Dental Press Jounal of Orthodontics
Dental Press International

v. 16, no. 1

Dental Press Journal of Orthodontics – ISSN 2176-9451

Dental Press J. Orthod.

v. 16, no. 1

January / February

2011


Editorial

The orthodontic treatment will be offered free of charge in all Specialized Dental Clinics in Brazil, and it will benefit millions of Brazilians over the years

Jorge Faber

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Last December I gave a class in Taiwan. On a tour around the island, I was impressed with the image that Brazil currently topples in Asia. All the comments I heard did not refer to our football, but to both, the economic growth and the position the country is in the geopolitical pitch. Hearing the opinions of the international scouts called my attention to a reality in our area: wherever we are in Brazil, we can see people being submitted to an orthodontic treatment.

This fact shows the relevance people give to this type of correction, either for esthetic or functional reasons. It was the rise in consumption of Classes C and D that enabled a larger number of people to have access to Orthodontics. And the part of the population who will benefit from orthodontic treatment will further increase.

From 2011 on, orthodontic treatment will be an integral part of the services offered by public centers known as CEOs?Dental Specialized Clinics, which are part of a program called Brasil Sorridente (Smiling Brazil)?the Federal Government Program for oral health. Such an advance has already been published in the Brazilian newspaper called Diário Oficial da União, and will mark a new way of access to orthodontic treatment.

Evidently, this new way of access will not come true easily and spontaneously. It will require a great involvement of the Ministry of Health?as well as of the Brazilian orthodontic community, through the Brazilian Association of Orthodontics and Dentofacial Orthopedics (ABOR)?so that we can have protocols based on evidence that support the treatment decisions that will be made for our population. In addition, it is important mentioning that these two parties have already been working hard with this purpose, and that the partnership between government and society is essential for us to build the country we want in the future.

In 2010 Dr. Gilberto Pucca, the National Coordinator of Oral Health, told me something interesting during an informal dinner in Brasília. We were talking about his periodic meetings with President Lula, the progress of the implementation of the CEOs, and the relevance that the President himself used to give to oral health when he told me: ?Faber, every time I meet the President, he asks me: ?Hey, Pucca, have children already been placing braces??

In my opinion perhaps that was the dream of the former President himself as a child, and it is very gratifying to know that such a dream will come true for many of our children. 

Have a good reading.

What´s new in Dentistry

Why orthodontists should be aware of the quality of life of their patients

Daniela Feu

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Given the elective nature of orthodontic treatment the decision to start treatment hinges on the opinions of patients and their parents, which means that patients? motivation is often derived from the negative impact of their malocclusion, be it aesthetic, functional or social. Therefore, this patient autonomy plays an important role in predicting the final results since theoretically satisfaction is related to a reduction or utter elimination of the factors that led them to seek treatment in the first place. So how can orthodontists perform treatments capable of benefitting patients psychosocially and be successful in this endeavor without gaining insight into the impact caused by malocclusion? 

Faced with this new paradigm, Evidence- Based Dentistry has posed a major challenge to orthodontic practice, namely: To be aware of how orthodontic treatment impacts on patients? daily lives. The reason for this lies in the fact that, to be considered viable, any treatment, including orthodontic treatment, should be capable of bringing significant benefits above and beyond the biological and financial costs to each individual patient.3,20,26 [...]

Orthodontic Insight

Multiple or severe root resorptions are not associated with systemic factors, individual susceptibility, family tendency or individual predisposition

Alberto Consolaro, Telma Regina Gobbi Franscischone, Laurindo Zanco Furquim

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Multiple or severe root resorptions, still often assigned to systemic changes, particularly endocrinopathies, are seen when the severity of alveolar bone loss is great, especially during orthodontic movements.18,19,20 

In bone turnover, matrix deposition alternates continuously with bone resorption at different sites and times. This dynamic process enables the bone to adapt to the functional demands of each skeletal area and to actively participate in the maintenance of the mineral homeostasis to control serum calcium and phosphorus concentrations.2,3,6,15 The skeleton renews completely at variable time intervals according to the patient?s age.22 

Teeth, particularly root structures, do not have bone turnover,1,8,12,17 a consequence of the activity of osteoblasts, osteocytes, macrophages and osteoclasts. These cells organize in basic multicellular units (BMUs), or bone remodeling cells, and receive stimuli from systemic and local mediators found in membrane surface receptors of several cell types, particularly osteoblasts and macrophages.2,7,22  [...]

