Periodontal evaluation after maxillary expansion with a tooth-bone-borne expander in growing patients : A randomized clinical trial.

PURPOSE: This two-arm parallel randomized controlled trial aimed to evaluate and compare periodontal changes due to rapid maxillary expansion (RME) using tooth-bone-borne and tooth-borne devices in growing patients via clinical examinations and cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Forty-two eligible patients (aged 11-14 years; transverse maxillary deficiency, posterior crossbite) were screened and divided into two groups based on the treatment received (randomization was performed using computer-generated numeric sequences): hybrid hyrax tooth-bone-borne group (TBB) and hyrax tooth-borne group (TB). The primary outcome was the change in cortical bone thickness (by CBCT). In addition, the clinical attachment level (CAL), gingival recession, and bleeding were assessed. Both examinations were performed before and 3 months after the activation phase. Intergroup comparisons were performed using analysis of covariance (ANCOVA; P < 0.05). RESULTS: Twenty-one patients (12 girls and 9 boys; mean initial age, 13.3 years) were included in the TBB group and 21 (5 girls and 16 boys; mean initial age, 13.2 years) were included in the TB group. The TB group exhibited a decrease in buccal bone thickness in the first premolars and first molars at all three evaluated levels. Specifically, tooth 14 at 3 mm from the enamel-cement junction showed a significant width reduction (0.7 mm; p < 0.001), accompanied by a notable increase in palatal cortical thickness at 6 mm of enamel-cement junction (1.13 mm; p < 0.001). CONCLUSIONS: RME resulted in buccal bone thickness reduction at the first premolar with hyrax treatment. In the molar region, both devices resulted in cortical bone alterations that were less pronounced in the TBB group.

[Fixed orthodontic appliances and clear aligner system: a comparative review]. / Aparatos ortodónticos fijos y el sistema de alineadores transparentes: una revisión comparativa.

One of the biggest controversies in current orthodontics is determining the appliance to use, since today patients seek better results in shorter times, in addition to putting aesthetics first. OBJECTIVE: compare the benefits and disadvantages that arise when using fixed orthodontic appliances and transparent aligners. MATERIALS AND METHODS: An investigation and compilation of specialized bibliographic information on the topic was carried out in scientific search engines such as PubMed, SciElo and Web of Science between the years 1991 to 2023, focused on research work related to the effects of the use of orthodontic appliances. fixed compared to clear aligners. RESULTS: The review was carried out based on 53 articles found that met the selection criteria. CONCLUSION: Fixed orthodontic appliances are better in complex cases, they are more precise and less likely to relapse; Transparent aligners are more aesthetic, hygiene is more affective and the bone density of the mandibular condyle decreases.

Expression of artefacts from different orthodontic brackets and wires in cone beam computed tomography scans-an in vitro study.

OBJECTIVES: To investigate artefacts produced by different orthodontic brackets and wires in cone-beam computed tomography (CBCT) scans. MATERIALS AND METHODS: Two dental arches were made using extracted human teeth and plaster. Three pairs of acetate plates containing different brackets - metallic, ceramic, and self-ligating ceramic with NiTi clip - along with a control plate (i.e., without brackets) were prepared. Wire changes (NiTi and steel) were made during CBCT acquisitions, performed with a fixed exposure protocol. Axial slices were selected for mean gray values and standard deviation measurement in three regions of interest (buccal, lingual, and tooth). Noise and contrast-to-noise ratio (CNR) were calculated and compared among the different brackets and wires by ANOVA with a significance level of 5%. RESULTS: Overall, the buccal and tooth region were mostly affected by the metallic and self-ligating brackets, showing higher noise, and lower CNR (p < 0.05). On the other hand, less impact of ceramic brackets in the image quality was observed (p ≥ 0.05). The lingual region did not show expressive differences among the brackets and wire combinations (p ≥ 0.05). The presence of wire associated with the brackets did not worsen image quality (p ≥ 0.05). CONCLUSIONS: In conclusion, metallic and self-ligating brackets have greater artefact expression than ceramic brackets. The wire did not influence image quality. CLINICAL RELEVANCE: One should pay attention to the type of brackets when requesting a CBCT scan during treatment, as metallic and self-ligating brackets may express greater artefacts than ceramic brackets.

