Avaliação digital tridimensional da movimentação dentária com alinhadores transparentes / Three-dimensional digital assessment of tooth movement with transparent aligners

O objetivo deste estudo foi avaliar a concordância das medidas obtidas em modelos sobrepostos em dois programas com as medidas propostas pelo software ClinCheck; além de avaliar a eficácia da movimentação dentária obtida por alinhadores dentários, por meio de sobreposições de modelos digitais. Sete pacientes foram submetidos a tratamento ortodôntico com o sistema Invisalign. Os modelos digitais iniciais e finais fornecidos pela Align Technology foram sobrepostos nos programas 3D Slicer 4.6.2 e GOM Inspect 2017 para mensurar as movimentações dentárias e comparar com as que foram propostas pelo software ClinCheck; os modelos iniciais e finais obtidos clinicamente foram digitalizados e sobrepostos no software GOM Inspect 2017 para mensurar os movimentos dentários obtidos clinicamente e comparar com as medidas propostas pelo software ClinCheck. Posteriormente, os dados das sobreposições dos modelos iniciais e finais fornecidos pelo Align Technology foram comparados pela Análise de Concordância de BlandAltman. No programa GOM Inspect 2017, houve concordância em dois dos seis movimentos avaliados; já no programa 3D Slicer 4.6.2, foi encontrada concordância em três dos seis movimentos. Já os dados das sobreposições dos modelos iniciais e finais obtidos clinicamente foram comparados pelo teste de Wilcoxon. Os movimentos de extrusão, translação vestibular e translação mesial na maxila não apresentaram diferença estatisticamente significativa. Todos os movimentos na mandíbula e os movimentos de intrusão, translação lingual e translação distal na maxila apresentaram diferença estatisticamente significante. Apesar de clinicamente a diferença encontrada entre os softwares analisados e o ClinCheck ser desprezível, não podemos substituir o ClinCheck por outros softwares. Desta forma, para substituir um método por outro, o ideal seria que todas as análises apresentassem concordância com o software ClinCheck. Já para a comparação da movimentação dentária obtida clinicamente com a que foi proposta pela Align Technology, percebemos que movimentos dentários na mandíbula são imprecisos. Os movimentos de extrusão, translação vestibular e translação mesial na maxila foram identificados como precisos. As diferenças obtidas foram clinicamente desprezíveis considerando os movimentos isolados, mas significantes quando consideramos todos os movimentos propostos para um grupo de dentes. (AU)

The aim of this study was to evaluate the agreement of measures obtained by superimposition of models in two different programs with the measures proposed by the ClinCheck software; besides evaluating the efficacy of tooth movement obtained by dental aligners, through superimposition of digital models. Seven patients underwent orthodontic treatment with the Invisalign system. The initial and final digital models provided by Align Technology were superimposed on 3D Slicer 4.6.2 and GOM Inspect 2017 software to measure dental movements and compare with those proposed by the ClinCheck software; the initial and final models clinically obtained were digitized and superimposed on the GOM Inspect 2017 software to measure clinically obtained dental movements and compare with the measures proposed by the ClinCheck software. Subsequently, the superimposition data of the initial and final models provided by Align Technology were compared by the Bland-Altman Concordance Analysis. In the GOM Inspect 2017 software, there was agreement in two of the six movements evaluated; nevertheless, in the 3D Slicer 4.6.2 program, concordance was found in three of the six movements. The superimposed data of the initial and final models obtained clinically were compared by the Wilcoxon test. The movements of extrusion, vestibular translation and mesial translation in the maxilla did not present a statistically significant difference. All mandible tooth movements and the movements of intrusion, lingual translation and distal translation in the maxilla presented a statistically significant difference. Although clinically the difference found between the analyzed software and ClinCheck is negligible, we can not replace ClinCheck with other software. Thus, to substitute one method for another, ideally all analyzes would agree with ClinCheck software. In order to compare the dental movement obtained clinically with that proposed by Align Technology, we noticed that dental movements in the mandible are imprecise. The movements of extrusion, vestibular translation and mesial translation in the maxilla were identified as accurate. The differences obtained were clinically negligible considering the isolated movements, but significant when considering all the proposed movements for a group of teeth. (AU)

Predictability of orthodontic movement with orthodontic aligners: a retrospective study.