Interview

An interview with Didier Fillion

Luiz Fernando Eto

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? Graduate from the Paris V University.

? Specialist from the Paris V University.

? The only orthodontist practicing lingual orthodontics exclusively for

over 30 years (Paris-London).

? Member of the American Association of Orthodontists (AAO).

? Member of the American Lingual Orthodontics Association (ALOA).

? President of the British Lingual Orthodontic Society (BLOS).

? Honorary President of the French Lingual Orthodontic Society (SFOL).

? Honorary Secretary of the European Society of Lingual Orthodontics (ESLO).

? Founding Member of the World Society of Lingual Orthodontics (WSLO).

? Adjunct Professor, Paris V University.

? Adjunct Professor, New York University (NYU), USA.

? Visiting Professor, University of Ferrara (Italy).

Online Article

Comparative study of complications during Herbst treatment with Cantilever Bite Jumper and removable mandibular acrylic splint

Alexandre Moro, Guilherme Janson , Ricardo Moresca, Marcos Roberto de Freitas, José Fernando Castanha Henriques

Herbst appliance. Class II. Complications.

Objective: To assess and compare the type of complications during Herbst treatment with Cantilever Bite Jumper (CBJ) and removable mandibular splint.>

Methods: Twenty one consecutive Herbst patients treated with the CBJ were compared with twenty one consecutively treated Herbst patients with stainless steel crowns on the maxillary first molars and a removable mandibular acrylic splint. The initial mean age for the CBJ group was 12 years and 3 months and for the Splint group was 11 years and 3 months. Both groups used the Herbst appliance for 12 months. Based on the patients? clinical records an occurrence survey of complications during Herbst treatment was performed. 

Results: There were 24 complications for the CBJ and 53 for the Splint group, which were statistically different (Mann-Whitney test, p<0.05). The prevalence of patients exhibiting complications during treatment was 66.67% in the CBJ and 85.71% in the Splint group. The frequencies of complications were also statistically different between the groups. Conclusions: The CBJ exhibited a significantly smaller number of complications during Herbst appliance treatment than the removable mandibular splint. Herbst appliance with first molar crowns and a cantilever on the mandibular molars is preferable to the removable mandibular acrylic splint because of savings in clinical and laboratory time.

Comparison between cavum and lateral cephalometric radiographs for the evaluation of the nasopharynx and adenoids by otorhinolaryngologists

Rhita Cristina Cunha Almeida, Flavia Artese, Felipe de Assis Ribeiro Carvalho, Rachel Dias Cunha, Marco Antonio de Oliveira Almeida

Orthodontics. Otorhinolaryngology. Cavum radiograph. Cephalometric radiograph.

 Introduction: The lateral cephalometric, as well as the cavum radiograph, allow the evaluation of the nasopharyngeal airway (NAW). Otorhinolaryngologists routinely use the cavum radiograph, even when the patient already has a lateral cephalometric headfilm.>

Objectives: The aim of this study was to (a) acknowledge which exams otorhinolaryngologists use for the evaluation and measurement of the NAW; (b) evaluate if the otorhinolaryngologists are acquainted to the cephalometric method; (c) compare both radiographs to see which one is preferred to visualize the NAW and adenoids and (d) correlate the visual analysis to the measuring method of Schulhof. 