The Effect of Motivational Interviewing on Oral Hygiene Behavior in Patients With Fixed Orthodontic Appliances: A Randomised Clinical Trial

The aim of this study was to evaluate the effectiveness of motivational interviewing on improving oral hygiene behavior in patients with fixed orthodontics appliances. A parallel-group randomized clinical trial was conducted with 45 patients of the Orthodontic Clinic of Unibe's Postgraduate Unit. A computer-generated list of numbers created with SPSS V21.0 was used to randomly allocate participants into the experimental or the control group. Monthly oral hygiene instructions and an oral hygiene kit from GUM® with special orthodontic hygiene tools were given to the participants. Furthermore, the experimental group underwent motivational interviewing sessions facilitated by a periodontist who received training from two expert psychologists. These psychologists also provided supervision to the interviewer, ensuring the accurate implementation of the intervention. Simplified Oral Hygiene Index (SOHI), Gingival Index (GI), Periodontal Probing Depth (PPD) and Bleeding on Probing (BoP) were recorded at baseline, three and six months after the beginning of the study. The participant and the evaluator (another periodontist who recorded the data) were masked. Repeated-measures mixed- model analysis of variance and chi-squared test were conducted. Mean SOHI, GI, PPD and BoP scores did not differ significantly across the three time points (baseline, three and six months). Nevertheless, a significant interaction on SOHI scores (F (2, 58) = 3.463, p = .038, h2 = .052) was found between the sessions and the treatment conditions (experimental vs control group) at the third and sixth month. Motivational interviewing plus oral hygiene instructions appears to maintain a better control of dental biofilm and calculus in comparison with conventional oral hygiene instructions alone.

El objetivo de este trabajo fue evaluar la efectividad de las entrevistas motivacionales para mejorar el comportamiento de higiene oral en pacientes con aparatos ortodóncicos fijos. Se llevó a cabo un ensayo clínico aleatorizado de grupos paralelos con 45 pacientes de la Clínica de Ortodoncia de la Unidad de Posgrado de Unibe. Se utilizó una lista de números generada por computadora con SPSS V21.0 para asignar aleatoriamente a los participantes al grupo experimental o de control. Se les proporcionó a los participantes instrucciones mensuales de higiene oral y un kit de higiene oral de GUM® con utensilios de higiene especiales para ortodoncia. Además, el grupo experimental recibió sesiones de entrevista motivacional facilitadas por un periodoncista capacitado por dos psicólogas expertas. Estas psicólogas también supervisaron al entrevistador, asegurando la implementación precisa de la intervención. Se registró el Índice Simplificado de Higiene Oral (IHO-S), el Índice Gingival (IG), la Profundidad de Sondaje Periodontal (PS) y el Sangrado al Sondaje (SS) al inicio, a los tres y seis meses después del inicio del estudio. Tanto el participante como el evaluador (otro periodoncista que registró los datos) estaban enmascarados. Se realizaron análisis de varianza de medidas repetidas con modelo mixto y pruebas de chi-cuadrado. Las puntuaciones medias del IHO-S, IG, PS y SS no difirieron significativamente en los tres momentos (inicio, tres y seis meses). Sin embargo, se encontró una interacción significativa en las puntuaciones del IHO-S (F (2, 58) = 3.463, p = .038, h2 = .052) entre las sesiones y las condiciones de tratamiento (grupo experimental vs grupo de control) en el tercer y sexto mes. Las entrevistas motivacionales junto con las instrucciones de higiene oral parecen mantener un mejor control de la biopelícula dental y el cálculo en comparación con las instrucciones convencionales de higiene oral por sí solas.

Evaluation of the success of predicted dental changes with clear-aligner treatment: A pilot study.

Objective: This pilot study concerned evaluation of the success of predicted dental changes in patients presenting with Class I malocclusions who were submitted to treatment aligners, using the superimposition. Methods: The digital models were superimposed and analyzed using 3DSlicer 5.0 software. Treatment and predicted changes regarding horizontal and vertical linear displacements, mesiodistal rotations, and incisor buccolingual tipping were quantified. The success rates were calculated by dividing the mean treatment change amount by the predicted change amount. Results: Lower-incisor intrusion was the most accurate of the predicted vertical displacements (86.96 %), and buccal expansion of upper canines (99.32 %) and mesial translation of the lower incisors (98.57 %) were the most accurate horizontal linear displacements. The predicted rotation was achieved with the highest accuracy for lower incisors (75.69 %). Incisor buccolingual tipping success rates ranged between 45.78 % and 69.31 %. Low accuracy of predicted changes was found for upper-molar extrusion (10.23 %) and constriction (8.91 %). However, minimal corrections in these directions were planned. Conclusions: Dental changes for all regions of maxillary and mandibular arches could be evaluated. High success rates were observed for most of the movements planned for ClearCorrect aligner therapy.