BACKGROUND: The aim of this study was to evaluate the predictability of F22 aligners (Sweden & Martina, Due Carrare, Italy) in guiding teeth into the positions planned using digital orthodontic setup. METHODS: Sixteen adult patients (6 males and 10 females, mean age 28 years 7 months) were selected, and a total of 345 teeth were analysed. Pre-treatment, ideal post-treatment-as planned on digital setup-and real post-treatment models were analysed using VAM software (Vectra, Canfield Scientific, Fairfield, NJ, USA). Prescribed and real rotation, mesiodistal tip and vestibulolingual tip were calculated for each tooth and, subsequently, analysed by tooth type (right and left upper and lower incisors, canines, premolars and molars) to identify the mean error and accuracy of each type of movement achieved with the aligner with respect to those planned using the setup. RESULTS: The mean predictability of movements achieved using F22 aligners was 73.6%. Mesiodistal tipping showed the most predictability, at 82.5% with respect to the ideal; this was followed by vestibulolingual tipping (72.9%) and finally rotation (66.8%). In particular, mesiodistal tip on the upper molars and lower premolars were achieved with the most predictability (93.4 and 96.7%, respectively), while rotation on the lower canines was the least efficaciously achieved (54.2%). CONCLUSIONS: Without the use of auxiliaries, orthodontic aligners are unable to achieve programmed movement with 100% predictability. In particular, although tipping movements were efficaciously achieved, especially at the molars and premolars, rotation of the lower canines was an extremely unpredictable movement.

Effectiveness of adjunctive interventions for accelerating orthodontic tooth movement: a systematic review of systematic reviews.

This study was aimed to summarise published systematic reviews (SRs) that assess the effects of adjunctive interventions on the acceleration of orthodontic tooth movement (OTM). Electronic and manual searches were performed up to August 2016. Systematic reviews investigating the impact of adjunctive techniques on the promotion of OTM were included. The methodological quality of the included reviews was evaluated using the A Measurement Tool to Assess Systematic Reviews (AMSTAR) scale. The quality of evidence for each intervention was assessed using GRADE. The Jadad decision algorithm was used to select a study to provide body evidence from discordant reviews on the same intervention. A total of 11 SRs were included in this study. AMSTAR scores ranged from 4 to 10 of 11. The quality of evidence ranged from very low to low. The short-term (1-3 months) effects of low-level laser therapy (LLLT, 5 and 8 J cm-2 ) and corticotomy were supported by low-quality evidence. The evidence regarding the efficacy of photobiomodulation, pulsed electromagnetic field, interseptal bone reduction, two vibrational devices (Tooth Masseuse and Orthoaccel) and electrical current was of very low quality. Relaxin injections and extracorporeal shock waves were reported to have no impact on OTM according to low- and very low-quality evidence, respectively. Based on currently available information, we conclude that low-quality evidence indicates that LLLT (5 and 8 J cm-2 ) and corticotomy are effective to promote OTM in the short term. Future high-quality trials are required to determine the optimal protocols, as well as the long-term effects of LLLT and corticotomy, before warranting recommendations for orthodontics clinics.

Efficacy of 2 finishing protocols in the quality of orthodontic treatment outcome.

INTRODUCTION: The objectives of this prospective clinical study were to evaluate the quality of treatment outcomes achieved with a complex orthodontic finishing protocol involving serpentine wires and a tooth positioner, and to compare it with the outcomes of a standard finishing protocol involving archwire bends used to detail the occlusion near the end of active treatment. METHODS: The complex finishing protocol sample consisted of 34 consecutively treated patients; 1 week before debonding, their molar bands were removed, and serpentine wires were placed; this was followed by active wear of a tooth positioner for up to 1 month after debonding. The standard finishing protocol group consisted of 34 patients; their dental arches were detailed with archwire bends and vertical elastics. The objective grading system of the American Board of Orthodontics was used to quantify the quality of the finish at each time point. The Wilcoxon signed rank test was used to compare changes in the complex finishing protocol; the Mann-Whitney U test was used to compare changes between groups. RESULTS: The complex finishing protocol group experienced a clinically significant improvement in objective grading system scores after treatment with the positioner. Mild improvement in posterior space closure was noted after molar band removal, but no improvement in the occlusion was observed after placement of the serpentine wires. Patients managed with the complex finishing protocol also had a lower objective grading system score (14.7) at the end of active treatment than did patients undergoing the standard finishing protocol (23.0). CONCLUSIONS: Tooth positioners caused a clinically significant improvement in interocclusal contacts, interproximal contacts, and net objective grading system score; mild improvement in posterior band space was noted after molar band removal 1 week before debond.

Postorthodontic root approximation after opening space for maxillary lateral incisor implants.