Methods: For this purpose, cephalometric and cavum radiographs of 15 mouthbreathing children were taken on the same day. These radiographs were masked leaving only the NAW and the adenoids visible, and were blindly presented to 12 otorhinolaryngologists. They received the radiographs together with a questionnaire asking about their familiarity with the lateral cephalometric radiograph, which exams are used for NAW and adenoid evaluation and if they use any method for measuring the NAW obstruction level. They were also asked to visually classify the NAW and the adenoids according to their sizes into small, medium and large. 

Results: The results demonstrated that all otorhinolaryngologists in the sample use the cavum radiograph. Only one uses the cephalometric radiograph and two are familiar with this technique. The cephalometric radiograph was preferred by 49.4% of the otorhinolaryngologists, the cavum by 22.8%, and 27.8% did not see any difference between both methods. There was low correlation between the visual method and the Schulhof measuring method.

Brazilian consensus of snoring and sleep apnea ? aspects of interest for orthodontists

Cauby Maia Chaves Junior, Cibele Dal-Fabbro , Veralice Meireles Sales de Bruin, Sergio Tufik, Lia Rita Azeredo Bittencourt

The objective of this article is to clarify the positions of the medical societies that have worked together to establish a consensus regarding the clinical and laboratory parameters involved in sleep-disordered breathing, particularly snoring and obstructive sleep apnea syndrome (OSAS). Orthodontists have gradually come to take part in multidisciplinary teams that act in the area of human sleep, but few know about the uniformity coordinated by the Brazilian Association of Sleep. Clinical and scientific studies from the field of dentistry (particularly orthodontics) also must observe and follow these diagnosis and treatment criteria established by the Brazilian medical community.

Original Article

Assessment of the effect of different surface treatments on the bond strength of brackets bonded to acrylic resin

Deise Lima Cunha Masioli, Marco Antonio de Oliveira Almeida, Marco Antonio Masioli, José Roberto Moraes de Almeida

Orthodontics. Acrylic resin. Composite resin. Brackets.

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Objective: To evaluate the influence of the surface treatment of acrylic resins on the shear bond strength of brackets bonded with composite resin. 

Material and Methods: Were fabricated 140 discs with autopolymerizing acrylic resin (Duralay®) and divided them into 14 groups (n = 10). In each group, the specimens received a different type of surface treatment. Group 1- untreated surface (control), Group 2- silane, Group 3- aluminum oxide blasting (AOB), Group 4- AOB + silane, Group 5- diamond bur, Group 6- diamond bur + silane, Group 7- hydrofluoric acid, Group 8- hydrofluoric acid + silane, Group 9- phosphoric acid, Group 10- phosphoric acid + silane, Group 11-methylmethacrylate monomer (MMA), Group 12- MMA + silane, Group 13- plastic conditioner (Reliance®); Group 14- plastic conditioner (Reliance®) + silane. After surface treatment the specimens were analyzed using a surface roughness tester. Subsequently, standard edgewise central incisor brackets (Morelli®) were bonded using Transbond XT® light-cure adhesive system, according to the manufacturer?s instructions. 

Results: The silane-based wetting agent had no statistically significant effect on bond strength values. Treatments with AOB and bur generated the highest topographical changes on the surface of acrylic resin as well as the highest roughness values. A nonlinear correlation was found between bond strength and surface roughness. Monomer + AOB treatment yielded the highest bond strength values. 

Conclusions: Silane failed to increase the bond strength between brackets and acrylic resin. We encourage further studies on this subject since the bond strength achieved in our study was extremely low.

Effects of orthodontic ligation-using elastomeric and stainless steel ligatures-on periodontal health

Clotilde Freitas Rodrigues, Lígia de Araújo Ramos Sales, Robert Willer Farinazzo Vitral, Marcelo Reis Fraga, Cátia Cardoso Abdo Quintão

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Objective: This study aimed to conduct a clinical evaluation of the periodontal conditions of a test group and a control group using three periodontal indexing systems, namely: dental biofilm index (DBI), bleeding index (BI) and pocket probing depth (PPD). 

