The effects of miniscrew-assisted rapid palatal expansion on the upper airway of adults with midpalatal suture in the last two degrees of ossification.

BACKGROUND: Transverse deficiencies of the maxillary basal bone have been treated in adult patients using miniscrew-assisted rapid palatal expansion (MARPE) therapy. However, the midpalatal suture's degree of ossification may affect the upper airway dimensions. This study compared the volumetric changes of the total upper, retropalatal, retroglossal airways, and the minimal transverse airway constriction after MARPE therapy in patients with midpalatal suture in the last stages of ossification. METHODS: This controlled clinical trial included a total of 20 adult patients (mean age 24.5 ± 6.2 years) with maxillary atresia treated with MARPE. Preoperative (T0) cone-beam computed tomography scans were used to determine the degree of midpalatal suture ossification. Two groups were formed considering the last two stages of sutural ossification "D" or "E" (n = 10 per group). After 120 days of the therapy (T1), cone-beam computed tomography assessments were performed to compare the pre and post-treatment outcomes. The total upper, retropalatal, and retroglossal airways and the minimal transverse airway constriction were evaluated. The three-dimensional reconstruction was performed with OsiriX MD software. The comparisons were carried out using mixed models for repeated measures at fixed time points (α = 0.05). RESULTS: Groups D and E showed no significant difference for any of the analyzed parameters (P > 0.05). Both groups showed a statistically significant increase for all airway segments after the treatment with MARPE (P < 0.05). The total upper airway increased (11.6% and 16.1%) for groups D and E, respectively (P = 0.3356). CONCLUSIONS: MARPE therapy resulted in dimensional gains of the upper airway for adult patients, irrespective of the intermaxillary sutural degree of ossification.

Should midline diastema in mixed dentition be an aesthetic concern?

BACKGROUND: Mixed dentition determines an important period of occlusion development in childhood. OBJECTIVE: This study aimed to evaluate the aesthetic impact of the midline diastema cut-off point in mixed dentition. DESIGN: A cross-sectional study was performed with 257 children aged 8-10 years in late mixed dentition, with midline diastema of 1-5 mm and normal maxillary overjet. Orthodontic Aesthetic Subjective Impact Score determined the aesthetic impact of the midline diastema. Four quartiles of diastema measurements and impact scores were considered as cut-off points. Receiver Operating Characteristic curves were constructed, and the distances representing the distances to the ideal point were calculated. The Yuden index determined the efficiency of measuring the diastema to assess the aesthetic impact. The Kruskal-Wallis test compared the groups of participants classified according to the diastema cut-off by the sample quartile regarding the impact score. The analyses were performed with a significance level of 5%. RESULTS: There was no significant difference between the four groups of measurement quartiles of the diastema regarding the aesthetic impact (P > .05). CONCLUSIONS: The perception of dental aesthetics in mixed dentition children was not affected by the midline diastema, regardless of the cut-off point.

Correlation between malocclusion and history of bullying in vulnerable adolescents.

OBJECTIVES: To assess the correlation between malocclusion and a history of bullying. MATERIALS AND METHODS: A cross-sectional study of 494 adolescents aged 12 to 15 years was conducted. The National School Health Survey questionnaire (PeNSE 1 and 2) was used to determine history of bullying by identifying the victim and the abuser. Variables were evaluated based on the individual (age), environment (income, father's and mother's education, housing, government assistance, and parents' occupation), social and emotional well-being (CPQ11-14 domains), self-perceived need for orthodontic treatment, and clinical conditions (crowding, diastema, maxillary and mandibular overjet, and anterior open bite). Data were analyzed by Spearman correlation and by multivariate analysis, which allowed graphical representation of the eight variables studied in only two dimensions. RESULTS: There was no correlation between bullying and variables related to the individual and the environment. Maxillary overjet and self-perception related to the need for orthodontic treatment were important to explain the data variability. CONCLUSIONS: Malocclusion did not correlate with bullying history. However, increased maxillary overjet influences adolescent self-perception, suggesting a potential condition for bullying events.

Temporomandibular disorder symptoms, sleep quality, and burnout syndrome in teachers.

OBJECTIVE: The aim of this study was to assess the association between the symptoms of temporomandibular disorder (TMD), sleep quality, and indicators of burnout syndrome in teachers. METHODS: This cross-sectional study included 330 teachers with an average age of 43 years. The Diagnostic Criteria for Temporomandibular Disorders, Pittsburgh Sleep Quality Index, and the questionnaire to assess burnout syndrome - teachers' version were used for data collection. Simple and multiple logistic regression models were applied to analyze the independent variables at a 5% significance level. RESULTS: Teachers with poor sleep quality, indicators of burnout syndrome, female sex, and impact on the domains of psychological exhaustion and guilt were, respectively, 1.91,1.92, 2.66, 1.97, and 2.60 times more likely to present at least one TMD symptom (p < 0.05). CONCLUSION: Teachers with indicators of burnout syndrome and impaired sleep quality were more likely to present with at least one TMD symptom.

Upper airways after mandibular advancement orthognathic surgery: A 4-year follow-up.