INTRODUCTION: Orthodontic space opening during adolescence is a common treatment for congenitally missing maxillary lateral incisors. Because of continued facial growth and compensatory tooth eruption, several years can elapse between completion of orthodontic treatment for a teenage patient and implant placement. There are reports that, after successful orthodontic opening of the implant space, the central incisor and canine roots reapproximate during retention and prevent implant placement. METHODS: To study this phenomenon, the records of 94 patients with missing maxillary lateral incisors were collected. Periapical and panoramic radiographs were used to measure intercoronal and interradicular distances between the central incisor and the canine adjacent to the missing lateral incisor before and after orthodontic treatment and at implant placement. RESULTS: Although root approximation between the adjacent central incisor and canine during retention did not occur consistently, 11% of the patients experienced relapse significant enough to prevent implant placement. CONCLUSIONS: To ensure sufficient space for implant placement, we recommend at least 6.3 mm of intercoronal space and 5.7 mm of interradicular space between the adjacent central incisor and canine. A bonded wire or resin-bonded bridge will help to reduce root approximation that might occur during retention.

Permissible limit for mandibular expansion.

In recent years, mandibular expansion has been increasingly performed in conjunction with orthodontic treatment. Lateral tipping of the molars associated with mandibular expansion should, however, be considered, because excessive expansion may result in excessive buccal tooth inclination, which may disturb the occlusal relationship. This study was conducted to quantitatively clarify molar movement during mandibular expansion using the Schwarz appliance to determine the permissible limit of mandibular expansion as a clinical index for inclination movement. Inclinations in the masticatory surface of the first molar and intermolar width were measured before expansion (T1), after expansion (T2), and before edgewise treatment (T3). Lower plaster models from 29 subjects treated with expansion plates were used and compared with models from 11 control subjects with normal occlusion. The average treatment change (T1-T2) in intermolar width was 5.42 mm (standard deviation 1.98), and the average angle of buccal tooth inclination was 10.16 degrees (standard deviation 3.83). No significant correlation was found between age prior to treatment and the treatment period when they were compared with the intermolar width increments and inclination angles. There was a significant positive correlation between retention duration and the amount of expansion. The regression coefficient of the angle of buccal tooth inclination during expansion to the increment of the intermolar width was approximately 0.2. This means that 1 mm of expansion is accompanied by 5 degrees of molar lateral tipping. This coefficient is clinically useful for estimating the permissible limit for mandibular expansion.

Avanços na colagem de acessórios ortodônticos / Breakhroughs in the bonding of orthodontic attachment

O objetivo deste artigo é revisar a literatura no intuito de esclarecer os avanços nos materiais utilizados na colagem direta de acessórios aos dentes, apresentando as vantagens e desvantagens dos mais tradicionais até os atuais, discutindo suas aplicações clínicas

Mandibular incisor uprighting identification.

An important consideration during the diagnosis and subsequent treatment of every orthodontic patient is the position of the mandibular incisors. This article proposes guidelines for posttreatment mandibular incisor position that, when used, either preserve or enhance facial balance and harmony, and explains the interrelationship of the profile line and its relationship to the tip of the nose with the ratio of posterior facial height to anterior facial height. The article offers ideas about posttreatment mandibular incisor position that will allow the clinician a better understanding of facial balance and harmony.

Orientaciones Basicas para la Realizacion de Movimientos Dentarios Menores / Basic Orientations for Minor Dental Movements

En el desenvolvimiento del tema es importante dominar algunos conceptos de la embriologia humana, antes de entrar en materia como son la diferenciacion de las etapas de crecimiento y desarrollo, partiendo de la fecundacion del huevo, la diferenciacion de todos los tejidos, especialmente de cavidad oral y maduracion de estos. A continuacion es necesario tener ciertas bases en cuanto a las caracteristicas anatomicas de huesos, musculos, articulacion temporomandibular y la fisiologia de estas estructuras que pueden estar involucradas en un proceso patologico. Veremos a continuacion las caracteristicas de una oclusion normal, tanto en denticion temporal, mixta y permanente relacionadas con dientes adyacentes, antagonistas, maxilares, en si, podriamos decir la armonia que debe guardar dentro de un conjunto craneofacil. Hemos sustraido las ideas de especialistas en la materia, para el analisis de la patologia de la oclusion, asi como sus posibles causas, las cuales estan mas ligadas a edades tempranas pero posiblemente con estragos en la edad adulta, si no son corregidos o interceptados a tiempo. Un importante elemento de trabajo para nosotros es la historia clinica, como medio de diagnostico, en donde ofrecemos un breve recuento de la historia pasada, desde todo punto de vista, un examen general y local del estado del paciente en el momento de asistir a la consulta. Una vez los datos acerca del paciente procedemos a hacer un diagnostico acertado y este se ha dividido en morfologico diferencial, etiopatogenico y clinico, para (RESUMEN TRUNCADO EN 1650 CARACTERES)..