Methods: The test group consisted of 20 subjects with a mean age of 13.5 years undergoing fixed orthodontic treatment involving the use of two types of ligature: elastomeric ligature (EL) and stainless steel ligature (SSL). The results were compared with a control group without prior orthodontic treatment, comprising 15 subjects with a mean age of 15.3 years. The measurements were performed prior to orthodontic treatment (T1) and six months after placement of a fixed orthodontic appliance (T2); and in the control group, six months after the initial measurement (T2). Both groups were instructed about oral hygiene, according to the Bass technique, before treatment. 

Results and Conclusions: Dental surfaces showed a statistically significant increase in levels of biofilm (P=0.000), gingival bleeding (P=0.000) and probing depth (P=0.000), when T1 and T2 and the groups were compared, however, no statistically significant differences were found between EL and SSL in terms of these periodontal indexes.

Evaluation of the determinants of facial profile aesthetics

Sílvia Augusta Braga Reis, Jorge Abrão, Cristiane Aparecida de Assis Claro, Leopoldino Capelozza Filho

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Objective: To evaluate the influence of age, gender, sagittal occlusal relationship, facial pattern and 8 facial profile measures on profile aesthetics. 

Methods: Contingency tables, chi-square test and Cramer?s coefficient were used to evaluate the possible association between the scores assigned by 32 examiners (14 orthodontists, 12 laypeople and 6 artists) to the aesthetics of the profile of 100 Brazilian Caucasian adults, all patients with lip seal competence, and age, gender, sagittal occlusal relationship, facial pattern and the variables of the numerical analysis of the facial profile. 

Results: No association was found between age, gender and sagittal occlusal relationship and the aesthetics of facial profile. An association was observed between profile scores and facial pattern, facial convexity angle and lower face angle. 

Conclusions: Among the factors evaluated in this study, facial profile convexity and anterior chin projection were the key determinants of facial profile aesthetics.

Perception of changes in the gingival plane affecting smile aesthetics

Daniela Feu, Fabíola Bof de Andrade, Ana Paula Camata Nascimento, José Augusto Mendes Miguel, Antonio Augusto Gomes, Jonas Capelli Junior

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Objective: This study investigated how 80 dental professionals and 80 lay persons, patients from private practice offices and from the School of Dentistry, Federal University of Espírito Santo (UFES), perceived the presence of changes in the gingival plane. 

Methods: A photograph of a smiling young woman was digitally modified to produce symmetrical changes in the gingival height of the central incisors and lateral incisors, thereby causing the gingival plane to ascend progressively. Individuals were asked to choose the most pleasant looking picture and thereafter the interviewer questioned each individual to find out if they knew what was being changed in the sequence of pictures, i.e., whether or not they were able to identify changes in the gingival plane. 

Results: The results showed a significant prevalence in the selection of a harmonious gingival plane in the group of dentists and patients (p<0.001 and 0.05, respectively). Furthermore, there were no significant differences between the specialties comprised in the group of dentists (p = 0.538), which was the case in the lay group (p = 0.05), showing a greater perception on the part of the group of dental office patients. Identification of changes in the gingival plane was significant in the group of dentists (p<0.001) without significant differences between group specialties. Neither was it significant in the lay group (p = 0.100). The results also highlight a significantly higher ability to identify problems in the group of dentists compared to the lay group (p<0.001). 

Conclusion: It was therefore concluded that symmetrical changes greater than 2 mm can be perceived by both dentists and lay people. Moreover, no differences were found in this perception among the dental specialties. Finally, the group of dental office patients was significantly more perceptive than UFES patients.

Orthodontic treatment plan changed by 3D images

Iury Oliveira Castro, Carlos Estrela, José Valladares Neto

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Introduction: Cone-Beam Computed Tomography (CBCT) was introduced in the 90?s and studies have improved its use in dentistry. 