Influence of pain duration and severity on oral health-related quality of life and patient satisfaction during adult treatment with clear aligners.

BACKGROUND: This study aims to compare the impact of pain on quality of life and patient satisfaction during treatment with aligners. METHODS: Ninety-four subjects in active treatment were invited to answer self-reported questions concerning pain severity and duration, occurrence of other signs and symptoms, and level of satisfaction with their treatment. Also, the OHIP-14 questionnaire was applied to assess patients' OHRQoL. RESULTS: Ninety-four patients (49 women and 45 men) answered the survey. Pain duration of 1-3 days was reported by 69.1% of patients (n = 60). For those who reported pain (n = 84), it was considered mild severity by 42.9% and moderate by 52.4%. Almost sixty-four percent of the sample were very satisfied with the aligner's aesthetics (n = 60) and forty-nine percent were satisfied with treatment in general (n = 46). Mean OHIP-14 score was 3.36 ± 2.54. OHRQoL was significantly associated with pain severity, whereas patients who reported having experienced moderate pain presented a significantly higher mean OHIP-14 score than those who reported having experienced mild pain (3.92 ± 1.93 and 2.69 ± 2.83, respectively; p = 0.036). The "psychological discomfort" OHIP-14's domain was the most influenced by the level of pain. CONCLUSION: Pain severity significantly influenced OHRQoL, in adult patients under treatment with clear aligners. However, high levels of patient satisfaction were reported, regardless of pain duration or severity.

Assessment of patients' knowledge and preferences for the use of orthodontic aligners.

OBJECTIVE: To evaluate the knowledge and preference of patients treated at a Dental School in Jaraguá do Sul, Brazil, about using aligners and the reasons for choosing this device as a treatment option. DESIGN: A cross-sectional study. PARTICIPANTS: A total of 82 participants aged 18-45 years recruited at a screening clinic. METHODS: A questionnaire was completed in person using a tablet with digital forms. RESULTS: Almost half of the participants (49%) knew about aligners; 40% were aged 18-24 years, and 77% were female. When observing the images of the types of orthodontic appliances, the aligners had an acceptance rate of 80%. Among the reasons that led to the preference for choosing aligners, 68% cited aesthetics and 42% comfort. CONCLUSION: Recently, clear aligners have become a popular choice for orthodontic treatment, particularly among adults. Despite their popularity and effectiveness, many patients still need more information about aligner treatment. Over half of the respondents did not know what orthodontic aligners were. Younger participants had more knowledge about aligners than older participants. Patients still need more knowledge about the types of appliances available for orthodontic treatment. When presented with images of the kinds of devices available, almost 80% of participants showed greater satisfaction with aligners.

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

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

Efficacy of microchips and 3D sensors for orthodontic force measurement: A systematic review of in vitro studies.

OBJECTIVE: To evaluate the efficacy of microchips and 3D microsensors in the measurement of orthodontic forces. METHODS: Through September 2023, comprehensive searches were conducted on PubMed/MEDLINE, SCOPUS and SCIELO without restrictions. RESULTS: After removing duplicate entries and applying the eligibility criteria, 23 studies were included for analysis. All the studies were conducted in vitro, and slightly more than half of them were centred on evaluating orthodontic forces exerted by aligners. Eight utilized microchips as measurement tools, while the remaining studies made use of 3D microsensors for their assessments. In the context of fixed appliances, key findings included a high level of agreement in 3-dimensional orthodontic force detection between simulation results and actual applied forces. Incorporating critical force-moment combinations during smart bracket calibration reduced measurement errors for most components. Translational tooth movement revealed a moment-to-force ratio, aligning with the bracket's centre of resistance. The primary findings in relation to aligners revealed several significant factors affecting the forces exerted by them. Notably, the foil thickness and staging were found to have a considerable impact on these forces, with optimal force transmission occurring at a layer height of 150 µm. Furthermore, the type of material used in 3D-printing aligners influenced the force levels, with attachments proving effective in generating extrusive forces. Deliberate adjustments in aligner thickness were observed to alter the forces and moments generated. CONCLUSIONS: Microchips and 3D sensors provide precise and quantitative measurements of orthodontic forces in in vitro studies, enabling accurate monitoring and control of tooth movement.

The effect of micro-osteoperforations on the rate of maxillary incisors' retraction in orthodontic space closure: a randomized controlled clinical trial.

