in five months. Results: A nearly bodily distal movement without anchorage loss was obtained. Conclusion: The mini-screw-supported modified Hyrax appliance was found to be helpful for achieving en-masse distal movement of maxillary posterior teeth.

RESUMO Objetivo: o objetivo do presente estudo foi apresentar um novo método para a distalização bilateral de todo o segmento posterior superior. Relato do caso: uma jovem de 17 anos de idade, com má oclusão esquelética de Classe I (relação de molares em topo a topo, linha média desviada e deficiência de espaço para o canino superior esquerdo) foi encaminhada para tratamento ortodôntico, mas recusou-se a autorizar a extração dos primeiros pré-molares superiores. Um aparelho Hyrax modificado (Dentaurum, Ispringen, Alemanha) foi utilizado para a distalização bilateral simultânea dos dentes posteriores superiores. O vetor de expansão foi definido no sentido anteroposterior. As barras de conexão posteriores do Hyrax foram soldadas às bandas dos primeiros molares superiores. Em cada um dos lados, todos os dentes posteriores foram agrupados com um segmento de fio de aço inoxidável de calibre 0,017" x 0,025" passando por vestibular. As barras de conexão anteriores do Hyrax foram dobradas em forma de loop e conectadas à região anterior do palato por meio de dois mini-implantes (2 x 10mm) (Jeil Medical Corporation, Seoul, Coreia do Sul). A taxa de abertura do Hyrax foi de 0,8mm / mês. Telerradiografias laterias foram usadas para avaliar a extensão dos movimentos de distalização. Resultados: em um prazo de cinco meses, foi obtida uma distalização de 3,5mm dos dentes posteriores superiores. O movimento realizado foi praticamente de corpo (translação), sem qualquer perda de ancoragem. Conclusão: o aparelho Hyrax modificado suportado por mini-implantes mostrou-se útil para efetuar o movimento de distalização em massa dos dentes posteriores superiores.