INTRODUCTION: The purpose of this study was to assess the stability of changes in the upper airways 4 years after orthognathic surgery in patients with skeletal Class II malocclusion. METHODS: A retrospective clinical study was conducted including 33 cone-beam computed tomography images from 11 patients (average age of 35.91 years) followed up longitudinally for 4 years. The airways were measured with the help of the Dolphin Imaging software (Dolphin Imaging and Management Systems, Chatsworth, Calif) at 3 points: T1 (preoperative), T2 (6 months after surgery), and T3 (4 years after surgery). The parameters assessed were surface area (SA), minimum axial area, and volume (VOL) of the pharyngeal airway space. The times were compared using analysis of variance and Tukey's test. Pearson's analysis was performed to assess the correlation with surgical changes and age (P <0.05). RESULTS: Four years after operating on the airway spaces, the means of SA and VOL were significantly higher than those observed before the surgery (P <0.05). The means at 6 months were intermediate, with no significant difference before the surgery and 4 years after it (P >0.05). There was no significant correlation of the changes in SA, VOL, and minimum axial area with the amount of mandibular advancement, counterclockwise rotation of the occlusal plane, and age of the patient (P >0.05). CONCLUSIONS: Four years after mandibular advancement surgery in patients with skeletal Class II malocclusion, the increases in the airways remained stable.

Anti-inflammatory and antimicrobial effects of Zingiber officinale mouthwash on patients with fixed orthodontic appliances.

INTRODUCTION: This study aimed to assess the anti-inflammatory and antimicrobial effects of mouthwashes with 0.12% chlorhexidine (CLX) and 0.5% Zingiber officinale essential oil (ZOEO). METHODS: The gas chromatography-mass spectrometry of ZOEO was developed, and the mouthwash was prepared. Thirty-one adult subjects of both sexes with fixed orthodontic appliances were selected. For 7 days, the mouthwashes with CLX, ZOEO, and flavored sterile water placebo were used randomly, with a 15-day interval between each solution. Saliva was collected before the first mouthwash, 1 minute and 15 minutes after it, and on the seventh day. The patients were subjected to clinical examinations of the bonded bracket index proposed by Ciancio, bleeding on probing, and sensory analysis (flavor). Generalized linear models were used to assess in vitro cell viability. The GENMOD procedure was used to assess the changes of bleeding on probing, and Friedman and Wilcoxon tests were used for data on colony-forming units per milliliter (CFU/mL), bonded bracket index, and flavor, at the 5% significance level. RESULTS: In the microbiologic analysis, the ZOEO mouthwash presented antimicrobial effectiveness for Streptococcus mutans as well as the CLX mouthwash, but it did not show the same substantivity. The ZOEO was efficient in controlling dental biofilm and reducing gingival bleeding. The sensory analyses showed that the flavor for ZOEO and CLX solutions presented low acceptability. CONCLUSIONS: The ZOEO mouthwash has an anti-inflammatory property with an effect on reducing gingival bleeding. However, it requires adjustments to the formulation to improve flavor quality.

Association between 2 indexes for evaluating malocclusion in the mixed dentition.

INTRODUCTION: This study aimed to associate 2 indexes for evaluating malocclusion in the mixed dentition. METHODS: A population-based cross-sectional study was conducted involving 743 children aged 8-10 years, divided into early and late mixed dentition. The Dental Aesthetic Index (DAI) and criteria proposed by Grabowski were used to evaluate malocclusion. Associations between the DAI (outcome variable) and the other independent variables (gender, race, and mixed dentition stage) were analyzed using logistic regression models. Simple logistic regression models were constructed, estimating the crude odds ratios with the respective 95% confidence intervals (CIs). The variables with P < 0.20 in the simple analyses were tested in multiple logistic regression models, estimating adjusted odds ratios with the respective 95% CIs. RESULTS: We found that 84.01% (185/220) of the diagnoses were coincidental between the Grabowski Index and DAI in patients without malocclusion. In contrast, 59.80% (439/734) of the patients were diagnosed by both indexes (Grabowski and DAI) with malocclusion. Children with malocclusion, diagnosed by the Grabowski Index, were 5.85 (P = 0.0001 and 95% CI: 4.08-8.39) times more likely to show malocclusions when diagnosed by the DAI. CONCLUSIONS: DAI and the criteria proposed by Grabowski were expressed differently in relation to malocclusion in the mixed dentition. This study suggests the importance of specific criteria for the evaluation of malocclusion at this stage of development.

A retrospective cephalometric study on upper airway spaces in different facial types.

BACKGROUND: Craniofacial growth pattern has been correlated with variations in size of the upper airway spaces. The objective of this study was to evaluate the nasopharyngeal, oropharyngeal, and hypopharyngeal airway spaces variations according to the craniofacial growth pattern, by comparing brachyfacial, mesofacial, and dolichofacial in Angle Class I individuals. METHODS: To measure the spaces, 45 lateral teleradiographs were used and divided into 3 groups per the craniofacial growth pattern, determined by the Tweed cephalometry angular measurements: FMA and Y-axis. To evaluate the airways, sleep apnea cephalometry was used, containing 28 points that compose 14 factors. Three groups were compared relative to each of the 14 sleep apnea cephalometry measurements. Adherence test to the normal curve was performed. For the non-normally distributed data-measurement of the inferior pharyngeal space-the Kruskal-Wallis test was used for comparison between the groups. For the remaining data, the distribution was normal and ANOVA test was used. RESULTS: Statistically significant difference was verified among the groups for the measurement of the median posterior-palatal space, with the difference being pointed out by the post hoc test between the brachyfacial and dolichofacial groups. For the other measurements, there was no statistically significant difference. CONCLUSIONS: It could be concluded that there was difference in the median posterior-palatal space measurement, in the oropharynx region, which was reduced for individuals with a dolichofacial pattern.