BACKGROUND: This single-centered randomized controlled clinical trial aimed to evaluate the effectiveness of micro-osteoperforations (MOPs) in accelerating the orthodontic retraction of maxillary incisors. METHODS: Forty-two patients aged 16-40 were recruited and randomly assigned into two groups, one which underwent MOPs (MOPG) in the buccal and palatal region of all maxillary incisors immediately before the start of retraction and one which did not (CG). Eligibility criteria included the orthodontic need for maxillary first premolars extraction and space closure in two phases. The primary outcome of the study consisted of measuring the rate of space closure and, consequently, the rate of incisors' retraction using digital model superimposition 14 days later and monthly thereafter for the next 4 months. The secondary outcomes included measuring anchorage loss, central incisors' inclination, and root length shortening, analyzed using cone beam computed tomography scans acquired before retraction and 4 months after retraction. Randomization was performed using QuickCalcs software. While clinical blinding was not possible, the image's examinator was blinded. RESULTS: Twenty-one patients were randomly assigned to each group. However, due to various reasons, a total of 37 patients (17 male and 20 female) were analyzed (mean age: 24.3 ± 8.1 years in the MOPG; 22.2 ± 4.2 years in the CG) during the trial. No statistically significant difference was found between the MOPG and the CG regarding the incisors' retraction measured at different time points at the incisal border (14 days, 0.4 mm vs. 0.5 mm; 1 month, 0.79 mm vs. 0.77 mm; 2 months, 1.47 mm vs. 1.41 mm; 3 months, 2.09 mm vs. 1.88 mm; 4 months, 2.62 mm vs. 2.29 mm) and at the cervical level (14 days, 0.28 mm vs. 0.30 mm; 1 month, 0.41 mm vs. 0.32 mm; 2 months, 0.89 mm vs. 0.61 mm; 3 months, 1.36 mm vs. 1.10 mm; 4 months, 1.73 mm vs. 1.39 mm). Similarly, no statistically significant differences were detected in the space closure, anchorage loss, central incisors' inclination, and radicular length between groups. No adverse effect was observed during the trial. CONCLUSIONS: MOPs did not accelerate the retraction of the maxillary incisors, nor were they associated with greater incisor inclination or root resorption. Trial registration ClinicalTrials.gov NCT03089996. Registered 24 March 2017- https://clinicaltrials.gov/ct2/show/NCT03089996 .

Microbial contamination profile on esthetic elastomeric ligatures through the checkerboard DNA-DNA hybridization technique : A randomized split-mouth study.

OBJECTIVE: The aim of this study is to assess the microbial contamination of three different brands of esthetic elastomeric ligatures. MATERIALS AND METHODS: Different brands of esthetic ligatures (Unistick Pearl [American Orthodontics, Sheboygan, WI, USA], Power Sticks Pearl [Ortho Technology, Tampa, FL, USA], and Ease [Obscure, 3M Unitek, Monrovia, CA, USA]) were randomly assigned to permanent canines of 25 patients (aged 11-18 years) undergoing corrective orthodontic treatment. After 30 days, the ligatures were removed, processed, and the biofilm composition was analyzed by checkerboard DNA-DNA hybridization for 40 bacterial species. The microbiological data were analyzed using a nonparametric mixed model. RESULTS: The ligatures presented intense microbial contamination after 30 days, but no statistically significant differences were observed among the three groups (p > 0.05). The levels of the evaluated individual species and proportions of the microbial complexes showed no statistically significant differences among the ligature groups (p > 0.05). CONCLUSIONS: Esthetic elastomeric ligatures became multicolonized by several bacterial species after 30 days of exposure to the oral cavity. However, no relevant differences were observed among the biofilm composition formed on the different ligature brands.

A finite element study comparing Advansync® and Twin Block in mandibular anterior repositioning.

OBJECTIVE: This study aims to utilize the finite element method (FEM) to compare the dentoalveolar and mandibular effects associated with anterior mandibular repositioning using AdvanSync® (ADV) and Twin Block (TB). METHODS: A patient with Class II skeletal malocclusion and mandibular retrognathism was selected. A TB appliance was subsequently applied. Computed Tomography (CT) scans were acquired at the beginning of treatment (T1) and 8 months later (T2). Concurrently, a numerical TB model was validated through FEM simulations, which were compared with the T2 results. The ADV appliance was virtually simulated to evaluate stress and deformation on the condyle, symphysis, first lower molar and lower central incisors. RESULTS: Both simulations demonstrated significant mandibular advancement. However, ADV led to less incisor proclination and more molar intrusion compared to TB. ADV exhibited increased stress in the lower molar area, while TB had higher stress in the lower incisor region. Stress and deformations in the condyle and mandibular symphysis were similar in both simulations, with the highest stress observed at the condylar neck and the lowest at the upper pole of the condylar head. CONCLUSIONS: Both appliances achieved similar levels of mandibular advancement, with greater proclination of the lower central incisors and more widespread distribution of stress and molar intrusion when using ADV compared to TB.