Objective: The aim of this article was to investigate the influence of three-dimensional (3D) images in orthodontic treatment planning. 

Methods: Two clinical situations (bone dehiscence and cervical resorption) were described by 3D images. 

Results: The orthodontic treatment plan was redirected to a simplified mechanics and control of the lesions during orthodontic treatment. 

Conclusion: 3D images are able to increase diagnostic accuracy and redirect orthodontic treatment plan.

Evaluation of the effect of rapid maxillary expansion on the upper airway using nasofibroscopy: case report and description of the technique

Edmilsson Pedro Jorge, Ary dos Santos-Pinto, Luiz Gonzaga Gandini Junior, Odilon Guariza Filho, Anibal Benedito Batista Arrais Torres de Castro

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The aim of the present investigation is to evalute the effect of rapid maxillary expansion on the upper airway. A clinical case is presented to describe how patients with atresic maxilla and reduced naso-respiratory function can have benefits from rapid maxillary expansion. In order to better understand the morphological alterations present in patients with respiratory disorders, it is necessary to understand the anatomy and physiology of the respiratory system. However, it is relevant to mention that this patient undergoes a multidisciplinary treatment, involving the orthodontist, the otorhinolaryngologist and the speech therapist.
Analysis of the rotational position of the maxillary first permanent molar in normal occlusion and Class II, division 1 malocclusion

Marisa Helena Zingaretti Junqueira, Karyna Martins Valle-Corotti, Daniela Gamba Garib, Ricardo Brandão Vieira, Flávio Vellini Ferreira

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Objective: The purpose of this study was to evaluate and compare the rotational position of maxillary first permanent molars (U6) in subjects in the permanent dentition presenting normal occlusion and Class II, division 1 malocclusion. 

Methods: Casts of 60 subjects with normal occlusion (Group 1, mean age 15.1 years) and 120 with untreated Class II, division 1 malocclusion (Group 2, mean age 15.5 years) were evaluated. The maxillary dental casts were scanned and the position of maxillary molars was analyzed using three angular measurements and one linear measurement, named indicators 1, 2, 3 and 4, respectively. The mesiopalatal rotation of maxillary first molars was evidenced by an increase in the values of indicators 1 and 4 and decrease in the indicators 2 and 3. Comparisons between groups were performed using Student´s t test for measurements with normal distribution and by the Mann-Whitney test for non-normal distribution, at p<0.05. 

Results: Statistically significant differences were found between Groups I and II for all indicators, on both right and left sides. 

Conclusion: It was concluded that individuals with Class II, division 1 malocclusion present greater mesiopalatal rotation of the maxillary first molars.

Evaluation of facial proportions in the vertical plane to investigate the relationship between skeletal and soft tissue dimensions

Márcia Cristina Cunha Costa, Marcelo de Castellucci e Barbosa, Marcos Alan Vieira Bittencourt

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Objective: To determine the relationship between facial heights by evaluating the soft tissues and underlying skeleton and by analyzing vertical facial proportions in the anterior region. 

Methods: The study used 24 lateral cephalometric x-rays and 48 photographs of the face, 24 in profile view and 24 in front view, belonging to 24 Brazilian individuals, 7 men and 17 women whose ages ranged from 19 to 38 years. Cephalometric tracings were performed and linear measurements obtained according to the analyses suggested by Schudy, Wylie and Johnson, and Thompson and Brodie. The anatomical landmarks glabella, subnasal and menton were identified on the photographs, which allowed the measurement of linear distances between these points. The data were then statistically analyzed. 

Results and Conclusions: A positive correlation was found between evaluations of the soft tissues and underlying skeleton based on the analyses advanced by Schudy (r=0.619, p<0.001), Wylie and Johnson (r=0.595, p<0.002) and Thompson and Brodie (r=0.630, p<0.001), although, individually, some discrepancies were identified due to variability in soft tissue thickness.