Accuracy of arch expansion with two thermoplastic materials in Invisalign® patients: EX30® and SmartTrack®

ABSTRACT Objective: The purpose of this retrospective study was to compare accuracy of arch expansion using two different thermoplastic materials in Invisalign aligners: EX30® (Polyethylene Terephthalate Glycol, or PETG) and SmartTrack® (polyurethane). Methods: The study sample comprised 65 adult patients consecutively treated with Invisalign from two private practices: group 1 - treated with EX30® (358 teeth) and group 2 - treated with SmartTrack® (888 teeth). Six hundred and twenty-three measurements were assessed in three digital models throughout treatment: model 1 - initial, model 2 - predicted tooth position, and model 3 - achieved position. Sixteen reference points per arch were marked and, after best alignment, 2 points per tooth were copied from one digital model to another. Linear values of both arches were measured for canines, premolars, and first molars: on lingual gingival margins and cusp tips of every tooth. Comparisons were performed by Wilcoxon and Mann-Whitney test. Results: Both termoplastic materials presented significant differences between predicted and achieved values for all measurements, except for the lower molar cusp tip in the SmartTrack® group. There is no statistical difference in the accuracy of transverse expansion between these two materials. Overall accuracy for EX30® aligners in maxilla and mandible were found to be 37 and 38%, respectively; and Smarttrack® presented an overall accuracy of 56.62% in the maxilla and 68.72% in the mandible. Conclusions: It is not possible to affirm one material expands better than the other. Further controlled clinical studies should be conducted comparing SmartTrack® and EX30® under similar conditions.

RESUMO Objetivo: O objetivo deste estudo retrospectivo foi comparar a acurácia na expansão da arcada utilizando alinhadores Invisalign com dois tipos de material termoplástico: EX30® (Polietileno Tereftalato Glicol, ou PETG) e SmartTrack® (poliuretano). Método: A amostra desse estudo incluiu 65 pacientes adultos tratados consecutivamente em dois consultórios particulares: grupo 1 - tratado com EX30® (358 dentes), e grupo 2 - tratado com SmartTrack® (888 dentes). Foram avaliadas 623 medidas em três pares de modelos digitais, ao longo do tratamento: modelo 1 - inicial, modelo 2 - posição dentária planejada, modelo 3 - posição alcançada. Foram marcados 16 pontos de referência por arcada e, após o bestfit, 2 pontos por arcada foram copiados de um modelo digital para o outro. Medidas lineares de ambas as arcadas foram aferidas para caninos, pré-molares e primeiros molares, localizadas na margem gengival lingual e ponta de cúspide de todos os dentes. Foram realizadas comparações usando os testes Wilcoxon e Mann-Whitney. Resultados: Ambos os materiais termoplásticos apresentaram diferenças significativas entre os valores planejados e alcançados em todas as medidas, exceto na ponta de cúspide dos primeiros molares inferiores do grupo SmartTrack®. Não houve diferença estatística entre esses dois materiais quanto à acurácia da expansão transversa. Em termos gerais, a acurácia dos alinhadores EX30® na maxila e mandíbula foi de 37% e 38%, respectivamente. O grupo SmartTrack® apresentou acurácia de 56,62% e 68,72% na maxila e mandíbula, respectivamente. Conclusões: Não foi possível afirmar que um material expande melhor que o outro. Estudos clínicos controlados futuros devem ser conduzidos comparando SmartTrack® e EX30® sob condições similares.

Insertion torque, flexural strength and surface alterations of stainless steel and titanium alloy orthodontic mini-implants: an in vitro study