Evaluation of friction in self-ligating brackets subjected to sliding mechanics: an in vitro study

Mariana Ribeiro Pacheco, Dauro Douglas Oliveira , Perrin Smith Neto, Wellington Correa Jansen

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Introduction: Friction generated at the bracket/archwire interface during sliding mechanics can reduce the efficiency of orthodontic movement. The ligation method employed to tie the archwire to the bracket plays an important role in determining this friction. 

Methods: This study compared the frictional force generated by four different types of selfligating brackets (Time®, Damon 2®, In-Ovation R® and Smart Clip®) with a group of conventional orthodontic brackets (Dynalock®) that require the use of traditional elastomeric ligatures (ExDispens-A-Stix®), which served as the control group. Static friction force was measured using an EMIC DL® 500 universal testing machine using stainless steel round 0.018-in and rectangular 0.017x0.025-in archwires. 

Results: ANOVA and Tukey?s test showed low levels of friction in the four self-ligating brackets in tests with the 0.018-in wire (P <0.05). However, the results noted when the self-ligating brackets were tested using 0.017x0.025-in archwires showed high resistance to sliding in the self-ligating groups.

Qualitative evaluation in photoelastic experimental models of the force system generated by T-springs placed in the center of the interbracket space with pre-activations advocated by Burstone

Luiz Guilherme Martins Maia, Vanderlei Luiz Gomes , Ary dos Santos-Pinto, André da Costa Monini, Luiz Gonzaga Gandini Junior

Orthodontic space closure. biomechanics

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Objective: To evaluate the force system generated by T-springs placed in the center of the interbracket space using the pre-activations advocated by Burstone. Material and Methods: Photoelastic models were used to assess T-springs fabricated with 0017?x0.025? rectangular titanium-molybdenum alloy wire (TMA), centrally positioned, with 6.0 mm activation, 3 mm activation, and in neutral position. To ensure reliable results, tests were repeated on three photoelastic models equally duplicated and fabricated by the same operator. An interbracket distance of 27.0 mm was used. For a better understanding of the results, the fringes were viewed in a polariscope, then photographed and qualitatively analyzed. 

Results: Through qualitative analysis of the fringe order in the photoelastic model it was noted that both the retraction and anchorage ends displayed force system symmetry across the full extent of the root.

BBO Case Report

Angle Class I malocclusion, with anterior open bite, treated with extraction of permanent teeth*

Mirian Aiko Nakane Matsumoto

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Open bite is an anomaly with distinct characteristics which, in addition to involving complex, multiple etiologic factors, entails aesthetic and functional consequences. Many alternative approaches have been employed to treat open bite, including palatal crib, orthopedic forces, occlusal adjustment, camouflage with or without extractions, miniimplants or mini-plates, and orthognathic surgery. By determining accurate diagnosis and etiology professionals can set the goals and ideal treatment plan for this malocclusion. This report, describing the two stages treatment of Angle Class I malocclusion with Class II skeletal pattern and anterior open bite, was presented to the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO), representative of category 2, as partial fulfillment of the requirements for obtaining the title of BBO diplomate.

Special Article

Rapid canine retraction

Paulo Renato Carvalho Ribeiro, Sérgio Henrique Casarim Fernandes, Gustavo Saggioro Oliveira

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Introduction: Rapid canine retraction through distraction of the periodontal ligament is a tooth movement technique that allows space closure of first premolar extraction space within a period of two to three weeks while providing significant reduction in orthodontic treatment time. 

Objective: To propose changes in the original surgical technique and in the placement of distractors. 

Conclusions: Rapid canine retraction is a technique that provides significant reduction in orthodontic treatment time. Changes in the surgical technique provided greater speed and safety in surgery. As a minimum benefit, when positioned palatally, distractors helped to preserve the buccal bone plate and prevented canine proclination.

Dental Press Journal of Orthodontics - v. 16, no. 1 Download full issue pdf