ABSTRACT Objective: This study aimed to compare the insertion torque (IT), flexural strength (FS) and surface alterations between stainless steel (SS-MIs) and titanium alloy (Ti-MIs) orthodontic mini-implants. Methods: Twenty-four MIs (2 x 10 mm; SS-MIs, n = 12; Ti-MIs, n = 12) were inserted on artificial bone blocks of 20 lb/ft3 (20 PCF) and 40 lb/ft3 (40 PCF) density. The maximum IT was recorded using a digital torque meter. FS was evaluated at 2, 3 and 4 mm-deflection. Surface topography and chemical composition of MIs were assessed by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS). General linear and mixed models were used to assess the effect of the MI type, bone density and deflection on the evaluated outcomes. Results: The IT of Ti-MIs was 1.1 Ncm greater than that obtained for the SS-MIs (p= 0.018). The IT for MIs inserted in 40 PCF test blocks was 5.4 Ncm greater than that for those inserted in 20 PCF test blocks (p < 0.001). SS-MIs inserted in higher density bone (40 PCF) had significantly higher flexural strength than the other groups, at 2 mm (98.7 ± 5.1 Ncm), 3 mm (112.0 ± 3.9 Ncm) and 4 mm (120.0 ± 3.4 Ncm) of deflection (p< 0.001). SEM evidenced fractures in the Ti-MIs. EDS revealed incorporation of 18% of C and 2.06% of O in the loaded SS-MIs, and 3.91% of C in the loaded Ti-MIs. Conclusions: Based on the findings of this in vitro study, it seems that SS-MIs offer sufficient stability and exhibit greater mechanical strength, compared to Ti-MIs when inserted into higher density bone.

RESUMO Objetivo: O objetivo deste estudo foi comparar o torque de inserção (TI), a resistência flexural (RF) e as alterações de superfície em mini-implantes ortodônticos de aço inoxidável (MIs-Ai) e de liga de titânio (MIs-Ti). Métodos: Vinte e quatro MIs (2 x 10 mm; MIs-Ai, n = 12; MIs-Ti, n = 12) foram inseridos em blocos de osso artificial de densidades de 20 lb/ft3 (20 PCF) e 40 lb/ft3 (40 PCF). O torque máximo de inserção foi registrado por meio de um torquímetro digital. A resistência flexural foi avaliada nas deflexões de 2, 3 e 4 mm. Topografia de superfície e composição química dos MIs foram avaliadas por Microscopia Eletrônica de Varredura (MEV) e Espectroscopia de Energia Dispersiva de Raios X (EDS). Modelos lineares gerais e mistos foram utilizados para avaliar o efeito do tipo de MI, da densidade óssea e da deflexão nos desfechos avaliados. Resultados: O TI dos MIs-Ti foi 1,1 Ncm maior do que o obtido para os MIs-Ai (P = 0,018). O TI para MIs inseridos em blocos de teste de 40 PCF foi 5,4 Ncm maior do que para aqueles inseridos em blocos de teste 20 PCF (p < 0,001). MIs-Ai inseridos em osso de maior densidade (40 PCF) apresentaram resistência flexural significativamente maior do que outros grupos, em deflexões de 2 mm (98,7 ± 5,1 Ncm), 3 mm (112,0 ± 3,9 Ncm) e 4 mm (120,0 ± 3,4 Ncm) (p < 0,001). A MEV evidenciou fraturas nos MIs-Ti. A EDS revelou incorporação de 18% de C e 2,06% de O nos MIs-Ai e 3,91% de C nos MIs-Ti, ambos submetidos a testes mecânicos. Conclusões: Com base nos resultados desse estudo in vitro, os MIs-Ai aparentam oferecer adequada estabilidade e maior resistência mecânica, em comparação aos MIs-Ti, quando inseridos em osso de maior densidade.

Methodological Quality of Systematic Reviews Addressing Orthodontic Interventions: Methodological Study

ABSTRACT Objective: To assess the methodological quality and characteristics of systematic reviews (SRs) of interventional studies in orthodontics and assess how the certainty of the evidence is reported using the GRADE approach. Material and Methods: Six electronic databases were searched, followed by a hand search of the reference lists of eligible studies (PROSPERO #CRD42020180852). The required study design was randomized and nonrandomized studies of interventions published between January 2019 and May 2020. The Assessing the Methodological Quality of Systematic Reviews (AMSTAR 2) tool was used for the quality appraisal of the included SRs. Paired reviewers independently screened the studies, extracted data, and appraised the methodological quality. Results: The study included 46 SRs; 19.5% had moderate to high methodological quality, and the remaining had low to critically low methodological quality. Fifty-four percent of the reviews assessed the certainty of evidence using the GRADE approach, and 34.8% followed all GRADE criteria. Conclusion: Most reviews had a good judgment of the AMSTAR2 items, although some critical items contributed to decreased overall quality. Half of the reviews used the GRADE approach to assess the certainty of the evidence, and this approach should be included in future systematic reviews of interventions.

Changes in the arch width and buccal corridor after fixed orthodontic treatment with Damon self-ligating system: premolar extraction vs. non-extraction

ABSTRACT Introduction: Extraction vs. non-extraction is a crucial decision in orthodontic therapy. Objective: The aim of the present study was to investigate the changes in the dental arch width and buccal corridor after orthodontic treatment using extraction and non-extraction therapy with Damon self-ligating system. Material and Methods: This retrospective study consisted of 35 patients (20 female and 15 male patients with median age of 12.5 years), treated by extracting 4 or 2 premolars, and 37 patients (16 female and 21 male patients with the median age of 12.8 years), treated without premolar extraction. Both groups were treated with Damon self-ligating system. Plaster models before (T0) and after (T1) treatment were measured, and the arch width values were determined at the level of the first molars, second premolars, canines and palatal rugae. Buccal corridor width was measured using the extraoral images at T0 and T1. Paired t-test was used for the analysis of the normally distributed data, and Wilcoxon Mann-Whitney U test was used for the data with non-normal distribution. Values of p<0.05 were set as statistically significant. Results: The upper intercanine width increased significantly in both groups (p<0.01). In the non-extraction group, the arch width increased significantly in the maxillary second premolar and first molar region (p<0.01) as well as in the region of the canines (p=0.04), second premolars (p=0.01) and first molars (p<0.01) of the mandible. The buccal corridor decreased significantly in the non-extraction group (p<0.01). Conclusion: Premolar extraction in combination with Damon self-ligating system did not lead to reduction of the dental arch width in the maxilla, nor did it increase the size of the buccal corridors.

RESUMO Introdução: Extrair ou não extrair dentes é uma decisão crucial no tratamento ortodôntico. Objetivo: O objetivo do presente estudo foi investigar as alterações na largura da arcada dentária e no corredor bucal após o tratamento ortodôntico com extração e o tratamento sem extração com o sistema autoligável Damon. Material e Métodos: Esse estudo retrospectivo consistiu de 35 pacientes (20 do sexo feminino e 15 do sexo masculino, com idade média de 12,5 anos), tratados com extração de 4 ou 2 pré-molares; e 37 pacientes (16 do sexo feminino e 21 do sexo masculino, com idade média de 12,8 anos), tratados sem extração de pré-molares. Ambos os grupos foram tratados com o sistema autoligável Damon. Os modelos de gesso antes (T0) e depois (T1) do tratamento foram medidos, e os valores de largura da arcada foram determinados ao nível dos primeiros molares, segundos pré-molares, caninos e rugas palatinas. A largura do corredor bucal foi medida usando as imagens extrabucais em T0 e T1. O teste t pareado foi usado para a análise dos dados com distribuição normal, e o teste U de Wilcoxon Mann-Whitney foi usado para os dados com distribuição não normal. Valores de p < 0,05 foram considerados estatisticamente significativos. Resultados: A distância intercaninos superiores aumentou significativamente em ambos os grupos (p<0,01). No grupo sem extração, a largura da arcada aumentou significativamente na região dos segundos pré-molares e primeiros molares superiores (p<0,01), bem como na região dos caninos (p=0,04), segundos pré-molares (p=0,01) e primeiros molares (p<0,01) inferiores. O corredor bucal diminuiu significativamente no grupo sem extração (p<0,01). Conclusão: A extração de pré-molares em combinação com o sistema autoligável Damon não levou à redução na largura da arcada dentária superior, nem aumentou o tamanho dos corredores bucais.

A utilização de torques resistentes ao movimento compensatório dos dentes anteriores no tratamento da Classe III no paciente adulto / The use of torques resistant to compensatory movement of anterior teeth in the treatment of Class III in adult patients

Este trabalho visou relatar o caso clínico de um paciente padrão III com mordida cruzada anterior, através de um tratamento compensatório com o uso de bráquetes que geram torques resistentes nos incisivos. O paciente JPCN, 42 anos, leucoderma, gênero masculino, procurou a clínica ortodôntica com a queixa principal de mordida cruzada anterior. Na análise extrabucal, observou-se a presença de padrão horizontal, simetria facial, maxila deficiente, ângulo nasolabial fechado, presença de selamento labial passivo e perfil côncavo com o lábio inferior à frente do superior. A prescrição utilizada foi a biofuncional, apresentado 0° de torque nos incisivos superiores e 10° nos incisivos inferiores. Foram realizados o alinhamento e nivelamento, mecânica de acentuação da curva de Spee no arco superior e reversão no arco inferior simultaneamente aos elásticos intermaxilares. Ao final do tratamento, foram observados correção da relação anteroposterior e intercuspidação dentária, trespasse horizontal e vertical normais, linhas médias coincidentes e selamento labial passivo. Concluiu-se que a utilização de torques resistentes nos incisivos gerados pelo uso de bráquetes da técnica biofuncional foi eficiente para manter uma boa inclinação desses dentes durante a correção damá oclusão de Classe III com o uso de elásticos intermaxilares (AU)

This study aimed to report the clinical case of a patient with pattern III with anterior crossbite, through a compensatory treatment with the use of brackets that generate resistant torques in the incisors. Patient JPCN, 42 years old, caucasian, male, came to the orthodontic clinic with the main complaint of anterior crossbite. In the extraoral analysis, it was observed the presence of a horizontal pattern, facial symmetry, deficient maxilla, closed nasolabial angle, presence of passive lip seal, and concave profile with the lower lip in front of the upper. The prescription used was the biofunctional, with 0° of torque on the upper incisors and 10° on the lower incisors. Alignment and leveling, orthodontic mechanics of Spee curve accentuation in the maxillary arch and reversal in the mandibular arch were performed simultaneously with intermaxillary elastics. At the end of the treatment, Class III correction, correction of the anteroposterior relationship and dental intercuspation, normal overbite and overjet, coinci-dent midlines and passive lip seal were observed. It was concluded that the use of resistant torques on the incisors promoted by the use of biofunctional technique brackets was efficient to maintain a good inclination of these teeth during the correction of Class III malocclusion with the use of intermaxillary elastics (AU)

Eficiência da prescrição de bráquetes ortodônticos no tratamento com diferentes sistemas de bráquetes - uma proposta clínica / Orthodontic bracket prescription efficiency in treatment with different bracket systems - a clinical proposal

Com a diversificação das prescrições existentes, a correta escolha de acordo com a necessidade individual de cada má oclusão pode ser importante para estabelecer maior controle biomecânico durante o tratamento ortodôntico. Este estudo teve como objetivo avaliar o tratamento ortodôntico com a versatilidade na associação de diferentes prescrições em um relato de caso clínico e determinar se existe alguma relação com a dimensão vertical, transversal e o perímetro de arco que podem contribuir com a estabilidade e longevidade do tratamento ortodôntico. A prescrição, quando corretamente indicada, tem impacto no controle do movimento dentário para estabelecer oclusão, estética e estabilidade adequadas. Concluiu-se que o surgimento de novas prescrições tende a favorecer ao máximo a abrangência de mais pacientes no tratamento ortodôntico (AU)

With the diversification of existing bracket prescriptions, the correct choice according to the individual needs of each malocclusion is essential to establish greater biomechanical control during orthodontic treatment. This study aimed to evaluate orthodontic treatment with the versatility in association of different prescriptions in a clinical case report and to determine whether there is any relationship with the vertical dimension, transverse dimension, and arch perimeter that can contribute to the stability and longevity of the orthodontic treatment. The prescription, when correctly indicated, has an impact on the control of tooth movement to establish proper occlusion, esthetics, and stability. It was concluded that the emergence of new prescriptions favors the maximum coverage of more patients in orthodontic treatment. (AU)

Alinhadores x ortodontia fixa ­ relato de caso / Aligners x fixed orthodontics ­ case report

A cada ano que passa a procura por tratamentos ortodônticos está mais frequente, e isso se dá pelo fato da valorização do sorriso e da estética facial estar cada vez mais perceptível perante a sociedade. As modalidades de tratamento são diversas, e com o avanço da tecnologia, estão cada vez mais modernas, confortáveis e objetivas para suprir a necessidade do paciente. Dentre elas, podemos citar a aparatologia ortodôntica fixa que é o sistema mais antigo e os alinhadores estéticos que são os aparelhos mais modernos na ortodontia digital. Esse estudo tem como objetivo relatar dois casos clínicos e revisar a literatura científica existente acerca do tratamento ortodôntico utilizando aparelhos fixos comparados aos alinhadores removíveis, evidenciando suas vantagens e desvantagens, indicações e limitações (AU)

With each passing year the search for orthodontic treatments is more frequent, and this is due to the fact that the appreciation of smile and facial aesthetics is increasingly noticeable before society. The treatment modalities are diverse, and with the advancement of technology, are increasingly modern, comfortable, and objective in view of the needs of the patient. Among them, we can mention the fixed orthodontic aparatology, which is the oldest system, and the aesthetic aligners that are the most modern devices in the face of digital orthodontics. This study aims to report clinical cases and review the existing scientific literature on orthodontic treatment using fixed devices compared to removable aligners, evidencing its advantages and disadvantages indications, and limitations.(AU)